Confirmatory factor analysis of the GHQ-12: can I see that again?

The use of 12-item General Health Questionnaire (GHQ-12) in Ukrainian refugees: translation and validation study of the Ukrainian version

Following the Russian-Ukrainian conflict, the well-being of millions of Ukrainians has been jeopardised. This study aims to translate and test the psychometric features of the Ukrainian version of the General Health Questionnaire 12 (GHQ-12). The study included Ukrainian refugees housed in Verona (Italy) between November/2022 and February/2023. The Ukrainian translation was obtained through a 'forward-backward' translation. Questionnaire was completed by 141 refugees (females: 78.7%). Median age was 36 years (IQR 23-43). Individuals with a score suggestive of psychological distress were 97 (68.8%). Cronbach's coefficient was 0.84 (0.95CI 0.80-0.88). According to confirmatory factor analysis, both single- (modelB1) and two-factor (model B2) structures with bimodal scoring method fitted the data satisfactorily. The two factors of model B2 had a 0.88 correlation. Pearson coefficient showed a positive significant correlation between the GHQ-12 and International Trauma Questionnaire scores (ρ = 0.53, 0.95CI 0.40-0.64, p < 0.001). The GHQ-12 Ukrainian translation showed good psychometric features being a reliable and valid instrument to assess Ukrainian refugees' general well-being.

The impacts of COVID-19 outbreak on mental health in general population in different areas in China

BACKGROUND

This study aimed to explore the impacts of COVID-19 outbreak on mental health status in general population in different affected areas in China.

METHODS

This was a comparative study including two groups of participants: (1) general population in an online survey in Ya'an and Jingzhou cities during the COVID-19 outbreak from 10-20 February 2020; and (2) matching general population selected from the mental health survey in Ya'an in 2019 (from January to May 2019). General Health Questionnaire (GHQ-12), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used.

RESULTS

There were 1775 participants (Ya'an in 2019 and 2020: 537 respectively; Jingzhou in 2020: 701). Participants in Ya'an had a significantly higher rate of general health problems (GHQ scores ⩾3) in 2020 (14.7%) than in 2019 (5.2%) (p < 0.001). Compared with Ya'an (8.0%), participants in Jingzhou in 2020 had a significantly higher rate of anxiety (SAS scores ⩾50, 24.1%) (p < 0.001). Participants in Ya'an in 2020 had a significantly higher rate of depression (SDS scores ⩾53, 55.3%) than in Jingzhou (16.3%) (p < 0.001). The risk factors of anxiety symptoms included female, number of family members (⩾6 persons), and frequent outdoor activities. The risk factors of depression symptoms included participants in Ya'an and uptake self-protective measures.

CONCLUSIONS

The prevalence of psychological symptoms has increased sharply in general population during the COVID-19 outbreak. People in COVID-19 severely affected areas may have higher scores of GHQ and anxiety symptoms. Culture-specific and individual-based psychosocial interventions should be developed for those in need during the COVID-19 outbreak.

Correlates of psychological distress and self-rated health among Palestinian citizens of Israel: findings from the health and environment survey (HESPI)

OBJECTIVES

Psychological distress is a problem strongly associated with socio-economic conditions. This study aims to assess rates of psychological distress and 'poor' self-rated health among Palestinian citizens of Israel, who constitute 21% of the population and nearly 50% live in poverty, and compare their psychological distress scores with those of the general Israeli population.

DESIGN

The Health and Environment Survey among Palestinian citizens of Israel (HESPI-2015), included a representative sample of this minority; 2018 individuals aged ≥18 were interviewed. The questionnaire included socio-demographic and health-related information, the General Health Questionnaire-12, (GHQ-12) and Self-rating of health (SRH).

RESULTS

Subjects with GHQ-12 global scores of ≥17 were considered to have high distress. Low education, female gender, obesity and the presence of chronic diseases were significantly associated with high psychological distress over and above the effect of the other variables. Poor SRH was strongly associated with having a chronic disease and additional risk factors were older age group, low education and high psychological distress. Comparing psychological distress scores of Arabs in Israel with those of the general population showed that 30% of the former were classified as asymptomatic, as compared to 75% in the general population while the proportion of symptomatic or highly symptomatic was 14% in the latter as compared with 45% in the former.

CONCLUSIONS

It appears that the burden of poverty, chronic disease and low education in this population, which suffers from multiple stressors, is disproportionate and should be addressed by the authorities, together with concrete plans to improve the education of the younger generations. Clearly, the association between discriminating policies and deprivation with psychological distress is not unique to the case of the Palestinian minority in Israel and therefore this study will allow for the examination and generalization of the current findings to other discriminated and disadvantaged minorities.

Athletes' Psychological Adaptation to Confinement Due to COVID-19: A Longitudinal Study

Studies of individuals under conditions of confinement or severe social and physical restrictions have consistently shown deleterious mental health effects but also high levels of adaptability when dealing with such conditions. Considering the role of physical activity and sport in psychological adaptation, this paper describes a longitudinal study to explore to what extent the imposed restrictions due to the outbreak of SARS-CoV-2 may have affected athletes' mental health outcomes and how far the process of adaptation to confinement conditions is differentially affected depending on whether the sports activity was practiced individually or in a group, and outdoors, indoors, or both. Two hundred and seventy-four athletes were assessed over 7 weeks using the GHQ-28 and an ad hoc survey exploring the practice of physical activity. A mixed-model fixed effects ANCOVA was used to analyze the effects of time, place, and company in which the sport was practiced, with an index of the amount of physical activity expended as a covariate. Results show a significant effect of time in three out of four of the GHQ-28 subscales, in all cases showing a consistent adaptation to conditions over time. Results also show that playing sport indoors, outdoors, or both, and practicing alone vs. with others differentially affect the somatic symptoms exhibited during confinement: Athletes who practiced sport with others showed higher levels of somatic symptoms at the beginning of the set of data but a quicker rate of adaptation. Differences arising from practicing sport alone or with others were more pronounced in the case of indoor sports, which could be related to the fact that physical activity that can be practiced during confinement is more similar to that practiced indoors alone. Implications relating to what sport psychologists and other health professionals may offer to athletes in stressful situations are discussed.

Comparison of cognitive flexibility, appropriate risk-taking and reaction time in individuals with and without adult ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental and psychiatric disorder that affects different aspects of an individual life, such as cognitive functions. ADHD comprise a complex symptomatology such as cognitive flexibility and inappropriate risk-taking. We aimed to compare cognitive flexibility and appropriate risk-taking of adults with and without ADHD. For this purpose, the Conners' Adult ADHD Rating Scale (CAARS) was used to screen 580 students of Tehran University in Iran. Forty participants who scored highest in CAARS were invited to have a clinical interview with a trained psychiatrist. The diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), using the Wender Utah Rating Scale (WURS). Finally, thirty individuals were diagnosed with ADHD. Meanwhile, the 30 students with the lowest scores on the CAARS and General Health Questionnaire (GHQ) were included as the control group. The two groups then were compared using the Cognitive Flexibility Inventory (CFI) and the Iowa Gambling Task (IGT). The results of the one-way ANOVA indicated that scores of case group in the components of cognitive flexibility were significantly lower in the patients compared to the control group. Also, the ADHD group had lower scores concerning appropriate risk-taking and had a shorter reaction time. Findings of the current study might help to open further avenues in the rehabilitation of cognitive flexibility and controlling reward-seeking and risk-seeking impulses.

Alternative Models Examination and Gender Measurement Invariance of the 12-item General Health Questionnaire among Nigerian Adolescents

OBJECTIVE

The objective of this study was to examine the factor structures of the a priori alternative models of the 12-items General Health Questionnaire (GHQ-12), its psychometric characteristics and gender measurement invariance in a sample of non-clinical Nigerian adolescents (n=1326; Mage=15.16).

METHODS

The sample consisted of 606 (45.7%) males, who completed the GHQ-12 in addition to the Hospital Anxiety and Depression Scale (HADS), the Rosenberg Self-Esteem Scale (RSES) and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). We compared 21 models to identify which has the best fit indices applying confirmatory factor analysis. Gender measurement invariance was examined with nested multiple-group confirmatory factor analysis (MGCFA).

RESULTS

The model that best captures psychological distress was a three-factor model that was initially described among the Australian general population (CFI=0.952, SRMR=0.0310, RMSEA=0.042) (90%CI=0.035-0.049). The internal consistencies (ω) of this model and its dimensions were modestly satisfactory. The criterion validity of this model was supported via significant correlations with the other study measures. MGCFA supported the configural, metric and scalar gender invariances of this model.

CONCLUSION

A three-factor GHQ-12 model (anhedonia/sleep disturbances; social performance and Loss of confidence) is useful as a psychological distress assessment tool among Nigerian adolescents.

Understanding the population structure of the GHQ-12: Methodological considerations in dimensionally complex measurement outcomes

BACKGROUND

Mental health and its complexity, measurement and social determinants are increasingly important avenues of research for social scientists. Quantitative social science commonly investigates mental health as captured by population screening metrics. One of the most common of these metrics is the 12-Item General Health Questionnaire (GHQ-12). Despite itscanonical use as an outcome of interest in social science, the traditional use of the summed scores of summed questionnaires carries empirical and substantive assumptions which are often not fully considered or justified in the research. We outline the implications of these assumptions and the restrictions imposed by traditional modelling techniques and advocate for a more nuanced approach to population mental health modelling and inference.

DATA & METHODS

We use novel Exploratory Structural Equation Modelling (ESEM) on a large, representative UK sample taken from the first wave of the Understanding Society Survey, totalling 40,452 respondents. We use this to exemplify the potential of traditional, restrictive assumptions to bias conclusions and policy recommendations.

RESULTS

ESEM analysis identifies a 4-factor structure for the GHQ-12, including a newly proposed "Emotional Coping" dimension. This structure is then tested against leading proposed factor structures from the literature and is demonstrated to perform better across all metrics, under both Maximum Likelihood and Bayesian estimation. Moreover, the proposed factors are more substantively dissimilar than those retrieved from previous literature.

CONCLUSIONS

The results highlight the inferential limitations of using simple summed scores as population health outcomes. We advocate for the use of the highlighted methods, which in combination with population studies offer quantitative social scientists the opportunity to explore predictors and patterns of underlying processes of population mental health outcomes, explicitly addressing the complexity and measurement error inherent to mental health analysis.

The structure of the General Health Questionnaire (GHQ-12): two meta-analytic factor analyses

The General Health Questionnaire (GHQ-12) is a popular measure of psychological distress. Despite its widespread use, an ongoing controversy pertains to its internal structure. Although the GHQ-12 was originally constructed to capture a unitary construct, empirical studies identified different factor structures. Therefore, this study examined the dimensionality of the GHQ-12 in two independent meta-analyses. The first meta-analysis used summary data published in 38 primary studies (total N = 76,473). Meta-analytic exploratory factor analyses identified two factors formed by negatively and positively worded items. The second meta-analysis included individual responses of 410,640 participants from 84 independent samples. Meta-analytic confirmatory factor analyses corroborated the two-dimensional structure of the GHQ-12. However, bifactor modelling showed that most of the variance was explained by a general factor. Therefore, subscale scores reflected rather limited unique variance. Overall, the two meta-analyses demonstrated that the GHQ-12 is essentially unidimensional. It is not recommended to use and interpret subscale scores because they primarily reflect general mental health rather than distinct constructs.

Factorial Validity of the General Health Questionnaire 12 in an Angolan Sample

Abstract. Most evidence available has found multidimensional solutions for the General Health Questionnaire’s (GHQ12) structure, contrary to the authors’ original one-factor solution. Recently, the study of method effects associated to negatively worded items has been included in the study of GHQ12’s factor structure, and the most common conclusion has been that the best-fitting structure is a single factor confounded by response bias. Current study analyzes the factor structure of the Portuguese version of the GHQ12. The sample consisted of 1,332 young Angolan adults. Previously-reported structures, including one-factor and multidimensional substantive ones, as well as bifactor structures, and models positing method effects among negatively worded items were tested via Confirmatory Factor Analyses. Results suggested that a three substantive factor solution adequately represented the scale’s underlying structure. The emerging factors were dysphoria, social dysfunction, and loss of confidence. Method effects did not play a clear role in explaining the multidimensionality observed in the factor structures tested for the GHQ12.

The factor structure of the 12-item general health questionnaire (GHQ-12) in young Chinese civil servants

Background

The 12-item General Health Questionnaire (GHQ-12) is a commonly used screening instrument for measuring mental disorders. However, few studies have measured the mental health of Chinese professionals or explored the factor structure of the GHQ-12 through investigations of young Chinese civil servants.

Method

This study analyses the factor structure of the GHQ-12 on young Chinese civil servants. Respondents include 1051 participants from six cities in eastern China. Exploratory Factor Analysis (EFA) is used to identify the potential factor structure of the GHQ-12. Confirmatory Factor Analysis (CFA) models of previous studies are referred to for model fitting.

Results

The results indicate the GHQ-12 has very good reliability and validity. All ten CFA models are well fitted with the actual data.

Conclusion

All the ten models are feasible and fit the data equally well. The Chinese version of the GHQ-12 is suitable for professional groups and can serve as a screening tool to detect anxiety and psychiatric disorders.

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey

BACKGROUND

Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.

METHODS

Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n =  5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.

RESULTS

After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.

CONCLUSIONS

ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.

The effect of progressive muscle relaxation on pregnant women's general health

Background:

Pregnancy may be accompanied by serious physiological and psychological changes as it is a stressful period in a woman's life. So, this study was conducted to determine the effect of progressive muscle relaxation on pregnant women's general health.

Materials and Methods:

In this clinical trial, 60 primigravida women admitted to the prenatal clinic of selected hospitals in Iran constituted the study population. Using purposive sampling method, the level of general health of the women was measured with General Health Questionnaire-28 (GHQ-28). Then, the samples were randomly divided into control and experimental groups. Three 1.5–2 h relaxation training sessions were held for the experimental group. After 8 weeks, the level of general health of both groups was measured again. Finally, the collected data were analyzed using Chi-square and paired t-test (P < 0.05).

Results:

Total mean score of general health of the experimental group and the control group before the intervention was 35.83 (6.92) and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and 27.85 (8.24). Although after the intervention both groups showed an increased level of general health, the difference in general health between before and after intervention was significant in the experimental group (P < 0.001). Furthermore, comparison of variations in mean scores of general health level before and after intervention in the two groups showed a significant difference (P < 0.001).

Conclusions:

Given that the results showed the effectiveness of progressive muscle relaxation on pregnant women's general health, the prenatal clinics can include a training program for progressive muscle relaxation in the routine training programs for pregnant women.

[Does the GHQ-12 scoring system affect its factor structure? An exploratory study of Ibero American students]

This study aimed to evaluate whether the scoring system of the General Health Questionnaire (GHQ-12) alters the instrument's factor structure. The method considered 1,972 university students from nine Ibero American countries. Modeling was performed with structural equations for 1, 2, and 3 latent factors. The mechanism for scoring the questions was analyzed within each type of structure. The results indicate that models with 2 and 3 factors show better goodness-of-fit. In relation to scoring mechanisms, procedure 0-1-1-1 for models with 2 and 3 factors showed the best fit. In conclusion, there appears to be a relationship between the response format and the number of factors identified in the instrument's structure. The model with the best fit was 3-factor 0-1-1-1-formatted, but 0-1-2-3 has acceptable and more stable indicators and provides a better format for two- and three-dimensional models.

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.

Adolescents and young adults with physical illness: a comparative study of psychological distress

AIM

There is limited research investigating the relationship between physical illness and psychological distress among adolescents during the transition to young adulthood. This study examined risk for clinically relevant psychological distress over a 10-year period comparing adolescents and young adults with asthma or epilepsy with healthy controls.

METHODS

This research used data from the British Household Panel Survey (1991-2009) to compare healthy 16 to 25-year-olds (n = 7342) with individuals with asthma (n = 1798) and epilepsy (n = 117). Psychological distress was measured using the 12-item General Health Questionnaire. Controlling for sociodemographic characteristics, generalised linear modelling was used to examine risk of psychological distress over time.

RESULTS

Using healthy individuals as the reference category, prevalence ratios for psychological distress among individuals with asthma and epilepsy ranged from 1.1 to 2.7 and 2.3 to 7.0, respectively. Controlling for potential confounding factors (sex, marital status, employment status, income), risk for psychological distress was increased among individuals with asthma (OR = 1.94, p < 0.0001) or epilepsy (OR = 3.45, p = 0.0002) compared with healthy controls during the follow-up.

CONCLUSION

Recognizing the increased risk among individuals with physical illness, paediatric and adult health professionals are well positioned to facilitate successful transition to adult health services and prevent or reduce psychological distress in this vulnerable population.

Internal consistency and factor structure of 12-item general health questionnaire in visually impaired students

BACKGROUND

As there are no instruments to measure psychological wellness or distress in visually impaired students, we studied internal consistency and factor structure of GHQ-12 in visually impaired children.

MATERIALS AND METHODS

Internal consistency analysis (Cronbach's alpha and item total correlation) and exploratory factor analysis (principal component analysis) were carried out to identify factor structure of 12-item general health questionnaire (GHQ-12).

RESULTS

All items of GHQ-12 were significantly associated with each other and the Cronbach's alpha coefficient for the scale was 0.7. On analysis of principal component, three-factor solution was found that accounted for 47.92% of the total variance. The factors included, 'general well-being', 'depression' and 'cognitive', with Cronbach's alpha coefficients being 0.70, 0.59, and 0.34, respectively.

CONCLUSION

Our study findings suggest GHQ-12 is a reliable with adequate internal consistency scale and multidimensional factor structure in visually impaired students.

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.

Factorial validity and invariance of the GHQ-12 among clinical and nonclinical samples

The purpose of this study was to examine the internal reliability, factorial validity, and measurement invariance of a Brazilian-Portuguese version of the General Health Questionnaire-12 (GHQ-12) across clinical and nonclinical groups. The clinical sample consisted of 228 chronic hemodialysis patients (41.7% female), with a mean age of 48.23 (SD = 16.02) years, whereas the nonclinical sample comprised 350 university students (59.1% female), with a mean age of 21.15 (SD = 2.04) years. Initial model fit comparison of 16 factor structures reported in the literature, through confirmatory factor analysis (CFA), provided mixed results. Additional revisions based on CFA modification indices demonstrated that a reduced (8-item) one-factor model with three error covariances provided the best fit to the data in both samples (comparative fit index > .98 and root mean square error of approximation < .05) and acceptable internal reliability estimates (>.70). Pearson's correlations between the original and the reduced scale was .96 for both samples. Multigroup analysis supported partial strong measurement equivalence across groups. Latent mean differences showed an expected higher factor mean for the clinical sample. Overall results demonstrated that the 8-item one-factor of the GHQ-12 showed good psychometric properties in both samples and provided preliminary support for meaningful comparisons of factor means across clinical and nonclinical groups.

The factor structure of the 12-item General Health Questionnaire in a literate Kenyan population

The study evaluated the factorial structure of the 12-item General Health Questionnaire (GHQ-12) in a population of Kenyan adults and adolescents. A sample of 1216 people aged 12-60 years completed the English version of the GHQ-12. To evaluate the factor structure of the GHQ-12, a confirmatory analysis using MPLUS was carried out. A unidimensional model of GHQ-12 as originally conceptualized did not provide a good fit for the data (Comparative Fit Index = 0.843, Tuckler Lewis Index = 0.841, Root Mean Square of Error Approximation = 0.078, Standardized Root Mean Square Residual = 0.063). Unidimensional models, which partial out the effects of negative wording showed an adequate fit to the data. Additionally, multidimensional models showed an excellent fit to the data. Based on the principles of parsimony, pattern of item loading and the correlation between identified factors in the multidimensional models, it was concluded that the GHQ-12 is a unidimensional measure whose structure is significantly influenced by wording effects. The GHQ-12, when applied to a literate population in Africa, showed similar factor structure as in other regions of the world; hence, it can be recommended for use as a screening tool for general symptoms of psychological distress.

Clarification of the factor structure of the 12-item General Health Questionnaire among Japanese adolescents and associated sleep status

If the factors affecting the mental health status of adolescents and their association with sleep status could be clarified, this information would be helpful for formulating lifestyle and healthcare guidance for the promotion of healthy growth and the prevention of mental problems in these individuals. The purpose of this study was to clarify (1) the factor structure of the 12-item General Health Questionnaire (GHQ-12), and (2) the associations between the factors extracted from this questionnaire and lifestyle, in particular sleep status, by using a representative sample population of Japanese adolescents. One hundred three thousand sixty hundred fifty self-administered questionnaires were collected from students enrolled in junior high and high schools in Japan. Of these questionnaires, 99,668 were analyzed. Sleep duration, subjective sleep assessment, bedtime, and insomnia symptoms of these students over the past month were studied to investigate sleep status. The factor analyses yielded two factors: depression/anxiety and loss of positive emotion. Sleep duration of less than 7h was found to be associated with both depression/anxiety and loss of positive emotion, whereas sleep duration of 8h or more was associated only with loss of positive emotion. Subjective sleep assessment and insomnia symptoms were associated with both depression/anxiety and loss of positive emotion. It was demonstrated that two underlying factors of mental health status were associated with differences in sleep status. In order to improve the mental health status of adolescents, it is important to provide guidance about sleep and lifestyle habits according to the mental health status of the individual.

General Health Questionnaire-12 items: adaptation study to the Portuguese population

Aims – To assess the validity and reliability of the GHQ-12 in Portugal. Methods – Using a standard ‘forwardbackward’ translation procedure, the English language version of the questionnaire was translated into Portuguese. To test reliability the internal consistency was assessed by Cronbach's alpha coefficient. Validity was performed using convergent validity. Finally, the factor structure of the questionnaire was extracted by performing principal component analysis using varimax rotation. Results – In all 790 undergraduates entered into the study. Reliability analysis showed satisfactory result (Cronbach's alpha coefficient = 0.91). Convergent validity indicated a significant negative correlation between the GHQ-12 and social support scores as expected (r = -0.54, P < 0.001). The principal component analysis showed that the GHQ-12 was a measure with two-factor structure. Conclusion – The Portuguese version of the GHQ-12 has a good structural characteristic for measuring psychological well being.

Declaration of Interest: None.

Examining the factor structure and discriminant validity of the 12-item General Health Questionnaire (GHQ-12) among Spanish postpartum women

In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins's one-factor model with "method effects" obtained the best fit. In addition, Graetz's three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12.

Applying the impairment, activity limitation, and participation restriction constructs of the ICF model to osteoarthritis and low back pain trials: a reanalysis

OBJECTIVE

To test the hypothesis that interventions targeting the relief of pain and disability in musculoskeletal diseases may have differential effects on activity limitation and participation restriction as defined in the International Classification of Functioning, Disability and Health (ICF).

METHODS

Full data were obtained for 3 randomized controlled trials that used the Western Ontario and McMaster Universities Osteoarthritis Measure (WOMAC), the Medical Outcomes Study Short-form 36 (SF-36), or the Oswestry Disability Questionnaire as their primary outcome measures. The trial outcomes were reanalyzed using items previously designated as assessing pure activity limitation (A) or participation restriction (P), or a mixture of the 2 (A/P) only, and the results compared with the outcomes found using the full scales, which assess a mixture of outcome domains.

RESULTS

The results did not refute the hypothesis. An exercise-based intervention and injection therapies both appeared to have more effect on participation restriction (P) than on activity limitation (A), while a drug-based intervention had more effect on A than on P.

CONCLUSION

Different interventions used to treat musculoskeletal disorders may have differential effects on impairment, activity limitation, and restricted participation. The use of outcome measures that do not differentiate these 3 domains may obscure the true value of an intervention.

Promoting a secure attachment: A primary prevention practice model

It is increasingly recognized that early sensitive care-giving predicts a secure attachment in infancy and early childhood.This preliminary report details the development, implementation and evaluation of a clinical programme that used a targeted prevention approach following a universally-offered screening of parent-infant interactions. The CARE-Index was used to assign dyads to low, medium and high risk groups, and interventions - featuring reflective videotape-based feedback - were tailored to each risk group in order to increase maternal sensitivity and improve infant attachment status. Results showed improved maternal sensitivity in the intervention conditions compared to comparisons. In addition, infants in the intervention conditions were significantly more likely to be classified as secure, and significantly less likely to be classified as having DMM complex attachment strategies. Methodological shortcomings, however, mean that these findings should be regarded as tentative.

Dental beliefs: factor structure of the revised dental beliefs survey in a group of regular dental patients

The aim of this study was to investigate the factor structure of the revised dental beliefs survey (DBS-R) in a group of regular dental patients. The study group consisted of 278 patients (mean age 54 yr), 61% of whom were women. The DBS-R item mean value was 1.6. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were performed. The initial PCA among the 28 DBS-R items showed four factors with eigenvalues of > 1 explaining 67% of the total variance. Five different CFA models were tested. The final model revealed a four-factor solution with one second-order factor (i.e. a hierarchical CFA). Thus, the latent second-order variable, 'dental beliefs', explains the variance from all DBS-R items through the four first-order factors labeled 'ethics', 'belittlement', 'communication and empathy', and 'control and anxiety'. The results suggest a somewhat different factor structure of DBS-R than previously reported for dental-fear patients. Hence, the underlying factor structure of the DBS-R may differ between different patient groups. The results point towards the use of the original 28-item DBS-R and interpreting the scale as measuring an overall construct of 'dental beliefs' and thus patients' attitudes and feelings related to dentists and dentistry.

A Rasch and confirmatory factor analysis of the general health questionnaire (GHQ)--12

BACKGROUND

The General Health Questionnaire (GHQ) - 12 was designed as a short questionnaire to assess psychiatric morbidity. Despite the fact that studies have suggested a number of competing multidimensional factor structures, it continues to be largely used as a unidimensional instrument. This may have an impact on the identification of psychiatric morbidity in target populations. The aim of this study was to explore the dimensionality of the GHQ-12 and to evaluate a number of alternative models for the instrument.

METHODS

The data were drawn from a large heterogeneous sample of cancer patients. The Partial Credit Model (Rasch) was applied to the 12-item GHQ. Item misfit (infit mean square >or= 1.3) was identified, misfitting items removed and unidimensionality and differential item functioning (age, gender, and treatment aims) were assessed. The factor structures of the various alternative models proposed in the literature were explored and optimum model fit evaluated using Confirmatory Factor Analysis.

RESULTS

The Rasch analysis of the 12-item GHQ identified six misfitting items. Removal of these items produced a six-item instrument which was not unidimensional. The Rasch analysis of an 8-item GHQ demonstrated two unidimensional structures corresponding to Anxiety/Depression and Social Dysfunction. No significant differential item functioning was observed by age, gender and treatment aims for the six- and eight-item GHQ. Two models competed for best fit from the confirmatory factor analysis, namely the GHQ-8 and Hankin's (2008) unidimensional model, however, the GHQ-8 produced the best overall fit statistics.

CONCLUSIONS

The results are consistent with the evidence that the GHQ-12 is a multi-dimensional instrument. Use of the summated scores for the GHQ-12 could potentially lead to an incorrect assessment of patients' psychiatric morbidity. Further evaluation of the GHQ-12 with different target populations is warranted.

Psychological Disorders in Old Age

Optimal cutoff points based on response to the General Health Questionnaire (GHQ) used to identify cases of psychological disorder have serious limitations. We used a latent class model (LCM) to improve case identification, on a national survey data of 999 individuals aged 65 + years, living in Britain. The method suggested three clusters of homogeneous response to GHQ-12, comprising 70% noncases, 24% possible, and 6%, probable cases. The three groups differ in characteristics including objective ones, such as health and subjective such as optimism. The solution seems sensible in recognizing a range of case severity, which will help in applying suitable interventions on mild and moderate cases that are common among older people and are likely to become more serious.

Factorial structure of the Chinese version of the 12-item General Health Questionnaire in adolescents

AIMS

To evaluate the underlying factor structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents and find out which factor model proposed by previous empirical research is the best-fit model.

BACKGROUND

The 12-item General Health Questionnaire has been extensively used with adolescents in the West. Yet, it has not been used with adolescents in a Hong Kong Chinese context.

DESIGN

A cross-sectional study was employed.

METHOD

Chinese students between the ages of 12-19 from four secondary schools were invited to participate in the study using the multiple-stage stratified random sampling method during the period from December 2007-February, 2008. The total sample size included in the final analysed was 1883.

RESULTS

The General Health Questionnaire-12 was found to be internally consistent. The results of exploratory factor analysis showed that there are two factors underlying the General Health Questionnaire-12. Of nine factor models were tested by means of confirmatory factor analysis, only three factor model: the eight-item two-factor model, 12-item three-factor model and 10-item two-factor model, demonstrated good model fit across all model fit indices.

CONCLUSION

This study addressed a gap in the literature by evaluating the factorial structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents. The findings revealed that the eight-item two-factor model is the best-fit model.

RELEVANCE TO CLINICAL PRACTICE

The adolescent mental health problem is alarming and aggravating and warrants special attention. It is essential for community nurses to differentiate psychological distress in adolescents and to identify those adolescents who are at a higher risk of suffering from mental health problems. The availability of a valid and reliable instrument that measures adolescents' psychological distress is crucial before any nursing interventions to promote their mental health can be appropriately planned, implemented and evaluated.

GHQ increases among Scottish 15 year olds 1987-2006

BACKGROUND

Increases in a number of psychosocial disorders have been identified among Western youth in the second half of the Twentieth century. However findings are not consistent, trends are complex, and comparisons over time are hampered by methodological problems.

METHODS

Data were drawn from three samples identical in respect of age (15 years), school year (final year of statutory schooling) and geographical location (the West of Scotland). Each sample was administered the 12-item General Health Questionnaire, a measure of self-report psychological distress, in 1987 (N = 505), 1999 (N = 2,196) and 2006 (N = 3,194). Analyses were conducted to examine changes in: GHQ 'caseness'; individual items; and factors, derived via confirmatory factor analysis representing (a) 'negative' and 'positive' items, and (b) 'anxiety and depression', 'loss of confidence or self-esteem' and 'anhedonia and social dysfunction'.

RESULTS

Based on the standard (2/3) cut-off, 'caseness' rates in 1987, 1999 and 2006 were 12.7, 15.1 and 21.5% (males) and 18.8, 32.5 and 44.1% (females). Similar increases were observed with more stringent 'caseness' cut-offs. Examination of individual items showed some to have increased much more markedly over time than others. There were larger increases among females for all except two items and some evidence, among both genders, of steeper increases among 'negative' items compared with 'positive' ones. However, the differences in slope were very small compared with the overall increases in both types.

CONCLUSIONS

Data from three samples identical in respect of age, school year and geographical location, show marked increases in GHQ-12 'caseness' among females between 1987 and 1999 and among both males and females between 1999 and 2006. Although slightly steeper increases in 'negative' items raise the possibility that endorsing such symptoms may have become more acceptable, these were small in comparison with increases in all dimensions of psychological distress. The next step is to identify causal explanations for the increases reported here.

Acne's relationship with psychiatric and psychological morbidity: results of a school-based cohort study of adolescents

BACKGROUND

There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology.

OBJECTIVE

This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship.

METHODS

The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14-17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables.

RESULTS

Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation.

CONCLUSION

The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an early age, prior to the onset of acne.

Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists (LEMONADE Study): study design and profile of nationwide cohort participants at baseline

Background

To examine the association between oral health and general well-being, we are currently conducting a nationwide cohort study comprising members of the Japan Dental Association (JDA). Herein, we describe the study design and the profile of the participants at baseline.

Methods

From 2001 through 2006, the participants completed a baseline questionnaire that surveyed factors related to lifestyle, general health, and oral health. Morbidity and mortality have been monitored by using information from fraternal insurance programs operated by prefectural dental associations. All respondents provided written, informed consent for participation and the use of their insurance data.

Results

A total of 21 272 JDA members participated in the baseline survey (response rate, 36.2%). Their mean age ± SD was 52.3 ± 12.3 years; 8.0% were women. Among the respondents, 30.2% of men and 10.7% of women were current smokers; 73.5% of men and 44.8% of women were current drinkers. The cohort scored higher on oral health indices than did the general Japanese population: dentists were more likely to brush their teeth ≥3 times/day, to have ≥20 teeth, to have fewer lost teeth, to be free from periodontal diseases, and to have higher General Oral Health Assessment Index scores. There was, however, considerable inter-individual variation in scores on the indices.

Conclusions

More than one-third of JDA members participated in the study. Their oral average health status was better than that of the general population. Nevertheless, it will be possible to compare morbidity and mortality between those with better and worse scores on oral health indices.

Factor structure and internal consistency of the 12-item General Health Questionnaire (GHQ-12) and the Subjective Vitality Scale (VS), and the relationship between them: a study from France

BACKGROUND

The objectives of this study were to test the factor structure and internal consistency of the 12-item General Health Questionnaire (GHQ-12) and the Subjective Vitality Scale (VS) in elderly French people, and to test the relationship between these two questionnaires.

METHODS

Using a standard 'forward-backward' translation procedure, the English language versions of the two instruments (i.e. the 12-item General Health Questionnaire and the Subjective Vitality Scale) were translated into French. A sample of adults aged 58-72 years then completed both questionnaires. Internal consistency was assessed by Cronbach's alpha coefficient. The factor structures of the two instruments were extracted by confirmatory factor analysis (CFA). Finally, the relationship between the two instruments was assessed by correlation analysis.

RESULTS

In all, 217 elderly adults participated in the study. The mean age of the respondents was 61.7 (SD = 6.2) years. The mean GHQ-12 score was 17.4 (SD = 8.0), and analysis showed satisfactory internal consistency (Cronbach's alpha coefficient = 0.78). The mean VS score was 22.4 (SD = 7.4) and its internal consistency was found to be good (Cronbach's alpha coefficient = 0.83). While CFA showed that the VS was uni-dimensional, analysis for the GHQ-12 demonstrated a good fit not only to the two-factor model (positive vs. negative items) but also to a three-factor model. As expected, there was a strong and significant negative correlation between the GHQ-12 and the VS (r = -0.71, P < 0.001).

CONCLUSION

The results showed that the French versions of the 12-item General Health Questionnaire (GHQ-12) and the Subjective Vitality Scale (VS) are reliable measures of psychological distress and vitality. They also confirm a significant negative correlation between these two instruments, lending support to their convergent validity in an elderly French population. The findings indicate that both measures have good structural characteristics.

General mental health, quality of life and suicide-related attitudes among Kurdish people in Iran

AIM

To investigate (1) general mental health, (2) quality of life and (3) suicide-related attitudes in Kurds living in Iranian Kurdistan.

METHODS

Cross-sectional investigation; cluster random sampling procedure; 1,000 Kurds were randomly selected from 1,000 of 68,000 households in Sannandaj City, Iran; General Health Questionnaire (GHQ-12); Questionnaire on Attitudes Towards Suicide (ATTS).

RESULTS

About 27% of the subjects had to be regarded as probably suffering from a psychological disturbance. There was no gender difference regarding the number of ;cases'. These possible ;cases' were younger than ;non-cases'. The most ;cases' occurred among the unemployed. An increasing number of experiences related to suicide and the increasing emotional closeness of those experiences was found to be related to an increased probability that the individual would be classified as a ;case' according to the GHQ-12 total score. Unmarried individuals more often evaluated their overall quality of life as ;moderate' or ;bad' compared to married individuals. Unemployed people, self-employed people and housewives formed the groups who most often reported a ;very bad' or ;bad' quality of life.

CONCLUSIONS

Kurdish people in Iran are in need of facilities and interventional programmes aiming to improve general mental health.

A cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices

BACKGROUND

There is considerable evidence for an association of skin diseases with psychological morbidity. This relationship is best established for acne, psoriasis and atopic eczema. Previous studies have mostly been performed in specialist dermatological practice, and there is a lack of studies that include patients from general practice and a lack of controlled studies employing multivariate analysis.

AIMS/OBJECTIVES

This study aims to examine the relationship of acne, psoriasis and atopic eczema with psychological morbidities in patients recruited from general practice as well as specialist dermatology practice.

METHODS AND SUBJECTS

In this cross-sectional study, 108 patients from general and specialist dermatology practices with the three diseases had disease severity assessed and completed measures of minor psychological disturbance (General Health Questionnaire-12), anxiety and depression (Hospital Anxiety and Depression Scale), public self-consciousness and social anxiety (Fenigstein Self-Consciousness Scale), and neuroticism and extraversion/introversion (Eysenck Personality Inventory). Demographic data were also collected, along with self-ratings of disease severity. Control subjects were 96 patients without skin disease recruited from the same general practices as the subjects.

RESULTS

On univariate analyses, patients with skin disease had higher levels of minor psychological disturbance, public self-consciousness and neuroticism than did controls. There were no differences in psychological measures between specialist and general practice patients or between patients with different skin diseases. On multivariate analyses, the significant differences did not persist.

CONCLUSIONS

This study demonstrates confounding in the relationship of skin diseases with psychological morbidity. The complex relationship of skin disease and psychological morbidity should be re-examined.

Factor structure of the General Health Questionnaire (GHQ-12) in subjects who had suffered from the 2004 Niigata-Chuetsu Earthquake in Japan: a community-based study

Background

Factor structure of the 12-item General Health Questionnaire (GHQ-12) was studied by a survey of subjects who had experienced the 2004 Niigata-Chuetsu earthquake (6.8 on the Richter scale) in Japan.

Methods

Psychological distress was measured at two years after the earthquake by using GHQ-12 in 2,107 subjects (99.0% response rate) who suffered the earthquake. GHQ-12 was scored by binary, chronic and Likert scoring method. Confirmatory factor analysis was used to reveal the factor structure of GHQ-12. Categorical regression analysis was performed to evaluate the relationships between various background factors and GHQ-12 scores.

Results

Confirmatory factor analysis revealed that the model consisting of the two factors and using chronic method gave the best goodness-of-fit among the various models for factor structure. Recovery in the scale for the factor 'social dysfunction' was remarkably impaired compared with that of the factor 'dysphoria'. Categorical regression analysis revealed that various factors, including advanced age, were associated with psychological distress. Advanced age affected the impaired recovery of factor 'social dysfunction' score as well as total GHQ score.

Conclusion

The two-factor structure of GHQ-12 was conserved between the survey at five month and that at two years after the earthquake. Impaired recovery in the ability to cope with daily problems in the subjects who had experienced the earthquake was remarkable even at two years after the earthquake.

Psychometric properties of the 12-item General Health Questionnaire (GHQ-12) in Chinese women during pregnancy and in the postnatal period

The GHQ-12 is a widely used instrument designed to screen for psychological disturbance (defined as the inability to carry out normal psychological functions and/or the emergence of new distressing phenomena), in a wide variety of clinical groups. The Chinese version of the GHQ-12 is widely used in Hong Kong to screen women during pregnancy and in the postnatal period. The underlying factor structure of the GHQ-12 has been extensively investigated and there is strong evidence to suggest that the instrument is multi-dimensional. The current investigation explored the psychometric properties of this instrument using confirmatory factor analysis, logistic regression and reliability analysis in Chinese women during the third trimester of pregnancy and in the postnatal period. Two- and three-factor models offered superior fit to the data compared to the presumed uni-dimensional structure. However, a four-item sub-scale from an eight-item two-factor model was found to be a significant antenatal predictor of postnatal GHQ-12 assessed caseness. Further evaluation of the clinical utility of this specific two-factor model is recommended.

A Confirmatory Factor Analysis of the GHQ12 Using a Large Australian Sample

The GHQ12 has become a popular screening instrument used by both clinicians and researchers. To date there have been a number of studies investigating the factor structure of the GHQ12. Most have identified a factorial structure to the instrument but there has been little consistency in the factors identified. One reason for this may be that different investigators are using different scoring methods and this could impact the structure identified. This study used structured equation modeling (LISREL 8.7) to carry out a confirmatory factor analysis, with a large sample of 8,732 university staff, on four 3-factor and one unitary model solutions using the three most common scoring methods (Classical, Corrected, and Likert). It was found that the method of scoring substantially affects model estimation and suggestions were made as to the best scoring method for future use.

A comparative assessment of the factor structures and psychometric properties of the GHQ-12 and the GHQ-20 based on data from a Finnish population-based sample

The General Health Questionnaire (GHQ) is a self-report questionnaire designed to identify psychological distress. Psychometric properties of two versions of GHQ-12 and GHQ-20 were assessed in a large population-based sample of Finnish twins, ages 22 to 27 (n= 4580). Participants were randomized into two subgroups, namely Twin1 (n= 2294) and Twin2 (n= 2286). The GHQ-12 data were assessed using Confirmatory Factor Analysis (CFA). The factor structure of the GHQ-20 was first assessed with Exploratory Factor Analysis (EFA) in the Twin1 dataset, and the results obtained were then subjected to CFA in Twin1 and Twin2 datasets. The CFA of the GHQ-12 indicated that the best fit and the simplest solution were provided by the three-factor solution in both subpopulations. Analyses of the GHQ-20 suggested that the four-factor structure was superior to the three-factor model. This result is also theoretically justifiable. Compared to the 12-item version, GHQ-20 provides additional fourth factor of anhedonia, suggesting some discriminative power.

Impaired psychological recovery in the elderly after the Niigata-Chuetsu Earthquake in Japan:a population-based study

BACKGROUND

An earthquake measuring 6.8 on the Richter scale struck the Niigata-Chuetsu region of Japan at 5.56 P.M. on the 23rd of October, 2004. The earthquake was followed by sustained occurrence of numerous aftershocks, which delayed reconstruction of community lifelines. Even one year after the earthquake, 9,160 people were living in temporary housing. Such a devastating earthquake and life after the earthquake in an unfamiliar environment should cause psychological distress, especially among the elderly.

METHODS

Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12) in 2,083 subjects (69% response rate) who were living in transient housing five months after the earthquake. GHQ-12 was scored using the original method, Likert scoring and corrected method. The subjects were asked to assess their psychological status before the earthquake, their psychological status at the most stressful time after the earthquake and their psychological status at five months after the earthquake. Exploratory and confirmatory factor analysis was used to reveal the factor structure of GHQ12. Multiple regression analysis was performed to analyze the relationship between various background factors and GHQ-12 score and its subscale.

RESULTS

GHQ-12 scores were significantly elevated at the most stressful time and they were significantly high even at five months after the earthquake. Factor analysis revealed that a model consisting of two factors (social dysfunction and dysphoria) using corrected GHQ scoring showed a high level of goodness-of-fit. Multiple regression analysis revealed that age of subjects affected GHQ-12 scores. GHQ-12 score as well as its factor 'social dysfunction' scale were increased with increasing age of subjects at five months after the earthquake.

CONCLUSION

Impaired psychological recovery was observed even at five months after the Niigata-Chuetsu Earthquake in the elderly. The elderly were more affected by matters relating to coping with daily problems.

Are depressed drinking/driving offenders more receptive to brief intervention?

The relationship between depressed mood and interest in additional counseling was examined in three samples of adjudicated first DUI (drinking/driving) offenders who were participating in a court-mandated program. Based on prior research suggesting a relationship between depressed mood, higher motivation to change drinking and drinking/driving, and greater effectiveness of additional supportive brief intervention during the program, it was hypothesized that offenders expressing a depressed mood would be more receptive and less resistant to counseling than would offenders not expressing a depressed mood. In three sub-studies using several different measures of depressed mood, depressed mood was related to higher receptivity/lower resistance to counseling. Resistance rates were lowest for counseling that would occur within the program at no additional cost and highest when counseling required extra sessions or extra cost. Overall, Caucasian males were more resistant to counseling than were females or African-American males, although a differential relationship between depression and counseling resistance was not confirmed in comparisons of gender by ethnic groups.