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

Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study

Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.

Engagement, Mental Health, and Substance Use Under In-Person or Remote School Instruction During the COVID-19 Pandemic

BACKGROUND

Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic.

METHODS

During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting.

RESULTS

Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86).

CONCLUSIONS

Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies

Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.

The Kessler Psychological Distress Scale in Australian adolescents: Analysis of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing

INTRODUCTION

The 10-item Kessler Psychological Distress Scale (K10) is used to screen adolescents for mental disorders in Australian clinical practice; however, there are no Australian adolescent normative data.

METHODS

Data were drawn from a nationally representative sample (N = 2964) of Australian adolescents (11-17 years). This study had three aims: (1) to examine concurrent validity between the K10 and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms subscale, (2) to establish normative Australian adolescent K10 data and (3) to determine optimal K10 cut-off scores for screening for major depressive disorder (MDD) via receiver operator characteristic curve analysis and stratum-specific likelihood ratios.

RESULTS

The K10 and SDQ emotional symptoms scales were moderately correlated (rs = 0.63, p < 0.001). Older female adolescents reported higher total K10 scores compared with younger female adolescents (15-17 years: M = 20.2, standard error [SE] = 0.3; 11-14 years: M = 16.8, SE = 0.3) and male adolescents (11-14 years: M = 16.6, SE = 0.2; 15-17 years: M = 16.0, SE=0.2). K10 scores to optimally discriminate those with and without MDD varied by age and sex and had low specificities. Stratum-specific likelihood ratios indicated adolescents with a K10 score of ≥30 will have a 12.9 (95% confidence interval = [10.2, 16.2]) increased likelihood of MDD.

CONCLUSION

The K10 has utility for assessing psychological distress in health care and epidemiological research in Australian adolescents. Adolescents with K10 scores in the 'very high' range are at increased risk of MDD. Further assessment of these young people is indicated to identify those with or at risk of developing MDD.

Associations between cannabis use, opioid misuse and severe psychological distress in adolescents: A cross-sectional school-based study

BACKGROUND

Cannabis use and nonmedical use of prescription opioids are consumed by a small to moderate number of adolescents. However, little is known about their combined influence on mental health in this age group. This study examined the association between cannabis use, nonmedical use of prescription opioids, or both with serious psychological distress among adolescents and tested if sex could moderate these associations.

METHODS

We based our analyses on cross-sectional data from the 2019 Ontario Student Drug Use and Health Survey, a provincially representative sample of students in grades 7 through 12 (aged 11-20 years or older) across Ontario, Canada (n= 7097; mean age: 15.2 ± 1.2 years). Logistic regression analyses were adjusted for important covariates.

RESULTS

We found that 20.5% reported cannabis use only, 5.8% reported opioid use only, and 5% reported both cannabis and opioid use. Cannabis use only (odds ratio [OR]:1.91; 95% confidence interval [CI]:1.53-2.37), opioid use only (OR: 2.21; 95% CI: 1.63-3.00), and both cannabis and opioid use (OR: 3.24; 95% CI: 2.25-4.66) were associated with greater odds of serious psychological distress after adjustment for covariates. Associations were similar for males and females.

CONCLUSION

The use of both cannabis and opioids is significantly associated with serious psychological distress among adolescents. Adolescents who use both cannabis and opioids represent a small and vulnerable group that should be targeted in future interventions against mental health problems. Health professionals should consider screening for polysubstance use, especially when working with adolescents who use cannabis.

Structure of psychopathology in adolescents and its association with high-risk personality traits

The present study examined high-risk personality traits and associations with psychopathology across multiple levels of a hierarchical-dimensional model of psychopathology in a large adolescent, general population sample. Confirmatory factor analyses were run using data from two randomized controlled trials of Australian adolescents (N = 8,654, mean age = 13.01 years, 52% female). A higher-order model - comprised of general psychopathology, fear, distress, alcohol use/harms, and conduct/inattention dimensions - was selected based on model fit, reliability, and replicability. Indirect-effects models were estimated to examine the unique associations between high-risk personality traits (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) and general and specific dimensions and symptoms of psychopathology. All personality traits were positively associated with general psychopathology. After accounting for general psychopathology, anxiety sensitivity was positively associated with fear; negative thinking was positively associated with distress; impulsivity was positively associated with conduct/inattention; and sensation seeking was positively associated with alcohol use/harms and conduct/inattention, and negatively associated with fear. Several significant associations between personality traits and individual symptoms remained after accounting for general and specific psychopathology. These findings contribute to our understanding of the underlying structure of psychopathology among adolescents and have implications for the development of personality-based prevention and early intervention programs.

Psychometric properties of the Distress Questionnaire-5 (DQ5) for measuring psychological distress in adolescents

Screening for psychological distress may assist in identifying at-risk adolescents. While several measures of adolescent psychological distress have been used, most have limited or suboptimal psychometric properties. This study aimed to assess the psychometric properties of the Distress Questionnaire-5 (DQ5), a brief measure of psychological distress, in a large community-based sample of adolescents. Data for the study (n = 3117) were drawn from the baseline and 6-week follow-up assessments of the Future Proofing Study, which collected data from three cohorts of Year 8 students (M = 13.9 years; 48% female) between August 2019 and May 2022. Participants completed the DQ5 at each measurement occasion, as well as measures of depression, generalised and social anxiety, and suicidal ideation. The DQ5 had good fit to a unidimensional construct, with standardised factor loadings ranging between 0.69 and 0.90. The scale had strong criterion (AUC ranged from 0.84 to 0.93) and predictive (AUC ranged from 0.81 to 0.87) validity when compared against indicators for depression, generalised anxiety, social anxiety and suicidal ideation. The DQ5 cut-point of ≥14 had 80% sensitivity and 90% specificity for identifying adolescents meeting symptom thresholds for any of the assessed mental health conditions. Changes in DQ5 scores over 6 weeks had moderate associations with changes in other symptom scales, suggesting sensitivity to change. In conclusion, the DQ5 demonstrates strong psychometric properties and is a reliable measure of psychological distress in adolescents. Given its brevity and ease of interpretation, the DQ5 could be readily used in schools to screen for psychological distress in students.

Heterogeneity in the trajectories of psychological distress among late adolescents during the COVID-19 pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic has constrained opportunities in social, educational and professional domains, leading to developmental challenges for adolescents initiating their transition to adulthood. Meta-analysis indicated that there was a small increase in psychological distress during the first year of the COVID-19 pandemic. However, significant heterogeneity in the psychological response to the COVID-19 pandemic was noted. Developmental antecedents as well as social processes may account for such heterogeneity. The goal of this study was to characterize trajectories of psychological distress in late adolescence during the COVID-19 pandemic.

Methods

5014 late adolescents born between 2000 and 2002 from the UK Millennium Cohort Study completed online self-reported assessments at three occasions during the first year of the COVID-19 pandemic (May 2020, September/October 2020 and February/March 2021). These surveys assessed psychological distress, loneliness, social support, family conflict, as well as other pandemic stressors. Information on developmental antecedents were obtained when cohort members were 17 years of age.

Results

Four distinct trajectories class were identified. Normative class (52.13%) experienced low and decreasing levels of psychological distress, while moderately increasing class (31.84%) experienced a small, but significant increase in distress over time and increasing class (8.75%) exhibited a larger increase in distress after the first wave of the pandemic. Inverted U-shaped class (7.29%) experienced elevated psychological distress during the first wave of the pandemic, followed by a decrease in distress in subsequent waves of the pandemic. Larger longitudinal increases in loneliness were noted among individuals in the elevated distress trajectory, compared to other trajectories. Pre-pandemic psychopathology was associated with elevated distress early in the pandemic.

Conclusions

The largest trajectory showed low and declining psychological distress, highlighting the resilience of the majority of late adolescents. However, a subgroup of adolescents experienced large increases in psychological distress, identifying a group of individuals more vulnerable to pandemic-related stress.

Psychometric Properties of a Risk Tool Across Indigenous Māori and European Samples in Aotearoa New Zealand: Measurement Invariance, Discrimination, and Calibration for Predicting Criminal Recidivism

Due to recent legal cases highlighting a lack of cross-ethnicity validity research using correctional risk assessment tools, we evaluated psychometric properties of Dynamic Risk Assessment for Offender Re-entry (DRAOR) scores across Māori (n = 1,812) and New Zealand (NZ) European samples (n = 1,211) in Aotearoa NZ. Using routine administrative data, our analyses suggested scoring properties were invariant across ethnicity for 15 of 19 items. Discrimination properties were also equivalent, but we observed a higher recidivism base rate among Māori participants, consistent with official statistics. Consequently, calibration analyses using a fixed follow-up (N = 372) demonstrated higher predicted recidivism rates for Māori participants at each DRAOR score. This suggests that Māori participants with similar levels of DRAOR-assessed need factors as NZ European participants experienced relatively greater continued justice contact. DRAOR users should prioritize delivering quality case management to clients, recognizing that both case-specific and systemic factors may underlie differential base rates.

Comparing Virtual and In-Person Implementation of a School-Based Sexual Health Promotion Program in High Schools with Large Latino Populations

Many sexual health programs transitioned to virtual implementation during the COVID-19 pandemic. Despite its devastation, the pandemic provided an opportunity to learn about virtual compared to in-person implementation of a sexual health promotion program-El Camino. This study assessed differences in program attendance, engagement, quality, and student ratings for virtual versus in-person implementation of El Camino as part of a rigorous evaluation in high schools with high Latino populations in Maryland. Drawing on positive youth development practices, El Camino helps participants identify personal goals and learn about sexual reproductive health and healthy relationships. This mixed-methods study incorporates data from performance measures, baseline and post-intervention participant surveys, observations, monthly implementation reports, and debriefs with facilitators to describe and compare virtual and in-person program implementation. At baseline, participants were an average of 16.2 years old; between 8 and 12th grade; 61% female; 79% Hispanic, Latino, or of Spanish origin; and 54% spoke mostly Spanish at home. Recruitment and retention of students outside of school classes were challenging for both forms of implementation. However, attendance was higher during in-person implementation and in schools where the organization implementing El Camino had a strong presence before the pandemic. Findings indicate high fidelity, excellent quality ratings, and positive student perceptions of the program and facilitators in both the virtual and in-person cohorts, which suggest that both forms of implementation were comparable and furthermore highlight the strength of the virtual adaptation of the El Camino program.

The influence of an esports-adapted coping effectiveness training (E-CET) on resilience, mental health, and subjective performance among elite league of Legends players: A pilot study

OBJECTIVE

This study aimed to develop, and pilot esports-adapted coping effectiveness training (E-CET) and measure its influence on coping effectiveness (global and specific), subjective performance, mental health (psychological distress and wellbeing), and resilience.

DESIGN

Five elite male League of Legends players competing in the League of Legends Circuit Oceania participated in a mixed methods research design. The effects of E-CET were measured using a within-subjects quasi-experimental design (i.e., pre-to-post, no control group). To measure the effects of E-CET on specific stressors, a longitudinal diary design was used.

METHOD

Players participated in a 2-h session of E-CET and a 45-min follow-up workshop. The 2-h workshop delivered content on two conceptual areas: (1) developing awareness of the stress and coping process; and (2) how to cope with stress. Players completed pre-intervention, post-intervention, and follow-up measures and twice-weekly stress journals.

RESULTS

E-CET led to increases in players' perceived coping effectiveness and subjective performance, but there were no changes in psychological distress, psychological wellbeing, and resilience. However, the results indicate some positive signs for future coping interventions with League of Legends players and iterations of E-CET.

CONCLUSION

The E-CET program appears to provide an opportunity to improve performance and mental health for esports players.

Factors Associated With Visual Impairment Among Adults With a History of Criminal Justice Involvement

The purpose of this study was to investigate the prevalence of and factors associated with visual impairment among adults with a history of criminal justice involvement (CJI). This retrospective, cross-sectional study reviewed adult respondents from the 2015-2018 National Survey on Drug Use and Health. We analyzed sociodemographic and health characteristics to determine factors associated with visual impairment among adults with and without a history of CJI. In this national, population-based study, we found similar rates of visual impairment among adults with and without CJI (5.7% vs. 4.2%, p < .001). However, adults with CJI were more likely to report visual impairment at a younger age. Among adults with CJI, visual impairment was associated with female sex, older age, Black/African American race, less education, lower income, and chronic health conditions (including diabetes, heart disease, respiratory illness, mental health symptoms, and hearing impairment). CJI in the past year (probation [adjusted odds ratio, AOR, 0.70; 95% confidence interval, CI, 0.53-0.93]; one arrest [AOR, 1.47; 95% CI, 1.14-1.89]; two or more arrests [AOR, 1.73; 95% CI, 1.29-2.33]) was uniquely associated with visual impairment among adults with a CJI history (p < .05 for all relationships). Research, screening, and treatment for visual impairment should include those with justice involvement to improve health equity.

Prevalence and correlates of addictive eating behaviours in a large cohort of Australian adolescents

OBJECTIVE

Research shows highly palatable foods can elicit addictive eating behaviours or 'food addiction'. Early adolescence is theorised to be a vulnerable period for the onset of addictive eating behaviours, yet minimal research has examined this. This study explored the prevalence and correlates of addictive eating behaviours in a large early adolescent sample.

METHODS

6640 Australian adolescents (Mage = 12.7 ± 0.5, 49%F) completed an online survey. Addictive eating was measured with the Child Yale Food Addiction Scale (YFAS-C). Negative-binomial generalised linear models examined associations between addictive eating symptoms and high psychological distress, energy drink consumption, sugar-sweetened beverage (SSB) consumption, alcohol use, and cigarette use.

RESULTS

Mean YFAS-C symptom criteria count was 1.36 ± 1.47 (of 7). 18.3% of participants met 3+ symptoms, 7.5% endorsed impairment and 5.3% met the diagnostic threshold for food addiction. All examined behavioural and mental health variables were significantly associated with addictive eating symptoms. Effects were largest for high psychological distress and cigarette use; with those exhibiting high psychological distress meeting 0.65 more criteria (95%CI = 0.58-0.72, p < 0.001) and those who smoked a cigarette meeting 0.51 more criteria (95%CI = 0.26-0.76, p < 0.001). High psychological distress and consumption of SSB and energy drinks remained significant when modelling all predictors together.

CONCLUSION

In this large adolescent study, addictive eating symptoms were common. Further research should establish directionality and causal mechanisms behind the association between mental ill-health, alcohol and tobacco use, and addictive eating behaviours. Cross-disciplinary prevention initiatives that address shared underlying risk factors for addictive eating and mental ill-health may offer efficient yet substantial public health benefits.

Examination of Behavioural Patterns of Psychological Distress and Evaluation of Related Factors: A latent class regression

Objectives

This study aimed to identify the behavioural pattern of psychological distress (PD) in the population of 18 to 65 years old people in Mashhad, Iran, using latent class regression and evaluate the related factors. PD is a unique emotional state with suffering in response to a stressor or specific need that leads to temporary or permanent impacts. Due to its negative effects on several features of life like the quality of life, health, performance and productivity of individuals, PD and its consequences are considered a public health priority.

Methods

A cross-sectional study was performed on 425,286 individuals aged 18 to 65, who were referred to health centres in Mashhad, northeastern Iran in the first half of 2018. The information required for this study, including a checklist of demographic information and the six-item Kessler Psychological Distress Scale (K-6), was obtained from the Sina System.

Results

Latent class regression identified three latent patterns of PD in answering the questions of the K-6 questionnaire, including severe PD (14%), low PD distress (40%) and no PD (46%). Statistical variables of this study due to the results are considered as the following: women, illiterate people, unemployed and divorced people, individuals aged between 50 and 59 years and people with low weight were more likely to be in the severe PD class than in the no PD class.

Conclusion

Although a small percentage of people were classified as severely disturbed, the findings showed a high rate of symptoms of distress and sadness even in the no PD class.

Is the association between psychological distress and risky alcohol consumption shifting over time? An age-period-cohort analysis of the Australian population

This study explored age, period, and cohort effects associated with trends in psychological distress and risky alcohol consumption. Data came from 108,536 Australians aged 14-79 years old from birth cohorts between 1925-2005, endorsing past year alcohol use in the 2004-2019 Australian National Drug Strategy Household Surveys. Risky alcohol consumption was split into exceeding weekly national drinking limits (>10 drinks per week) or daily limits (>4 drinks per day). An extended hierarchical age-period-cohort model was used to investigate differential effects on trends in psychological distress. Psychological distress showed an inverse U-shape throughout the lifespan with a peak in distress at age 60. Exceeding weekly alcohol limits was positively related to psychological distress prior to age 40 while exceeding daily alcohol limits remained positively related across the lifespan. There were relatively flat period effects, with no alcohol-related changes in psychological distress across years. Lastly, psychological distress gradually increased across birth cohorts until a notable spike among Australians born from 1980-2005 alongside weakening alcohol-related cohort effects. Overall, the recent increases in psychological distress did not appear to be meaningfully explained by risky alcohol consumption though risky alcohol consumption remained an important factor to consider alongside psychological distress.

Psychological empowerment and future orientation among adolescents in a youth participatory action research program

Youth participatory action research (YPAR) empowers youth to address challenges in their environment. Empowerment is associated with prosocial behaviors; however, understanding of how empowerment may serve as a protective factor and promote emotional health remains limited. We sought to characterize protective factors (future orientation and resilience) and emotional health (difficulties regulating emotion and psychological distress) among youth engaged in YPAR and examine associations with psychological empowerment. We administered cross-sectional surveys to 63 youth in YPAR programming. Multivariable linear regression examined relationships between psychological empowerment, protective factors, and emotional health. Participants had high future orientation and resilience with high psychological distress. Empowerment was significantly associated with higher future orientation. There was no significant relationship between empowerment and measures of emotional health. We demonstrate the importance of evaluating protective factors and emotional health constructs in empowerment frameworks, calling for strategies that incorporate such protective factors and more directly address emotional health.

The Chinese version of the Functionality Appreciation Scale: Psychometric properties and measurement invariance across gender and age

BACKGROUND

Functionality appreciation, as an important aspect of positive image, is associated with fewer body image disturbances, fewer disordered eating behaviors, and improved psychological well-being. However, it has been under-researched in Asian countries. The current work aimed to examine the psychometric properties of the Functionality Appreciation Scale (FAS) among four Chinese samples of different ages, and further examine measurement invariance and differences of the FAS across gender and age groups.

METHODS

Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to examine the factorial structure of the FAS among four Chinese samples of different ages, including middle school adolescents (n = 894, M_age = 12.17 years), high school adolescents (n = 1347, M_age = 15.07 years), young adults (n = 473, M_age = 21.95 years), and older adults (n = 313, M_age = 67.90 years). The measurement invariance of the FAS across gender and age was examined. Internal consistency reliability and construct validity were evaluated.

RESULTS

The FAS had a unidimensional structure and was invariant across gender and age groups. The FAS presented sound psychometric properties in all age groups by gender, with good internal consistency reliability [e.g., high Cronbach's α values (.91 ~ .97)] and good construct validity (e.g., significant associations with body appreciation, body dissatisfaction, and disordered eating). Moreover, group comparisons showed minimal gender differences in functionality appreciation. However, significant age differences were found in functionality appreciation, with older ages generally associated with higher functionality appreciation.

CONCLUSION

Overall, findings suggest that the FAS is a sound instrument to be used in the Chinese context. Furthermore, functionality appreciation was found to be higher in older adults than adolescents or young adults, suggesting the potential important role of aging in functionality appreciation.

Assessing Emotional Distress in Adolescents: Psychometrics of the Spanish Version of the Social Emotional Distress Scale-Secondary

Background

The Social Emotional Distress Scale-Secondary (SEDS-S) is a short measure designed for comprehensive school-based mental health screening, particularly for using very brief self-reported measures of well-being and distress. Whereas prior studies have shown validity and reliability evidence for the English version, there is a lack of literature about its psychometric properties for Spanish-speaking youths.

Objective

To examine the psychometric properties of the SEDS-S in a large sample of Spanish adolescents, providing evidence of its reliability, structure, convergent and discriminant validity, longitudinal and gender measurement invariance, and normative data.

Methods

Participants were 5550 adolescents aged 12-18 years old. Test-retest reliability was examined using Cronbach's alpha and McDonald's omega coefficients, and evidence for convergent and discriminant validity was measured using Pearson's correlation. Confirmatory factor analysis (CFA) was used to examine structure validity, while multigroup and longitudinal measurement invariance analysis was conducted for longitudinal and gender latent structure stability.

Results

The CFA supported a unidimensional latent structure, which was also observed to be invariant between gender groups and over time. The scale showed evidence of reliability, with coefficients above .85. In addition, the SEDS-S score was positively related to measures assessing distress and negatively related to measures assessing well-being, thereby providing convergent/discriminant validity of the total scores.

Conclusion

This study provides the first evidence of the reliability and validity of the Spanish version of the SEDS-S for assessing emotional distress among adolescents, cross-sectionally and longitudinally. Furthermore, findings indicated that SEDS-S could be a suitable assessment tool for screening and program evaluation purposes at different contexts beyond the school setting.

Does social media usage ameliorate loneliness in rural youth? A cross sectional pilot study

AIM

To investigate the relationship between social media use and loneliness and psychological wellbeing of youth in rural New South Wales.

DESIGN

This was a web-based cross-sectional survey.

METHODS

The survey consisted of 33 items including demography (12 items), participants' social media use (9 items), mood and anxiety (6 items), perceived loneliness (6 items), the impact of COVID-19 on social media usage or perceived loneliness (2 items). The participants' mood and anxiety were evaluated using the psychological distress tool (K6), while loneliness was measured using the De Jong Gierveld 6-item scale. Total loneliness and psychological distress scores were compared between demographic variables.

RESULTS

A total of 47 participants, aged 16-24 years took part in the study. The majority were women (68%) and many had K6 score that was indicative of psychological distress (68%). About half of the participants indicated that Facebook (FB) was their most used social media platform and two in five participants were on social media within 10 min of waking up each day, about 30% spent more than 20 h per week on social media, and more than two-third sent private messages, images, or videos, multiple times a day. The mean loneliness score was 2.89 (range, 0 to 6), with 0 being 'not lonely' and 6 being 'intense social loneliness'. One-way ANOVA and χ2 test results showed that those who used FB most frequently had significantly higher mean scores for loneliness compared to those that used other social media platforms (p = 0.015). Linear regression analysis revealed that those who commonly used FB were more likely to report higher loneliness scores (coefficient = -1.45, 95%CI -2.63, -0.28, p = 0.017), while gender (p = 0.039), age (p = 0.048), household composition (p = 0.023), and education level (p = 0.014) were associated with severe psychological distress.

CONCLUSIONS

The study found that social media usage, particularly FB, as measured by time used and active or passive engagement with the medium, was significantly linked to loneliness, with some impact on psychological distress. Social media use within ten minutes of waking increased the likelihood of psychological distress. However, neither loneliness nor psychological distress were associated with rurality among the rural youth in this study.

Psychometric Properties of the Kessler Psychological Distress Scale in a Sample of Adolescents from Ecuador

The Kessler psychological distress scale is a useful tool for identifying possible psychological problems and has been widely used in research and health services. Unfortunately, its application in various populations has not always been psychometrically supported. For this reason, the present study investigated the psychometric properties of its Spanish version in adolescents, verifying its factorial structure, measurement invariance by gender, internal consistency and the discrimination and difficulty parameters of its items according to the Item Response Theory (IRT). A sample of 5132 Ecuadorian adolescents was evaluated. The sample is equally distributed between male and female participants (50%) and basic and higher education (51% the former). All participants were between 11 and 20 years old. The results show that a 9-item version with correlated intercepts presents the best fit. In addition, it is invariant by gender at a strict level and has adequate internal consistency. IRT analyses indicated that all the items, except for item eight, present adequate discrimination and difficulty. Based on these results, we conclude that the 9-item version of the Psychological Distress Scale is the most appropriate for this population.

Dose-response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence

OBJECTIVE

To investigate associations between key modifiable lifestyle behaviours (sleep; physical activity; fruit, vegetable and sugar-sweetened beverage consumption; screen time; alcohol use and tobacco use) and mental health among early adolescents in Australia.

METHODS

Cross-sectional self-report data from 6,640 Year 7 students (M_age:12.7[0.5]; 50.6% male, 48.9% female, 0.5% non-binary) from 71 schools in New South Wales, Queensland and Western Australia were analysed using multivariate linear regression adjusting for sociodemographic factors and school-level clustering.

RESULTS

All examined behaviours were associated with anxiety, depression and psychological distress (p≤0.001), with the lowest mental health symptom scores observed in participants who slept 9.5-10.5 hours per night; consumed three serves of fruit daily; consumed two serves of vegetables daily; never or rarely drank sugar-sweetened beverages; engaged in six days of moderate-to-vigorous physical activity per week; kept daily recreational screen time to 31-60 minutes; had not consumed a full standard alcoholic drink (past six months); or smoked a cigarette (past six months).

CONCLUSIONS

Targeting modifiable risk behaviours offers promising prevention potential to improve adolescent mental health; however, further longitudinal research to determine directionality and behavioural interactions is needed.

IMPLICATIONS FOR PUBLIC HEALTH

While Australian Dietary, Movement and Alcohol Guidelines target physical health, findings indicate similar behaviour thresholds may offer mental health benefits.

Stability of symptoms of psychological distress: A 13-year study using Australian national data

This study examined the stability of 10 symptoms of psychological distress measured by the Kessler Psychological Distress Scale (K10) in an Australian adult sample. Data were collected at seven time points, 2 years apart, between 2007 and 2019. The average stability of the 10 symptoms was 49%. However, there were differences between items. The items can be categorised based on two characteristics: Degree of extremity and arousal. More extreme symptoms (i.e., those beginning with 'so', such as 'so sad that...') tended to change more over time, whereas milder symptoms (e.g., "nervous") tended to be more stable. Symptoms with low levels of arousal (e.g., 'hopeless') tended to reflect more situation-specific influences, whereas symptoms with high levels of arousal (e.g., 'restless or fidgety') tended to reflect more nonsystematic influences.

Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism

RATIONALE

John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women.

OBJECTIVE

We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes.

METHODS

Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension.

RESULTS

John Henryism and SWS were moderately correlated with one another (rs = 0.30-0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002).

CONCLUSIONS

We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women.

A Survey of Living Conditions and Psychological Distress in Japanese University Freshmen during the COVID-19 Pandemic

Since the novel coronavirus disease 2019 (COVID-19) pandemic, educational institutions have implemented measures such as school closures, raising concerns regarding the increase in psychological distress among university students. The purpose of this study is to identify factors that have influenced psychological distress among college freshmen during the COVID-19 pandemic. A questionnaire survey was conducted at the conclusion of the sixth wave of COVID-19 in Japan. Psychological distress was measured using the six-item Kessler Psychological Distress Scale (K6). Factors affecting psychological distress were calculated using regression analysis. Of the 2536 participants, 1841 (72.6%) reported having no psychological distress, while 695 (27.4%) reported having psychological distress. Factors that were identified to contribute to psychological distress were lack of sleep, weight gain or loss, worsening of interpersonal relationships, and physical symptoms and illnesses. A willingness to join an athletic club and having an environment in which it is easy to discuss worries and anxieties with others were factors that were identified to hinder psychological distress. It is necessary for universities to offer enhanced supports for physical and interpersonal activities. Additionally, it is imperative to encourage students to look after their physical health and to actively utilize university-based consultation systems.

Sanctuary city policies and Latinx immigrant mental health in California

This quasi-experimental study examined whether "sanctuary city" policies are an effective mechanism for reducing mental health inequalities by immigrant origin status in Latinx populations in California. Ample evidence indicates that people experience mental health problems when restrictive immigration policies are imposed. It remains unclear whether sanctuary city policies can improve population mental health in the groups targeted by restrictive immigration policies: undocumented immigrant Latinxs, documented immigrant Latinxs, and native-born Latinxs. We combined data on California's 482 cities concerning whether and when they implemented a sanctuary policy with health data on approximately 142,000 adults, 6400 adolescents and 13,000 children from the multi-year California Health Interview Survey. After using propensity score matching to identify non-sanctuary cities comparable to sanctuary cities, we estimated respondent-level difference-in-differences models to determine whether sanctuary city policies had beneficial mental health effects on three age groups: adults, adolescents, and children during the period 2007-2018. There was a trend toward improved mental health in sanctuary cities after policy enactment, but the patterns of mental health in the three Latinx immigration sub-groups of each age group did not conform to our hypotheses. Buffering the adverse effects of harsh federal immigration policies may need to involve other approaches, such as expanded local mental health care access. We discuss these results in terms of alternative treatment interference, residents' policy awareness, the policy's capacity to address past health impacts, methodological issues, and potential policy momentum.

The impact of the initial COVID-19 outbreak on young adults' mental health: a longitudinal study of risk and resilience factors

Few studies assessing the effects of COVID-19 on mental health include prospective markers of risk and resilience necessary to understand and mitigate the combined impacts of the pandemic, lockdowns, and other societal responses. This population-based study of young adults includes individuals from the Neuroscience in Psychiatry Network (n = 2403) recruited from English primary care services and schools in 2012-2013 when aged 14-24. Participants were followed up three times thereafter, most recently during the initial outbreak of the COVID-19 outbreak when they were aged between 19 and 34. Repeated measures of psychological distress (K6) and mental wellbeing (SWEMWBS) were supplemented at the latest assessment by clinical measures of depression (PHQ-9) and anxiety (GAD-7). A total of 1000 participants, 42% of the original cohort, returned to take part in the COVID-19 follow-up; 737 completed all four assessments [mean age (SD), 25.6 (3.2) years; 65.4% female; 79.1% White]. Our findings show that the pandemic led to pronounced deviations from existing mental health-related trajectories compared to expected levels over approximately seven years. About three-in-ten young adults reported clinically significant depression (28.8%) or anxiety (27.6%) under current NHS guidelines; two-in-ten met clinical cut-offs for both. About 9% reported levels of psychological distress likely to be associated with serious functional impairments that substantially interfere with major life activities; an increase by 3% compared to pre-pandemic levels. Deviations from personal trajectories were not necessarily restricted to conventional risk factors; however, individuals with pre-existing health conditions suffered disproportionately during the initial outbreak of the COVID-19 pandemic. Resilience factors known to support mental health, particularly in response to adverse events, were at best mildly protective of individual psychological responses to the pandemic. Our findings underline the importance of monitoring the long-term effects of the ongoing pandemic on young adults' mental health, an age group at particular risk for the emergence of psychopathologies. Our findings further suggest that maintaining access to mental health care services during future waves, or potential new pandemics, is particularly crucial for those with pre-existing health conditions. Even though resilience factors known to support mental health were only mildly protective during the initial outbreak of the COVID-19 pandemic, it remains to be seen whether these factors facilitate mental health in the long term.

Does weight impact adolescent mental health? Evidence from China

In this paper, we examine the causal impact of weight on adolescent mental health. Using the China Family Panel Studies, we find significant negative effects of adolescent weight, instrumented by cohort-level parental body mass index (BMI), on mental illness. In particular, a one standard deviation increase in adolescent BMI z-score decreases the K6 score by 0.766 (or 0.232 standard deviations). This finding is contrary to recent evidence from adults. We find this contrast can partly be explained by the different impacts of adolescent weight on self-image and social relationships. Unlike adults, heavy adolescents feel that they are popular among peers in China.

A healthy lifestyle text message intervention for adolescents: protocol for the Health4Me randomized controlled trial

BACKGROUND

Adolescence presents a window of opportunity to establish good nutrition and physical activity behaviours to carry throughout the life course. Adolescents are at risk of developing cardiovascular and other chronic diseases due to poor the complex interplay of physical and mental health lifestyle risk factors. Text messaging is adolescents main form of everyday communication and text message programs offer a potential solution for support and improvement of lifestyle health behaviours. The primary aim of this study is to determine effectiveness of the Health4Me text message program to improve adolescent's physical activity or nutrition behaviours among adolescents over 6-months, compared to usual care.

METHODS

Health4Me is a virtual, two-arm, single-blind randomised controlled trial, delivering a 6-month healthy lifestyle text message program with optional health counselling. Recruitment will be through digital advertising and primary care services. In total, 330 adolescents will be randomised 1:1 to intervention or control (usual care) groups. The intervention group will receive 4-5 text messages per week for 6-months. All text messages have been co-designed with adolescents. Messages promote a healthy lifestyle by providing practical information, health tips, motivation and support for behaviour change for physical activity, nutrition, mental health, body image, popular digital media and climate and planetary health. Virtual assessments will occur at baseline and 6-months assessing physical health (physical activity, nutrition, body mass index, sleep), mental health (quality of life, self-efficacy, psychological distress, anxiety, depression, eating disorder risk) and lifestyle outcomes (food insecurity and eHealth literacy).

DISCUSSION

This study will determine the effectiveness of a 6-month healthy lifestyle text message intervention to improve physical activity and nutrition outcomes in adolescents.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000949785 , Date registered: 05/07/2022.

Factor structure and longitudinal measurement invariance of the K6 among a national representative elder sample of China

Background

As the number of older people is rapidly growing, prevention, screening, and treatment of mental health problems (including anxiety and depression) in this population increasingly become a heavy burden to individuals, families, and even the whole society. The Kessler-6 screening measure (K6) is an efficient and effective instrument for general mental health problems. However, few studies have examined its measurement invariance across time, which is particularly important in longitudinal studies, such as exploring developmental trajectories of non-specific psychological distress and evaluating the effects of certain interventions.

Methods

The current study investigated the factor structure and the longitudinal measurement invariance of the K6 among a national representative elder sample of China. Longitudinal data in two survey waves (the year 2010, and the year 2014) from the China Family Panel Studies were drawn for secondary data analysis. A total of 3845 participants aged 60 years old and above (52.2% male, mean age = 66.99 years, SD = 5.93 years) responded to both waves of the survey.

Results

A comparison of four existing models with confirmatory factor analysis supported a two-factor solution of the K6. A series of multi-group confirmatory factor analyses further indicated that the K6 held strict longitudinal measurement invariance across time. Additionally, the internal consistency indices across time and the stability coefficients over time were acceptable.

Conclusions

The findings further confirmed the psychometric defensibility of the K6 when used in the old Chinese population. The longitudinal measurement invariance justified comparisons of psychological distress scores among different measurement time points.

Association between unmet post-arrival expectations and psychological symptoms in recently arrived refugees

Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 "Resilient Post Traumatic Stress (PTS)" (54.1%), "Improving PTS" (15.0%), "Deteriorating PTS" (17.3%), and "Persistently High PTS" (13.6%). For the K6, three classes were identified: "Persistently Mild K6" (60.4%), "Resilient K6" (9.4%), and "Persistently High K6" (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.

Psychological distress, multimorbidity and health services among older adults in rural South Australia

OBJECTIVE

Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization.

DESIGN

A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population.

RESULTS

The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ² = 14.4, p < 0.001), <80 years (χ² = 11.7, p = 0.019), lower education (χ² = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ² = 51.1, p < 001), increasing age (χ² = 173.6, p < 0.001) and lower education (χ² = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress.

CONCLUSION/IMPLICATION

Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Exploring Social Media Rumination: Associations With Bullying, Cyberbullying, and Distress

In this study, we examined students' perceptions of peer aggression occurring within their school environment and how these perceptions are interconnected with both social media rumination and distress. Social media usage is associated with a range of negative mental health and interpersonal outcomes for adolescents. Social media use can increase youth's vulnerability to peer victimization and psychosocial difficulties. In addition, ruminating when sad or stressed has been linked to elevated distress for youth experiencing peer aggression. Yet rumination specifically regarding social media activities has not been investigated in relation to peer aggression and distress, nor has the degree to which students perceive peer aggression occurring at school been included in these investigations. Participants were 169 high school students (age, M = 15.89, SD = .87), largely identifying as Black/African American and female, who completed surveys as part of a larger program working with at-risk youth in a Midwestern, urban city. We found that social media rumination mediated the relationship between perceptions of bullying at school and feelings of distress, but mediation was not supported when examining student perceptions of cyberbullying frequency and youth distress. In the case of bullying, rumination may disrupt other forms of coping-such as positive cognitive distractions-that would ameliorate symptoms of distress. Furthermore, we present evidence that social media rumination is experienced by, and has different influences on, youth. We highlight the need for differentiated intervention and prevention efforts regarding these two forms of peer aggression. Future research may be justified to examine these possibilities.

Risk of eating disorders in a representative sample of Italian adolescents: prevalence and association with self-reported interpersonal factors

PURPOSE

Adolescence represents a critical period for the onset of eating disorders (EDs). The present study aimed to provide the prevalence of individuals at risk for EDs psychopathology in a representative population of adolescents aged 14-19 and to characterize this population regarding interpersonal and psychological factors.

METHODS

The percentage of participants at risk for EDs in a representative high school population was assessed through the SCOFF screening questionnaire (cut-off score: 3) in the total sample (N: 6551) and in gender-based subgroups for different body mass index (BMI) categories. Odds ratios for being at risk of ED (SCOFF ≥ 3) were esteemed in a multivariable analysis including self-reported parental education, quality of family and peer relationships, bullying victimization, age at first sexual intercourse, and psychological distress.

RESULTS

A SCOFF score ≥ 3 was found in 31.0% of participants (boys: 19.4%; girls: 44.6%), with a greater prevalence among higher BMI categories. Bad family relationships, being bullied, having the first sexual intercourse before the age of 14, and experiencing high distress were associated with this risk condition. Among girls, bad peer relationships were associated with a low-risk SCOFF score.

CONCLUSION

A remarkable percentage of adolescents reported significant body image or eating concerns. Screening programs are deeply needed, and particular attention should be devoted to interpersonal factors, such as the quality of family relationships and interactions with peers, which represent potential indicators of this vulnerability.

LEVEL OF EVIDENCE

Level V - Cross-sectional study.

Preventative diabetes self-care management practices among individuals with diabetes and mental health stress

BACKGROUND

The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress.

METHODS

Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors.

RESULTS

Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior.

LIMITATIONS

Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional.

CONCLUSIONS

Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.

Adolescent Sexual Behavior Patterns, Mental Health, and Early Life Adversities in a British Birth Cohort

This study tested adolescent sexual behavior patterns at age 14, their association with mental health at age 17 (psychological well-being, substance use, and self-harm attempts), and the influence of early life adversities upon this association. A British birth cohort (5,593 boys and 5,724 girls from the Millennium Cohort Study) was used. Latent class analysis suggested five subgroups of adolescent sexual behaviors: a "no sexual behavior" (50.74%), a "kisser" (39.92%), a "touching under clothes" (4.71%), a "genital touching" (2.64%), and an "all sexual activities" class (1.99%). Adolescents from the "kisser," "touching under clothes," "genital touching," and "all sexual activities" classes reported significantly more substance use and self-harm attempts compared to adolescents from the "no sexual behavior" group. The associations became weaker after controlling for early life adversities (reducing around 4.38% to 37.35% for boys, and 9.29% to 52.56% for girls), and reduced to a smaller degree after further controlling for mental health variables at 14. The associations between sexual behaviors and psychological well-being became non-significant after controlling for early life adversities. Adolescents who have engaged in low-intensity sexual activities at early age may have poorer reported mental health, a pattern that is stronger for girls and early life adversity may partially explain this association.

Sport Participation, Extracurricular Activity Involvement, and Psychological Distress: A Latent Class Analysis of Canadian High School Student-Athletes

Although psychological distress has been shown to increase during adolescence, participation in organized activities may have protective effects. The present study aimed to identify whether there is a relationship between high school student-athletes’ breadth of participation in organized activities and psychological distress, using a latent class analysis. Canadian adolescent-athletes (n = 930) in Grades 11 and 12 completed an online survey that measured: (a) high school sport participation, (b) community sport participation, (c) nonsport extracurricular activities participation, and (d) psychological distress. The latent class analysis indicated that a two-class model (i.e., Class 1 = narrower breadth, low distress; Class 2 = wider breadth, moderate distress) was most appropriate. Results indicated that despite the divergent probability of organized activity participation, participants in both classes had a low to moderate probability of presenting elevated levels of psychological distress. However, levels of psychological distress were still higher than other Canadian adolescent populations, suggesting that overscheduling could be of concern. Gender and time (i.e., prior/during COVID-19 pandemic) were significant covariates in the model.

Measurement invariance of the Kessler Psychological Distress Scale (K10) among children of Chinese rural-to-urban migrant workers

INTRODUCTION

Kessler Psychological Distress Scale (K10) is a 10-item screening tool designed for nonspecific psychological distress. The current study aims to identify a best-fitting factor structure of the K10, and to test its cross-gender measurement invariance based on the structure.

METHODS

Using convenience sampling, we included 339 (n = 192 for boys and 135 for girls) children of Chinese rural-to-urban migrant workers in Hangzhou, China.

RESULTS

Confirmatory factor analysis for ordered-categorical measures revealed a two-factor structure as the best-fitting model, in which five items (hopeless, depressed, effort, severely depressed, and worthless) loaded on depression and the other five items loaded on anxiety (tired, nervous, severely nervous, restless, and severely restless). The model held at different levels of the measurement invariance testing, that is, full measurement invariance was not rejected in our sample, suggesting that gender differences as assessed with K10 reflect true differences. Structural invariance testing showed that girls in our sample showed significantly higher levels of depression and anxiety than boys.

CONCLUSION

These findings support that the K10 is suitable for gender-comparative research among children of Chinese migrant workers. Using the K10 as a screening tool among this population should be promoted. Limitations and directions for future research were discussed.

Educational Attainment and Psychological Distress Among Working-Age Adults in the United States

This study builds on a growing body of literature analyzing the education-health gradient across detailed educational categories, which documents that US working-age adults who attended college but did not earn a bachelor's degree report equal or worse health than adults with a high school diploma. This is known as the "anomaly" in the education-health gradient. The purpose of this study is to test whether this pattern extends to measures of serious psychological distress (SPD) and individual symptoms by using data from the National Health Interview Survey (NHIS, 1997-2018) and a series of logistic regression models. We find that the anomaly in the education-health gradient is present for a summary measure of SPD as well as for five of the six symptoms that make up this measure. The exception was reporting feeling sad most or all the time during the last month, where adults with "some college" were found to have lower odds than those with a high school diploma. Further stratified analysis by sex revealed that this result for feeling sad was driven by women. In terms of associate degrees, our models show that adults with a vocational/technical associate degree have statically similar odds of SPD and reporting four out of six symptoms (exceptions were feeling hopeless and sadness), while those with an academic associate degree have significantly lower odds in all outcomes. The robustness of the models used is supported by an extensive sensitivity analysis. Overall, we find evidence of the anomaly in the education-health gradient in SPD and individual symptoms of psychological distress at the sub-baccalaureate level, adding to previous studies that document the anomaly in markers of physiological dysregulation, health conditions, vision problems, functional limitations, and pain.

Comparative Study of Risk Profiles for Non-Communicable Diseases in Urban and Suburb Adolescents in Padang City (Indonesia)

Adolescence is when we still like to experiment and often develop bad habits which may lead to non-communicable diseases (NCDs) in the future. This study aimed to understand the lifestyle at risk of non-communicable diseases in adolescents that live in the urban and rural areas of Padang city. This research method is comparative descriptive with a descriptive-analytical approach, with a total sample of 788 people. The study was conducted from March 2019 to November 2019. Results: A total of 57.77% of respondents in urban areas and 69.54% of respondents in rural areas like to eat junk food. 45.35% urban respondents and 60.21% rural respondents like to consume high-sweetened beverages. 73.4% of urban respondents and 7.6% of rural respondents like to smoke. 80.6% of urban respondents and 87.8% of rural respondents lack physical activity. 59.9% of urban respondents and 49.05% of rural respondents do not like to exercise. 67% of urban respondents and 80.2% of rural respondents sleep late at night. Conclusion: The risk behavior of non-communicable diseases in rural adolescents is higher than in urban adolescents. It is recommended that parents, teachers, and health workers work together to carry out intervention activities for healthy lifestyles for all adolescents.

Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents

Background

There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health.

Methods

Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools.

Discussion

This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India.

Trial registration

Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).

Heart rate variability and psychosocial symptoms in adolescents and young adults with cancer

Background

Heart Rate Variability (HRV) is a valid, scalable biomarker of stress. We aimed to examine associations between HRV and psychosocial outcomes in adolescents and young adults (AYAs) with cancer.

Methods

This was a secondary analysis of baseline data from a randomized trial testing a resilience intervention in AYAs with cancer. Two widely used HRV metrics, the standard deviation of normal to normal beats (SDNN) and root mean square of successive differences (RMSSD), were derived from electrocardiograms. Patient-reported outcome (PRO) survey measures included quality of life, anxiety, depression, distress, and resilience. Linear regression models were used to test associations between HRV and PRO scores. The Wilcoxon rank sum test was used to test differences in median HRV values among participant subgroups.

Results

Among the n = 76 patients with available electrocardiograms, the mean age was 16 years (SD 3y), 63% were white, and leukemia/lymphoma was the most common diagnosis. Compared to healthy adolescents, AYAs with cancer had lower median HRV (SDNN [Females: 31.9 (12.8–50.7) vs 66.4 (46.0–86.8), p<0.01; Males: 29.9 (11.5–47.9) vs 63.2 (48.4–84.6), p<0.01]; RMSSD [Females: 28.2 (11.1–45.5) vs 69.0 (49.1–99.6), p<0.01; Males: 27.9 (8.6–48.6) vs 58.7 (44.8–88.2), p<0.01]). There was no statistically significant association between PRO measures and SDNN or RMSSD in either an unadjusted or adjusted linear regression models.

Conclusion

In this secondary analysis, we did not find an association between HRV and psychosocial PROs among AYAs with cancer. HRV measures were lower than for healthy adolescents. Larger prospective studies in AYA biopsychosocial research are needed.

The psychometric characteristics of the Kessler Psychological Distress Scale (K6) in help-seeking youth: What do you miss when using it as an outcome measure?

This is the first study to describe psychometric properties of the Kessler Psychological Distress Scale (K6) in a large cohort of help-seeking young people presenting to primary mental health care services. The aim was to determine whether the K6 was appropriate for monitoring outcomes in such settings. 1067 young people were recruited from Australian headspace services. We examined dimensionality of the K6, measurement invariance, and how the K6 correlated with the the Patient Health Questionnaire-9 (PHQ-9)and the Generalised Anxiety Disorder-7 Scale (GAD-7). Standardised Response Mean (SRM) and Cohen's d effect size (ES) were used to examine 3-month stability of the K6. The best-fitting model was a two-factor model: (i) nervous and restlessness; and (ii) hopeless, worthless, depressed and effort. Measurement non-invariance was observed for sex and age groups. K6 strongly correlated with the PHQ-9 and GAD-7. The K6 was less sensitive to change compared to these other two measures. There was some support for the K6 being a screener for young people presenting to primary care; however, there issues arise with its use as an outcome measure. These issues include measurement non-invariance, concern about the dimensionality and focus of items, and its sensitivity to change.

The Use of Virtual Reality for Managing Psychological Distress in Adolescents: Systematic Review

Acute and chronic psychological distress are prevalent during adolescence and can have negative impacts on adolescents in all life domains. The aim of this systematic review was to appraise the use of virtual reality (VR) interventions to manage symptoms of psychological distress symptoms among adolescents. MEDLINE, PubMed, PsycINFO, and Scopus databases were searched up to June 2020. Available citations were de-duplicated and screened by two authors using title and abstract information. A total of 301 articles were retained for full-text evaluation next to eligibility criteria. Empirical studies of all designs and comparator groups were included if these appraised the impact of an immersive VR intervention on any standardized measure indicative of psychological distress in an adolescent sample. Data were extracted into a standardized coding sheet. Results were tabulated and discussed with a narrative synthesis due to the heterogeneity between studies. A total of seven studies met inclusion criteria. There were four randomized controlled trials and three uncontrolled pilot studies on new VR interventions. Distress-related issues included: state-anxiety, venepuncture, risk taking, public speaking anxiety, social anxiety disorder, sexual victimization, and chemotherapy administration. All studies reported significant changes on outcome measures after VR treatment. Six studies reported small-to-large reductions in symptoms. The average attrition rate was 3.6 percent during the active VR treatment phase. Treatment acceptability was high in the studies that assessed user engagement factors. The VR technology can provide a safe, rapidly efficacious, and acceptable treatment modality for managing psychological distress in several key adolescent populations.

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

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

A National Study to Assess Validity and Psychometrics of the Short Kessler Psychological Distress Scale (K6)

This study aimed to test the validity and reliability of the Kessler Psychological Distress Scale-6 (K6) with a nationally representative clinical sample with various mental health disorders. The cross-sectional, nationally representative, and publicly available data were extracted from the 2014 Health Center Patient Survey (HCPS), which was sponsored by the Health Resources and Services Administration (HRSA). After excluding certain individuals for the purpose of this study, we had a total of 1,863 participants. The highest and lowest psychological distress weighted scores were reported by individuals with bipolar disorder ( M = 17.16) and individuals with schizophrenia ( M = 16.09), respectively, although psychological distress interference was highest in individuals with schizophrenia ( M = 2.44). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results yielded a unidimensional factor solution for K6 scale in all subgroups. The K6 is a brief, reliable, and valid measure of psychological distress in adults with panic disorder, generalized anxiety disorder, bipolar disorder, and schizophrenia.

Profiles of mental health help seeking among Australian adolescent males

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

COVID-19 and psychological distress: Lessons for India

Purpose

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

Method

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

Results

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

Conclusions

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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