The psychometric properties of the Kessler Psychological Distress Scale (K6) in a general population sample of adolescents

Psychological Distress of International Students during the COVID-19 Pandemic in China: Multidimensional Effects of External Environment, Individuals' Behavior, and Their Values

The COVID-19 epidemic has had a significant impact on society. In particular, it has had a strong impact on college students, including international students. Through an online questionnaire survey, it is found that the psychological distress experienced by international students is the result of a combination of the external environment (including the lockdown measures, social distancing, and social support) and internal factors such as values and behavior. The analysis shows that the new teaching mode and the corresponding changes in learning behavior are significantly associated with the psychological distress brought about by the COVID-19 epidemic. In addition, the influence of international students' values also plays a significant role in their psychological distress. Collective values are conducive to the alleviation of psychological distress, while individual values have the opposite effect. At the same time, the study also reveals that if there is sufficient social support, isolation (due to lockdown or social distancing early or later on) is not necessarily directly related to psychological distress. However, only formal social support can effectively alleviate psychological distress, while informal social support does not play a similar role. These conclusions have certain policy significance for the prevention of and response to epidemics in other countries.

Profiles of mental health help seeking among Australian adolescent males

INTRODUCTION

Adolescent males are at increased risk of mental illness and are reluctant to engage in treatment. This study aims to identify subgroups of help-seeking intentions among a sample of Australian male adolescents.

METHODS

A sample of 1038 male adolescent sport participants in Australia (age M = 14.69 years, SD = 1.35) reported help-seeking intentions from ten sources and from 'no one'. Latent profile analysis was conducted based on these 11 items. Identified profiles were then compared across mental health measures.

RESULTS

Four latent profiles were identified: Low general help-seekers (10.5%), Moderate general help-seekers (46.8%), High general help-seekers (25.5%), High family and friends help-seekers (17.2%). Low, Moderate, and High general help-seekers had uniformly low, moderate, and high intentions to seek help from all sources, respectively. High family and friends help-seekers reported high endorsement of intentions to seek help from intimate partners, friends, parents, and other relatives, but low intentions for other sources. Low general help-seekers had lower intentions to seek help from parents compared to all other profiles. They also had significantly lower perceived family support and higher psychological distress.

CONCLUSIONS

Low general help-seekers were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Their distinct profile offers potential to identify this high-risk group through the use of ratings on the parent help-seeking intentions item. Further research should investigate the predictive utility of this item on help-seeking and mental health, and should consider the influence of masculinity and previous experiences of help-seeking.

COVID-19 and psychological distress: Lessons for India

Purpose

The COVID-19 pandemic has undoubtedly altered the routine of life and caused unanticipated changes resulting in severe psychological responses and mental health crisis. The study aimed to identify psycho-social factors that predicted distress among Indian population during the spread of novel Coronavirus.

Method

An online survey was conducted to assess the predictors of distress. A global logistic regression model was built, by identifying significant factors from individual logistic regression models built on various groups of independent variables. The prediction capability of the model was compared with the random forest classifier.

Results

The respondents (N = 1060) who are more likely to be distressed, are in the age group of 21-35 years, are females (OR = 1.425), those working on site (OR = 1.592), have pre-existing medical conditions (OR = 1.682), do not have health insurance policy covering COVID-19 (OR = 1.884), have perceived seriousness of COVID-19 (OR = 1.239), have lack of trust in government (OR = 1.246) and whose basic needs’ fulfillment are unsatisfactory (OR = 1.592). The ones who are less likely to be distressed, have higher social support and psychological capital. Random forest classifier correctly classified 2.3% and 17.1% of people under lower and higher distress respectively, with respect to logistic regression.

Conclusions

This study confirms the prevalence of high distress experienced by Indians at the time of COVID-19 and provides pragmatic implications for psychological health at macro and micro levels during an epidemiological crisis.

Increases in Serious Psychological Distress among Ontario Students between 2013 and 2017: Assessing the Impact of Time Spent on Social Media

OBJECTIVE

The objective of the current research was to examine the association between time spent on social media and serious psychological distress between 2013 and 2017, a period when the rates of both were trending upward.

METHODS

The current study analyzed population-based data from 3 waves of the Ontario Student Drug Use and Health Survey (N = 15,398). Multivariate logistic regression models were used to examine the association between time spent on social media and serious psychological distress controlling for theoretically relevant covariates. Interactions were tested to assess whether the association changed over time.

RESULTS

The prevalence of serious psychological distress increased from 10.9% in 2013 to 16.8% in 2017 concomitantly with substantial increases in social media usage, especially at the highest levels. In the multivariate context, we found a significant interaction between social media use and the survey year which indicates that the association between time spent on social media and psychological distress has decreased from 2013 to 2017.

CONCLUSION

Although both social media use and psychological distress increased between 2013 and 2017, the interaction between these variables indicates that the strength of this association has decreased over time. This finding suggests that the higher rate of heavy social media use in 2017 compared to 2013 is not actually associated with the higher rate of serious psychological distress during the same time period. From a diffusion of innovation perspective, it is possible that more recent adopters of social media may be less prone to psychological distress. More research is needed to understand the complex and evolving association between social media use and psychological distress. Researchers attempting to isolate the factors associated with the recent increases in psychological distress could benefit from broadening their investigation to factors beyond time spent on social media.

Cross-cultural adaptation and psychometric properties of the Kessler Distress Scale (K10): an application of the rating scale model

BACKGROUND

The Kessler Distress Scale (K10) is a self-report scale for the assessment of non-specific psychological distress in the general and clinical population. Because of its ease of application and good psychometric properties, the K10 has been adapted to several cultures. The present study seeks to adapt the K10 to Brazilian Portuguese and estimate its validity evidence and reliability.

METHODS

A total of 1914 individuals from the general population participated in the study (age = 34.88, SD = 13.61, 77.7% female). The adjustment indices were compared among three different measurement models proposed for the K10 through confirmatory factor analysis (CFA). The items' properties were analyzed by Andrich's Rating Scale Model (RSM). Furthermore, evidence based on relations to other variables (depression, stress, anxiety, positive and negative affects, and satisfaction with life) was estimated.

RESULTS

CFA indicated the adequacy of the bifactor model (CFI= 0.985; TLI= 0.973; SMR= 0.019; RMSEA= 0.050), composed of two specific factors (depression and anxiety) and one general factor (psychological distress), corresponding to the theoretical hypothesis. Additionally, it was observed multiple-group invariance by gender and age range. The RSM provided an understanding of the organization of the continuum represented by the psychological distress construct (items difficulty), which varied from -0.89 to 1.00; good adjustment indexes; infit between 0.67 and 1.32; outfit between 0.68 and 1.34; and desirable reliability, α= 0.87. Lastly, theoretically coherent associations with the external variables were observed.

CONCLUSIONS

It is concluded that the Brazilian version of the K10 is a suitable measure of psychological distress for the Brazilian population.

Body weight trends in adolescents of Central Italy across 13 years: social, behavioural, and psychological correlates

Aim

The study aimed to determine trends in the prevalence of underweight, overweight, obesity and their putative risk factors in different cohorts from a representative population of adolescents in Central Italy.

Subject and methods

After random sampling, five cohorts of adolescents attending public high schools – aged 14 to 18 years – were evaluated from 2005 to 2018 (n: 25,174). Collected information included self-reported body mass index (BMI), descriptors of family environment, eating behaviour, physical activity, screen use, bullying victimisation, sexual behaviour (age at first intercourse, number of partners) and perceived psychological distress. For these data, between-cohort prevalence differences were used to esteem prevalence variations across time. In the 2018 cohort, the association between these factors and body weight was evaluated through multinomial regressions with sex-specific crude relative risk ratios for different BMI categories.

Results

An increased prevalence of overweight was observed for both boys and girls. The study outlined a transition towards higher parental education and unemployment, reduced soft drinks consumption and higher psychological distress. Sex-specific changes were observed for physical and sexual activity, and a rising percentage of girls reported being bullied and distressing family relationships. Parental education and employment, together with physical activity, confirmed to be protective factors against pathological weight. The latter clustered with reduced soft drinks consumption, bullying victimisation, early sexual activity, worse family relationships and higher distress.

Conclusion

An increased prevalence of both overweight and underweight was observed across time. Economic factors associated with unemployment and changes in behavioural patterns may have contributed to this trend.

The Canadian 24-Hour Movement Guidelines and Psychological Distress among Adolescents: Les Directives canadiennes en matière de mouvement sur 24 heures et la détresse psychologique chez les adolescents

OBJECTIVE

The Canadian 24-Hour Movement Guidelines for Children and Youth recommend at least 60 minutes of physical activity per day, 2 hours or less of recreational screen time per day, and 9 to 11 hours of sleep per night for 5 to 13 years old and 8 to 10 hours per night for 14 to 17 years old. This study examined the association between meeting these guidelines and psychological distress among adolescents.

METHODS

The present cross-sectional sample included 6,364 students aged 11 to 20 years from the 2017 Ontario Student Drug Use and Health Survey. This provincially representative school-based survey is based on a 2-stage cluster design. A confirmatory factor analysis (CFA) was first conducted to confirm the factor structure of the K6, and structural equation modeling adjusted for age, sex, ethnoracial background, subjective socioeconomic status, and body mass index z-score was used to investigate the association between meeting the 24-Hour Movement Guidelines and K6 factors among adolescents.

RESULTS

The CFA demonstrated that a 2-factor model (representing anxiety and depressive symptoms) of the K6 fit the data well. The anxiety and depression items demonstrated a composite reliability (Cronbach's α) of 0.86 and 0.83, respectively, indicating a high level of internal consistency. Compared to meeting none of the recommendations, meeting all 3 movement behavior recommendations was associated with lower anxiety (β = -0.076; P = 0.028) and depressive symptoms (β = -0.067; P = 0.028). Meeting the screen time + sleep duration recommendations had the strongest association with anxiety (β = -0.157; P < 0.001) and depressive symptoms (β = -0.139; P < 0.001), followed by meeting the sleep duration recommendation only for both anxiety (β = -0.135; P < 0.001) and depressive symptoms (β = -0.106; P < 0.001).

CONCLUSIONS

Meeting the 24-Hour Movement Guidelines was associated with lower anxiety and depressive symptoms among adolescents, and these associations appear mainly driven by meeting the sleep duration recommendation.

Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men

Background

Sexual minority men (SMM) often experience stressful social environments dominated by stigma and discrimination. SMM are typically more likely than heterosexual men to engage in certain risky behaviours such as problem gambling. This study aimed to compare gambling behaviour among SMM and examine potential risk factors (erroneous gambling cognitions, gambling outcome expectancies, hazardous alcohol use, impulsivity, and psychological distress; as well as perceived stigma and discrimination for the SMM participants) and potential protective factors (resilience, social support, and community connectedness) for problem gambling severity and gambling-related harms among SMM living in Australia.

Methods

An online survey, with an over-representation of SMM participants and problem, moderate-risk, and low-risk gamblers, was completed by 101 SMM (mean age = 28.5) and 207 heterosexual men (mean age = 26.4).

Results

SMM were found to have significantly lower levels of problem gambling severity compared with heterosexual men, and report significantly lower gambling participation, frequencies and expenditure on any gambling activity, casino table games, horse racing/greyhound betting, sports betting, and keno. However, in the SMM group, 38.3% were classified in the problem gambling category of the Problem Gambling Severity Index and 27.6% were classified in the moderate-risk gambling category. There were no significant differences between groups in gambling-related harms. Multiple regression analyses revealed that problem gambling severity and related harms were independently predicted by higher levels of impulsivity and erroneous gambling cognitions for both groups.

Conclusions

Lower frequency of gambling behaviours among SMM and similar risk factors predicting problem gambling severity/harms for both groups suggests that problem gambling is not pronounced among SMM. This study adds new evidence to the gambling literature which can be used as comparative benchmarks for future research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00597-4.

Ecological Momentary Mood, Resilience, and Mental Health Status as Predictors of Quality of Life Among Young Adults Under Stress: A Structural Equation Modeling Analysis

Multiple internal factors, such as psychological resilience and mental health status, have been shown to contribute to overall quality of life (QoL). However, very few studies to date have examined how these factors contribute to QoL of youth and young adults in a stressful situation. Here, we studied the contribution of these factors, as well as of ecological momentary mood assessment, to QoL of young army recruits during their Basic Training Combat (BCT). To this end, we collected data from 156 male and female soldiers in a mixed-gender unit in the Israel Defense Forces (IDF). Using a mobile app installed on participants' phones, participants provided self-reports regarding their mental health status and psychological resilience at baseline, and QoL 2 weeks later. Momentary mood reporting was further collected during the 2-week interval period using a daily self-report mood scale (IMS-12). Structural equation modeling (SEM) was used to examine the interrelationships among the study variables based on a hypothesized model. We found that a model with all factors (gender, resilience, mental health status and momentary mood) provided a good fit for the data based on its fit indices [χ2(38) = 47.506, p = 0.139, CFI = 0.979, NFI = 0.910, RMSEA = 0.040, TLI = 0.964]. However, the only direct contributors to QoL were gender and momentary mood, accounting together for 61.5% of the variance of QoL. Psychological resilience and mental health status contributed to QoL only indirectly, through their associations with momentary mood. Collectively, these results highlight the importance of ecological momentary assessment of mental-health related factors such as mood to the prediction of QoL in young adults under stress. These findings may have broader implications for monitoring and improvement of well-being in young healthy populations as well as in clinical ones.

Loneliness, social relationships, and mental health in adolescents during the COVID-19 pandemic

Loneliness is a common experience in adolescence and is related to a range of mental health problems. Such feelings may have been increased by social distancing measures introduced during the COVID-19 pandemic. We aimed to investigate the effect of loneliness, social contact, and parent relationships on adolescent mental health during lockdown in the UK. Young people aged 11-16 years (n = 894) completed measures of loneliness, social contact, parent-adolescent relationships, and mental health difficulties during the first 11 weeks of lockdown and one-month later (n = 443). We examined cross-sectional associations and longitudinal relationships between loneliness, social contact, and parent relationships and subsequent mental health. Adolescents who reported higher loneliness had significantly higher symptoms of mental health difficulties during lockdown. We found that adolescents who had closer relationships with their parents reported significantly less severe symptoms of mental health difficulties and lower levels of loneliness. We also found that adolescents who spent more time texting others reported higher symptoms of mental health difficulties. Our hypothesis that loneliness would predict poorer mental health one month later was not supported. Time spent texting others at baseline was significantly associated with higher hyperactivity at follow-up, and closeness to parents was significantly associated with lower psychological distress at follow-up. We conclude that while loneliness was associated with greater mental health difficulties at baseline, it did not predict increased mental health difficulties one month later. Moreover, existing mental health problems significantly predicted later increase, thereby highlighting the importance of continuing support for vulnerable people.

Mentoring for Improving the Self-Esteem, Resilience, and Hope of Unaccompanied Migrant Youth in the Barcelona Metropolitan Area

In the last few years, the number of unaccompanied youths arriving in Europe has increased steadily. During their settlement in host countries, they are exposed to a great variety of vulnerabilities, which have an impact on their mental health. This research examines the effects of participation in a mentoring programme on the psychological and educational outcomes among unaccompanied migrant youths who live in the Barcelona metropolitan area. Data in this mixed-methods study were obtained from 44 surveys with mentored (treatment group) and non-mentored (control group) male youths who had recently turned 18, as well as through thirty semi-structured interviews with mentored youths, their adult mentors, and non-mentored youths. Our findings indicated that participation in the mentoring programme improved the mentored youths’ self-esteem, resilience, and hope, as well as their desired or expected educational outcomes in this new context. We conclude that well-targeted and problem-specific mentoring programmes have positive and marked effects on unaccompanied migrant youths’ mental health. The social and political implications of these outcomes are also discussed, providing information on how interventions can offer effective networks of support for the settlement and social inclusion of unaccompanied migrant youths.

Impact of Covid-19 outbreak on psychological health-The case of Bangladesh

BACKGROUND

The outbreak of COVID-19, a profoundly contagious disease has unnerved the world in a calamitous manner from diverse aspects. The present study ventures to expand the literature by exploring loneliness, social isolation, risk perception, financial distress, and psychological distress amidst the lockdown phase of the general population of Bangladesh.

METHODS

Through an online survey among 474 respondents (between April 17th and April 23rd, 2020), data were collected from the Bangladeshi residents (21 years or above). Descriptive and inferential statistical analyses were conducted using IBM Statistical Package for Social Science (SPSS) and Warp-PLS.

RESULTS

Findings suggest a strong positive correlation among the factors and social isolation, risk perception, financial distress are manifested as the predictors of psychological distress. Besides, females, aged people, and lower-income group are found to be more psychologically distressed.

CONCLUSION

This study yields new insights into the psychological facets of a lower-middle-income earning country, Bangladesh.

DetectaWeb-Distress Scale: A Global and Multidimensional Web-Based Screener for Emotional Disorder Symptoms in Children and Adolescents

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for emotional disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood (major depression and dysthymic disorder), anxiety (separation anxiety, generalized anxiety, social phobia, panic disorder/agoraphobia, and specific phobia), obsessive-compulsive disorder, post-traumatic stress disorder, suicidality (suicidal ideation, plans, and attempts), and global distress. A total of 1,499 participants (aged 8-18) completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency (McDonald's ω ranging from 0.65 to 0.94); and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive-compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents.

Quality of life in the COVID-19 outbreak: influence of psychological distress, government strategies, social distancing, and emotional recovery

Considering the severity of the effects of COVID-19 on psychological health and quality of life, the present study investigates the direct effects of government strategies and social distancing and the moderating effect of emotional recovery on psychological distress and quality of life using the tenets of the theory of attachment and learned helplessness. The snowball sampling technique was used to recruit respondents from Bangladesh who completed a self-administered questionnaire via Google Forms, which provided cross-sectional data. The results revealed that both social distancing and government strategies have significant negative influences on psychological distress. Besides, government strategies have a significant positive influence on social distancing. Although psychological distress has a significant negative influence on quality of life, emotional recovery shows no moderating effect on the relationship between psychological distress and quality of life during the COVID-19 pandemic. The study provides insights for regulatory bodies and policymakers for developing effective policy interventions to ensure the well-being of people during this pandemic. Finally, the study highlights the implications for both theory and practice and a few notes for further research.

An Intervention for Mental Health Literacy and Resilience in Organized Sports

PURPOSE

In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants.

METHODS

The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes' psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mean differences on the primary and secondary outcomes were analyzed using linear mixed models, adjusted for clustering at club level, participant age, and socioeconomic status.

RESULTS

Significant positive group-time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group-time interaction for the secondary outcome of well-being. There were no group-time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress.

CONCLUSIONS

Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.

Predictive Psychosocial Factors of Child-to-Parent Violence in a Sample of Mexican Adolescents

The aim of this study was to carry out a psychosocial analysis of child-to-parent violence (CPV) in a sample of school adolescents, considering a set of individual variables (psychological distress, problematic use of social networking sites, and perceived non-conformist social reputation) and family variables (open and problematic communication with parents) according to sex. The sample consisted of 3,731 adolescents (54% boys), aged between 14 and 16 years (M = 14.6 years, SD = 0.567), from the state of Nuevo León, Mexico. The scores of the boys and girls were analyzed to check for differences. Also, correlations between all the study variables were calculated. Finally, a multiple stepwise regression analysis was carried out for the total sample and also for boys and girls separately. Results confirmed the important role of individual variables as predictors of CPV in boys and girls. The main difference between boys and girls was observed in the predictive weight of problematic use of social networking sites, which was higher in girls than in boys. Open communication with the father was a significant factor for predicting the decrease of CPV levels in the case of boys, while open communication with the mother predicted the decrease of CPV in girls. Problematic communication with the mother showed similar values in boys and girls when predicting CPV, however, the predictive weight of problematic communication with the father was higher in girls than in boys. These results are interesting and have important implications for the prevention of CPV.

School-Based Prevention in Very Remote Settings: A Feasibility Trial of Methods and Measures for the Evaluation of a Social Emotional Learning Program for Indigenous Students in Remote Northern Australia

Purpose: Skills for Life (SFL) is a social-emotional curriculum for Indigenous middle school students that was co-developed with educators and community members in a remote community of northern Australia. This preliminary study aimed to test the feasibility of processes and methods of data-gathering, the reliability of youth self-report measures, and to identify the direction of effects for an evaluation of a longer-term pilot of the curriculum.

Design/Methodology/Approach: Indigenous Students in years 7–9 of a remote school participated in SFL over 2 years. The Strengths and Difficulties Questionnaire (SDQ), Kessler 6 (K6), and a purpose-designed Connected Self Scale (CSS) were administered to 63 students pre- and post-program.

Findings: Only the K6, Prosocial behavior (SDQ), and two CSS subscales showed sufficient internal consistency for analysis. Change was positive but non-significant for SDQ and CSS. There was evidence of a dosage effect: students receiving the intervention over 2 years showed greater reduction in psychological distress than other students. There was no evidence of iatrogenic effects.

Conclusions: The feasibility pilot is a critically important phase in the development of evaluation design and cjhoice of evaluation measures for challenging remote settings. This study found that evaluation of SFL with culturally and linguistically distinct Indigenous middle school students using self-report measures is feasible. However, the SDQ may not be suitable for this project. High levels of psychological distress suggest the need to investigate sources of life stress and potential supports for adolescent resilience in this context. This preliminary pilot aimed to trial methods and measures for evaluation of a social-emotional curriculum developed specifically for remote Australian Indigenous students who are at risk of poor psychosocial outcomes. No studies have examined the appropriateness of standardized self-report measures for evaluation of SEL with this student population in remote school settings.

The Impact of Family Separation and Worry About Family on Psychological Adjustment in Refugees Resettled in Australia

Few reliable predictors of postarrival psychological adjustment have been identified with regard to refugees once they arrive in their host country. We investigated the association between family separation and psychological symptoms in refugees resettled in Australia from 2013 to 2016. Participants were 1,495 adult refugees (M = 38.9 years, SD = 12.7) who participated in the Building a New Life in Australia population-based study across 4 years. Participants were assessed for psychological distress and posttraumatic stress symptoms (PTSS) using the Kessler Psychological Distress Scale (K6) and Posttraumatic Stress Disorder-8 (PTSD-8), respectively. We used latent class growth analysis (LCGA) to identify latent longitudinal trajectories and binary logistic regression to assess the contribution of family predictor variables toward PTSD-8 and K6 symptom trajectory class membership. The LCGA supported a four-class solution for PTSS, categorized as improving PTSS (18.4%), persistently high PTSS (11.5%), resilient PTSS (57.3%), and deteriorating PTSS (12.6%). For the K6, LCGA supported a four-class solution comprising classes categorized as persistently high psychological distress (PD; 7.0%), improving PD (17.3%), resilient PD (61.1%), and deteriorating PD (14.6%). Separation from family members did not independently predict the course of psychological symptoms; however, worry about family and friends contributed to the persistence of high PTSD-8 scores, OR = 1.75, and deteriorating K6 scores, OR = 1.57. The current findings suggest persistently high or worsening psychological symptom trajectories during the postsettlement phase may be marked by worry about family and friends, in addition to older age and female gender, rather than separation alone.

The Impact of Physical Distancing Policies During the COVID-19 Pandemic on Health and Well-Being Among Australian Adolescents

PURPOSE

Physical distancing policies in the state of New South Wales (Australia) were implemented on March 23, 2020, because of the COVID-19 pandemic. This study investigated changes in physical activity, dietary behaviors, and well-being during the early period of this policy.

METHODS

A cohort of young people aged 13-19 years from Sydney (N = 582) were prospectively followed for 22 weeks (November 18, 2019, to April 19, 2020). Daily, weekly, and monthly trajectories of diet, physical activity, sedentary behavior, well-being, and psychological distress were collected via smartphone, using a series of ecological momentary assessments and smartphone sensors. Differences in health and well-being outcomes were compared pre- and post-implementation of physical distancing guidelines.

RESULTS

After the implementation of physical distancing measures in NSW, there were significant decreases in physical activity (odds ratio [OR] = .53, 95% confidence interval [CI] = .34-.83), increases in social media and Internet use (OR = 1.86, 95% CI = 1.15-3.00), and increased screen time based on participants' smartphone screen state. Physical distancing measures were also associated with being alone in the previous hour (OR = 2.09, 95% CI: 1.33-3.28), decreases in happiness (OR = .38, 95% CI = .18-.82), and fast food consumption (OR = .46, 95% CI = .29-.73).

CONCLUSIONS

Physical distancing and social restrictions had a contemporaneous impact on health and well-being outcomes associated with chronic disease among young people. As the pandemic evolves, it will be important to consider how to mitigate against any longer term health impacts of physical distancing restrictions.

A Mokken scale analysis of the Kessler-6 screening measure among Chinese older population: findings from a national survey

BACKGROUND

The aging population increases rapidly across the world. Timely and effective screening of their mental-health problems is important to individuals, families, and the whole society. The Kessler-6 screening measure (K6) is a very popular instrument for non-specific psychological distress. However, few studies have focused on the psychometric properties of this instrument in the older population.

METHODS

The present study employed Mokken scale analysis to evaluate its dimensionality and structure. This study also used differential item functioning (DIF) to examine whether the same structure existed across sex in a national representative sample of old Chinese people. Data were drawn from a public data set, the 2010 China Family Panel Studies (CFPS2010), and responses from a total of 6450 participants aged 60 years old and above (3136 males and 3314 females) were included in the final analysis.

RESULTS

Mokken scale analysis supported the unidimensional structure of the K6. Differential item functioning (DIF) analysis revealed that two of the six items ("Hopeless" and "Everything was an effort") were marked for DIF based on the Chi-square. However, their impacts were negligible in terms of McFadden's pseudo R2.

CONCLUSIONS

The K6 demonstrates adequate psychometric properties in the old Chinese population. The sum of all six items can be used as an indicator of non-specific psychological distress. Differences in the indicator across sex should be considered as a real difference in psychological distress between the female and the male.

Effects of gentrification on health status after Hurricane Katrina

Despite substantial debate about the impacts of gentrification on cities, neighborhoods, and their residents, there is limited evidence to demonstrate the implications of gentrification for health. We examine the impacts of gentrification on several health measures using a unique individual-level longitudinal data set. We employ data from the Resilience in Survivors of Hurricane Katrina (RISK) project, a study of low-income parents, predominantly non-Hispanic Black single mothers, who participated in a New Orleans-based study before and after Hurricane Katrina. After Katrina, all participants were displaced, at least temporarily, from New Orleans, and had little or no control over neighborhood placement immediately following the storm. This near-random displacement after Katrina created a natural experiment. We employ a quasi-experimental intent to treat design to assess the causal effects of gentrification on health in the RISK population. We do not find evidence of significant main effects of being displaced to a gentrified neighborhood on BMI, self-rated health, or psychological distress. The analysis employs a quasi-experimental design and has several additional unique features--homogeneous population, limited selection bias, and longitudinal data collection-- that improve our ability to draw causal conclusions about the relationship between gentrification and health. However, the unique context of displacement by natural disaster may limit the generalizability of our findings to other circumstances or residents experiencing gentrification.

Psychological Resilience, Mental Health, and Inhibitory Control Among Youth and Young Adults Under Stress

Psychological resilience allows one to cope successfully with adversities occurring during stressful periods, which may otherwise trigger mental illness. Recent models suggest that inhibitory control (IC), the executive control function which supports our goal-directed behavior and regulates our emotional response, may underlie resilience. However, the ways in which this is manifested during stressful situations in real life is still unclear. Here, we examined the relationship between IC, psychological resilience, psychological distress, and anxiety among 138 female and male participants in a stressful situation: during their initial combat training in the military. Using a mobile app, we assessed IC using emotional and non-emotional variations of the Go/No-Go task. Psychological resilience, psychological distress, and anxiety were assessed using mobile versions of self-report questionnaires. We found that psychological resilience is significantly correlated with non-emotional IC (r = 0.24, p < 0.005), but not with emotional IC; whereas, psychological distress and anxiety are correlated with emotional IC (r = -0.253, p < 0.005 and r = -0.224, p < 0.01, for psychological distress and anxiety, respectively), but not with non-emotional IC. A regression model predicting emotional IC confirmed non-emotional IC and distress as unique contributors to the variance, but not psychological distress. In addition, associations between psychological distress and emotional IC were found only for female participants. Collectively, the results clarify the link between IC, resilience, and mental health in real-life stressful situations, showing separate mechanisms of IC involved in resilience on the one hand, and mental health on the other hand. These results have implications for building mobile resilience interventions for youth and young adults facing stressful situations.

Do gender differences in housework performance and informal adult caregiving explain the gender gap in depressive symptoms of older adults?

We assess whether gender differences in domestic time-use, including informal adult caregiving and housework, explain the gender gap in depression among older adults. Using data from the Panel Study of Income Dynamics, we model depressive symptoms as a function of informal adult caregiving and housework. The analytic sample includes 539 men and 782 women. Findings suggest informal adult caregiving is associated with increased depressive symptoms for women (p < .05) and men (p < .05). Time spent on housework is associated with decreased depressive symptoms for women and female caregivers (p < .01). Women may experience elevated depressive symptoms relative to men despite their domestic time-use.

The Psychometric Properties of the Kessler Psychological Distress Scale (K6) in an Epidemiological Sample of Canadian Youth

OBJECTIVE

This study (1) describes the distribution of Kessler Psychological Distress Scale (K6) scores in an epidemiological sample of youth, (2) reports its item correlations and internal consistency reliability, (3) tests for measurement invariance by age (youth vs. adults) and sex, and (4) examines its predictive power for past-year psychiatric disorders.

METHOD

Youth aged 15 to 19 years (n = 2010) and adults aged 20 to 64 years (n = 2010) from the Canadian Community Health Survey-Mental Health who completed the K6 were included. Past-year psychiatric disorders were measured using the World Health Organization Composite International Diagnostic Interview 3.0 (WHO-CIDI). Polychoric correlation matrices and ordinal reliability coefficients were calculated to assess internal consistency of the K6, and confirmatory factor analysis was used to test for measurement invariance. Area under the curves (AUCs) were computed to determine the extent to which the K6 predicted a positive screen on the WHO-CIDI.

RESULTS

K6 scores showed a J-shaped distribution, with >50% of youth having scores ≤3. Item and total scores were higher for females versus males. Item correlations were robust (0.31-0.78) and internal consistency was high (α = 0.86). Full measurement invariance was demonstrated between youth and adults, as well as between male and female youth. The K6 was a strong predictor of major depressive episode (AUC = 0.848), generalized anxiety disorder (AUC = 0.847), and bipolar disorder (AUC = 0.853).

CONCLUSIONS

The K6 is a valid and reliable measure of psychological distress among youth. Its brevity and robust predictive power for psychiatric disorder confirm its utility in clinical and community settings to identify youth needing comprehensive psychiatric assessment.

Screening for depressive and anxiety disorders among adolescents in Indonesia: Formal validation of the centre for epidemiologic studies depression scale - revised and the Kessler psychological distress scale

BACKGROUND

This study aimed to culturally verify and examine the empirical psychometric properties of the Indonesian versions of the Centre for Epidemiologic Studies Depression Scale - Revised (CESD-R), the Kessler Psychological Distress Scale - 10 items (K10) and a subset of 6 items of the K10, the K6 to detect depressive and anxiety disorders among older adolescents in Indonesia.

METHODS

The empirical psychometric properties were examined formally among students aged 16-18 years attending high schools in Jakarta. The scales were validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid) modules for major depressive episode, dysthymia, panic disorder, separation anxiety disorder, and generalized anxiety disorder.

RESULTS

In total, 196 students contributed complete data. All of the scales had Cronbach's alpha >0.8. The areas under the ROC Curve of CESD-R against MINI depressive disorders and K10/K6 against MINI depressive and anxiety disorders were at moderate to high accuracy levels (0.78 to 0.86). The optimal cut-off value of CESD-R (scores ranging: 0-60) to screen for any depressive disorder is ≥20 (sensitivity 75.0%; specificity 79.9%). The optimal cut-off value of K10 to detect any depressive/anxiety disorders is ≥18 (sensitivity 85.7%; specificity 74.7%); and K6 is ≥12 (sensitivity 81.0%; specificity 76.6%); LIMITATIONS: The school-based sample limits the generalisability of the findings to this group.

CONCLUSIONS

This study suggests that the CESD-R I is a useful tool for screening for depressive disorders and both the K10 I and K6 I are useful for screening for any depressive or anxiety disorders among Indonesian adolescents.

Lifestyle risk indices in adolescence and their relationships to adolescent disease burden: findings from an Australian national survey

BACKGROUND

The current study investigates the extent to which an adolescent-specific lifestyle risk factor index predicts indicators of the leading causes of adolescent morbidity and mortality.

METHODS

Data came from 13 to 17 year-old respondents from the 2013-2014 nationally representative Australian Child and Adolescent Survey of Mental Health and Wellbeing (n = 2314). Indicators of adolescent disease burden included Major Depressive Disorder, psychological distress, self-harm and suicide attempt. Risk factors included risky alcohol use, drug use, unprotected sex, smoking, BMI and sleep duration. The extent to which these risk factors co-occurred were investigated using tetrachoric correlations. Several risk indices were then constructed based on these risk factors. Receiver Operating Characteristic curves determined the precision with which these indices predicted the leading causes of adolescent disease burden.

RESULTS

Risky alcohol use, drug use, smoking, unprotected sex, and sleep were all highly clustered lifestyle risk factors, whereas BMI was not. A risk index comprising risky alcohol use, drug use, unprotected sex and sleep duration predicted the disease burden outcomes with the greatest precision. 31.9% of the sample reported one or more of these behaviours.

CONCLUSIONS

This lifestyle risk factor index represents a useful summary metric in the context of adolescent health promotion and non-communicable disease prevention. Lifestyle risk factors were found to cluster in adolescence, supporting the implementation of multiple health behaviour change interventions.

Ahead of the game protocol: a multi-component, community sport-based program targeting prevention, promotion and early intervention for mental health among adolescent males

BACKGROUND

There is a recognised need for targeted community-wide mental health strategies and interventions aimed specifically at prevention and early intervention in promoting mental health. Young males are a high need group who hold particularly negative attitudes towards mental health services, and these views are detrimental for early intervention and help-seeking. Organised sports provide a promising context to deliver community-wide mental health strategies and interventions to adolescent males. The aim of the Ahead of the Game program is to test the effectiveness of a multi-component, community-sport based program targeting prevention, promotion and early intervention for mental health among adolescent males.

METHODS

The Ahead of the Game program will be implemented within a sample drawn from community sporting clubs and evaluated using a sample drawn from a matched control community. Four programs are proposed, including two targeting adolescents, one for parents, and one for sports coaches. One adolescent program aims to increase mental health literacy, intentions to seek and/or provide help for mental health, and to decrease stigmatising attitudes. The second adolescent program aims to increase resilience. The goal of the parent program is to increase parental mental health literacy and confidence to provide help. The coach program is intended to increase coaches' supportive behaviours (e.g., autonomy supportive behaviours), and in turn facilitate high-quality motivation and wellbeing among adolescents. Programs will be complemented by a messaging campaign aimed at adolescents to enhance mental health literacy. The effects of the program on adolescent males' psychological distress and wellbeing will also be explored.

DISCUSSION

Organised sports represent a potentially engaging avenue to promote mental health and prevent the onset of mental health problems among adolescent males. The community-based design, with samples drawn from an intervention and a matched control community, enables evaluation of adolescent males' incremental mental health literacy, help-seeking intentions, stigmatising attitudes, motivation, and resilience impacts from the multi-level, multi-component Ahead of the Game program. Notable risks to the study include self-selection bias, the non-randomised design, and the translational nature of the program. However, strengths include extensive community input, as well as the multi-level and multi-component design.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000709347 . Date registered 17 May 2017. Retrospectively registered.

Shared trauma reality in war: Mental health therapists' experience

INTRODUCTION

Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions.

METHOD

Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress.

RESULTS

These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion.

DISCUSSION

These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.

Depression, psychological distress and Internet use among community-based Australian adolescents: a cross-sectional study

Background

There has been rapid increase in time spent using Internet as a platform for entertainment, socialising and information sourcing. This study aimed to evaluate the relationship between duration of time spent using Internet for leisure, depressive symptoms, and psychological distress among Australian adolescents.

Methods

Depressive symptoms were indicated by the youth self-report module from the Diagnostic and Statistical Manual of Mental Disorders Version IV criteria, and psychological distress was measured by Kessler Psychological Distress scale. Internet use was self-reported based on use on an average weekday, and an average weekend day. Multivariate logistic regression models were used to examine the relationship between Internet use and mental health outcomes. Models were adjusted for potential confounders: age; relative level of socio-economic disadvantage, and body mass index.

Results

Adolescents were aged 11–17 years (M = 14.5 years, SD = 2.04 years). Greatest time spent using internet (≥7 h a day) was significantly associated with experiencing depressive symptoms among females (OR = 2.09, 95% CI = 1.16, 3.76, p < 0.05), and high/very high levels of psychological distress for male (OR = 2.23, 95% CI = 1.36, 3.65, p < 0.01) and female (OR = 2.38, 95% CI = 1.55, 3.67, p < 0.01) adolescents.

Conclusions

With current initiatives to improve health behaviours among adolescents to improve physical health outcomes such as overweight or obesity, it is imperative that the reciprocal relationship with mental health is known and included in such public health developments. Internet use may interact with mental health and therefore could be a modifiable risk factor to reach and improve mental health outcomes for this age group. Caution is advised in interpretation of findings, with some inconsistencies emerging from this evidence.

Suicide Risk Assessment in Adolescents - C-SSRS, K10, and READ

BACKGROUND

Assessment and screening are often the first step in planning interventions to help adolescents at risk of suicide. Causes of suicidal thoughts and behavior are multifaceted and it is important for clinical work that assessment reflects this complexity.

AIMS

To investigate whether a general psychological Resilience Scale for Adolescents (READ) is associated with a validated suicide rating scale (C-SSRS).

METHOD

An observational study of self-reported suicidality (C-SSRS), psychological distress (K10), and resiliency (READ) in three adolescent samples: suicide clinic (N = 147); general psychiatric clinic (N = 85); and a nonclinical sample (N = 92).

RESULTS

Resiliency scores were significantly higher (p < .05) in the nonclinical compared with the clinic samples on all READ scales. READ scores were similar in the two clinic samples apart from the family cohesion subscale, which was significantly lower in the suicide clinic sample. READ was predictive of levels of suicidality within all samples independently of general psychological distress (K10).

LIMITATIONS

The study did not examine other early childhood factors that may contribute to individual resiliency or suicidality.

CONCLUSION

READ provides a reliable and valid assessment of individual resilience for both clinical and nonclinical settings. Evaluation of protective resources is a useful adjunct to the assessment and treatment of suicidal behavior.