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Pflanz CP, Gallacher J, Bauermeister S. A psychometric evaluation of the 16-item PHQ-ADS concomitant anxiety and depression scale in the UK biobank using item response theory. J Affect Disord 2024; 347:335-344. [PMID: 38000468 DOI: 10.1016/j.jad.2023.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) provides a reliable and valid measure of concomitant depression and anxiety. However, research on its psychometric efficiency and optimal scale length using item-response theory (IRT) has not been reported. This study aimed to optimize the length of the PHQ-ADS scale without losing information by discarding items that were a poor fit to the IRT model. METHODS The UK Biobank is a large cohort study designed to investigate risk factors for a broad range of disease. PHQ-ADS data were available from n = 152,826 participants (age = 55.87 years; SD = 7.73; 56.4 % female), 30.4 % of the entire UK Biobank sample. Psychometric properties of the PHQ-ADS were investigated using a 2-parameter IRT and Mokken analysis. Item statistics included discrimination, difficulty and Loevinger H coefficients of monotonicity. RESULTS In the entire 16-item scale, item discrimination ranged from 1.40 to 4.22, with the item 'worrying' showing the highest level of discrimination and the item 'sleep disturbance' showing the lowest. Mokken analysis showed that the 16-item PHQ-ADS scale could be reduced to a 7-item scale without loss of test information. The reduced scale comprised mainly items measuring cognitive-affective symptoms of anxiety/depression, whereas items measuring somatic symptoms were discarded. The revised scale showed high discrimination and scalability. LIMITATIONS Findings are limited by the use of cross-sectional data that only included the baseline online questionnaire, but not other waves. CONCLUSIONS IRT is a useful technique for scale reductions which serve the clinical and epidemiological need to optimize screening questionnaires to reduce redundancy and maximize information. A reduced-item 7-item PHQ-ADS scale reduces the response burden on participants in epidemiological research settings, without loss of information.
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Affiliation(s)
- Chris Patrick Pflanz
- Dementias Platform UK, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, United Kingdom.
| | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Sarah Bauermeister
- Dementias Platform UK, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, United Kingdom
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Todorović A, Baumann C, Blanchin M, Bourion-Bédès S. Validation of Generalized Anxiety Disorder 6 (GAD-6)-A Modified Structure of Screening for Anxiety in the Adolescent French Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085546. [PMID: 37107826 PMCID: PMC10138941 DOI: 10.3390/ijerph20085546] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Anxiety disorders remain underdiagnosed and undertreated, especially in child and adolescent populations. This study aimed to examine the construct validity of the Generalized Anxiety Disorder Scale 7 (GAD-7) in a sample of French adolescents by combining the Classical Test Theory (CTT) and the Item Response Theory (IRT) and to assess the invariance of items. A total of 284 adolescents enrolled in school in the Lorraine region were randomly selected to participate in a cross-sectional study. A psychometric evaluation was performed using a combination of CTT and IRT analyses. The study of psychometric properties of GAD-7 revealed poor adequation to the sample population, and engendered the deletion of one item (#7) and the merger of two response modalities (#2 and #3). These modifications generated the new GAD-6 scale, which had a good internal consistency reliability (Cronbach α = 0.85; PSI = 0.83), acceptable goodness-of-fit indices (χ2 = 28.89, df = 9, P = 0.001; RMSEA (90% CI) = 0.088 [0.054; 0.125]; SRMR = 0.063; CFI = 0.857), and an acceptable convergent validity (r = -0.62). Only one item (#5) had a consistent Differential Item Functioning (DIF) by gender. This study evaluated the structure of the GAD-7 scale, which was essentially intended at discriminating adolescent patients with high levels of anxiety, and adapted it to a population of adolescents from the general population. The GAD-6 scale presents better psychometric properties in this general population than the original GAD-7 version.
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Affiliation(s)
- Anja Todorović
- UR4360 APEMAC, School of Public Health, Faculty of Medicine, University of Lorraine, 54000 Nancy, France
| | - Cédric Baumann
- UR4360 APEMAC, School of Public Health, Faculty of Medicine, University of Lorraine, 54000 Nancy, France
- Methodology, Data Management and Statistics Unit, University Hospital of Nancy, 54000 Nancy, France
| | - Myriam Blanchin
- SPHERE U1246, University of Nantes, University of Tours, INSERM, 44000 Nantes, France
| | - Stéphanie Bourion-Bédès
- UR4360 APEMAC, School of Public Health, Faculty of Medicine, University of Lorraine, 54000 Nancy, France
- Versailles Hospital, University Department of Child and Adolescent Psychiatry, 78157 Versailles-Le-Chesnay, France
- Correspondence: ; Tel.: +33-139638346
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Dao A, Khann S, Seponski DM, Hoang-Minh D, Tran CV, Weiss B. Concurrent and convergent validity of culture-specific psychopathology syndromes among Cambodian adolescents. Transcult Psychiatry 2022; 60:332-344. [PMID: 36573014 DOI: 10.1177/13634615221140704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychopathology is defined in part by its impacts on life functioning (e.g., fulfillment of daily responsibilities at work or school, in family relationships). Relations to life functioning are particularly important in the validation of culture-specific syndromes (patterns of mental health symptoms specific to a particular culture), to demonstrate that culture-specific symptom patterns do in fact represent pathology. The current study's goal was to assess the construct validity of the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). The study focused on the statistically unique effects of the CSSI on life functioning (i.e., effects of the CSSI on life functioning, controlling for Western psychopathology syndromes), to determine whether the CSSI contributes information beyond standard Western measures, which would support CSSI culture-specific convergent validity. Because adolescence is a key period when psychopathology often develops, study participants were 391 high-school students in one urban and one rural area of Cambodia. Participants completed the CSSI, the Western psychopathology surveys Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder questionnaire (GAD-7), and life functioning measures assessing functional impairment, quality of life, and help-seeking. Results indicated strong CSSI concurrent validity (canonical correlation = 0.75) with the PHQ-9 and GAD-7, and CSSI total effects convergent validity on life functioning indicators. All CSSI statistically unique effects (controlling for the PHQ-9 and GAD-7) on life functioning measures were non-significant indicating that the CSSI, shown to be a valid assessment measure in the current study, does not add predictive information beyond standard Western measures. A key limitation that should be considered in interpretation of these results is that the life functioning measures, although reviewed by Khmer psychologists, were Western-based, thus potentially inflating relations with Western psychopathology measures.
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Affiliation(s)
- Anh Dao
- Department of Psychology and Human Development, 5718Vanderbilt University, USA
| | - Sareth Khann
- Psychology Department, Royal University of Phnom Penh, Cambodia
| | - Desiree M Seponski
- Department of Human Development and Family Science, 1355University of Georgia, USA
| | | | | | - Bahr Weiss
- Department of Psychology and Human Development, 5718Vanderbilt University, USA
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Vogazianos P, Motrico E, Domínguez-Salas S, Christoforou A, Hadjigeorgiou E. Validation of the generalized anxiety disorder screener (GAD-7) in Cypriot pregnant and postpartum women. BMC Pregnancy Childbirth 2022; 22:841. [DOI: 10.1186/s12884-022-05127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Anxiety is increasingly acknowledged as a common mental health issue during the perinatal period. Its prevalence as well as the associated adverse effects constitute screening imperative. This study evaluates the psychometric properties and underlying factor structures of a Greek version of GAD-7 among pregnant and postpartum women (up to 6 months) in Cyprus.
Methods
This study was conducted from June to December 2020. A total of 457 Cypriot women in the perinatal period (222 pregnant and 235 postpartum) were surveyed. The assessment included anxiety (GAD-7) and depression (EPDS), and psychosocial factors related with anxiety. The internal consistency and factor structure of GAD-7 were evaluated using reliability coefficients, Cronbach’s Alpha and McDonald's Omega, and factor analysis, both Exploratory as well as Confirmatory.
Results
GAD-7 demonstrated good internal consistency (α = 0.907; Ω = 0.909). Horn's parallel analysis indicated a single factor as the most appropriate. CFA using the standard ML method indicated a good model fit, χ2 = 21.207, p = 0.096; CFI = 0.999; SRMR = 0.027. More studies are needed to determinate the cut-off point and the maximisation of the scale’s sensitivity and specificity in pregnant and postpartum Greek Cypriot women.
Conclusions
GAD-7 is a valid and reliable measure and healthcare professionals should utilize GAD-7 as a standard instrument for the screening of anxiety symptoms in pregnant and postpartum Greek Cypriot women.
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Zagurny ESF, Compton SD, Dzomeku V, Cannon LM, Omolo T, Munro-Kramer ML. Understanding Stalking Among University Students in Ghana: A Mixed-Methods Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13045-NP13066. [PMID: 33757369 DOI: 10.1177/08862605211001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study is to explore experiences of stalking behaviors among midwifery students at one Ghanaian university, as well as their association with mental health disorders. Specifically, this study had the following three aims: (a) to identify the frequency of stalking experiences in this population; (b) to explore mental health symptoms, such as depression and anxiety, within this population; and (c) to better understand intervention opportunities related to stalking, including bystander intervention and use of available resources. The study utilized an exploratory mixed-methods design with surveys (n = 118) and focus group discussions (n = 2 with 16 participants) with midwifery students recruited from a centrally located Ghanaian university campus in July of 2018 using convenience sampling. Results indicate a large percentage (80.3%) of participants have experienced stalking behavior(s) within the last six months. Multiple regression analyses demonstrate a statistically significant relationship between any stalking behaviors and depressive symptomatology as well as between unwanted monitoring/following and anxiety. This was reinforced by focus group discussions in which participants discussed the themes of: (a) types of stalking, with a heavy emphasis on using technology for unwanted following/monitoring; (b) positive versus negative perceptions of stalking intentions, where some types of monitoring and following could be seen as forms of flattery or interest; and (c) barriers to seeking help that focused on stigma, cultural barriers, systemic barriers, and personal barriers. Future research should delve more deeply into barriers to existing resources to identify ways to increase accessibility for stalking survivors in connection with mental health services. This study also highlights the need for additional research to more clearly understand stalking in Ghana so that interventions can begin to address mental health services, healthy relationships, communication, and consent.
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Affiliation(s)
| | | | - Veronica Dzomeku
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
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Barthel D, Kriston L, Yao ED, Fordjour D, Armel KEJ, Eberhardt KA, Hinz R, Ehrhardt S, Bindt C. Psychomotor development in two-year-old Ivorian and Ghanaian children - Psychometric properties of the Kilifi Developmental Inventory. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022; 40:471-486. [PMID: 35838113 DOI: 10.1111/bjdp.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/23/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
The assessment of psychomotor development in young children from low- and middle-income countries is impeded due to the lack of tools specifically designed for these resource-constrained contexts. This cross-sectional study aimed at analysing the measurement properties of the Kilifi Developmental Inventory (KDI) in two-year-old children. We administered the KDI to 289 children from Côte d'Ivoire and 230 children from Ghana. The postulated internal structure with two first-order latent variables (locomotor performance and eye-hand coordination) that loaded on a second-order latent variable (psychomotor functioning) was supported. The reliability of most factors and scales was sufficient. Interrater reliability of most items was acceptable. Correlations were weak between the scale scores and age and gender, respectively. The findings are limited by the restricted age range of the sample. Overall, the KDI showed promising measurement properties for the assessment of psychomotor performance in children from sub-Saharan countries.
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Affiliation(s)
- Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center, Hamburg, Germany
| | - Esther Doris Yao
- Centre de Recherche pour le Développement (CRD), Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Daniel Fordjour
- Department of Psychiatry, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Physician Assistantship Studies, Faculty of Health Sciences, Garden City University College, Kumasi, Ghana
| | - Koffi Ekissi Jean Armel
- Département de Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan, Côte d'Ivoire
| | - Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,I. Department of Medicine, University Medical Center, Hamburg, Germany
| | - Rebecca Hinz
- Department of Clinical Microbiology, Synlab MVZ Hamburg GmbH, Hamburg, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg, Germany
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS One 2022; 17:e0270042. [PMID: 35771857 PMCID: PMC9246197 DOI: 10.1371/journal.pone.0270042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. METHODS We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. RESULTS Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. CONCLUSION Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
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Donenberg GR, Merrill KG, Obiezu-umeh C, Nwaozuru U, Blachman-Demner D, Subramanian S, Fournier A, Iwelunmor J. Harmonizing Implementation and Outcome Data Across HIV Prevention and Care Studies in Resource-Constrained Settings. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:166-177. [PMID: 35411334 PMCID: PMC8987520 DOI: 10.1007/s43477-022-00042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
Harmonizing measures across studies can facilitate comparisons and strengthen the science, but procedures for establishing common data elements are rarely documented. We detail a rigorous, 2-year process to harmonize measures across the Prevention And Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium, consisting of eight federally-funded studies. We created a repository of measured constructs from each study, classified and selected constructs for harmonization, and identified survey instruments. Measures were harmonized for implementation science, HIV prevention and care, demographics and sexual behavior, mental health and substance use, and economic assessment. Importantly, we present our harmonized implementation science constructs. A common set of implementation science constructs have yet to be recommended in the literature for low-to-middle-income countries despite increasing recognition of their importance to delivering and scaling up effective interventions. Drawing on RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) and the Implementation Outcomes Framework, items were harmonized for staff/administrators and study participants to measure reach, adoption, implementation, maintenance, feasibility, acceptability, appropriateness, and fidelity. The process undertaken to harmonize measures and the codified set of implementation science measures developed by our consortium can inform future data harmonization efforts, critical to strengthening the replication and generalizability of findings while facilitating collaborative research-especially in resource-limited settings. We conclude with recommendations for research consortia, namely ensuring representation from all study teams and research priorities; adopting a flexible, transparent, and systematic approach; strengthening the literature on implementation science harmonization; and being responsive to life events (e.g., COVID-19). Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00042-7.
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Affiliation(s)
- Geri R. Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL USA
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL 60612 USA
| | - Katherine G. Merrill
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | | | | | - Dara Blachman-Demner
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD USA
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Elugbadebo OO, Baiyewu O. Mild anxiety and depression disorders: Unusual reactions to COVID-19 lockdown in caregivers of older adults attending a psychogeriatric clinic in Southwest Nigeria. Niger Postgrad Med J 2022; 29:13-19. [PMID: 35102945 DOI: 10.4103/npmj.npmj_708_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Many sub-Saharan African countries have fragile healthcare systems and the mental health care of older adults is in a precarious state. The lockdown that accompanied COVID-19 infection was another monumental event. Objective This study examined the effect of the restriction and lockdown on the mental health of the caregivers of older patients attending a psychogeriatric clinic in Ibadan, Nigeria. Materials and Methods We selected 178 dyads of patients and their caregivers. These caregivers were administered a semi-structured questionnaire that collected demographic information and asked questions on effect of COVID-19 on caregiving. In addition, Patient Health Questionnaire-9 and generalised anxiety disorder-7 item scale were administered. Participants were interviewed through telephone. Results One hundred and seventy-eight patients' caregivers' dyads were interviewed. About 62.4% of the caregivers were children of the patients. More importantly, 97.2% and 93.8% had neither depressive nor anxiety symptoms and the caregivers expressed little worry about COVID-19. There was no significant difference in the mean depressive and anxiety scores in caregivers of patients with and without dementia (F = 0.28, P = 0.60). Caregivers who were lesser than 50 years in age had significantly higher mean score compared with those who were 50 years and above (F = 5.54, P = 0.03). Conclusion The rate of anxiety and depressive symptoms was very low in this cohort as the lockdown during the pandemic produced little distress to caregivers including those caring for patients with dementia and cognitive impairment. This is a deviation from reports of some other countries and cultures which described psychological implications of COVID-19 on caregivers as severe.
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Affiliation(s)
| | - Olusegun Baiyewu
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Armstrong R, Silumbwe A, Zulu JM. Mental health, coping and resilience among young men who have sex with men in Zambia. CULTURE, HEALTH & SEXUALITY 2021; 23:1626-1640. [PMID: 32924794 DOI: 10.1080/13691058.2020.1788726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
Current law in Zambia criminalises same-sex sexual contact while strong socio-cultural values drive a profoundly negative view of the moral status of gender and sexual minorities. Despite this, Zambia's national HIV programme has recently identified the predominantly young population of men who have sex with men as a priority group for HIV and other sexual health programming. Research in other African settings has shown how the sexual health of these young men is affected by mental health. This mixed-methods study, which drew on the minority stress model as an analytical framework, sought to explore mental health as an initial step towards understanding its influence on other health domains. Findings describe the tension, and its psychological effects, surrounding the trajectory of discovering and affirming same-sex sexuality in an environment replete with social, physical and emotional risks, but one in which young men must nevertheless seek to create and maintain a meaningful, if precarious, social existence. To achieve this, in the absence of supportive mental health services or other programmatic responses, they adopt numerous risk-mitigation or coping strategies to attempt to build resiliency and to preserve their psychological and emotional well-being.
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Affiliation(s)
- Russell Armstrong
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Adam Silumbwe
- School of Public Health, Health Promotion and Education Department, University of Zambia, Lusaka, Zambia
| | - Joseph Mumba Zulu
- School of Public Health, Health Promotion and Education Department, University of Zambia, Lusaka, Zambia
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Donenberg G, Merrill KG, Atujuna M, Emerson E, Bray B, Bekker LG. Mental health outcomes of a pilot 2-arm randomized controlled trial of a HIV-prevention program for South African adolescent girls and young women and their female caregivers. BMC Public Health 2021; 21:2189. [PMID: 34847908 PMCID: PMC8630514 DOI: 10.1186/s12889-021-12010-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background South African adolescent girls and young women (AGYW) report significant mental distress and sexual and reproductive health concerns. Mental health problems and trauma symptoms are consistently associated with sexual and reproductive health behavior. Despite their intersection, few interventions address them simultaneously or engage female caregivers (FC) as collaborators. This study presents findings from a pilot test of an empirically supported culturally adapted family-based HIV-prevention program, Informed Motivated Aware and Responsible Adolescents and Adults- South Africa (IMARA-SA), on AGYW anxiety, depression, and trauma. Methods Sixty 15–19-year-old AGYW (mean age = 17.1 years) and their FC from outside Cape Town were randomized to IMARA-SA or a health promotion control program. AGYW reported their anxiety using the GAD-7, depression using the PHQ-9, and trauma using the PC-PTSD-5 at baseline and follow-up (6–10 months post). Both interventions were delivered by Xhosa-speaking Black South African women in groups over 2 days for approximately 10 h. We examined intervention effects using zero-inflated negative binomial regression for anxiety, multinomial logistic regression for depression, and logistic regression for trauma. Results At baseline, groups did not differ in demographic characteristics but AGYW randomized to IMARA-SA had higher depression scores than controls (p = 0.04) and a greater proportion screened positive for PTSD (p = .07). Controlling for baseline mental health scores, AGYW who received IMARA-SA compared to controls had significantly fewer anxiety symptoms at follow-up (adjusted incidence rate ratio for count model = 0.54, 95% CI = 0.29–0.99, p = 0.05), were less likely to report at least one depressive symptom relative to no symptoms (relative risk ratio = 0.22, 95% CI = 0.05, 0.95, p = 0.04), and were less likely to report symptoms of PTSD relative to no symptoms, but this difference was not statistically significant. Conclusions Mental health is implicated in risky sexual behavior, and reducing emotional distress can mitigate exposure to poor sexual and reproductive health outcomes. This pilot study yielded promising findings for the mental health impact of IMARA-SA, justifying replication in a larger randomized trial. Trial registration ClinicalTrials.gov Number NCT04758390, accepted 17/02/2021.
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Affiliation(s)
- Geri Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA.
| | - Katherine G Merrill
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA
| | | | - Erin Emerson
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA
| | - Bethany Bray
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL, 60612, USA
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van Wijk CH, Martin JH, Maree DJ. Clinical validation of brief mental health scales for use in South African occupational healthcare. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2021. [DOI: 10.4102/sajip.v47i0.1895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Luo Z, Shen Y, Yuan J, Zhao Y, Liu Z, Shangguan F. Perceived Stress, Resilience, and Anxiety Among Pregnant Chinese Women During the COVID-19 Pandemic: Latent Profile Analysis and Mediation Analysis. Front Psychol 2021; 12:696132. [PMID: 34367022 PMCID: PMC8339262 DOI: 10.3389/fpsyg.2021.696132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a major threat to pregnant women's mental health. This study aimed to characterize the patterns of perceived stress in pregnant Chinese women during the COVID-19 pandemic, to examine the profile differences on anxiety and resilience, and to investigate whether the differences in these profiles on anxiety were mediated by resilience. Methods: From February 28, 2020 to April 26, 2020, a sample of 2,116 pregnant Chinese women who participated in online crisis interventions completed an online self-reporting questionnaire assessing their demographic characteristics, perceived stress, resilience, and anxiety. Results: Latent profile analysis (LPA) on two stress dimensions [perceived helplessness (HEL) and perceived self-efficacy (SEL)] indicated four perceived stress profiles: adaptive (33.7% of the sample), resistant (44.6%), insensitive (19.1%), and sensitive (2.6%). The women with both adaptive and insensitive profiles had the lowest levels of anxiety, whereas those with the resistant profile had the lowest levels of resilience. Multicategorical mediation analysis showed that resilience partially mediated the differences in the pregnant women's anxiety between the adaptive/insensitive and resistant profile. Conclusion: This study showed the heterogeneity in the perceived stress patterns of pregnant women during the COVID-19 pandemic, revealing the internal mechanisms of pregnant women's anxiety using a person-centered approach, and provided initial evidence guiding the development of differentiated stress interventions to alleviate pregnant women's anxiety during the pandemic.
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Affiliation(s)
- Zheng Luo
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Yaqing Shen
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Jiajia Yuan
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Yifan Zhao
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fangfang Shangguan
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
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14
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Barthel D, Kriston L, Guo N, Yao ED, Armel KEJ, Fordjour D, Mohammed Y, Kotchi CEB, Eberhardt KA, Hinz R, Ehrhardt S, Bindt C. Psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in two-year-old Ivorian and Ghanaian children. APPLIED DEVELOPMENTAL SCIENCE 2021. [DOI: 10.1080/10888691.2021.1931216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dana Barthel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nan Guo
- Stanford University, Stanford, CA, USA
| | | | | | - Daniel Fordjour
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Physician Assistantship Studies, Faculty of Health Sciences, Garden City University College, Kumasi, Ghana
| | | | | | - Kirsten Alexandra Eberhardt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Stephan Ehrhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carola Bindt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Laurenzi CA, Hunt X, Skeen S, Sundin P, Weiss RE, Kosi V, Rotheram-Borus MJ, Tomlinson M. Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample. Glob Health Action 2021; 14:1861909. [PMID: 33397222 PMCID: PMC7801103 DOI: 10.1080/16549716.2020.1861909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%). Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Phillip Sundin
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University , Belfast, UK
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16
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Generalized anxiety symptoms among women attending antenatal clinic in Mwanza Tanzania; a cross-sectional study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Gong Y, Zhou H, Zhang Y, Zhu X, Wang X, Shen B, Xian J, Ding Y. Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women. J Affect Disord 2021; 282:98-103. [PMID: 33401129 DOI: 10.1016/j.jad.2020.12.129] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anxiety is common during pregnancy. The 7-item Generalized Anxiety Disorder scale (GAD-7) is a self-rating scale for detecting anxiety and has been validated in various populations, but it has not been validated in pregnant Chinese women. The objective of this study was to validate the GAD-7 as a screening tool to detect anxiety during pregnancy among Chinese women. METHODS The GAD-7 and the anxiety subscale of the Hospital Anxiety and Depression scale (HADS-A) were administered to 140 pregnant Chinese women to evaluate the Cronbach's alpha and the criterion-related validity. Additionally, a diagnostic study (n=170) was conducted by using the Mini International Neuropsychiatric Interview (MINI) as a gold standard to examine the screening performance of the GAD-7. We calculated the sensitivity, specificity, and area under the curve (AUC) by receiver operating characteristic (ROC) analysis. RESULTS Cronbach's alpha for the GAD-7 was 0.84. The Pearson correlation coefficient between GAD-7 and HADS-A scores was 0.66 (P<0.01). At the maximum Youden Index of 0.53, the optimal cutoff score for the GAD-7 among pregnant women was 7, and an AUC of 0.83, a sensitivity of 96.8%, and a specificity of 56.1% were obtained. LIMITATION The majority of the participants were in the first trimester, and thus, the findings cannot be generalized to all pregnant women. CONCLUSIONS The GAD-7 is a suitable screening instrument for detecting antenatal anxiety in mainland China. Further validation is warranted in women in different trimesters of pregnancy.
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Affiliation(s)
- Yiqian Gong
- School of Nursing, Fudan University, 200032, China; Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Huixin Zhou
- Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Ying Zhang
- Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Xinli Zhu
- Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Xiao Wang
- Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China; Department of Human Sperm Bank, Obstetrics & Gynaecology of Fudan University, Shanghai 200011, China
| | - Beibei Shen
- Department of Obstetrics, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Jing Xian
- Department of Psychiatry, Huangpu District Mental Health Centre, Shanghai 200003, China
| | - Yan Ding
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai 200011, China.
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de Mello DB, Trettim JP, da Cunha GK, Rubin BB, Scholl CC, Ardais AP, Dos Santos Motta JV, Nedel F, Ghisleni G, Pinheiro KAT, Pinheiro RT, de Avila Quevedo L, de Matos MB. Generalized Anxiety Disorder, Depressive Symptoms and the Occurrence of Stressors Events in a Probabilistic Sample of Pregnant Women. Psychiatr Q 2021; 92:123-133. [PMID: 32474679 DOI: 10.1007/s11126-020-09763-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the study is to verify the association between GAD, the severity of depressive symptoms and stressors in pregnant women between the first and second trimester. Cross-sectional study, part of a cohort that followed 980 women during the gestational period of a city in southern Brazil. We performed bivariate analysis using the t-test and chi-square. The variables that presented p ≤ 0.20 were taken for multivariate analysis, through logistic regression, in order to control possible confounding factors. The Mini International Neuropsychiatric Interview Plus was used to evaluate GAD, the severity of depressive symptoms was investigated through the Beck Inventory of Depression II, and stress events according to the Social Readjustment Assessment Scale of Holmes e Rahe. The sample consisted of 980 women. Women with mild depression symptoms had 9.8 (IC95% 4.6;21.0) times more GAD, those with moderate symptoms had 27.5 (IC95% 12.5;60.0) times more GAD, and those with severe symptoms had 52.9 (IC95% 19.1;146.5) times more GAD when compared to pregnant women with no symptoms or minimal symptoms. Regarding the stressful events, the pregnant women who presented GAD had an increase of 1.0 (IC95% 1.0;1.1) point in the mean of occurrence of stressor events when compared to those without GAD. These findings highlight the need for prevention strategies and interventions to promote maternal mental health, which benefit the development of infants in the long term.
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Affiliation(s)
- Daniele Behling de Mello
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Jéssica Puchalski Trettim
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Gabriela Kurz da Cunha
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Bárbara Borges Rubin
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Carolina Coelho Scholl
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Ana Paula Ardais
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Janaína Vieira Dos Santos Motta
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Fernanda Nedel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Gabriele Ghisleni
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | | | - Ricardo Tavares Pinheiro
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil.
| | - Luciana de Avila Quevedo
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
| | - Mariana Bonati de Matos
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil
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19
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Byrd-Bredbenner C, Eck K, Quick V. GAD-7, GAD-2, and GAD-mini: Psychometric properties and norms of university students in the United States. Gen Hosp Psychiatry 2021; 69:61-66. [PMID: 33571925 DOI: 10.1016/j.genhosppsych.2021.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Generalized Anxiety Disorder (GAD-7 & GAD-2) scales are reliable and valid instruments for assessing generalized anxiety symptoms in the general and clinical populations. However, little attention has been given to the psychometric qualities of GAD-7 and reduced length versions in a diverse sample of young adult college students stratified by sex. Thus, the aims for this study are to test psychometric properties and normative values of GAD-7, GAD-2, and GAD-Mini scales. METHOD U.S university students (N = 4128; females n = 2527, males n = 1601) ages 18-26 years completed an online survey composed of the GAD-7, Patient Health Questionnaire (PHQ-2), and demographic questions. RESULTS Exploratory principal components analysis yielded a one factor solution for GAD-7 across sexes. In reducing scale length, iterative confirmatory principal components analyses stratified by sex revealed a two-item scale (GAD-Mini) with high factor loading items, internal consistency (α ≥ 0.85), and construct validity with PHQ-2 (r ≥ 0.55). Normative data indicate that regardless of whether GAD-7, GAD-2, or GAD-Mini scores were considered, about three-quarters of men and two-thirds of women scored below the reasonable cut-points in screening for GAD. CONCLUSION Findings from this study may help health care providers and researchers better understand the interpretation of these scales among university students when screening for GAD.
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Affiliation(s)
- Carol Byrd-Bredbenner
- Department of Nutritional Sciences, School of Environmental & Biological Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, USA
| | - Kaitlyn Eck
- Department of Nutritional Sciences, School of Environmental & Biological Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, USA
| | - Virginia Quick
- Department of Nutritional Sciences, School of Environmental & Biological Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, USA.
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20
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Zhang C, Wang T, Zeng P, Zhao M, Zhang G, Zhai S, Meng L, Wang Y, Liu D. Reliability, Validity, and Measurement Invariance of the General Anxiety Disorder Scale Among Chinese Medical University Students. Front Psychiatry 2021; 12:648755. [PMID: 34093269 PMCID: PMC8170102 DOI: 10.3389/fpsyt.2021.648755] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Medical students are affected by high levels of general anxiety disorder. However, few studies have specifically focused on the applicability of universal anxiety screening tools in this sample. This study was aimed to evaluate the psychometric property of the 7-item Generalized Anxiety Disorder Scale (GAD-7) among Chinese medical university students. Methods: A questionnaire survey was conducted among 1,021 medical postgraduates from six polyclinic hospitals. Internal consistency and convergent validity of the GAD-7 were evaluated. Factor analyses were used to test the construct validity of the scale. An item response theory (IRT) framework was used to estimate the parameters of each item. Multi-group confirmatory analyses and differential item function analyses were used to evaluate the measurement equivalence of the GAD-7 across age, gender, educational status, and residence. Results: Cronbach's α coefficient was 0.93 and the intraclass correlation coefficients ranged from 0.71 to 0.87. The GAD-7 summed score was significantly correlated with measures of depression symptoms, perceived stress, sleep disorders, and life satisfaction. Parallel analysis and confirmatory factor analysis supported the one-factor structure of the GAD-7. Seven items showed appropriate discrimination and difficulty parameters. The GAD-7 showed good measurement equivalence across demographic characteristics. The total test information of the scale was 22.85, but the test information within the range of mild symptoms was relatively low. Conclusions: The GAD-7 has good reliability, validity, and measurement invariance among Chinese medical postgraduate students, but its measurement precision for mild anxiety symptoms is insufficient.
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Affiliation(s)
- Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Beijing, China.,Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tingting Wang
- International Student Office of International Cooperation Department, Peking University Health Science Center, Beijing, China
| | - Ping Zeng
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Beijing, China.,Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Minghao Zhao
- School of Basic Medicine, Peking University Health Science Center, Beijing, China
| | - Guifang Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Beijing, China.,Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuo Zhai
- Department of Education, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lingbing Meng
- Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yuanyuan Wang
- National Center for Health Professions Education Development, Peking University Health Science Center, Beijing, China
| | - Deping Liu
- Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
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21
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Irfan M, Shahudin F, Hooper VJ, Akram W, Abdul Ghani RB. The Psychological Impact of Coronavirus on University Students and its Socio-Economic Determinants in Malaysia. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211056217. [PMID: 34802264 PMCID: PMC8606969 DOI: 10.1177/00469580211056217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article is to examine the impact of coronavirus disease 2019 (COVID-19) upon university students’ anxiety level and to find the factors associated with the anxiety level in Malaysia. We collected data from 958 students from 16 different universities using an originally designed questionnaire. The Generalized Anxiety Disorder Scale 7-item (GAD-7) was used to estimate the anxiety. Then we applied the ordered logit model to calculate the odds ratios (OR) and factors associated with the anxiety level. We find that 12.3% of students were normal, whereas 30.5% were experiencing mild anxiety, 31.1% moderate anxiety, and 26.1% severe anxiety. Surprisingly, only 37.2% of students were aware of mental health support that was provided by their universities. However, age above 20 years (OR = 1.30), ethnicity Chinese (OR = 1.72), having any other disease (OR = 2.0), decreased family income (OR = 1.71), more time spent on watching COVID-19-related news (OR = 1.52), and infected relative or friends (OR = 1.62) were risk factors for anxiety among students. We conclude that the government of Malaysia should monitor the mental health of the universities’ students more closely and universities should open online mental health support clinics to avoid the adverse impacts of anxiety.
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Affiliation(s)
- Muhammad Irfan
- School of Economics and Management, Xiamen University Malaysia, Malaysia
| | - Faizah Shahudin
- School of Economics and Management, Xiamen University Malaysia, Malaysia
| | - Vincent J Hooper
- School of Economics and Management, Xiamen University Malaysia, Malaysia
| | - Waqar Akram
- Department of Business Administration, Sukkur Institute of Business Administration, Sukkur, Pakistan
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22
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Byrd-Bredbenner C, Eck K, Quick V. Psychometric Properties of the Generalized Anxiety Disorder-7 and Generalized Anxiety Disorder-Mini in United States University Students. Front Psychol 2020; 11:550533. [PMID: 33071867 PMCID: PMC7541941 DOI: 10.3389/fpsyg.2020.550533] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Generalized anxiety disorder (GAD) is common in young adults, yet few studies have established the psychometric properties of the GAD-7 screener in college students. Methods: A secondary analysis of three studies was conducted to determine GAD-7 factor structure stability, create a GAD-Mini version using standard procedures, and evaluate the psychometric properties, validity, sensitivity, specificity, and predictive values of both versions in young adults. Results: Exploratory and confirmatory principal components analysis indicated the GAD-7 has a single factor structure with strong loadings, reliability, and stability across data collected in three studies. Data from all studies met criteria indicative of good to excellent model fit. Iterative confirmatory principal components analyses revealed the most parsimonious group of items that maintained scale unidimensionality, strong loadings, and high reliability was two items (not able to stop or control worrying and worried too much). Both the GAD-7 and GAD-Mini exhibited good construct and convergent validity. Specificity, sensitivity, and negative predictive value were high, and positive predictive value was moderate to high for the GAD-Mini. Conclusions: The GAD-Mini is a psychometrically sound tool that can serve as a step toward universal screening in clinical practice and contribute to early treatment and improved health outcomes for GAD.
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Affiliation(s)
| | - Kaitlyn Eck
- Department of Nutritional Science, Rutgers University, New Brunswick, NJ, United States
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23
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Chiang JM, Kaysen GA, Segal M, Chertow GM, Delgado C, Johansen KL. Low testosterone is associated with frailty, muscle wasting and physical dysfunction among men receiving hemodialysis: a longitudinal analysis. Nephrol Dial Transplant 2020; 34:802-810. [PMID: 30085235 DOI: 10.1093/ndt/gfy252] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Despite the high prevalence of frailty among patients receiving hemodialysis, few preventable or treatable contributing causes have been identified. Hypogonadism is also common in this population and low serum testosterone concentrations share several clinical phenotypes with frailty. We hypothesized that low serum testosterone concentrations would be associated with frailty and several of its individual components. METHODS We used data from 440 men from A Cohort Study To Investigate the Value of Exercise in ESRD/Analysis Designed to Investigate the Paradox of Obesity and Survival in ESRD, a longitudinal study that recruited participants from 14 dialysis centers in Atlanta, GA and the San Francisco, CA Bay Area from 2009 to 2011. We assessed frailty using the Fried Frailty Phenotype. We examined the association between free testosterone (as a continuous and dichotomous variable) and frailty, individual frailty components, sarcopenia, lower extremity function and muscle mass estimation by creatinine and body impedance spectroscopy over 12 months using generalized estimating equations. RESULTS The mean age was 56.1 ± 14.2 years and 27% were white. A 50% lower concentration of free testosterone was associated with 1.40-fold higher odds of being frail [95% confidence interval (CI) 1.05-1.53] and 1.40-fold higher odds of becoming frail over 12 months (95% CI 1.07-1.73). This association was mainly due to an association with two components of frailty: grip strength and gait speed. In addition, 50% lower free testosterone concentration was associated with a 1.55-fold higher odds of having sarcopenia (95% CI 1.09-2.02) and 1.72-fold higher odds for developing sarcopenia (95% CI 1.13-2.33) as well as with lower muscle mass and a decrease in muscle mass over 12 months as estimated by serum creatinine and by bioelectrical impedance spectroscopy. CONCLUSION Serum free testosterone concentration was associated with frailty, physical function, sarcopenia and muscle mass as well as with changes in these outcomes over 12 months. Testosterone replacement may be a feasible therapeutic target toward prevention of frailty, although clinical trials are needed to test this possibility.
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Affiliation(s)
- Janet M Chiang
- Department of Medicine, Division of Endocrinology, University of California, San Francisco, San Francisco, CA, USA
| | - George A Kaysen
- Department of Medicine, Division of Nephrology, University of California, Davis, Davis, CA, USA
| | - Mark Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn M Chertow
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cynthia Delgado
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, Department of Medicine, Division of Nephrology, San Francisco, CA, USA
| | - Kirsten L Johansen
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, Department of Medicine, Division of Nephrology, San Francisco, CA, USA
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24
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Henn C, Morgan B. Differential item functioning of the CESDR-R and GAD-7 in African and white working adults. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2019. [DOI: 10.4102/sajip.v45i0.1663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Orientation: Depression and anxiety can have undesirable consequences for employees and their employers. It is therefore important that employers pay attention to the existence and extent of depression and anxiety. However, measuring these constructs requires unbiased, reliable and valid instruments.Research purpose: To facilitate unbiased measurement of depression and anxiety, we investigated differential item functioning of the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Generalised Anxiety Disorder Scale 7 (GAD-7) in a sample of non-clinical African and white working adults.Motivation for the study: Biased measurement instruments can lead to serious problems when comparing scores between groups, using raw score cut-offs, or creating norm scores. Practitioners are legally and ethically required to ensure that any instrument used is unbiased.Research approach/design and method: A cross-sectional survey design was used. The CESD-R and GAD-7 were administered to working adults. A final sample of 551 CESD-R responses and 529 GAD-7 responses were included in the analyses. Ordinal logistic regression was performed to investigate differential item functioning.Main findings: Both CESD-R and GAD-7 showed some evidence of differential item functioning although it was mostly small in magnitude. Item bias had some minor non-negligible impact on aggregated observed scores within specific ranges of the underlying traits.Practical/managerial implications: Both CESD-R and GAD-7 show promise as instruments that can be utilised to explore the experience of anxiety and depression in African and white employees.Contribution/value-add: This study is a promising first step towards the measurement fairness of the CESD-R and GAD-7 in the South African context.
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Wykowski J, Kemp CG, Velloza J, Rao D, Drain PK. Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2059-2071. [PMID: 30659424 PMCID: PMC6639150 DOI: 10.1007/s10461-018-02390-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Untreated mental health disorders among people living with HIV (PLHIV) may prevent low- and middle-income countries (LMICs) from achieving the UNAIDS 90-90-90 targets. Anxiety disorders may be associated with decreased adherence to antiretroviral therapy (ART). We sought to review and meta-analyze studies estimating associations between anxiety and ART adherence in LMICs. We searched PubMed, PsychINFO, CINAHL and EMBASE for relevant studies published before July 18, 2018. We defined anxiety as reported anxiety scores from screening questionnaires or having a clinical diagnosis of an anxiety disorder, and poor ART adherence as missed doses, poor visit attendance, or scores from structured adherence questionnaires. We used a random effects model to conduct a meta-analysis for calculating a pooled odds ratio, and conducted sensitivity analyses by time on ART, anxiety evaluation method, and study region. From 472 screened manuscripts, thirteen studies met our inclusion criteria. Eleven studies were included in the meta-analysis. PLHIV who reported anxiety had 59% higher odds of poor ART adherence compared with those who did not report anxiety disorder (pooled odds ratio [pOR]: 1.59, 95% confidence interval [CI] 1.29-1.96, p < 0.001). When excluding PLHIV who initiated ART within 6 months, reported anxiety remained strongly associated with poor ART adherence (pOR: 1.61, 95% CI 1.18-2.20, p = 0.003). Among PLHIV in LMICs, reported anxiety was associated with poor ART adherence. This association persisted after the ART initiation period. Increased resources for mental health may be important for achieving virologic suppression in LMICs.
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Affiliation(s)
- James Wykowski
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA.
| | - Christopher G Kemp
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
| | - Jennifer Velloza
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Deepa Rao
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Paul K Drain
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
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Omani-Samani R, Maroufizadeh S, Ghaheri A, Navid B. Generalized Anxiety Disorder-7 (GAD-7) in people with infertility: A reliability and validity study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Barthel D, Kriston L, Fordjour D, Mohammed Y, Kra-Yao ED, Bony Kotchi CE, Koffi Armel EJ, Eberhardt KA, Feldt T, Hinz R, Mathurin K, Schoppen S, Bindt C, Ehrhardt S. Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a West African birth cohort study. PLoS One 2017; 12:e0187267. [PMID: 29107975 PMCID: PMC5673167 DOI: 10.1371/journal.pone.0187267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/17/2017] [Indexed: 01/06/2023] Open
Abstract
Background The vast majority of research on mental health has been undertaken in high income countries. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms. Methods In the Child Development Study, a prospective birth cohort study in Côte d’Ivoire and Ghana, the 9-item Patient Health Questionnaire (PHQ-9) was answered by N = 776 women 3 months antepartum, and 3, 12, and 24 months postpartum between April 2010 and March 2014. Growth mixture modeling was used to identify distinct trajectories of depressive symptoms. Several psychosocial, obstetric, and sociodemographic characteristics were assessed and multinomial regression analysis was performed to investigate the influence of these variables on the different depression trajectories. Results We found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%). The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577). Among other factors, higher levels of anxiety, new pregnancy 2 years after birth, economic stress, and family stress were associated with the risk classes. Conclusions A substantial proportion of West African women in our sample developed unfavorable patterns of depressive symptoms during the vulnerable phase of pregnancy and early motherhood. Psychosocial factors, especially antepartum anxiety symptoms, played a decisive role in this process. Perceived economic hardship further exaggerated the mental health burden.
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Affiliation(s)
- Dana Barthel
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Fordjour
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yasmin Mohammed
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Doris Kra-Yao
- Laboratoire de Santé, Nutrition et Hygiène, Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | | | - Ekissi Jean Koffi Armel
- Département de Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan, Côte d’Ivoire
| | | | - Torsten Feldt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Clinic of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Rebecca Hinz
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany
| | - Koffi Mathurin
- Laboratoire des Interactions Hôte-Microorganisme, Jean Lorougnon Guede University, Daloa, Côte d’Ivoire
| | - Stefanie Schoppen
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Ehrhardt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Moreno JA, McKerral M. Towards a taxonomy of sexuality following traumatic brain injury: A pilot exploratory study using cluster analysis. NeuroRehabilitation 2017; 41:281-291. [PMID: 29060943 DOI: 10.3233/nre-172201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Clinicians need to understand the heterogeneity of sexual problems following traumatic brain injury (TBI) for their adequate identification and treatment. OBJECTIVE To systematically identify groups of individuals with TBI showing similar patterns of sexual functioning. METHODS Forty-two individuals with TBI with a mean age of 37.9 years (SD = 9.7) and an average of 3.3 years post-injury (SD = 4.3). We included four primary measures in the cluster analysis (sexual quality of life questionnaire, sexual desire inventory, generalized anxiety disorder scale, and the patient health questionnaire for depression) and two secondary measures for cluster validation (post-concussion symptom scale and dysexecutive questionnaire). RESULTS A hierarchical cluster analysis using the Ward method revealed the existence of two groups of individuals with TBI: a) with sexual problems who were older, showed lower levels of sexual quality of life and sexual desire, with significant symptoms of anxiety and depression, and b) without sexual problems who were younger, showed high levels of sexual quality of life and sexual desire, as well as low complaints of anxiety and depression. CONCLUSIONS Clinicians must be more proactive in assessing sexual concerns, mostly when emotional and cognitive difficulties are present in older individuals with TBI, regardless of gender, chronicity and injury severity.
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Affiliation(s)
- Jhon Alexander Moreno
- Department of Sexology, Faculty of Human Sciences, Université du Québec à Montréal (UQÀM), Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR)-Centre de Réadaptation Lucie-Bruneau (CRLB) - CIUSSS Centre-sud-de-l'Île-de-Montréal (CIUSSS-CSMTL), Montréal, QC, Canada
| | - Michelle McKerral
- Center for Interdisciplinary Research in Rehabilitation (CRIR)-Centre de Réadaptation Lucie-Bruneau (CRLB) - CIUSSS Centre-sud-de-l'Île-de-Montréal (CIUSSS-CSMTL), Montréal, QC, Canada.,Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de Montréal, Montréal, QC, Canada
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Bártolo A, Monteiro S, Pereira A. Factor structure and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7) among Portuguese college students. CAD SAUDE PUBLICA 2017; 33:e00212716. [PMID: 28977285 DOI: 10.1590/0102-311x00212716] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/27/2017] [Indexed: 02/06/2023] Open
Abstract
: The Generalized Anxiety Disorder 7-item (GAD-7) scale has been presented as a reliable and valid measure to assess generalized anxiety symptoms in several clinical settings and among the general population. However, some researches did not support the original one-dimensional structure of the GAD-7 tool. Our main aim was to examine the factor structure of GAD-7 comparing the one-factor model fit with a two-factor model (3 somatic nature symptoms and 4 cognitive-emotional nature symptoms) in a sample of college students. This validation study with data collected cross-sectionally included 1,031 Portuguese college students attending courses in the six schools of the Polytechnic Institute of Coimbra, Coimbra, Portugal. Measures included the GAD-7, Hospital Anxiety and Depression Scale (HADS) and the University Student Risk Behaviors Questionnaire. Confirmatory factor analysis (CFA) procedures confirmed that neither factor structure was well fitting. Thus, a modified single factor model allowing the error terms of items associated with relaxing difficulties and irritability to covary was an appropriate solution. Additionally, this factor structure revealed configural and metric invariance across gender. A good convergent validity was found by correlating global anxiety and depression. However, this measure showed a weak association with consumption behaviors. Our results are relevant to clinical practice, since the comprehensive approach to GAD-7 contributes to knowing generalized anxiety symptoms trajectory and their correlates within the university setting.
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Affiliation(s)
- Ana Bártolo
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde, Universidade de Aveiro, Aveiro, Portugal
| | - Sara Monteiro
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
| | - Anabela Pereira
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.,Centro de Investigação em Didática e Tecnologia na Formação de Formadores, Universidade de Aveiro, Aveiro, Portugal
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Goldberg DP, Reed GM, Robles R, Minhas F, Razzaque B, Fortes S, Mari JDJ, Lam TP, Garcia JÁ, Gask L, Dowell AC, Rosendal M, Mbatia JK, Saxena S. Screening for anxiety, depression, and anxious depression in primary care: A field study for ICD-11 PHC. J Affect Disord 2017; 213:199-206. [PMID: 28278448 DOI: 10.1016/j.jad.2017.02.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. METHODS The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. RESULTS A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. LIMITATIONS This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings. CONCLUSIONS The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.
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Affiliation(s)
| | - Geoffrey M Reed
- World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Sandra Fortes
- Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Tai Pong Lam
- University of Hong Kong, Hong Kong, People's Republic of China
| | - José Ángel Garcia
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Linda Gask
- University of Manchester, Manchester, United Kingdom
| | | | - Marianne Rosendal
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Barthel D, Kriston L, Barkmann C, Appiah-Poku J, Te Bonle M, Esther Doris KY, Carine Esther BK, Jean Armel KE, Mohammed Y, Osei Y, Fordjour D, Owusu D, Eberhardt KA, Hinz R, Koffi M, N'Goran E, Nguah SB, Tagbor H, Schoppen S, Ehrhardt S, Bindt C. Longitudinal course of ante- and postpartum generalized anxiety symptoms and associated factors in West-African women from Ghana and Côte d'Ivoire. J Affect Disord 2016; 197:125-33. [PMID: 26991367 DOI: 10.1016/j.jad.2016.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics. METHODS 778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories. RESULTS Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that decreased gradually. 5.4% of women showed increasing anxiety symptoms over time. Few women (3.3%) had transient anxiety with elevated scores at three and 12 months postpartum. Risk factors for elevated anxiety levels around childbirth were antepartum depressive symptoms, higher levels of stress (economic, marital and social stress), lower child birth weight, and multiparity. Partner support was found to be protective. LIMITATIONS Anxiety symptoms were assessed using a screening instrument and not through a formal diagnostic classification system. Some putative risk factors were not investigated, and some psychosocial factors were assessed retrospectively. CONCLUSION The presence of different trajectories underline the importance of monitoring anxiety symptoms in pregnant women and in mothers with infants/toddlers.
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Affiliation(s)
- Dana Barthel
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John Appiah-Poku
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Marguerite Te Bonle
- Centre de Guidance Infantile, Institut National de Santé Publique, Abidjan BP V 47, Côte d'Ivoire
| | - Kra Yao Esther Doris
- Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Bony Kotchi Carine Esther
- Unité Pédagogique Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan BP V34, Côte d'Ivoire
| | - Koffi Ekissi Jean Armel
- Unité Pédagogique Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan BP V34, Côte d'Ivoire
| | - Yasmin Mohammed
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Osei
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Fordjour
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dorcas Owusu
- Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kirsten A Eberhardt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rebecca Hinz
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute for Tropical Medicine, German Armed Forces Hospital Hamburg, Germany
| | | | - Eliezer N'Goran
- Research Unit of Parasitology and Parasite Ecology at Unité de Formation et de Recherche en Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire
| | - Samuel Blay Nguah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Harry Tagbor
- Department Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stefanie Schoppen
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moreno JA, McKerral M. Relationships between risky sexual behaviour, dysexecutive problems, and mental health in the years following interdisciplinary TBI rehabilitation. Neuropsychol Rehabil 2016; 28:34-56. [PMID: 26872445 DOI: 10.1080/09602011.2015.1136222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Little is known about the long-term consequences of traumatic brain injury (TBI) regarding risky sexual behaviour. The objectives of the study were (1) to compare risky sexual behaviour in a sample of individuals with TBI having received interdisciplinary rehabilitation with that of healthy controls, and (2) to explore the relationships between risky sexual behaviour, executive functions, and mental health in individuals with TBI. The study group consisted of 42 individuals with TBI with a mean age of 37.9 years (SD = 9.7), 12.8 years of education (SD = 3.3), and 3.3 years post-injury (SD = 4.3). Healthy controls consisted of 47 participants, with a mean age of 37.6 years (SD = 10.7), and 13 years of education (SD = 3). Risky sexual behaviour was measured with the Sexual Risk Survey and executive function with the Dysexecutive Questionnaire. Mental health measures included the Generalised Anxiety Disorder Scale, and the Patient Health Questionnaire for depression. Compared to healthy controls, individuals with TBI reported more dysexecutive and mental health problems, without differences in risky sexual behaviour. In individuals with TBI, risky sexual behaviour was associated with behavioural, cognitive and emotional dysexecutive problems, but not with anxiety or depression. It was concluded that special attention should be given to individuals with TBI showing difficulties in executive functions given their association with risky sexual behaviour.
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Affiliation(s)
- Jhon Alexander Moreno
- a Center for Interdisciplinary Research in Rehabilitation (CRIR)-Centre de Réadaptation Lucie-Bruneau (CRLB) , Montréal , Canada
| | - Michelle McKerral
- b Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Department of Psychology , Université de Montréal , Montréal , Canada
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Barthel D, Barkmann C, Ehrhardt S, Schoppen S, Bindt C. Screening for depression in pregnant women from Côte d׳Ivoire and Ghana: Psychometric properties of the Patient Health Questionnaire-9. J Affect Disord 2015; 187:232-40. [PMID: 26343851 DOI: 10.1016/j.jad.2015.06.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/15/2015] [Accepted: 06/26/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Major depression in antepartum women is a considerable health problem. This article aims at exploring the psychometric properties of the 9-item Patient Health Questionnaire (PHQ-9) in West African pregnant women. METHODS In a cross-sectional survey, the PHQ-9 was administered to n=639 Ivorian and n=389 Ghanaian women in their last trimester of pregnancy (gestational age range: 28-40 weeks) in 2010-11. Statistical analysis applied methods from both classical test theory (CTT) and item response theory (IRT). RESULTS Internal consistency was Cronbach׳s α=.65 in Côte d׳Ivoire and α=.68 in Ghana. Investigation of factorial validity by confirmatory factor analyses showed that unidimensionality of the PHQ-9 was sufficient. Rasch analyses resulted in excellent item infit and outfit measures. Yet, unidimensionality was questionable in residual principal component analyses. IRT analyses suggested that the response categories were not utilized as intended. Analysis of differential item functioning revealed interviewer-related item bias for several items in both samples. Item-person-fit was not ideal because the PHQ-9 items showed a low discriminability in the region of the latent trait where the majority of the women from the general population were located. Convergent validity was demonstrated by correlations between the PHQ-9 and two measures assessing anxiety and perceived disability. LIMITATIONS Both samples were quite homogenous regarding residence in urban areas and gestational age. CONCLUSIONS In our samples of African pregnant women, depression measured with the PHQ-9 does not appear as an entirely homogenous construct. However, the use of the sum score of the PHQ-9 is appropriate for depression screening purposes.
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Affiliation(s)
- Dana Barthel
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Child and Adolescent Psychiatry, University Medical Center Hamburg, Eppendorf, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg, Eppendorf, Germany
| | - Stephan Ehrhardt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefanie Schoppen
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg, Eppendorf, Germany
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Moreno JA, McKerral M. Differences according to Sex in Sociosexuality and Infidelity after Traumatic Brain Injury. Behav Neurol 2015; 2015:914134. [PMID: 26543323 PMCID: PMC4620288 DOI: 10.1155/2015/914134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/23/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore differences according to sex in sociosexuality and infidelity in individuals with TBI and in healthy controls. PARTICIPANTS Forty-two individuals with mild, moderate, and severe TBI having completed a postacute TBI rehabilitation program, at least six months after injury, and 47 healthy controls. MAIN MEASURES Sociosexual Orientation Inventory-Revised (SOI-R) and Attitudes toward Infidelity Scale. RESULTS Overall, men score significantly higher than women in sociosexuality. However, there was a nonsignificant trend towards a reduction of sociosexuality levels in men with TBI. Infidelity levels were comparable in healthy controls and individuals with TBI. In individuals with TBI, less acceptance of infidelity was significantly associated with an unrestricted sociosexual orientation, but not in healthy controls. CONCLUSIONS As documented in previous cross-cultural studies, men have higher levels of sociosexuality than women. However, men with TBI showed a tendency towards the reduction of sociosexuality. The possibility of a latent explanatory variable is suggested (e.g., post-TBI neuroendocrinological changes). TBI does not seem to have an impact on infidelity, but individuals with TBI who express less acceptance of infidelity also report a more promiscuous mating strategy regarding their behavior, attitudes, and desire. Theoretical implications are discussed in terms of evolutionary theories of human sexuality and neuropsychology.
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Affiliation(s)
- Jhon Alexander Moreno
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Centre de Réadaptation Lucie-Bruneau (CRLB), 2275 Laurier Avenue East, Montréal, QC, Canada H2H 2N8
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Michelle McKerral
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Centre de Réadaptation Lucie-Bruneau (CRLB), 2275 Laurier Avenue East, Montréal, QC, Canada H2H 2N8
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de Montréal, Montréal, QC, Canada
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