The validity of the 12-item General Health Questionnaire in Australia: a comparison between three scoring methods

Prevalence and sociodemographic determinants of common mental disorders (CMDs) symptoms in a rural adult population of Haryana, North India

Objectives

Common mental disorders (CMDs), including depression, anxiety, and somatoform disorders, affect all stages of life and impact individuals, families, and communities. This study aimed to determine the magnitude of CMDs and their sociodemographic determinants in the adult population of a rural block in North India.

Material and Methods

A cross-sectional, quantitative, community-based study was conducted among adult residents of a rural block in Haryana, North India, using a multistage random sampling technique. The Hindi version of the General Health Questionnaire (GHQ-12), a well-validated tool, was used to screen participants for CMDs. Scores of 4 or above denoted the presence of CMDs. Bivariate analyses were performed to determine the associations between CMDs and sociodemographic characteristics.

Results

Of the 180 residents selected for the study, most were women (60.0%) and aged between 31 and 50 years (52.3%). The prevalence of CMDs symptoms in the study population was 20.0%. The presence of CMDs symptoms was significantly higher among those who were aged 60 years or older [OR=12.33, 95% CI 3.21-47.38], widowed, divorced or separated [OR=7.50, 95% CI 1.09-51.52], illiterate [OR= 6.25, 95% CI 2.84-13.77], had monthly family income below 10,000 INR [OR=3.33, 95% CI 1.54-7.20], had any chronic physical illness [OR=8.28, 95% CI 3.70-18.56] and had a family history of any psychiatric illness [OR=5.56, 95% CI 1.52-19.42].

Conclusion

The burden of CMDs was quite high among adults in rural North India. The presence of CMDs was closely associated with sociodemographic characteristics. Primary care and community-based settings need to screen for, diagnose, and manage CMDs to address this growing problem.

Revisiting the impact of public spaces on the mental health of rural migrants in Wuhan: an integrated multi-source data analysis

Current research on public spaces and mental health often focuses on the independent relationship of one or more social mediators, neglecting the nuanced implications and serial mechanisms inherent in the progressive social process. Using Wuhan city, China, as a study case with multi-source data, this research applies Multilevel Generalized Structural Equation Modeling and deep learning techniques to explore the differential effects of public spaces with varying degrees of publicness (i.e., typical, semi-, and privately owned) on rural migrants' mental health. Crucially, this study scrutinizes both explicit (social interaction) and implicit (perceived integration) social mechanisms to revisit the relationships. The findings reveal that not all public spaces equally influence mental health, with typical and privately owned public spaces conferring profound benefits. Notably, public spaces impact mental health chiefly through perceived integration instead of through direct social interaction. Social interaction improves mental health primarily by enhancing perceived integration, suggesting that meaningful connections beyond superficial encounters are critical. In particular, we observed significant social effects in typical and privately owned public spaces but limited social functionality in semi-public spaces. This evidence contributes to the knowledge required to create supportive social environments within public spaces, integral to nurturing inclusive urban development.

Socio-demographic differences in access to psychological treatment services: evidence from a national cohort study

BACKGROUND

Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level.

METHODS

Using a unique individual patient dataset that linked 2011 Census information of English residents to national IAPT data collected between April 2017 and March 2018, we estimated the rate of access by a wide range of socio-demographic characteristics that are not routinely available. A large household survey was used to estimate the prevalence of probable CMDs by these socio-demographic characteristics. We estimated the probability of access to IAPT amongst people with CMDs by comparing the rates of access from IAPT data and the estimates of prevalence of CMDs from the household survey. Both unadjusted and adjusted (for important patient characteristics) access rates were estimated in logistic regression models.

RESULTS

As a proportion of those with a probable CMD, access to IAPT varied markedly by socio-demographic characteristics. Older adults, males, people born outside of the UK, people with religious beliefs, people from Asian ethnic backgrounds, people reporting a disability and those without any academic or professional qualifications were underrepresented in IAPT services nationally, in adjusted models.

CONCLUSIONS

The identification of patients who may be underrepresented in IAPT provides an opportunity for services to target outreach and engagement with these groups. Further understanding of barriers to access should help increase equity in access.

Personality traits and dimensions of mental health

Individuals are different in a relatively constant pattern of thoughts, feeling, and behaviors, which are called personality traits. Mental health is a condition of well-being in which people may reach their full potential and deal effectively with stress, work efficiently, and contribute to their communities. Indeed, the link between personality and mental health as indicated by the 12-item version of the general health questionnaires (GHQ-12) has been well-established according to evidence found by decades of research. However, the GHQ-12 comprises many questions asking about different dimensions of mental health. It is unclear how personality traits relate to these dimensions of mental health. In this paper, we try to address this question. We analyzed data from 12,007 participants from the British Household Panel Study (BHPS) using a confirmatory factor analysis (CFA) and generalized linear models. We replicated the factor structure of GHQ-12 labeled as GHQ-12A (social dysfunction & anhedonia; 6 items), GHQ-12B (depression & anxiety; 4 items), and GHQ-12C (loss of confidence; 2 items). Moreover, Neuroticism was positively related to all dimensions of mental health issues, Extraversion was negatively related to GHQ-12A (social dysfunction & anhedonia) and GHQ-12B (depression & anxiety), Agreeableness and Conscientiousness were negatively related to GHQ-12A (social dysfunction & anhedonia) and GHQ-12C (loss of confidence), and Openness was negatively related to GHQ-12B (depression & anxiety). These results contribute to theories including the predisposition/vulnerability model, complication/scar model, pathoplasty/exacerbation model, and the spectrum model, which propose that personality traits are linked to mental health and explained possible reasons. Psychologists may use results from this study to identify individuals who may be at high risk of developing various non-psychiatric mental health issues and intervene to avoid negative outcomes.

Is use of opioid agonist treatment associated with broader primary healthcare use among men with recent injecting drug use histories following release from prison? A prospective cohort study

BACKGROUND

A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release.

METHODS

Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR).

RESULTS

Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88-4.86; AIRR: 3.66, 95%CI: 2.57-5.23), extended (AIRR: 2.56, 95%CI: 1.41-4.67; AIRR: 2.55, 95%CI: 1.60-4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42-5.20; AIRR: 2.27, 95%CI: 1.33-3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19-2.98; AIRR: 2.40, 95%CI: 1.71-3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81-8.85; AIRR: 8.30, 95%CI: 5.28-13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34-13.77; AIRR: 4.34, 95%CI: 2.37-7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24-9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52-3.48).

CONCLUSION

We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison.

The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version

Background

Health care professionals face a number of problems during crises, such as the COVID-19. Studies addressed the prevalence of moral injury among healthcare professionals during the COVID-19 outbreak. Lack of a valid standard of moral injury among health care professionals is one of the factors that has made it difficult to identify and treat this complication. This study aimed to evaluate the psychometric properties of the Moral Injury Symptoms Scale-Health Care Professionals (MISS-HP) among health care professionals in Iran.

Methods

This study was conducted to evaluate the validity and reliability of the MISS-HP. The sample included 455 healthcare professionals working in four teaching hospitals in Kerman, who were in direct contact with patients. In this study, face validity, content validity, construct validity (structural and convergent), and internal reliability of the MISS-HP were evaluated. Demographic information questionnaire, the Moral Injury Symptoms Scale-HealthCare Professionals (MISS-HP), General Health Questionnaire (GHQ), and Impact of Event Scale (IES) were administered to study participants.

Results

The MISS-HP was evaluated using translation-back translation technique. The content validity index of the items (I-CVI) and the scale (S-CVI) were 0.9 and 0.99, respectively. Exploratory factor analysis showed a three-factor structure in the MISS-HP that explained 57.49% of the variance. Confirmatory factor analysis indices were acceptable. The cut-off point of the questionnaire was 36.5. There was a positive and moderate correlation between the Persian version of MISS-HP, GHQ (r = 0.34), and IES-R (r = 0.40). The Cronbach’s alpha coefficient of the Persian version of MISS-HP was 0.70.

Conclusion

This study found that the MISS-HP is a concise, comprehensive, valid and reliable scale for assessing moral injury among health care professionals in clinical or research settings. This scale will be helpful for managers and researchers to identify and plan health policies and improve the psychological state of health care professionals.

COVID-19 Worry and Mental Health Among the Economically Active Population in Guangdong, China

Background

The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has caused people to worry, which has affected their mental health. This study aimed to access the impact of COVID-19 worry on the mental health of the economically active population (EAP) in a province of China.

Methods

An online cross-sectional survey study was conducted during an outbreak of COVID-19 in Guangdong, China. The survey used the 12-item General Health Questionnaire (GHQ-12) to evaluate participants' mental health status and was completed by 1,584 of the 1,708 participants (a response rate of 92.74%). Ordinary least squares (OLS) regression models were used to identify the correlation between COVID-19 worry and mental health.

Results

Approximately 42.05% of participants reported that they were very worried or extremely worried about the COVID-19 pandemic. COVID-19 worry was negatively correlated with mental health (p < 0.01) and exhibited a stronger influence on the mental health of participants who were male, younger (aged 16–45), or unemployed than on the mental health of participants who were women, older (aged over 45), or employed.

Conclusion

The findings suggest that COVID-19 worry has generated new inequalities in mental health among the EAP of China. The government should provide more public reassurance and psychological support to the EAP to mitigate the effects of COVID-19 worry and prevent mental health disorders.

Hot Yoga Leads to Greater Well-being: A Six-week Experience-sampling RCT in Healthy Adults

Practicing hot yoga may bring significant psychological benefits, but it is largely unstudied. We examined the effects of hot yoga on multifaceted well-being indicators with 290 healthy yoga-naïve volunteers partaking in a six-week randomized controlled trial. Participants completed questionnaires pre- and post-intervention, and reported their emotional experiences four times per day throughout an experience-sampling study. Results revealed that the hot yoga group (n = 137) improved their well-being from pre- to post-treatment, comparing to the wait-list control group (n = 153). These improvements included life satisfaction, general health, mindfulness, peace of mind, and eudaimonic well-being (ΔR² ranging from .01 to .08)-but not flourishing, which describes major aspects of social-psychological functioning. Multilevel analyses demonstrated that momentary positive emotional experiences increased significantly throughout the trial in the yoga group only (conditional R² = .68), particularly when attending a yoga class (conditional R² = .50). Interestingly, this increase in momentary positive emotion explained the improvement in post-intervention mindfulness, peace of mind, and general health by 21%, 31%, and 11%, respectively. Finally, the benefits of hot yoga were more notable in individuals with lower levels of baseline eudaimonic well-being (conditional R² = .45), flourishing (conditional R² = .61), and mental well-being (conditional R² = .65), even after ruling out any possible ceiling effects. To sum up, this study demonstrated multiple psychological benefits of hot yoga and its potential to be an effective positive psychology intervention. Future research-especially considering an active control group-is warranted.

Contextualising the Effectiveness of an Employee Assistance Program Intervention on Psychological Health: The Role of Corporate Climate

Organisations often engage Employee Assistance Programs (EAPs) to assist employees experiencing psychological distress, yet EAPs primarily focus on individual remedies rather than addressing the context of the problem (e.g., the corporate climate) which may render them limited in effectiveness. We investigated the effectiveness of EAPs and the role of organisation psychosocial safety climate (PSC) (the corporate climate for worker psychological health and safety) and client satisfaction in reducing client psychological distress. Client participants (Time 1, n = 100, Time 2, n = 28, Matched n = 25) from Australia and New Zealand entering an EAP took part in two online surveys, pre- and post-EAP, around five weeks apart. Multilevel analysis showed a significant reduction in psychological distress due to the EAP (individual effect) but particularly at high levels of PSC (organisational effect). Thus, EAPs could engender a more significant impact by also assisting organisations to improve their PSC (i.e., through implementation of policies, practices and procedures for worker psychological health and safety), in combination with individual interventions.

Preconception depression and anxiety symptoms and maternal-infant bonding: a 20-year intergenerational cohort study

Early maternal-infant bonding problems are often forerunners of later emotional and behavioural difficulties. Interventions typically target the perinatal period but many risks may be established well before pregnancy. Here we examine the extent to which adolescent and young adult depression and anxiety symptoms predict perinatal maternal-infant bonding difficulties. The Victorian Intergenerational Health Cohort Study (VIHCS, est. 2006) is following offspring born to the Victorian Adolescent Health Cohort Study (VAHCS; est. 1992). VAHCS participants were assessed for depression and anxiety symptoms nine times during adolescence and young adulthood (age 14-29 years), and then contacted bi-annually (from age 29-35 years) to identify pregnancies. The Postpartum Bonding Questionnaire (PBQ) was administered to mothers at 2 and 12 months postpartum. A total of 395 women (606 infants) completed the 2-month and/or 12-month postpartum interviews. For most infants (64%), mothers had experienced depression and/or anxiety before pregnancy. Preconception depression and anxiety symptoms that persisted from adolescence into young adulthood predicted maternal-infant bonding problems at 2 months (β = 0.30, 95% CI 0.04, 0.55) and 12 months postpartum (β = 0.40, 95% CI 0.16, 0.63). Depression and anxiety symptoms occurring in young adulthood only, also predicted bonding problems at 12 months postpartum (β = 0.37, 95% CI 0.02, 0.71). Associations between preconception depression and anxiety symptoms and anxiety-related maternal-infant bonding problems at 12 months postpartum remained after adjustment for antenatal and concurrent postpartum depressive symptoms. This study puts forward a case for extending preconception health care beyond contraception and nutrition to a broader engagement in supporting the mental health of young women from adolescence.

The Significance of Demographic Variables on Psychosocial Health from the Early Stage and Nine Months after the COVID-19 Pandemic Outbreak. A Cross-National Study

This cross-national study explored stability and change in mental health, quality of life, well-being and loneliness during the early stage and nine months after the implementation of COVID-19 pandemic social distancing measures and periodic lockdowns as adjusted by demographic variables. In the USA, the UK, Australia and Norway, 7284 individuals responded to the invitation to take part in two cross-sectional web-based surveys (April and November 2020), including questions about sociodemographic variables and psychosocial outcomes. Independent t-tests and generalized linear models (GLM) and estimated marginal means were used to analyze differences between subgroups and countries, multiple linear regression analyses were conducted on the psychosocial outcome measures by demographic variables and time in each country and mean responses presented by time after adjusting for all demographic variables in the model. Age, gender, civil status, education, employment, place of work and living area were all significant factors for psychosocial health across the countries. Differences in mental health, quality of life, well-being and loneliness were found between the countries in both April and November 2020, while time did not contribute to reducing the toll in any of the four countries over the nine-month period.

Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreak. A cross-country comparative study

BACKGROUND

The COVID-19 outbreak raised questions about how people experience their mental health, quality of life (QoL), wellbeing and loneliness in the context of social distancing, and the use of social media during this time.

AIMS

To examine the experience of mental health, QoL, wellbeing and loneliness and use of social media among people living in Norway, USA, UK and Australia.

METHODS

A cross-country comparative survey of people living in Norway, USA, UK and Australia. Relevant statistical analyses were used to examine differences between the countries and to explore associations between demographic, mental health and psychosocial variables and use of social media.

RESULTS

There were 3810 respondents from four countries, of which 50 - 74% showed a high level of emotional distress. The Norwegian population reported significantly better mental health, QoL and wellbeing and lower levels of loneliness compared to the other countries. High-frequent use of social media after the COVID-19 outbreak was associated with poorer mental- and psychosocial health.

CONCLUSIONS

The results suggest that the COVID-19 outbreak took a toll on people's experience of mental health, QoL, wellbeing and experienced loneliness, and high-frequent use of social media was associated with these factors.

Ethnicity, Immigration Status, And Driving Under The Influence Of Alcohol

BACKGROUND

Understanding risk factors for driving under the influence of alcohol (DUIA) informs development of effective interventions. This study examined the association between ethnicity, immigration status, and DUIA, exploring psychological distress and hazardous drinking as additional contributors.

METHOD

Data were derived from the 2003-2011 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor of 16,101 adults from Ontario, Canada. Hierarchical binary logistic regression analysis assessed self-identified ethnicity and immigration status as predictors of DUIA, adjusting for sociodemographics and driving exposure (Model 1), psychological distress (Model 2), and hazardous drinking (Model 3).

RESULTS

In Model 1, respondents born outside of Canada had reduced odds of engaging in DUIA compared to those born in Canada (AOR = 0.72, 95%CI = 0.56 - 0.92). Relative to those identifying as Canadian, the odds of DUIA were significantly reduced for those identifying as East Asian (AOR = 0.28, 95%CI = 0.13 - 0.61) and South Asian (AOR = 0.52, 95%CI = 0.27 - 0.98). In Model 3, individuals who reported psychological distress (AOR = 1.69, 95%CI = 1.33 - 2.16) and those who reported hazardous drinking (AOR = 6.28, 95%CI= 5.13 - 7.69) were more likely to DUIA. Those identifying as East Asian continued to have reduced odds of DUIA compared to those identifying as Canadian (AOR = 0.38, 95%CI = 0.17 - 0.85).

CONCLUSION

Individuals born outside of Canada were less likely to engage in DUIA than individuals born in Canada. Drivers who self-identified as East Asian were less likely to DUIA than those who self-identified as Canadian. Understanding ethnic differences underlying divergent risks for DUIA will improve prevention initiatives and remedial measures programming.

Valid and Reliable Measure of Adherence to Satter Division of Responsibility in Feeding

OBJECTIVE

To examine the validity and psychometrics of sDOR.2-6y, a 12-item measure of adherence to the Satter Division of Responsibility in Feeding (sDOR).

DESIGN

Cross-sectional survey.

SETTING

Online respondents in central Pennsylvania.

PARTICIPANTS

117 parents (94% female, 77% White, 62% in ≥1 income-based assistance program) of preschoolers aged 2-6 years (28% moderate/high nutrition risk).

MAIN OUTCOME MEASURES

The sDOR.2-6y and Nutrition Screening Tool for Every Preschooler (NutriSTEP), a measure of child nutrition risk and other validated measures of eating behavior and parent feeding practices.

ANALYSIS

Relationships were evaluated with Pearson r, t tests, ANOVA, or chi-square. Factor structure was investigated using principal components analysis with varimax rotation. Binary logistic regression and general linear model controlling for low-income status compared with sDOR.2-6y and NutriSTEP scores. Linear regression predicted NutriSTEP and Satter Eating Competence Inventory 2.0 scores from sDOR.2-6y.

RESULTS

The sDOR.2-6y ranged from 16-32 (mean, 25.9 ± 3.3; n = 114). Parents of youth at nutrition risk had lower sDOR.2-6y scores (P = 0.004). Each 1 point sDOR.2-6y increase decreased nutrition risk odds by 21% (95% confidence interval, 0.675-0.918; P = 0.002). The sDOR.2-6y scores were higher with less restriction and pressure to eat (both P < 0.001) and were associated with feeding style. Specificity was 87% with sDOR.2-6y cutoff ≥24; sensitivity was 66% with cutoff ≥26.

CONCLUSIONS AND IMPLICATIONS

The sDOR.2-6y accurately and reliably indicated adherence of low-income mothers to sDOR. Larger, diverse samples for future studies are recommended.

Promoting mental health in migrants: a GHQ12-evaluation of a community health program in Sweden

Background

Research increasingly highlight post-migration factors for migrants’ mental health status. We investigated the association between participation in a health promotion program and changes in migrants’ mental health, and if socio-demographic factors and length of time in the new home country, Sweden, influenced a potential association.

Methods

A five-week health promotion program named ‘Hälsostöd’ [Health Support], led by community health workers, was offered to migrants, primarily asylum seekers and newly arrived immigrants (N = 202). The framework for the program was salutogenic psycho-education, which focused on health effects of migration experiences, lifestyle and health, and the health care system. Mental health was measured at the start and end of the program. We analysed this follow up by using the recommended clinical cut off (i.e. > 11 of maximum 36, with higher scores indicating possible mental illness) in the 12- item version of the General Health Questionnaire (GHQ12). Chi Square test was used to analyse statistical significance of changes, and multinomial logistic regression to analyse associations to sociodemographic factors and length of stay in Sweden.

Results

The number of participants scoring above the clinical cut off after participation in the program (N = 79, 39.1%) was lower compared to the corresponding number before participation (N = 111, 55.0%), Chi Square = 10.17, p < .001. The majority of the participants had no change 72.3 (N = 146), 21.8% (N = 44) had a positive change, yet 5.9% (N = 12) had a negative change, compared to before participation in the program. None of the investigated sociodemographic factors showed to significantly influence the association. Length of stay in Sweden was trending, with participants with longer stay being more likely to have possible mental illness.

Conclusion

We conclude that psycho-educative programs, similar to ‘Hälsostöd’, have potential for promoting asylum seekers’ and newly arrived immigrants’ mental health as the evaluation showed a considerable number of positive changes in participants. The result suggests the importance of offering immigrants health promotive programs in close connection with arrival to the new home country. Future research should clarify under what circumstances sociodemographic factors influence the effects of such programs.

Parental mental health before and during pregnancy and offspring birth outcomes: A 20-year preconception cohort of maternal and paternal exposure

BACKGROUND

Preterm birth (PTB) and small for gestational age (SGA) are increasingly prevalent, with major consequences for health and development into later life. There is emerging evidence that some risk processes begin before pregnancy. We report on associations between maternal and paternal common mental disorders (CMD) before and during pregnancy and offspring PTB and SGA.

METHODS

398 women with 609 infants and 267 men with 421 infants were assessed repeatedly for CMD symptoms before pregnancy between age 14 and 29 and during pregnancy. Associations between preconception and antenatal CMD symptoms and offspring gestational age/PTB and size for gestational age/SGA were estimated using linear and Poisson regression.

FINDINGS

In men, persistent preconception CMD across adolescence and young adulthood predicted offspring PTB after adjustment for ethnicity, education, BMI and adolescent substance use (adjusted RR 7·0, 95% CI 1·8,26·8), corresponding to a population attributable fraction of 31% of preterm births. In women, antenatal CMD symptoms predicted offspring PTB (adjusted RR 4·4, 95% CI 1·4,14·1). There was little evidence of associations with SGA.

INTERPRETATION

This first report of an association between paternal preconception mental health and offspring gestational age, while requiring replication in larger samples, complements earlier work on stress in animals, and further strengthens the case for expanding preconception mental health care to both men and women.

FUNDING

National Health and Medical Research Council (Australia), Victorian Health Promotion Foundation, Australian Rotary Health, Colonial Foundation, Perpetual Trustees, Financial Markets Foundation for Children (Australia), Royal Children's Hospital Foundation, Murdoch Children's Research Institute, Australian Research Council.

Using the GHQ-12 to screen for mental health problems among primary care patients: psychometrics and practical considerations

Background

This study explores the factor structure of the Indonesian version of the GHQ-12 based on several theoretical perspectives and determines the threshold for optimum sensitivity and specificity. Through a focus group discussion, we evaluate the practicality of the GHQ-12 as a screening tool for mental health problems among adult primary care patients in Indonesia.

Methods

This is a prospective study exploring the construct validity, criterion validity and reliability of the GHQ-12, conducted with 676 primary care patients attending 28 primary care clinics randomised for participation in the study. Participants' GHQ-12 scores were compared with their psychiatric diagnosis based on face-to-face clinical interviews with GPs using the CIS-R. Exploratory and Confirmatory Factor Analyses determined the construct validity of the GHQ-12 in this population. The appropriate threshold score of the GHQ-12 as a screening tool in primary care was determined using the receiver operating curve. Prior to data collection, a focus group discussion was held with research assistants who piloted the screening procedure, GPs, and a psychiatrist, to evaluate the practicality of embedding screening within the routine clinic procedures.

Results

Of all primary care patients attending the clinics during the recruitment period, 26.7% agreed to participate (676/2532 consecutive patients approached). Their median age was 46 (range 18-82 years); 67% were women. The median GHQ-12 score for our primary care sample was 2, with an interquartile range of 4. The internal consistency of the GHQ-12 was good (Cronbach's α = 0.76). Four factor structures were fitted on the data. The GHQ-12 was found to best fit a one-dimensional model, when response bias is taken into consideration. Results from the ROC curve indicated that the GHQ-12 is 'fairly accurate' when discriminating primary care patients with indication of mental disorders from those without, with average AUC of 0.78. The optimal threshold of the GHQ-12 was either 1/2 or 2/3 point depending on the intended utility, with a Positive Predictive Value of 0.68 to 0.73 respectively. The screening procedure was successfully embedded into routine patient flow in the 28 clinics.

Conclusions

The Indonesian version of the GHQ-12 could be used to screen primary care patients at high risk of mental disorders although with significant false positives if reasonable sensitivity is to be achieved. While it involves additional administrative burden, screening may help identify future users of mental health services in primary care that the country is currently expanding.

Mental Ill-Health Risk Factors in the Construction Industry: Systematic Review

Mental ill health is a significant cause of suicide and disability worldwide. It has particularly affected the construction industry. The construction labor sectors in Australia and the United Kingdom have suicide rates 2 and 3.7 times higher, respectively, than their overall national averages, which has attracted the attention of researchers and the industry. However, few studies have examined the state of construction workers' mental health. This paper systematically reviews the existing body of knowledge on mental health in the construction industry. In total, 16 journal articles met inclusion criteria, and 32 risk factors (RFs) were deduced. The foremost RFs were related to job demand and job control. A conceptual framework and checklist to aid in better understanding these RFs were developed. In assessing mental health, the primary tool used was the Depression Anxiety Stress Scale. The findings of this study help to deepen the understanding of professional mental health assessment scales and relevant RFs and protective factors as used in the construction industry. The study concludes that stronger methodologies are needed for studies into RFs and protective factors in the construction industry.

Pre-conception self-harm, maternal mental health and mother-infant bonding problems: a 20-year prospective cohort study

BACKGROUND

Self-harm in young people is associated with later problems in social and emotional development. However, it is unknown whether self-harm in young women continues to be a marker of vulnerability on becoming a parent. This study prospectively describes the associations between pre-conception self-harm, maternal depressive symptoms and mother-infant bonding problems.

METHODS

The Victorian Intergenerational Health Cohort Study (VIHCS) is a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3-9. VIHCS enrolment began in 2006 (when participants were aged 28-29 years), by contacting VAHCS women every 6 months to identify pregnancies over a 7-year period. Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale during the third trimester, and 2 and 12 months postpartum. Mother-infant bonding problems were assessed with the Postpartum Bonding Questionnaire at 2 and 12 months postpartum.

RESULTS

Five hundred sixty-four pregnancies from 384 women were included. One in 10 women (9.7%) reported pre-conception self-harm. Women who reported self-harming in young adulthood (ages 20-29) reported higher levels of perinatal depressive symptoms and mother-infant bonding problems at all perinatal time points [perinatal depressive symptoms adjusted β = 5.40, 95% confidence interval (CI) 3.42-7.39; mother-infant bonding problems adjusted β = 7.51, 95% CI 3.09-11.92]. There was no evidence that self-harm in adolescence (ages 15-17) was associated with either perinatal outcome.

CONCLUSIONS

Self-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother-infant bonding problems.

Moving to a Continuing Care Retirement Community or Staying in the Community? A Comparison Between American and Israeli Older Adults

Using the theory of diffusion of innovations, this study examined differences between American and Israeli older adults who decided to move to continuing care retirement communities (CCRC) and American and Israeli older adults who decided to stay at home. A total of 101 American participants (52 residents, 49 nonresidents) and 154 Israeli participants (104 residents, 50 nonresidents) completed measures of attitudes toward CCRCs, well-being, limitations in daily living, health status, proximity to services, and collectivism. Americans were more likely to relocate to CCRCs compared with staying at home when they reported positive attitudes toward CCRCs, higher well-being, and poorer subjective health. Among Israelis, positive attitudes toward CCRCs, better subjective health, and higher collectivism were associated with moving to CCRCs compared with staying at home. This study has implications for facilitating older adults' decision-making and CCRC policies, as findings point to potential sources of influence on older adults' decision to relocate.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

The 12-item general health questionnaire (GHQ-12) has been extensively used with Chinese population. Yet, it has not been used from a national representative survey in rural China. The aim of this study was to examine how number of kins associated with the factor structures of the CHQ-12 among the rural residents in China. Data were obtained from the 2009 rural-to-urban migrants survey (RUMiC). Exploratory factor analysis (EFA) (principal component analysis with varimax rotation) was performed to identify factor structures of GHQ-12 regarding number of siblings, age ranking, and number of children. To investigate the reliability of the questionnaire, Cronbach’s alpha was used. Internal consistency was assessed by confirmatory factor analysis (CFA). In all, 32171 rural residents in China from 2009 RUMiC participated in the study. The mean age of the respondents was 37.03 (SD = 19.21) years. The psychometric properties and factor structures of the GHQ-12 used were described. All of the fit indices in CFA models were satisfactory. The two-factor and three-factor structures gathered the satisfactory fit indexes in the part of 2009 subsamples. The rural version of the GHQ-12 was reliable measures of psychological distress among the rural residents in China with respect to number of kins. The two-and three-factor structures derived from the present sample, with good model fit in the CFA analysis, which suggested that two-and three-factor solution could be used to assess mental health of rural residents in rural China.

The factor structure of the general health questionnaire (GHQ12) in Saudi Arabia

Background

The General Health Questionnaire-12 (GHQ-12) is one of the most unique and extensively used self-report instruments for evaluating psychological disorders and strains. However, the factor structure of GHQ-12 has not been fully explored. The current study aims to assess the factorial structure of GHQ-12 in a large cross-sectional data-set extracted from Al Kharj central region of Saudi Arabia.

Methods

Population based cross sectional data was extracted from January 2016 to June 2016 from Al Kharj population recruiting 1019 respondents aged 18 and above. Exploratory factor analysis (EFA) was applied together with multiple regression analysis to extract and retain factors. Mean GHQ-12 score for demographic and health-related traits were used for assessing this association. Statistical analysis was carried out using STATA version 12.1.

Results

Three factors, including social dysfunction, anxiety, and loss of confidence were extracted from the factor structure. 55% of the overall variance was obtained through these factors. Total score of GHQ-12 ranged from 0 to 32 with a mean score of 12.

Conclusion

Investigation of the factor structure of GHQ-12 demonstrated that GHQ-12 is a good measure for evaluating the general health of Saudi population. Future studies based on a larger sample size of non-clinical respondents will be useful to evaluate the practical effectiveness of GHQ-12 factors.

The Population Mean Mood Predicts The Prevalence of Depression in an Australian Context

BACKGROUND

The mean population mood has been demonstrated to strongly correlate with the prevalence of depression in European populations. Mean population mood has, therefore, been proposed as both a metric to measure the impact of population-level interventions to prevent depression and a target for public health policy.

AIM

To demonstrate the relationship between mean population mood and the prevalence of depression using Australian data in order to broaden the applicability of this finding to the Australian population.

METHODS

We used data from the Geelong Osteoporosis Study to assess the relationship between population mean mood and depression. Participants reported mood symptoms via questionnaire (the Hospital Anxiety and Depression Scale or General Health Questionnaire-12). Depression was diagnosed by semi-structured clinical interview ( Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient Edition). Stratification by age and socio-economic status was used to create subpopulation groups. Socio-economic status was measured using Index of Relative Socio-economic Advantage and Disadvantage quintiles, an area-based measure based on Australian census data and published by the Australian Bureau of Statistics. The mean subpopulation questionnaire scores and subpopulation prevalence of depression were then analysed using regression and predictive models.

RESULTS

Mean subpopulation questionnaire scores correlated well with the prevalence of depression across socio-economic status groups in women but not age groups. Questionnaire scores tended to underestimate the prevalence of depression in the young and overestimate it in the elderly.

CONCLUSION

The mean population mood was demonstrated to correlate with the population prevalence of depression in Australia for women, but not for men. Due to the issues of questionnaire validity and sample size in the oldest age groups, the age analysis is unlikely to be a representative of population characteristics. Further work to identify population determinants of mean mood could potentially create policy targets to reduce the prevalence of depression.

The psychometric properties of GHQ for detecting common mental disorder among community dwelling men in Goa, India

BACKGROUND

There have not been many attempts to validate screening measures for common mental disorders (CMD) in low- and middle-income countries. The aim of this study was to examine the criterion validity of the General Health Questionnaire 12 (GHQ-12) in a community-based study from Goa, India.

METHOD

Concurrent and convergent validity of the GHQ-12 were assessed against the Mini International Neuropsychiatric Interview (MINI) and World Health Organization Disability Assessment Scale (WHODAS) for CMD and functional status through the secondary analysis of a community cohort of men from Goa, India. Criterion validity of the GHQ-12 was determined using ROC analyses with the MINI case criterion as the gold standard. Concurrent validity was assessed against the gold standard of WHODAS functional disability and number of disability days.

RESULTS

In a sample of men (n=773), the GHQ-12 showed high internal reliability (Cronbach's alpha of 0.82) and acceptable criterion validity (Area under the receiver operating characteristic curve being 0.71). It had adequate psychometric properties for the detection of CMD (sensitivity of 68.75%; specificity of 73.14%) with the optimal cut-off score for identification of CMD being 2.

CONCLUSION

In order to optimize the usefulness and validity of the GHQ-12, a low cut-off point for CMD may be beneficial in Goa, India. Further validation studies for the GHQ-12 should be conducted for continued validation of the test for use in the community.

The effects of family structure and function on mental health during China's transition: a cross-sectional analysis

BACKGROUND

Social change, intensified by industrialization and globalization, has not only changed people's work lives but also their personal lives, especially in developing countries. The aim of this study was to provide evidence and recommendations regarding family structure, function, and mental health to actively respond to rapid social change.

METHODS

A cross-sectional survey was conducted face-to-face and door-to-door from July 2011 to September 2012 in Hubei Province, central China. Family structure comprised alone, couple, nuclear family, and extended family; family function was measured using the family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) scale, and mental health was measured using the Chinese version of the 12-item General Health Questionnaire (GHQ-12).

RESULTS

The urban-vs-rural difference of family structure among alone, couple, nuclear family, and extended family was statistically significant (5.21% vs 4.62%; 27.36% vs 13.14%; 33.22% vs 27.74%; 34.20% vs 54.50%, respectively; p < 0.0001); and those difference of family function was not statistically significant (8.11 ± 2.13 vs 8.09 ± 2.27, p = 0.9372). The general linear regression showed that the effect of family structure on mental health, whether urban or rural, was not significant, however, the effect of family function was significant, especially regarding better family functioning with better mental health.

CONCLUSIONS

Combined the effects of family structure and function on mental health, the external form of family (family structure) may not be important; while the internal quality of role (family function) might be key. Improving the residents' family function would be a priority strategy for family practice with their mental health.

Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study

BACKGROUND

The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

AIMS

This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

METHODS

This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

RESULTS

Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index AUC = 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity = 81.7 and specificity = 85.4), and for the Likert index ≥14 (sensitivity = 85.5 and specificity = 83.2).

CONCLUSIONS

The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.

A Study of Asynchronous Mobile-Enabled SMS Text Psychotherapy

BACKGROUND

Many obstacles to obtaining psychotherapy continue to diminish its reach despite its documented positive effects. Using short message service (SMS) texting and Web platforms to enable licensed psychotherapists to deliver therapy directly to the lived context of the client is one possible solution.

INTRODUCTION

Employing a feasibility study design, this pilot trial further evaluated the external validity for treatment outcomes of text therapy and extended findings to include mobile-enabled text platforms.

MATERIALS AND METHODS

Adults seeking text therapy treatment for a variety of disorders were recruited from a text therapy service (N = 57). Clinical outcomes were measured using the General Health Questionnaire-12 (GHQ-12) through 15 weeks of treatment. A process variable, the therapeutic alliance, was measured with the Working Alliance Inventory. Treatment acceptability was assessed with ratings of satisfaction for several aspects of the treatment, including affordability, effectiveness, convenience, wait times to receiving treatment, and cost-effectiveness.

RESULTS

Results indicate evidence for the effectiveness of the intervention (GHQ-12, Cohen's d = 1.3). Twenty-five (46%) participants experienced clinically significant symptom remission. Therapeutic alliance scores were lower than those found in traditional treatment settings, but still predicted symptom improvement (R² = 0.299). High levels of satisfaction with text therapy were reported on dimensions of affordability, convenience, and effectiveness. Cost-effectiveness analyses suggest that text therapy is 42.2% the cost of traditional services and offers much reduced wait times.

CONCLUSION

Mobile-enabled asynchronous text therapy with a licensed therapist is an acceptable and clinically beneficial medium for individuals with various diagnoses and histories of psychological distress.

Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population

OBJECTIVES

The 12-item version of the General Health Questionnaire (GHQ-12) is frequently used to measure common mental disorder in public health surveys, but few population-based validations have been made. We validated the GHQ-12 against structured psychiatric interviews of depression using a population-based cohort in Stockholm, Sweden.

METHODS

We used a population-based cohort of 484 individuals in Stockholm, Sweden (participation rate 62%). All completed the GHQ-12 and a semi-structured psychiatric interview. Last month DSM-III-R symptoms were used to classify major and minor depression. Three scoring methods for GHQ-12 were assessed, the Standard, Likert and Corrected method. Discriminatory ability was assessed with area under the receiver operating characteristic (ROC) curve.

RESULTS

A total of 9.5% had a major or minor depression. The area under the ROC curve was for the Standard method 0.73 (0.65-0.82), the Likert method 0.80 (0.72-0.87) and the Corrected method 0.80 (0.73-0.87) when using major or minor depression as standard criterion. Adequate sensitivity and specificity for separating those with or without a depressive disorder was reached at ≥12 Likert scored points (80.4 and 69.6%) or ≥6 Corrected GHQ points (78.3 and 73.7%). Sensitivity and specificity was at ≥2 Standard scored points 67.4% and 74.2%.

CONCLUSION

When scored using the Likert and Corrected methods, the GHQ-12 performed excellently. When scored using the Standard method, performance was acceptable in detecting depressive disorder in the general population. The GHQ-12 appears to be a good proxy for depressive disorder when used in public health surveys.

Developing a brief depression screen and identifying associations with comorbid physical and psychological illness in Australian Gulf War veterans

OBJECTIVE

Major depression occurs frequently in veterans, and is associated with comorbid psychological and physical disorders and poorer quality of life. Depression can be difficult to detect in primary care, while lengthy assessment instruments can deter use. Our study aimed to develop a brief depression screen that could be used by veterans and caregivers, and then to compare the association between the brief screen and comorbidities and quality of life with that of a longer instrument.

METHODS

Our dataset comprised 1204 male Royal Australian Navy veterans of the 1990/91 Gulf War. Depressive symptoms were assessed using the General Health Questionnaire (GHQ-12), health-related quality of life by the Short-Form Health Survey (SF-12), major depression and comorbid psychiatric diagnoses such as posttraumatic disorder (PTSD) using Diagnostic and Statistical Manual (DSM-IV) criteria. Comorbid physical illnesses including musculoskeletal disorders, chronic fatigue and diabetes were examined.

RESULTS

A brief depression screen of three key self-reported symptoms was identified. Veterans with major depression present according to the screen were over four times more likely to have multisymptom illness or PTSD, and almost twice as likely to have musculoskeletal disorders. Having depression according to the brief screen and having at least one other physical or psychological condition was associated with poorer quality of life. Similar results were obtained for a longer screen based on all GHQ-12 items.

CONCLUSION

A 3 item depression screen performed as well as a 12 item one in identifying major depression, comorbid physical and psychological illness and poorer quality of life in veterans.

The Malay Version of the Perceived Stress Scale (PSS)-10 is a Reliable and Valid Measure for Stress among Nurses in Malaysia

BACKGROUND

The Perceived Stress Scale-10 (PSS-10) is widely used to assess stress perception. The aim of this study was to translate the original PSS-10 into Malay and assess the reliability and validity of the Malay version among nurses.

METHODS

The Malay version of the PSS-10 was distributed among 229 nurses from four government hospitals in Selangor State. Test-retest reliability and concurrent validity was conducted with 25 nurses with the Malay version of the Depression Anxiety Stress Scales (DASS) 21. Cronbach's alpha, confirmatory factor analysis (CFA), intraclass correlation coefficient and Pearson's r correlation coefficient were used to determine the psychometric properties of the Malay PSS-10.

RESULTS

Two factor components were yielded through exploratory factor analysis with eigenvalues of 3.37 and 2.10, respectively. Both of the factors accounted for 54.6% of the variance. CFA yielded a two-factor structure with satisfactory goodness-of-fit indices [x²/df = 2.43; comparative fit index (CFI) = 0.92, goodness-of-fit Index (GFI) = 0.94; standardised root mean square residual (SRMR) = 0.07 and root mean square error of approximation (RMSEA) = 0.08 (90% CI = 0.07-0.09)]. The Cronbach's alpha coefficient for the total items was 0.63 (0.82 for factor 1 and 0.72 for factor 2). The intraclass correlation coefficient (ICC) was 0.81 (95% CI: 0.62-0.91) for test-retest reliability testing after seven days. The total score and the negative component of the PSS-10 correlated significantly with the stress component of the DASS-21: (r = 0.61, P < 0.001) and (r = 0.56, P < 0.004), respectively.

CONCLUSION

The Malay version of the PSS-10 demonstrated a satisfactory level of validity and reliability to assess stress perception. Therefore, this questionnaire is valid in assessing stress perception among nurses in Malaysia.

Factors Affecting Minor Psychiatric Disorder in Southern Iranian Nurses: A Latent Class Regression Analysis

Background:

Mental health is one of the most important dimensions of life and its quality. Minor Psychiatric Disorder as a type of mental health problem is prevalent among health workers. Nursing is considered to be one of the most stressful occupations.

Objectives:

This study aimed to evaluate the prevalence of minor psychiatric disorder and its associated factors among nurses in southern Iran.

Patients and Methods:

A cross-sectional study was carried out on 771 nurses working in 20 cities of Bushehr and Fars provinces in southern Iran. Participants were recruited through multi-stage sampling during 2014. The General Health Questionnaire (GHQ-12) was used for screening of minor psychiatric disorder in nurses. Latent Class Regression was used to analyze the data.

Results:

The prevalence of minor psychiatric disorder among nurses was estimated to be 27.5%. Gender and sleep disorders were significant factors in determining the level of minor psychiatric disorder (P Values of 0.04 and < 0.001, respectively). Female nurses were 20% more likely than males to be classified into the minor psychiatric disorder group.

Conclusions:

The results of this study provide information about the prevalence of minor psychiatric disorder among nurses, and factors, which affect the prevalence of such disorders. These findings can be used in strategic planning processes to improve nurses’ mental health.

Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study

BACKGROUND

Perinatal depression is a neglected global health priority, affecting 10-15% of women in high-income countries and a greater proportion in low-income countries. Outcomes for children include cognitive, behavioural, and emotional difficulties and, in low-income settings, perinatal depression is associated with stunting and physical illness. In the Victorian Intergenerational Health Cohort Study (VIHCS), we aimed to assess the extent to which women with perinatal depressive symptoms had a history of mental health problems before conception.

METHODS

VIHCS is a follow-up study of participants in the Victorian Adolescent Health Cohort Study (VAHCS), which was initiated in August, 1992, in the state of Victoria, Australia. In VAHCS, participants were assessed for health outcomes at nine timepoints (waves) from age 14 years to age 29 years. Depressive symptoms were measured with the Revised Clinical Interview Schedule and the General Health Questionnaire. Enrolment to VIHCS began in September, 2006, during the ninth wave of VAHCS; depressive symptoms at this timepoint were measured with the Composite International Diagnostic Interview. We contacted women every 6 months (from age 29 years to age 35 years) to identify any pregnancies. We assessed perinatal depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) by computer-assisted telephone interview at 32 weeks of gestation, 8 weeks after birth, and 12 months after birth. We defined perinatal depression as an EPDS score of 10 or more.

FINDINGS

From a stratified random sample of 1000 female participants in VAHCS, we enrolled 384 women with 564 pregnancies. 253 (66%) of these women had a previous history of mental health problems at some point in adolescence or young adulthood. 117 women with a history of mental health problems in both adolescence and young adulthood had 168 pregnancies, and perinatal depressive symptoms were reported for 57 (34%) of these pregnancies, compared with 16 (8%) of 201 pregnancies in 131 women with no preconception history of mental health problems (adjusted odds ratio 8·36, 95% CI 3·34-20·87). Perinatal depressive symptoms were reported at one or more assessment points in 109 pregnancies; a preconception history of mental health problems was reported in 93 (85%) of these pregnancies.

INTERPRETATION

Perinatal depressive symptoms are mostly preceded by mental health problems that begin before pregnancy, in adolescence or young adulthood. Women with a history of persisting common mental disorders before pregnancy are an identifiable high-risk group, deserving of clinical support throughout the childbearing years. Furthermore, the window for considering preventive intervention for perinatal depression should extend to the time before conception.

FUNDING

National Health and Medical Research Council (Australia), Victorian Health Promotion Foundation, Colonial Foundation, Australian Rotary Health Research and Perpetual Trustees.

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific.

Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey

The objective of the study was to examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in a representative population survey of adults and the association of these factors with health outcomes. Hierarchical and correlated factor analysis models were compared, and regression analyses with these models were used to determine the associations with psychological distress and substance use problems. A total of 1449 adults 18-65 years of age participated in a cross-sectional survey over the phone. ADHD symptom data came from an ADHD screener (10 items), and health outcomes were assessed using a questionnaire measuring psychological distress and two measures of substance use problems. The hierarchical general factor models with specific factors best represented the structure of ADHD in this representative population survey. The general factor and residual inattention factor were significantly associated with psychological distress, and the general factor was associated with substance use problems. From the correlated factor models, the inattention factor was associated with psychological distress and the hyperactivity factor was related to substance use problems. The hierarchical and correlated factor models explained similar levels of variance in outcomes. The results replicate previous studies indicating that a model of ADHD symptoms with a unitary dimension and separable dimensions of residual inattention and hyperactivity/impulsivity demonstrates a better fit than correlated factor models. The ADHD general factor was consistently significantly related to outcomes.

Student-teacher relationship trajectories and mental health problems in young children

BACKGROUND

This longitudinal study classified groups of children experiencing different trajectories of student-teacher relationship quality over the transition from preschool into school, and determined the strength of the association between different student-teacher relationship trajectories and childhood mental health problems in the second year of primary school.

METHODS

A community sample of 460 Australian children were assessed in preschool (age 4), the first school year (age 5), and second school year (age 6). Teachers at all three assessments reported on student-teacher relationship quality with the Student Teacher Relationship Scale. When the children were at preschool and in their second school year, parents and teachers rated children's mental health problems using the Strengths and Difficulties Questionnaire.

RESULTS

Latent-class growth modelling identified two trajectories of student-teacher relationship quality: (1) a stable-high student-teacher relationship quality and (2) a moderate/declining student-teacher relationship quality trajectory. Generalised linear models found that after adjusting for family demographic characteristics, having a stable high quality student-teacher relationship trajectory was associated with fewer parent-rated and teacher-rated total mental health problems, and fewer conduct, hyperactivity, and peer problems, and greater prosocial behaviour at age 6. A stable high quality trajectory was also associated with fewer teacher-rated, but not parent-rated emotional symptoms. These effects remained after adjustment for levels of mental health problems at age 4.

CONCLUSIONS

Findings suggest that early intervention and prevention strategies that focus on building stable high quality student-teacher relationships during preschool and children's transition into formal schooling, may help reduce rates of childhood mental health problems during the early school years.

Risk and resistance factors associated with paternal adjustment to obstetrical brachial plexus injuries

This study aimed to identify risk and resistance factors associated with the psychological adjustment of fathers of children with obstetrical brachial plexus injuries (OBPI). Participants were 34 fathers of children with OBPI recruited from an Australian OBPI clinic. Measures completed were OBPI severity, disability related stress, family functioning and social support. Together the risk and resistance factors of severity and family functioning accounted for 28% of the total variance in paternal psychological adjustment. Family functioning explained 12% of the variance in psychological adjustment in addition to that explained by severity. These findings highlight the importance of considering paternal perceptions of OBPI severity and family functioning when providing health care to families of children with OBPI.

Comparison of methods for imputing limited-range variables: a simulation study

Background

Multiple imputation (MI) was developed as a method to enable valid inferences to be obtained in the presence of missing data rather than to re-create the missing values. Within the applied setting, it remains unclear how important it is that imputed values should be plausible for individual observations. One variable type for which MI may lead to implausible values is a limited-range variable, where imputed values may fall outside the observable range. The aim of this work was to compare methods for imputing limited-range variables, with a focus on those that restrict the range of the imputed values.

Methods

Using data from a study of adolescent health, we consider three variables based on responses to the General Health Questionnaire (GHQ), a tool for detecting minor psychiatric illness. These variables, based on different scoring methods for the GHQ, resulted in three continuous distributions with mild, moderate and severe positive skewness. In an otherwise complete dataset, we set 33% of the GHQ observations to missing completely at random or missing at random; repeating this process to create 1000 datasets with incomplete data for each scenario.

For each dataset, we imputed values on the raw scale and following a zero-skewness log transformation using: univariate regression with no rounding; post-imputation rounding; truncated normal regression; and predictive mean matching. We estimated the marginal mean of the GHQ and the association between the GHQ and a fully observed binary outcome, comparing the results with complete data statistics.

Results

Imputation with no rounding performed well when applied to data on the raw scale. Post-imputation rounding and imputation using truncated normal regression produced higher marginal means than the complete data estimate when data had a moderate or severe skew, and this was associated with under-coverage of the complete data estimate. Predictive mean matching also produced under-coverage of the complete data estimate. For the estimate of association, all methods produced similar estimates to the complete data.

Conclusions

For data with a limited range, multiple imputation using techniques that restrict the range of imputed values can result in biased estimates for the marginal mean when data are highly skewed.

Attention deficit hyperactivity disorder, other mental health problems, substance use, and driving: examination of a population-based, representative canadian sample

PURPOSE

The purpose of this study is to examine the relationships among self-reported screening measures of attention deficit hyperactivity disorder (ADHD), other psychiatric problems, and driving-related outcomes in a provincially representative sample of adults 18 years and older living in the province of Ontario, Canada.

METHODS

The study examined the results of the Centre for Addictions and Mental Health (CAMH) Ontario Monitor, an ongoing repeated cross-sectional telephone survey of Ontario adults over a 2-year period. Measures included ADHD measures (Adult ADHD Self-Report Scale-V1.1 [ASRS-V1.1], previous ADHD diagnosis, ADHD medication use); psychiatric distress measures (General Health Questionnaire [GHQ12], use of pain, anxiety, and depression medication); antisocial behavior measure (The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview [APD]); substance use and abuse measures (alcohol, cannabis, and cocaine), Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), driving-related outcomes (driving after drinking, driving after cannabis use, street racing, collisions in past year), and sociodemographics (gender, age, vehicle-kilometers traveled).

RESULTS

A total of 4,014 Ontario residents were sampled, of which 3,485 reported having a valid driver's license. Overall, 3.22% screened positive for ADHD symptoms on the ASRS-V1.1 screening tool. A greater percentage of those who screened positive were younger, reported previous ADHD diagnosis and medication use, distress, antisocial behavior, anti-anxiety and antidepressant medication use, substance use, and social problems compared to those who screened negative. However, there were no statistically significant differences between those who screened positive or negative for ADHD symptoms on self-reported driving after having 2 or more drinks in the previous hour; within an hour of using cannabis, marijuana, or hash; or in a street race or collision involvement as a driver in the past year. When a sequential regression was conducted to predict self-reported collisions, younger age and higher weekly kilometers driven showed higher odds of collision involvement, and the odds ratio for cannabis use ever approached statistical significance.

DISCUSSION

This study is the first population-based study of a representative sample of adults 18 years and older living in Ontario, Canada. These results showed no relationship between the ADHD screen and collision when age, sex, and kilometers driven are controlled for. However, these analyses are based on self-report screeners and not psychiatric diagnoses and a limited sample of ADHD respondents. Thus, these results should be interpreted with caution.

Associations between confidentiality requirements, support seeking and burnout among university hospital physicians in Norway, Sweden, Iceland and Italy (the HOUPE study)

Concerns about protecting patient's privacy are experienced as a limitation in the opportunity to obtain and utilize social support by many physicians. As resources of social support can modify the process of burnout, patient confidentiality may increase risk of this syndrome by interfering with proper stress adaptation. This study investigates if experiencing limitations in seeking social support due to confidentiality concerns are associated with burnout. University hospital physicians in four European countries completed measures of burnout, (Index) of Confidentiality as a Barrier for Support (ICBS), and factors of social resources and job demands. Linear regression analysis showed that ICBS was significantly associated with the burnout dimension of Exhaustion and not with Disengagement. These findings were present when controlling for factors known to diminish or increase the likelihood of burnout. These results are the first to demonstrate that patient confidentiality is associated with burnout in the process of stress management among physicians.

Paternal psychological response after ultrasonographic detection of structural fetal anomalies with a comparison to maternal response: a cohort study

BACKGROUND

In Norway almost all pregnant women attend one routine ultrasound examination. Detection of fetal structural anomalies triggers psychological stress responses in the women affected. Despite the frequent use of ultrasound examination in pregnancy, little attention has been devoted to the psychological response of the expectant father following the detection of fetal anomalies. This is important for later fatherhood and the psychological interaction within the couple. We aimed to describe paternal psychological responses shortly after detection of structural fetal anomalies by ultrasonography, and to compare paternal and maternal responses within the same couple.

METHODS

A prospective observational study was performed at a tertiary referral centre for fetal medicine. Pregnant women with a structural fetal anomaly detected by ultrasound and their partners (study group,n=155) and 100 with normal ultrasound findings (comparison group) were included shortly after sonographic examination (inclusion period: May 2006-February 2009). Gestational age was >12 weeks. We used psychometric questionnaires to assess self-reported social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression): Impact of Event Scale. General Health Questionnaire and Edinburgh Postnatal Depression Scale. Fetal anomalies were classified according to severity and diagnostic or prognostic ambiguity at the time of assessment.

RESULTS

Median (range) gestational age at inclusion in the study and comparison group was 19 (12-38) and 19 (13-22) weeks, respectively. Men and women in the study group had significantly higher levels of psychological distress than men and women in the comparison group on all psychometric endpoints. The lowest level of distress in the study group was associated with the least severe anomalies with no diagnostic or prognostic ambiguity (p < 0.033). Men had lower scores than women on all psychometric outcome variables. The correlation in distress scores between men and women was high in the fetal anomaly group (p < 0.001), but non-significant in the comparison group.

CONCLUSION

Severity of the anomaly including ambiguity significantly influenced paternal response. Men reported lower scores on all psychometric outcomes than women. This knowledge may facilitate support for both expectant parents to reduce strain within the family after detectionof a fetal anomaly.

What is the General Health Questionnaire-12 assessing? Dimensionality and psychometric properties of the General Health Questionnaire-12 in a large scale German population sample

Since the dimensionality and the related psychometric properties of the 12-item General Health Questionnaire (GHQ-12) are still under debate, the present study compares different factor solutions from the literature to determine which shows the best fit and to investigate reliability and construct validity. The analyses are based on a German population based representative sample (N=2,041), using face-to-face-interviews. The confirmatory factor analysis indicates the best fit to the one-factor model including response bias on the negative worded items according to Hankins. Thus, the importance of methodical aspects for the dimensionality was emphasized. Moreover, the correlations of the different subscales of the two- and three-factor models with several external criteria (BDI, PHQ-2, SF-36, PHQ-Anxiety, SPIN) do not substantially differ. The preferred unidimensional model shows good psychometric properties. According to its associations with the external criteria under study, the GHQ-12 as a unidimensional measure seems to be a useful screening tool for the assessment of mental distress or a minor psychiatric morbidity with a main focus on depressive symptomatology.

Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies

BACKGROUND

Given that relatively little is known about the development of resilience in early childhood, this longitudinal study aimed to identify preschool resource factors associated with young children's mental health resilience to family adversity.

METHODS

A community sample of 474 young Australian children was assessed in preschool (mean age 4.59 years, 49% male), and again two years later after their transition into formal schooling. At each assessment, standard questionnaires were used to obtain ratings from both parents and teachers about the quality of children's relationships with parents and teachers, children's self-concept and self-control, mental health (Strengths and Difficulties Questionnaire), and family adversities (including stressful life events and socioeconomic disadvantage).

RESULTS

Greater exposure to cumulative family adversities was associated with both greater teacher- and parent-reported child mental health difficulties two years later. Multiple methodologies for operationalizing resilience were used to identify resources associated with resilient mental health outcomes. Higher quality child-parent and child-teacher relationships, and greater child self-concept and self-control were associated with resilient mental health outcomes. With the exception of child-teacher relationships, these resources were also prospective antecedents of subsequent resilient mental health outcomes in children with no pre-existing mental health difficulties. Child-parent relationships and child self-concept generally had promotive effects, being equally beneficial for children facing both low- and high-adversity. Child self-control demonstrated a small protective effect on teacher-reported outcomes, with greater self-control conferring greater protection to children under conditions of high-adversity.

CONCLUSIONS

Findings suggest that early intervention and prevention strategies that focus on fostering child-adult relationship quality, self-concept, and self-control in young children may help build children's mental health and their resilience to family adversities.

Driving frequency and Its impact on road rage offending and victimization: a view from opportunity theory

Road rage has been described as a key criminal justice and public health concern. Although research attention to this issue has expanded dramatically, most of this work has focused on the identification of predisposing individual factors. It is equally important to begin to assess those factors that may modify the likelihood of road rage including the broader structural opportunities that are connected with the propensity to be involved in a road rage incident. Drawing on opportunity theory, this article examines whether there is a relationship between increased opportunities to be involved in road rage and an increased likelihood of being a road rage victim or offender. The analysis is further extended to specifically test whether this relationship is linear, thereby examining the applicability of the opportunity saturation hypothesis. Using data from the Centre for Addiction and Mental Health (CAMH) Monitor, our findings support both the application of opportunity theory to understanding road rage and the presence of opportunity saturation. Although a clear relationship exists between kilometers driven and experiences of road rage, evidence emerged suggesting there may be a threshold whereby increased opportunities for road rage do not lead to road rage behavior.

Impact of an Online Healthful Eating and Physical Activity Program for College Students

Purpose.

To identify impact of an online nutrition and physical activity program for college students.

Design.

Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up).

Setting.

Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery.

Subjects.

College students (18–24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin).

Intervention.

A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine).

Measures.

Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress.

Analysis.

Repeated measures analysis of variance for outcome variables.

Results.

Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years.

Conclusion.

A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.

Mental health of a police force: estimating prevalence of work-related depression in Australia without a direct national measure

The risk of work-related depression in Australia was estimated based on a survey of 631 police officers. Psychological wellbeing and psychological distress items were mapped onto a measure of depression to identify optimal cutoff points. Based on a sample of police officers, Australian workers, in general, are at risk of depression when general psychological wellbeing is considerably compromised. Large-scale estimation of work-related depression in the broader population of employed persons in Australia is reasonable. The relatively high prevalence of depression among police officers emphasizes the need to examine prevalence rates of depression among Australian employees.