Psychological distress and its correlates in secondary school students in Pavia, Italy

Rethinking students' mental health assessment through GHQ-12: evidence from the IRT approach

BACKGROUND

The General Health Questionnaire-12 (GHQ-12) is a widely used screening tool for mental health assessment however its traditional scoring methods and cutoffs may not adequately capture the mental health complexities of younger populations.

METHODS

This study explores GHQ-12 responses from a sample of university students. Possible differences in means scores considering gender, age, academic field and degree course were assessed through t-test or one-way ANOVA as appropriate. To deeper understanding different levels of severity and individual item impact on general distress measurement, we applied Item-Response-Theory (IRT) techniques (two-parameters logistic model). We compared students' population with a population of workers who underwent a similar psychological evaluation.

RESULTS

A total of 3834 university students participated in the study. Results showed that a significant proportion (79%) of students reported psychological distress. Females and younger students obtained significantly higher average scores compared to others. IRT analysis found item-specific variations in mental distress levels, with more indicative items for short-term fluctuations and potential severe mental health concerns. Latent class analysis identified three distinct subgroups among students (including 20%, 37%, 43% of the participants respectively) with different levels of psychological distress severity. Comparison with a population of adults showed that students reported significantly higher scores with differences in the scale behavior.

CONCLUSION

Our results highlighted the unique mental health challenges faced by students, suggesting a reevaluation of GHQ-12 applicability and cutoff scores for younger populations, emphasizing the need for accurate instruments in mental health evaluation.

Sleep Duration Associated with the Lowest Risk of Depression/Anxiety in Adolescents

STUDY OBJECTIVES

To investigate sleep duration associated with the least depression/anxiety in adolescence.

METHODS

Grades 7-12 Japanese students (n = 18,250, aged 12-18 y) from public junior high/high schools were studied in a cross-sectional design. Due to missing/implausible data, 15,637 out of the 18,250 students were statistically analyzed. Relationship between sleep duration on school nights and depression/anxiety, measured using self-report questionnaires, including the General Health Questionnaire-12 (GHQ-12), were studied by sex and grade, controlling for bedtime regularity.

RESULTS

When sleep duration was classified by 1-h intervals, rate of adolescents with a GHQ-12 score ≥ 4 was the lowest in males and females who slept 8.5-9.5 h and 7.5-8.5 h, respectively, (designated "references") in both grades 7-9 and 10-12. The rate was significantly higher than the references in both males and females who slept < 7.5 h, regardless of grade (P < 0.05, logistic regression). GHQ-12 tended to be worse in adolescents (2.0%-13.5%) who slept longer than the references. Sleep duration for the minimum GHQ-12 score was estimated to be 8.8 and 8.5 h in males, and 8.0 and 7.5 h in females, in grades 7-9 and 10-12, respectively, using the General Additive Model.

CONCLUSIONS

Sleep duration of ≥ 8.5 h on school nights may be associated with the lowest risk of depression/anxiety on average in male adolescents. Although the duration was estimated to be shorter in females (≥ 7.5 h) than males, this should be interpreted carefully. Most adolescents may currently be sleeping less than the optimal duration.

COMMENTARY

A commentary on this article appears in this issue on page 1491.

Unhealthy Lifestyle, Poor Mental Health, and Its Correlation Among Adolescents

Objectives. The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide. Method. The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed. Results. Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students’ smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration. Conclusion. Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations.

Depression prevalence and related factors in Iranian students

This study designed to determine prevalence and related factors of depression in student of Arak, Iran. An analytical cross-sectional study was conducted on 304 undergraduate medical and basic students in Arak Universities, Markazi Province, Iran from May 2008 to July 2008. GHQ-28 questionnaire has been used for data gathering and analyzed by t and Chi square tests. Mean of mental health in students was 26.18 +/- 11.02 and 52.3% of students scored above the threshold of the GHQ- 28, indicating psychiatric disorder. Female sex, uninteresting of major, an uncertain future and positive family history were the most important risk factors of depression. In results didn't observe any significant relationship between age, education major and year. The prevalence of depression was higher than as compared to all population and in female exceed to male students. But there wasn't any difference between medical and non medical students. So attention to financial and occupational future graduated and under graduated students is essential.

A review of the validity of the General Health Questionnaire in adolescent populations

OBJECTIVE

To comprehensively review the validity of the General Health Questionnaire (GHQ) [1] with adolescents (aged 12-19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic.

METHOD

Systematic review of the English language peer-reviewed literature.

RESULTS

Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version.

CONCLUSION

The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated.

IMPLICATIONS

Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.