Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative

Childhood conditions and mental health among youth and young adults in Greenland: a latent class analysis

Poor mental health among youth in Greenland is a major challenge, childhood conditions are critical for mental health later in life. The study aimed to examine the clustering of childhood conditions by considering risk and protective factors for mental health among youth and young adults in Greenland and to explore the relationship between these clusters and mental health outcomes in youth. The study included 565 participants aged 15-34 living in Greenland. Seven indicators including childhood adversities (ACEs), childhood residence, language, and cultural indicators (protective factors) were used to define clusters via latent class analysis (LCA). The associations between clusters and mental health outcomes (satisfaction with life (Cantrill's ladder), self-esteem, self-efficacy, loneliness, psychological distress (General Health Questionnaire) and mental illness (Kessler 6)) were assessed by logistic regression. Four clusters were identified through LCA. While most participants reported positive childhoods, 40% (in two clusters) experienced ACEs. The two clusters differed as more participants in one cluster had experienced protective factors than the other. ACEs were associated with increased odds of negative aspects of mental health in youth. However, participants who faced high levels of adversity and few protective factors also had reduced odds of positive aspects of mental health in youth.

Fixed or Fluid? Sexual Identity Fluidity in a Large National Panel Study of New Zealand Adults

Sexual orientation has been defined as an enduring aspect of the self, but emerging evidence reveals that people's sexual attractions, behaviors, and identities can shift over time. To examine this possibility, we present a large longitudinal analysis of sexual orientation identity fluidity among New Zealand adults (Ntotal = 45,856; age = 18-99; lesbian, gay, bisexual, and other sexual minority (LGB+) ns = 746-3,387). Over seven years, 5.7% of participants changed sexual identities at least once. Change was bi-directional (i.e. toward and away from LGB+ identities) and most common in people who initially reported a plurisexual identity. Although women reported higher rates of plurisexuality than men, they were not more fluid in their identities, contradicting the notion of male fixedness and female plasticity in sexuality. Moreover, openness to experience was associated with increased odds of changing from a heterosexual to a plurisexual identity, while political liberalism and lower conscientiousness were associated with increased odds of changing from a heterosexual to a plurisexual identity and more identity changes over time. Overall, our study shows that sexual identity can be fluid into adulthood and has implications for how we understand contemporary human sexuality.

Feeling the distance: The relationship between emotion regulation and spatial ability in childhood

Research has shown experimentally that if children are taught to use language to create distance (socially, physically, and temporarily) when they revisit a potentially traumatic experience they reduce the intensity of their emotions. Building on this, this study was carried out to explore whether children with better spatial skills are better at such downregulation because of their very aptitude in understanding the concept of distance. Using data from a general-population birth cohort in the UK, the study examined the bidirectional association between emotional dysregulation and spatial ability among children aged 5 and 7 years. The findings reveal a significant reciprocal relationship even after adjusting for family, contextual, and individual confounders including verbal ability: spatial skills at age 5 years were inversely related to emotional dysregulation at age 7 years, and conversely, greater emotional dysregulation at age 5 years was associated with poorer spatial ability at age 7 years. The two paths were equally strong and there was no evidence of differences between them on the basis of sex. Our results suggest that enhancing spatial abilities could be a potential avenue for supporting emotion regulation in middle childhood.

Household and housing determinants of sleep duration during the COVID-19 pandemic: Results from the COHESION Study

BACKGROUND

Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19.

METHODS

Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender.

RESULTS

Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income.

CONCLUSION

Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.

Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009-2019

BACKGROUND

Cannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use.

METHODS

Retrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009-19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care.

FINDINGS

Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7-28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01).

CONCLUSIONS

Cannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.

Measuring what matters to older persons for active living: part I content development for the OPAL measure across four countries

AIMS

Many older persons do not think of themselves as "patients" but as persons wishing to live as actively as possible for as long as possible. However, most health-related quality of life (HRQL) measures were developed for use with clinical populations. The aim of this project was to fill that gap and to develop, for international use, a measure of what matters to older persons as they age and seek to remain as active as possible, Older Persons for Active Living (OPAL).

METHODS

For content development, interviews about active living were conducted with older persons from Canada, USA, UK, and the Netherlands in English, French, Spanish and Dutch, respectively with subsequent thematic analysis and harmonization.

RESULTS

Analyses of transcripts from 148 older persons revealed that active living was a "way of being" and not merely doing activities. Saturation was reached and a total of 59 content areas were identified. After grouping similar "ways" together and after conducting a consensus rating of importance, 19 unique and important "ways" remained. In some languages, formulating was challenging for three of the 19, resulting in changes to two English words and dropping two other words, yielding a final list of 17 "ways of being" with harmonized wording in 4 languages.

CONCLUSION

This study underscores the significance of listening to older adults and highlights the importance of considering linguistic and cultural nuances in measure development.

Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study

OBJECTIVE

This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).

METHODS

Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.

RESULTS

The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.

CONCLUSION

This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.

Can cessation of caregiving for parents relieve family caregivers' psychological distress? A longitudinal study using 17-wave nationwide survey data in Japan

BACKGROUND

Informal caregiving of older parents adversely affects the mental health of family caregivers. However, the psychological effects of caregiving cessation and the trajectories of these effects have rarely been examined in Japan. This study addresses this gap.

METHODS

Based on a 17-wave nationwide population-based survey in Japan, we analyzed longitudinal data from 8,280 individuals aged 50-59 years in 2005 who started caring for their older parents in 2006 or later and ceased caregiving by 2021. We identified the timings of caregiving onset and cessation and examined the trajectory of psychological distress (PD), defined as a Kessler score ≥ 5 on the 6-item Kessler scale (range 0-24). Linear mixed models were used to assess the trajectory of PD that evolved after caregiving cessation over the subsequent three years.

RESULTS

After adjusting for covariates, the probability of PD decreased by 5.6 percentage points (from 40.8%; 95% confidence interval [CI], 4.1-7.0) for female caregivers and by 1.9 percentage points (from 31.7%; 95% CI, 0.3-3.5) for male caregivers at caregiving cessation, remaining stable in subsequent years. For women, higher PD risks related to co-residence with a care recipient diminished quickly upon cessation of caregiving, while the unfavorable impacts of no social activity, extended duration of care, and long-hour daily care persisted in subsequent years. For male caregivers, the impact was generally more limited.

CONCLUSIONS

These results suggest that changes in mental health following caregiving cessation warrant serious consideration when developing support programs for former family caregivers.

Examining longitudinal associations between initial perceptions and experiences with electronic nicotine delivery system (ENDS) use and use patterns among adults who smoke and recently initiated ENDS

INTRODUCTION

Limited data exist on factors associated with concurrent use patterns of electronic nicotine delivery systems (ENDS) and cigarettes. We examined longitudinally perceptions and experiences with ENDS in relationship to concurrent use patterns among established, recent smokers who recently initiated ENDS.

METHODS

Participant recruitment took place using paid digital advertisements on social media. Between December 2020 and October 2021, 303 adults aged ≥21 years from across the US who currently or recently smoked and had initiated ENDS use within the past 30 days or reinitiated ENDS use after more than one year of non-use were surveyed. Multinomial logistic regressions were conducted to analyze association between the outcome of current use pattern at follow-up at 1 month [rejectors (discontinued ENDS, continued smoking), primary smokers (concurrent users, mostly smoke), dual user (similar smoking and ENDS use), primary vapers (concurrent users, mostly vape), and switchers (discontinued smoking, continued using ENDS) or quitters (discontinued both smoking and ENDS] and perceptions of and experiences with ENDS predictors at baseline.

RESULTS

At follow-up at 1 to 2 months after initiating ENDS, 20% were rejectors, 31% were primary smokers, 13% were dual users, 19% were primary vapers, and 17% were switchers/quitters. Perceiving ENDS as less harmful than smoking or being uncertain and as equally or more enjoyable smoking, experiencing a lot or complete reduction in cravings to smoking and in irritability with ENDS use, liking the taste of ENDS, and being satisfied with vaping were associated with higher odds of quitting smoking compared to rejecting ENDS or mostly smoking at follow-up at 1 month.

CONCLUSIONS

Findings highlight the importance of initial ENDS perceptions and experiences when examining tobacco outcomes and potentially for developing policies and interventions targeting smoking cessation. ENDS initiators are differentiating into distinct use patterns based on these factors within a short period of time.

Mainly heterosexual, bisexual, or other?: The measurement of sexual minority status and its impact on analytic sample, demographic distribution and health outcomes

BACKGROUND

Sexual orientation has been measured in a wide variety of ways which reflect both theoretical and practical considerations. However, choice of sexual orientation measure and recoding strategy can impact analytic sample, as well as demographic and health profiles, in analyses of sexual minority populations. We aimed to examine how choice of sexual orientation dimension and recoding decisions impact estimates in the sexual minority population in two population-based studies in the UK.

METHODS

We used data collected at age 17 (2018) in the UK Millennium Cohort Study and at sweep six (2012-13) and eight (2017-18) of the English Longitudinal Study of Ageing. Descriptive statistics were used to examine the impact of choice of sexual orientation dimension (i.e. identity, attraction and experience) and recoding decisions on achieved analytic sample and composition by selected demographic and health measures within and between datasets.

RESULTS

Dimension choice and recoding decisions resulted in variation in analytic sample. For example, more respondents reported some same-sex sexual attraction than reported a non-heterosexual identity (adolescents: 20.77% vs 8.97%, older adults: 4.77% vs 1.04%). Demographic distributions varied, but not substantially by dimension choice or recoding strategy. Overall, in both datasets sexual minority respondents were more likely to be White and in the highest quintiles for income and education than heterosexual respondents. Health status did not vary substantially by dimension choice or recoding strategy, however sexual minority respondents reported worse health than their heterosexual peers.

CONCLUSIONS

This study explores a range of practical and theoretical considerations when analysing sexual minority respondents using survey data. We highlight the impact recoding decisions may have on the numbers of sexual minority respondents identified within a dataset and demographic and health distributions in this understudied population. We also demonstrate the benefits of including multiple dimensions for capturing mechanisms of interest in elucidating ambiguous responses and exploring sexual diversity.

The Role of Social Determinants of Health in Self-Reported Psychological Distress among United States Adults Post-COVID-19 Pandemic

Psychological distress, an emotional condition with symptoms of anxiety and depression, leads to impaired function, behavior, and personal traits. The current study examined the association between social determinants of health and the severity of psychological distress among adults in the United States after the COVID-19 pandemic. Using multinomial multivariable logistic regression, we analyzed data from 5106 (n = 5106) participants in the Health Information National Trends Survey (HINTS) 6. Compared to non-Hispanic Whites, African Americans (AOR = 0.62, CI = 0.42-0.93) had lower odds of reporting mild psychological distress rather than no stress. Other variables associated with a higher likelihood of reporting moderate to severe psychological distress, rather than no distress, are being in the 50-64 years age group (AOR = 2.77, CI = 1.45-5.28), divorced (AOR = 2.50, CI = 1.70-3.69), and widowed (AOR = 3.78, CI = 2.15-6.64). Respondents living in an urban area had lower odds of reporting moderate to severe psychological distress (AOR = 0.56, CI = 0.39-0.80) compared to those living in rural areas. Our findings identify several risk factors for psychological distress by sociodemographic characteristics such as age, race, marital status, and urban living, providing empirical evidence for interventions in behavioral health. These findings suggest there is an utmost need for a multi-sectoral approach to address the social determinants of health associated with psychological distress post-COVID-19 pandemic.

BMI trajectories from infancy to 18 years and mental health in emerging adulthood

BACKGROUND

Studies exploring early life-course BMI trajectories and subsequent mental health outcomes are limited but may provide important insights for early intervention. We investigated associations between BMI trajectories from 0 to 18 years and mental health outcomes in emerging adulthood.

METHODS

Data were obtained from 434 participants in the Melbourne Atopy Cohort Study (MACS). Anthropometric data were collected across 26 timepoints from infancy to age 25 and group-based trajectory modelling used to develop BMI trajectories from 0.1 to 18 years. Moderate-to-severe psychological distress (MSPD) and likely depression were assessed at age 18 and 25 years. Associations between BMI trajectories and mental health at 25 years and change in mental health between 18 and 25 years were estimated using logistic regression. History of asthma, hay fever or eczema were independently examined as potential effect modifiers.

RESULTS

Five BMI trajectories were identified from 1 month to 18 years. When compared to the stable average BMI trajectory, we found increased risk of MSPD (OR = 2.97; 95%CI: 1.09,8.06) and likely depression (3.56; 1.39,9.12) at age 25 in the average increasing to high trajectory. This group also had a greater likelihood of new-onset depression (4.82; 1.54,15.0) from 18 to 25 years of age.

LIMITATIONS

MACS participants are not representative of the general population and mental health data was not available before 18 years of age.

CONCLUSION

Excessive weight gain across the childhood transition was associated with poorer mental health in emerging adulthood, highlighting the importance of monitoring growth to allow for early identification and stratification of individuals are risk of poor mental health.

Socioeconomic status, perceived family support and psychological distress in older Kenyans: a cross-sectional study

OBJECTIVES

Incidences of psychological distress are on the rise among older Kenyans. While socioeconomic status and family support have been shown to impact the mental health of older individuals, they remain understudied in the older Kenyan population. This study investigated the prevalence of psychological distress among older Kenyans and examined its relationships with economic status and perceived family support.

METHOD

Data came from a cross-sectional survey of 376 older Kenyans from four rural and urban areas in 2022. The survey collected demographic, global health, social support, socioeconomic, and psychological health variables. Structural equation modeling was used to test the relationship between socioeconomic status, family support, and psychological distress.

RESULTS

Overall, 61% reported high psychological distress, with women experiencing significantly higher levels. Structural equation modeling results indicated that food insecurity, flooring material, material wealth, chronic health, self-rated physical health, sex, and education were significant predictors. The dimensions of family support were not significantly associated with psychological distress.

CONCLUSION

The findings illuminate that psychological distress is a critical health concern for the sample and needs targeted health interventions. They also underline the essential role of economic status in the psychological distress of older Kenyans. Future studies should explore these relationships using longitudinal, family-level, and representative data.

Mental health in midwifery students: A French nationwide survey

BACKGROUND

Poor mental health in health students is a major public health issue, impacting personal quality of life and functioning, curriculum and care quality to patients.

PROBLEM

Few studies to date have examined mental health in midwifery students.

AIM

To evaluate the midwifery students'mental health.

METHODS

An online cross-sectional survey was performed between 02/11/2023 and 11/12/2023. Anonymous questionnaires were sent to midwife students via academic emails by all midwife faculties in France. We assessed the prevalence of current depressive symptoms, current generalised anxiety symptoms, burnout for students in internship, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum with specific questions. Multivariate logistic regression was performed to identify the main factors associated with major depressive disorder and suicidal ideation.

FINDINGS

Among midwifery students, 1920 (response rate: 51.9 %) were included. The prevalences of current depressive symptoms, anxiety symptoms, burnout, 12-month major depressive disorder, and 12-month suicidal ideation were 62 %, 47 %, 44 %, 13 % and 14 %, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19 %, 1.8 % and 0.7 %, respectively. In multivariable analyses, having important financial difficulties and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation.

DISCUSSION

>1 in 10 students suffered from 12-month depression and/or suicidal ideation, and almost half of them expressed various distressing symptoms.

CONCLUSION

These alarming results highlighted the need for interventions to improve mental health in midwifery students, including safer conditions of education and living.

Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan

BACKGROUND

Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied.

METHODS

We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD.

RESULTS

Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years.

CONCLUSION

The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

Relationships between climate change distress, generalized anxiety, and climate-related symptoms of mental disorders

BACKGROUND AND OBJECTIVE

We examined the possibility that reactions to climate change take two forms: distress, which may be adaptive, and symptoms of mental disorders, which may not be.

DESIGN AND METHOD

In a national sample of Polish adults (n = 1133), we measured climate change distress (experiencing unpleasant emotions and feelings due to climate change), climate-related symptoms of mental disorders (e.g., problems sleeping and problems working and planning), generalized anxiety, and depression.

RESULTS

Zero-inflated Poisson regression analyses of the occurrence of climate-related symptoms of mental disorders found two latent classes: People who experienced symptoms of the disorder and those who did not. For all eight symptoms, climate change distress predicted membership in the latent class of people who experienced a symptom, whereas how often people in the non-zero latent class experienced each symptom was positively related to generalized anxiety but was not related to distress or depression.

CONCLUSIONS

These results suggest that reactions to climate change take two forms. Some people do not experience climate change-related symptoms of mental disorders, and some do. People who experience symptoms have higher levels of climate change distress, and the frequency with which they experience these symptoms is determined by their dispositional, generalized anxiety.

Measuring psychological distress using the 12-item general health questionnaire and the six-item Kessler psychological distress scale. Psychometric comparison and equipercentile equating of the two scales

OBJECTIVES

This study aimed to examine if the General Health Questionnaire (GHQ)-12 and Kessler 6 (K6) assess the same underlying construct and to develop a score conversion table for the two scales.

METHODS

A random sample of 4303 people who completed both the GHQ-12 and K6 in 2021 were analyzed. Exploratory bifactor analysis evaluated if both scales measured the same construct, and Rasch analysis assessed item severities. The scales were transformed using Equipercentile equivalence for comparability and score conversion. Agreement was estimated with Cohen's Kappa coefficient, along with raw positive and negative agreement.

RESULTS

We found that the two scales measure the same phenomenon to the extent that they can be made equivalent. Conversion tables between GHQ-12 and K6 are presented. Applying the commonly used cut-off of ≥3 on the GHQ-12 bi-modal scoring, we found that the best corresponding cut-off on the K6 would be ≥8. The prevalence of psychological distress was then 22% with GHQ-12% and 21% with K6.

CONCLUSIONS

The GHQ-12 and K6 measure the same construct and corresponding cut-off scores on one scale were found for the other scale. This is valuable for longitudinal studies or time series where one scale has replaced the other scale.

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019

BACKGROUND

Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka.

METHODS

In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors.

RESULTS

The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV.

CONCLUSIONS

IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

Beyond Age, BMI, Gender Identity, and Gender Minority Stress, Weight Bias Internalization Is Uniquely Associated With More Eating and Body Image Disturbances and Poor Physical and Mental Health in Chinese Gender-Diverse Adults

OBJECTIVE

Weight bias internalization (WBI) is a robust, positive correlate of negative health outcomes; however, this evidence base primarily reflects cisgender individuals from Western cultural contexts. Gender-diverse individuals from non-Western cultural contexts (e.g., China) are at potentially high risk for WBI. Yet, no research has examined WBI and associated negative health consequences in this historically underrepresented population.

METHOD

A cross-sectional, online survey sampled Chinese gender-diverse individuals (N = 410, Mage = 22.33 years). Variables were self-reported, including demographics, WBI, body shame, body dissatisfaction, disordered eating, physical and mental health status, and gender minority stress (e.g., internalized cisgenderism). Analyses included correlations and multiple hierarchical regressions.

RESULTS

Pearson bivariate correlations demonstrated associations between higher WBI and more eating and body image disturbances and poor physical and mental health. After adjusting for age, BMI, gender identity, and gender minority stress, higher WBI was uniquely and positively associated with higher body shame, higher body dissatisfaction, higher disordered eating, and poor physical and mental health. Notably, WBI accounted for more unique variance in eating and body image disturbances (13%-25% explained by WBI) than physical and mental health (1%-4% explained by WBI).

DISCUSSION

While replication with longitudinal and experimental designs is needed to speak to the temporal dynamics and causality, our findings identify WBI as a unique, meaningful correlate of eating and body image disturbances in Chinese gender-diverse adults.

Patient and carer transition outcomes and experiences at the Westmead Centre for Adolescent and Young Adult Health, Westmead, Australia: protocol for a longitudinal cohort study

INTRODUCTION

The Westmead Centre for Adolescent and Young Adult Health is a purpose-built facility supporting integrated care for young patients with a variety of long-term health conditions transitioning from paediatric services at the Children's Hospital at Westmead to adult services at Westmead Hospital, Australia.

METHODS AND ANALYSIS

This protocol outlines a prospective, within-subjects, repeated-measures longitudinal cohort study to measure self-reported experiences and outcomes of patients (12-25 years) and carers accessing transition care at the Centre for Adolescent and Young Adult Health. Longitudinal self-report data will be collected using Research Electronic Data Capture surveys at the date of service entry (recruitment baseline), with follow-ups occurring at 6 months, 12 months, 18 months and after transfer to adult services. Surveys include validated demographic, general health and psychosocial questionnaires. Participant survey responses will be linked to routinely recorded data from hospital medical records. Hospital medical records data will be extracted for the 12 months prior to service entry up to 18 months post service entry. All young people accessing services at the Centre for Adolescent and Young Adult Health that meet inclusion criteria will be invited to join the study with research processes to be embedded into routine practices at the site. We expect a sample of approximately 225 patients with a minimum sample of 65 paired responses required to examine pre-post changes in patient distress. Data analysis will include standard descriptive statistics and paired-sample tests. Regression models and Kaplan-Meier method for time-to-event outcomes will be used to analyse data once sample size and test requirements are satisfied.

ETHICS AND DISSEMINATION

The study has ethics approval through the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH11125) and site-specific approvals from the Western Sydney Local Health District (2021/STE03184) and the Sydney Children's Hospitals Network (2039/STE00977). Patients under the age of 18 will require parental/carer consent to participate in the study. Patients over 18 years can provide informed consent for their participation in the research. Dissemination of research will occur through publication of peer-reviewed journal reports and conference presentations using aggregated data that precludes the identification of individuals. Through this work, we hope to develop a digital common that can be shared with other researchers and clinicians wanting to develop a standardised and shared approach to the measurement of patient outcomes and experiences in transition care.

Screen viewing patterns and their association with mental wellbeing and psychological distress: a cross-sectional study amongst university students

BACKGROUND

Dependency on screen viewing (SV) has reached unprecedented levels, and mental health issues are becoming a major public health concern. However, the associations between SV, including variations in purposes, devices, and timing, and mental health remain unclear. This study aims to provide insights into these associations among university students.

METHODS

This analysis used baseline data from a longitudinal cohort study among first-year university students matriculating in the 2021-2022 academic year. Self-reported data on sociodemographics, health behaviors and mental health outcomes alongside anthropometric measurements were collected. Unadjusted and adjusted logistic regression analyses were conducted.

RESULTS

The average age of the 997 valid students was 20.2 years, with 59.6% being female and 41.4% male. Students spent 14.3 h daily on SV, with females reporting higher SV than males. Daily SV was predominant for study purposes (7.6 h/day). Computer usage was the highest (7.0 h/day), while TV usage was the lowest (1.7 h/day). Poor mental wellbeing was reported by 33.6% of students, while 13.9% experienced psychological distress. Compared to students with low total SV, those with high levels were more likely to have poor mental wellbeing [OR (95% CI): 1.40 (0.99, 1.98)] and psychological distress [1.56 (1.00, 2.44)]. High levels of recreational and study related SV were significantly associated with poor mental wellbeing [1.81 (1.27, 2.56)] and psychological distress [1.75 (1.11, 2.83)], respectively. Those with high levels of computer time were more likely to have poor mental wellbeing [1.44 (1.01, 2.06)], and high weekend day SV was associated with greater odds of psychological distress [2.16 (1.17, 4.06)].

CONCLUSIONS

SV among university students was high, as was the high prevalence of poor mental wellbeing and psychological distress. Greater SV was associated with poor mental wellbeing and psychological distress. Differences according to purpose of SV were noted. Although recreational SV was associated with poor mental wellbeing, study related SV was associated with psychological distress. Variations across different devices and timing were also noted. This highlights the need for further longitudinal research to understand the impact of SV on mental health and to guide interventions for promoting mental health of university students globally.

Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study

INTRODUCTION

Parkinson's disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression.

OBJECTIVE

The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD.

DESIGN

This retrospective data linkage study analysed a subset of data from the Sax Institute's 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute's Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors.

FINDINGS

A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality.

DISCUSSION

Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship.

CONCLUSION

Further research is required on the longitudinal impact of these associations on mental health in PD.

Mental health symptom associations with COVID-19 testing and vaccination among urban American Indian and Alaska Native people

Background

The COVID-19 pandemic has substantially impacted American Indian and Alaska Native (AI/AN) communities. Rates of infection, hospitalization, and mortality have been severe relative to non-Hispanic whites. While AI/AN communities have had some of the highest levels of COVID-19 vaccination, utilization rates remain suboptimal and there is a need to identify facilitators and barriers to testing and vaccination.

Methods

We examined cross-sectional survey data from January to May 2021, among 619 AI/AN patients from five tribal health organizations (AK, CO, KS, NM, WA). Exposures include perceived stress, Kessler distress, PTSD screening, and AUDIT-C alcohol misuse screen. Poisson regression was used to estimate associations with prevalence of COVID-19 testing and vaccination.

Results

Over three-quarters of participants were tested for COVID-19 and nearly half were vaccinated. Perceived stress and positive PTSD screening were associated with reduced vaccination prevalence, Prevalence Ratio (PR) 0.83 (0.73, 0.93) and PR 0.80 (0.66, 0.98), respectively. There was reduced prevalence of COVID-19 testing in subgroups with lower reported psychological resilience and PTSD, PR 0.78 (0.64, 0.95).

Conclusions

Past-month perceived stress and positive PTSD screening are associated with reduced prevalence of COVID-19 vaccination in urban AI/AN people. Subgroups reporting limited resilience and PTSD symptoms had lower prevalence of COVID-19 testing. The complex relationship between mental health and COVID-19 testing and vaccination warrants further exploration to identify interventions to improve health among urban AI/AN people, a population with known disparities in both mental health and COVID-19 outcomes.

Exploring the Relationship between Food Insecurity, Chronic Health Conditions, and Serious Mental Illness in the United States: Implications for Social Work

Food insecurity (FI) is a modifiable social determinant of health that impacts approximately 10 percent of the U.S. population. FI has been linked to poorer health outcomes and higher healthcare costs. Given the prevalence of chronic health conditions in the United States, including serious mental illness (SMI), the current study aims to better understand the relationship between FI and chronic conditions, including SMI, in a nationally representative sample. Authors analyzed data from the 2016 Medical Expenditure Panel Survey household component and food security supplement. Findings indicate the prevalence of FI among those with diabetes, lung disease, stroke, and SMI is higher than among the general population, with the prevalence for those with SMI being particularly high (43 percent of the sample). Logistic regression models indicate strong, statistically significant relationships between FI and chronic conditions, including SMI, as well as FI and two or more chronic illnesses, even when controlling for sociodemographic and health factors. There are likely bidirectional relationships between FI and chronic conditions. Findings have implications for social workers, in relation to prevention and treatment of SMI and FI through direct care, advocacy, and integrated services in health, mental health, and social services.

Psychological Distress and Associated Factors among Technical Intern Trainees in Japan: A Cross-Sectional Study

Japan is experiencing significant demographic shifts due to an aging and declining population. In 1993, the Japanese Government introduced the Technical Intern Training Program (TITP) to accept foreign national workers. While the number of technical intern trainees under this program has constantly increased, many of them face challenges in their daily lives, such as stress, health insecurities and limited access to healthcare. Therefore, we conducted a cross-sectional study to assess the mental well-being of technical intern trainees, focusing on psychological distress and its related factors. This study included 304 technical intern trainees from 12 prefectures in Japan, and was conducted from August 2021 to October 2021. We used self-administered questionnaires in the participants' native languages to assess their sociodemographic conditions, health-related conditions such as health insecurities and healthcare-seeking behaviors, and psychological distress. The K6 Kessler Psychological Distress Scale was applied to evaluate the levels of psychological distress. Among the participants, 26.3% had moderate psychological distress and 2.3% had severe psychological distress. In addition, about 15% of the participants reported health insecurities and did not see a doctor despite wanting to. The multivariate model of logistic regression revealed significant associations between psychological distress and female gender (AOR 2.62, 95% CI 1.12-6.12), nationality other than Vietnamese (AOR 4.85, 95% CI 2.60-9.07), tough financial conditions (AOR 2.23, 95% CI 1.18-4.19), experiencing health insecurity (AOR 2.21, 95% CI 1.04-4.66) and the health behavior of refraining from seeking medical care (AOR 3.06, 95% CI 1.49-6.30). The top reasons for refraining from seeking medical care were the participants' limited knowledge about the healthcare system in Japan and their worries about medical bills. These findings highlight the necessity to extend mental health support services, including counseling services, and share information about Japan's healthcare system to supply medical services to the targeted technical intern trainee population.

The relationship between loneliness and blood glucose: a cross-sectional survey among Japanese

Recently, researchers have uncovered a correlation between loneliness and both the development and management of diabetes. Nevertheless, previous studies employing an unvalidated loneliness questionnaire impair result accuracy. Furthermore, this aspect has not been researched in the Japanese population. Therefore, this cross-sectional study analyzed data from the Kanagawa prospective "ME-BYO" Cohort Study (ME-BYO cohort) to investigate the correlation between loneliness, as measured by 20 items on the UCLA Loneliness Scale, and blood glucose levels. A total of 666 participants were included in the analysis, with a mean age of 54.1 years and a mean BMI of 23 kg/m2. Half of the participants had obtained an education level beyond high school. The mean household income and physical activity level were reported as 6.83 million Japanese yen and 12.3 METs-h/day, respectively. Model 1 of the linear regression analysis determined that there was no significant association between the loneliness scale and HbA1c (p = 0.512). After adjusting for age, gender, BMI (model 2), sitting time, physical activity level (model 3), housemates, household income, and final education (model 4), and controlling for social support, quality of life, and depression (model 5), the results showed no significant association, with a p-value of 0.823, 0.791, 0.792, and 0.816, respectively. Thus, the study found no link between loneliness and HbA1c in the high SES population. This finding contradicts previous results and may be attributed to the impact of population characteristics, SES status, or genetic backgrounds.

Dynamic interplay of developing internalising and externalising mental health from early childhood to mid-adolescence: Teasing apart trait, state, and cross-cohort effects

The current study examined the within-child, between-child, and between-cohort effects in the longitudinal relations between and within the internalising and externalising mental health symptoms' domains. Leveraging the data of 5998 children (ages 4, 6, 8, 10, 12, 14 years; 49% female) from the sequential Growing Up in Australia dual-cohort, multigroup longitudinal measurement invariance, and random-intercept cross-lagged panel models were deployed. Multigroup longitudinal measurement invariance revealed that the measurements of peer problems, emotional symptoms, and hyperactivity were strictly invariant, whereas conduct problems were partially strictly invariant across cohorts over time. The two cohorts did not display significant differences in the structural relations between internalising and externalising mental health symptoms, indicating the stability of the findings. In the internalising symptoms' domain, moderate to strong reciprocal effects were found from middle childhood onwards. In the externalising symptoms' domain, the results of reciprocal effects between conduct problems and hyperactivity were mainly not significant. Across domains, the reciprocal associations of emotional symptoms with hyperactivity and conduct problems were sporadic or non-existent. Peer problems were reciprocally associated with conduct problems and hyperactivity from middle childhood onwards. Overall, the findings clearly highlight the interdependence of developing internalising and externalising symptoms and reveal new insights about the early life-course development of internalising and externalising mental health symptoms.

HIV vulnerabilities and psychosocial health among young transgender women in Lima, Peru: results from a bio-behavioural survey

INTRODUCTION

Peruvian young transgender women (YTW) ages 16-24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older.

METHODS

Between February and July 2022, a cross-sectional quantitative study with YTW ages 16-24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status.

RESULTS

HIV prevalence was 41.5% (95% CI: 33.9-49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7-28.4), chlamydia 6.3% (95% CI: 3.1-11.1) and gonorrhoea 12.3% (95% CI: 7.9-18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse.

CONCLUSIONS

Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress

BACKGROUND

Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.

METHODS

Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.

RESULTS

Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.

CONCLUSIONS

The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

Psychological predictors of vaping uptake among non-smokers: A longitudinal investigation of New Zealand adults

INTRODUCTION

Demographic and health factors are known to predict vaping. Less is known about psychological predictors of vaping uptake, particularly among non-smoking adults using longitudinal designs. We aimed to model how psychological factors related to personality and mental health predicted the likelihood of vaping uptake over time in non-smoking adults ages 18+ using longitudinal data.

METHODS

Longitudinal regression models utilised data from the 2018-2020 waves of the New Zealand Attitudes and Values Study to assess how the Big Five personality traits, mental distress and self-control predicted who began vaping over time among non-users (non-vapers and non-smokers), controlling for gender, age, ethnicity and economic deprivation.

RESULTS

Analyses included 36,309 adults overall (ages 18 to 99; M = 51.0). The number of non-users who transitioned into current vaping was small (transitioned from 2018 to 2019, n = 147; 0.48%; 2019 to 2020, n = 189, 0.63%). Fully adjusted models showed that adults with higher mental distress (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.09-1.88), lower self-control (aOR 0.79; 95% CI 0.69-0.89) and higher extraversion (aOR 1.09; 95% CI 1.06-1.13) were more likely to begin vaping at the next time point compared to adults who remained non-users. Higher neuroticism and lower conscientiousness also predicted vaping uptake in initial models, but inclusion of mental distress and self-control superseded these traits.

DISCUSSION AND CONCLUSIONS

Psychological factors related to mental distress, impulse control and sociability predicted who was more likely to begin vaping as non-smoking adults. Harm prevention interventions could target these factors to reduce vaping uptake in non-smokers.

Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan

OBJECTIVE

Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses.

DESIGN

Cross-sectional survey.

SETTING

Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022.

PARTICIPANTS

This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models.

RESULTS

CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%).

CONCLUSION

CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended.

Associations among drug acquisition and use behaviors, psychosocial attributes, and opioid-involved overdoses

AIMS

This study sought to develop and assess an exploratory model of how demographic and psychosocial attributes, and drug use or acquisition behaviors interact to affect opioid-involved overdoses.

DESIGN

We conducted exploratory and confirmatory factor analysis (EFA/CFA) to identify a factor structure for ten drug acquisition and use behaviors. We then evaluated alternative structural equation models incorporating the identified factors, adding demographic and psychosocial attributes as predictors of past-year opioid overdose.

SETTING AND PARTICIPANTS

We used interview data collected for two studies recruiting opioid-misusing participants receiving services from a community-based syringe services program. The first investigated current attitudes toward drug-checking (N = 150). The second was an RCT assessing a telehealth versus in-person medical appointment for opioid use disorder treatment referral (N = 270).

MEASUREMENTS

Demographics included gender, age, race/ethnicity, education, and socioeconomic status. Psychosocial measures were homelessness, psychological distress, and trauma. Self-reported drug-related risk behaviors included using alone, having a new supplier, using opioids with benzodiazepines/alcohol, and preferring fentanyl. Past-year opioid-involved overdoses were dichotomized into experiencing none or any.

FINDINGS

The EFA/CFA revealed a two-factor structure with one factor reflecting drug acquisition and the second drug use behaviors. The selected model (CFI = .984, TLI = .981, RMSEA = .024) accounted for 13.1% of overdose probability variance. A latent variable representing psychosocial attributes was indirectly associated with an increase in past-year overdose probability (β = .234, p = .001), as mediated by the EFA/CFA identified latent variables: drug acquisition (β = .683, p < .001) and drug use (β = .567, p = .001). Drug use behaviors (β = .287, p = .04) but not drug acquisition (β = .105, p = .461) also had a significant, positive direct effect on past-year overdose. No demographic attributes were significant direct or indirect overdose predictors.

CONCLUSIONS

Psychosocial attributes, particularly homelessness, increase the probability of an overdose through associations with risky drug acquisition and drug-using behaviors. Further research is needed to replicate these findings with populations at high-risk of an opioid-related overdose to assess generalizability and refine the metrics used to assess psychosocial characteristics.

Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: the 'ASAP' study

BACKGROUND

Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations.

METHODS

Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians' treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time.

RESULTS

Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians' treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure.

CONCLUSION

Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.

The link between exposure to violence and psychological distress among middle-aged Muslims in Israel: the role of gender

Introduction

To date, it is still unclear if exposure to violence affects psychological distress in middle-aged adults and if the effects are gender specific. This age group is of special interest as it is at the onset of the aging process and is often overlooked or understudied in scholarly research. Specifically, targeted research on middle-aged Muslims living in Israel, a unique population exposed to increasing violence, is lacking.

Methods

We examined the relationship between exposure to violence and psychological distress in a cohort of 363 middle-aged adults (223 women) from three Muslim villages in northern Israel, collecting data on violence exposure (Screen for Adolescent Violence Exposure (SAVE) questionnaire), psychological distress (Kessler 6 Psychological Distress questionnaire), and other demographic characteristics including education level and socioeconomic status. We used this data to answer two questions: (1) is exposure to violence a predictor of psychological distress in middle-aged Muslims, and (2) does the relationship between exposure and distress differ between men and women?

Results

We revealed a positive link between exposure to violence and psychological distress (β = 0.145, p = 0.017) when controlling for gender, age, education level, and socioeconomic level.

Discussion

Despite previous evidence of gender-based differences in this interplay in younger cohorts, we did not find a significant interaction between gender and the violence exposure-psychological distress interplay. Our findings are some of the first to focus on middle-aged individuals and show that both men and women exhibit connections between exposure to violence and psychological distress when considering covariates. This research provides insights that can be used when planning community-wide interventions and treatment schemes to support healthy aging.

Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults

The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a correlation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items "so nervous," "lack of energy/effortful tasks," and "tired" were consistently equivalent for intercepts and factor loadings, respectively. However, items "depressed" and "so depressed" consistently differed across study countries (R2 = 0) for intercepts and factor loadings for both items. The K10 scale likely functions equivalently across the four countries for most items, except "depressed" and "so depressed." Differences in K10 items were more common in Kenya and Ethiopia, suggesting cultural context may influence the interpretation of some items and the potential need for cultural adaptations in these countries.

Characterising People who inject drugs, and association with HIV infection: A Situation Analysis in Kampala city, Uganda

Background

Uganda has implemented targeted interventions to address the rising burden of injection drug use, yet barriers persist in reaching persons who inject drugs (PWID). This study describes the characteristics of people who inject drugs, physical and mental health states, and associated risk behaviors, to inform the designing of programs that are tailored to client's needs and preferences.

Methods

A cross-sectional survey was conducted between August and December 2023 at selected hotspots in Kampala, interviewing 499 PWID aged ≥18 years. Data was collected using a semi-structured questionnaire administered by peer educators and Uganda Harm Reduction Network (UHRN) counselors. Measurements included socio-demographics, injecting drug use and sexual risk behaviors, and medical history. HIV serostatus was dtermined by self-report and testing for participants who had no recent history of testing and consented to be tested. Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviors of PWID.

Results

Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues were also noted, with reported cases of fever (32.9%), cough (32.5%), malaria (22%) and sexually transmitted infections (STIs) (15%).Regarding drug use patterns, the majority (82.6%) were introduced to drugs by close acquaintances, with 70.9% categorized as people who inject drugs. HIV prevalence among injecting drug users was 3.7%, with higher rates among females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status, highlighting the complex interplay between socio-demographic factors, risk behaviors, and HIV infection among individuals with injecting drug use Disorder in Uganda.

Conclusion

Our study provides a comprehensive insight into the socio-demographic, mental, physical health, and HIV risk behavoir of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviors suggests an urgent need for targeted interventions to address these intertwined challenges.

Parental Perception of Children's Mental Health During the Pandemic: Insights From an Italian Cross-Sectional Study

BACKGROUND

This study explores the impact of the pandemic on children's mental health. It examined the understanding of parents regarding their children's mental condition and their ability to identify issues, 2 years post the outbreak of the COVID-19 pandemic.

METHODS

Using a cross-sectional design, 507 Italian parents reported on their youngest child aged between 2 and 17, totaling 507 children. The outcomes focused on were parental perception of children's mental health deterioration, scores on the Strengths and Difficulties Questionnaire (SDQ) above the clinical cut-off, and parental under-recognition of mental health issues. Descriptive analyses and multivariable logistic regression models were executed (significance at p < .05).

RESULTS

Parents were 88.1% women (median age 41 years, interquartile range [IQR] = 36-47). Their children were 50.3% female [median age 6 years (IQR = 4-11)]. The data revealed 21.1% of parents perceived a deterioration in their children's mental health, while 44.2% had SDQ scores above the cut-off. Parental under-recognition of mental issues was found in 20.1% of cases. Significant correlations were found between parental perception of deterioration, SDQ scores, and factors like parental mental distress and children's sleep issues.

IMPLICATIONS

The findings suggest that schools and verified websites can serve as critical conduits for providing parents with reliable information. By promoting early identification and intervention, such mechanisms can help ensure mental health equity for children.

CONCLUSIONS

The research highlights the effect of the pandemic on children's mental health and the issue of parental under-recognition. The results underscore the importance of public health initiatives that enhance mental health information accessibility and reliability for parents.

Determinants of psychological distress during the COVID-19 pandemic among people who use drugs in Montreal, Canada

INTRODUCTION

Limited data exists on psychological impacts of the COVID-19 pandemic among people who use drugs (PWUD). This study aimed to determine the prevalence and correlates of severe psychological distress (PD) among PWUD in Montreal around the beginning of the pandemic.

METHODS

We conducted a rapid assessment study from May to December 2020 among PWUD recruited via a community-based cohort of people who inject drugs in Montreal (Hepatitis C cohort [HEPCO], N = 128) and community organisations (N = 98). We analysed self-reported data on changes in drug use behaviours and social determinants since the declaration of COVID-19 as a public health emergency, and assessed past-month PD using the Kessler K6 scale. Multivariable logistic regression was conducted to examine correlates of PD distress (score ≥13).

RESULTS

Of 226 survey participants, a quarter (n = 56) were screened positive for severe PD. In multivariable analyses, age (1-year increment) (adjusted odds ratio = 0.94, 95% confidence interval [0.90, 0.98]) and a decrease in non-injection drug use versus no change (0.26 [0.07, 0.92]) were protective against severe PD, while positive associations were found for any alcohol use in the past 6 months (3.73 [1.42, 9.78]), increased food insecurity (2.88 [1.19, 6.93]) and both moving around between neighbourhoods more (8.71 [2.63, 28.88]) and less (3.03 [1.18, 7.74]) often compared to no change.

DISCUSSION AND CONCLUSIONS

This study documented a high prevalence of severe PD among PWUD during the COVID-19 pandemic compared with pre-COVID-19 data. Social determinants such as food insecurity and mobility issues, alongside demographic and substance use-related factors, were linked to distress. Evidence-based risk mitigation strategies for this population could reduce negative consequences in future pandemics or disruptions.

Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial

Background

This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.

Methods

In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.

Results

Significant within-group improvements in BFSIE were observed for distres (-.48, p = .014), functional impairment (-.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = -.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.

Discussion

Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.

The performance of K6 as a screening tool for mood disorders: A population-based study of the São Paulo metropolitan area

AIM

The use of screening instruments allows the detection of psychological and behavioural manifestations there are often not identified in users of health services. We evaluated the performance of the Kessler Psychological Distress Scale (K6) in identifying mood disorders (MD), using the Composite International Diagnostic Interview (CIDI) as gold-standard, in a population-based sample (n = 5037) of adult residents of metropolitan São Paulo.

METHODS

Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated to assess the performance of K6 in detecting 30-day CIDI MD. All cut-points for each disorder were analysed using the Youden index and the area under the receiver operating characteristic curve (AUC), and the best cut-points were identified. Cronbach's alpha was calculated to assess internal consistency.

RESULTS

In total, 5.5% respondents screened positive for any MD (95% IC 4.84-6.14). A good detection performance was observed for all MD, with AUC values for any MD of 0.91 (95% IC 0.89-0.92), ranging from 0.80 (95% CI 0.71-0.98) for minor depression to 0.93 (95% CI 0.87-0.98) for bipolar I disorder. Best cut-points for each MD were identified, with overall sensitivity and specificity of 88.8% and 80.2%, respectively. Cronbach's alpha was 0.83.

CONCLUSIONS

K6 is a good screening tool for MD in the Brazilian population. It is a brief and easy to use instrument that can promote the early identification and treatment of MD, reducing the burden of mental illness.

Individual- and family-level associations between child psychopathology and parenting

Parenting can protect against the development of, or increase risk for, child psychopathology; however, it is unclear if parenting is related to psychopathology symptoms in a specific domain, or to broad liability for psychopathology. Parenting differs between and within families, and both overall family-level parenting and the child-specific parenting a child receives may be important in estimating transdiagnostic associations with psychopathology. Data come from a cross-sectional epidemiological sample (N = 10,605 children ages 4-17, 6434 households). Parents rated child internalizing and externalizing symptoms and their parenting toward each child. General and specific (internalizing, externalizing) psychopathology factors, derived with bifactor modeling, were regressed on parenting using multilevel modeling. Less warmth and more aversive/inconsistent parenting in the family, and toward an individual child relative to family average, were associated with higher general psychopathology and specific externalizing problems. Unexpectedly, more warmth in the family, and toward an individual child relative to family average, was associated with higher specific internalizing problems in 4-11 (not 12-17) year-olds. Less warmth and more aversive/inconsistent parenting are broad correlates of child psychopathology. Aversive/inconsistent parenting, is also related to specific externalizing problems. Parents may behave more warmly when their younger children have specific internalizing problems, net of overall psychopathology.

Investigating the linkages between food insecurity, psychological distress, and poor sleep outcomes among U.S. college students

OBJECTIVE

Research overwhelmingly demonstrates that sleep is key to human health and wellbeing. Several factors likely contribute to sleep quality, including factors, such as food security and low income. In addition, exposure to structural inequalities early in life likely have downstream effects upon multiple dimensions of health. The objective of this study is to fill gaps in literature by specifically examining the associations between childhood food insecurity, current food insecurity, psychological distress, and sleep among college students.

METHODS

QR codes were randomly distributed to students, linking them to an online quantitative survey. The survey measured sociodemographic variables, food security (current and childhood), diet, mental distress, and sleep quality. A total of n = 134 completed the entire survey. Data were analyzed using binary and multiple linear regressions, as well as cross-tabulations.

RESULTS

The findings revealed that psychological distress was the primary factor influencing sleep health (𝛽 = 1.51, p < .01). Students reporting higher childhood food insecurity were more likely to experience extreme psychological distress (OR = 4.61), food insecurity in college (OR = 8.41), and lack of stable housing (OR = 5.86).

CONCLUSION

This study demonstrates that potential linkages exist between childhood food insecurity, poor sleep, and greater psychological distress. While acknowledging the contribution of other factors, the study highlights the importance of addressing food insecurity in relation to sleep health, considering the significant impact of sleep to overall health and wellbeing.

Validation of the Indonesian version of the Recovery Experience Questionnaire

This study aimed to validate the Indonesian version of the Recovery Experience Questionnaire (REQ-I) to assess how individuals unwind and recuperate from work during their off-job times, specifically in terms of psychological detachment, relaxation, mastery, and control. The translated and back-translated REQ, which has gone through semantic and face validation processes, was administered through an internet survey using 740 Indonesian workers from various backgrounds. Furthermore, confirmatory Factor Analysis (CFA) was conducted to evaluate factorial validity. Construct validity was evaluated based on the correlation coefficients between recovery experience and potential consequences variables, while internal consistency and test-retest reliability were investigated to evaluate the reliability. The result of CFA showed that the hypothesized four-factor model was the most suitable for the data. Meanwhile, construct validity was supported by expected correlations of recovery experiences with possible consequences. Cronbach's α coefficient for each of the four subscales was sufficient at 0.85-0.92. Test-retest reliability of each of the four subscales with three months intervals was confirmed with sufficient intraclass correlation coefficients at 0.60-0.66. This current study confirmed that REQ-I was an adequate measure of recovery experiences used in the Indonesian context.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis

BACKGROUND

Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth.

METHODS

We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence.

RESULTS

For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence.

CONCLUSIONS

Findings highlight the internalized mental health burden of emotional and sexual violence.

Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho

BACKGROUND

Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa.

OBJECTIVES, PARTICIPANTS, SETTING

We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho.

METHODS

Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (nfemale = 7101; nmale = 1467) data.

RESULTS

Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females.

CONCLUSIONS

Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.

Improving psychosocial well-being and parenting practices among refugees in Uganda: Results of the journey of life effectiveness trial

Caregivers play a critical role in mediating the impacts of forced displacement on children; however, humanitarian programming remains hampered by a lack of evidence-based programming. We present findings from an evaluation of a group-based curriculum delivered over the course of 12 sessions, journey of life (JoL). A waitlist-control quasi-experimental design was implemented in the Kiryandongo refugee settlement (intervention n = 631, control n = 676). Caregiver mental distress, measured using the Kessler-6, was the primary outcome. Secondary outcomes included (a) functioning, (b) social support and (c) caregiving attitudes and behaviors. Propensity score matching (PSM) and Cohen's d estimates were used to examine the intervention effects. According to our primary PSM analysis, JoL led to significant improvements in mental distress (coef.: 2.33; p < 0.001), social support (coef.: 1.45; p < 0.001), functioning (coef.: 2.64; p < 0.001), parental warmth/affection (coef.: 2.48; p < 0.001), parental undifferentiated rejection (coef.: 0.49; p < 0.001) and attitudes around violence against children (VAC) (coef.: 1.98; p < 0.001). Evidence from Cohen's d analysis underscored the value of the intervention's effect on parental warmth/affection (0.74), mental distress (0.70) and VAC attitudes (0.68). This trial adds to the evidence on holistic parenting programming to improve the mental health and parenting outcomes among refugee caregivers.

Long-term recreational exercise patterns in adolescents and young adults: Trajectory predictors and associations with health, mental-health, and educational outcomes

Individual and societal factors influencing the formation of long-term recreational exercise habits during the transition from adolescence to young adulthood are not well explored. Using data from the Longitudinal Survey of Australian Youth (LSAY), a population-representative cohort study of Young People followed from age 15 to 25, we aimed to (1) model longitudinal recreational exercise trajectories from age 16 to 24, (2) examine predictors at age 15 of entering these trajectories, and (3) explore the association between the trajectories and health, mental health and educational achievement outcomes measured at the final study wave (age 25). Self-reported recreational exercise frequency data from 9353 LSAY participants were analysed using group-based trajectory modelling. We modelled the evolution of two patterns of recreational exercise behaviour: daily exercise, as per public health guidelines (Model 1); and at least once weekly exercise (Model 2). Model 1 trajectories were guideline-adherent exercisers (17.9% of the sample), never guideline exercisers (27.5%), guideline drop-outs (15.2%) and towards guideline (39.4%); Model 2 trajectories were weekly exercise (69.5% of the sample), decreasing (17.4%), increasing (4.8%), and infrequent (8.3%). For both models, at age 15, trajectory membership was predicted by gender, self-efficacy, time spent participating in sport, time spent watching TV, parental socioeconomic status, and academic literacy. At age 25, people in the guideline-adherent exerciser trajectory (model 1) reported better general health relative to other trajectories, Those in the weekly exerciser trajectory (model 2) had better general health and reduced rates of psychological distress, were happier with life and were more optimistic for the future relative to participants in less than weekly trajectory groups. Exercise-promoting interventions for Young People should specifically address the needs of females, people with low self-efficacy, reluctant exercisers, higher academic achievers, and those experiencing socioeconomic disadvantage.

Diminished psychedelic returns on distress: Marital status and household size

Although the use of psychedelics to impact health has seen growth, little research has tested the effects of culture conditions on the relationship. More specifically, how does marital status and family size affect the relationship between psychedelics and health? This study tests the relationship between Lifetime Classic Psychedelic Use (LCPU), marital status, and household size (number of people living in a household) on levels of psychological distress in the past 30 days. This project uses pooled data from the National Survey of Drug Use and Health (NSDUH) (2010 to 2018) (N = 674,521). The Final sample size is determined by the dependent variable, psychological distress in the past month (n = 158,633). The analysis includes a series of nested logistic regression models conducted in Stata 17. Results indicate that LCPU is independently associated with better health, but the association between LCPU and health varies across levels of household size. Larger households are associated with higher levels of distress, which are then exacerbated among psychedelics users. Furthermore, three-way interactions reveal that the negative association between household size and distress gets larger among psychedelic users who are married, divorced, and widowed. Overall, results suggest that household size negatively impacts the association between LCPU and health, with those who are married, divorced, and widowed experiencing the worst outcomes.

Longitudinal effects of disaster-related experiences on problem drinking among Fukushima nuclear plant workers

BACKGROUND

In the Fukushima nuclear power plant disaster of March 11, 2011, plant workers were exposed to various traumatic events and reported a subsequent increase in alcohol use. To determine the relationship between disaster-related experiences and problem drinking, we conducted a three-year follow-up study.

METHODS

Problem drinking among the nuclear plant workers was assessed annually from 2012-2014 using a modified version of the CAGE questionnaire that asked about current, rather than lifetime, drinking. A total of 1378 workers provided at least one CAGE response, and 2875 observations were used in the present analysis. Mixed-effects logistic regression models were used to analyze the relationship between disaster-related experiences and problem drinking over time.

RESULTS

The prevalence of problem drinking (CAGE score ≥2) increased over time. At the baseline assessment in 2012, a year after the disaster, plant workers who had experienced life-threatening danger and discrimination had significantly more symptoms of problem drinking, which persisted over the following 2 years. Although at baseline, plant workers who had experienced major property loss or the death of a colleague showed no significant differences in problem drinking symptoms from those without such experiences, over the next 2 years their problem drinking increased significantly.

CONCLUSIONS

Individuals who experienced life-threatening danger and discrimination during the Fukushima nuclear power plant disaster reported an increase in problem drinking. Although major property loss and the death of a colleague did not elevate problem drinking prevalence at baseline, it did so over the next 2 years. Different adverse effects of a natural disaster appear to differentially increase drinking behavior over time.