Establishing a set of mental health indicators for Europe

Mental health, gender, and higher education attainment

We compared the mental health of higher education students with that of nonstudents. Moreover, we examined whether the mental health of students predicts their probability of obtaining a higher education degree, and whether the extent to which mental health affects educational attainment varies by gender. Drawing on a risk and resilience framework, we considered five facets of mental health that may be implicated in distinct ways in the educational attainment process: positive attitude towards life, self-esteem, self-efficacy, negative affectivity, and perceived stress. We used data from a nationally representative panel study from Switzerland (Nstudents = 2070, 42.8% male; Nnonstudents = 3755, 45.9% male). The findings suggest that overall, the mental health of higher education students was relatively similar to that of nonstudents, although students exhibited slightly higher self-esteem, slightly weaker self-efficacy, greater negative affectivity, and higher levels of perceived stress. The effects of different facets of mental health on higher education degree attainment were mostly statistically and/or practically insignificant. However, positive attitudes towards life had a substantial positive effect on the probability of being awarded a higher education degree. Mental health was equally important for male and female students' educational attainment.

Supplementary Information

The online version of this article (10.1007/s11618-023-01187-3) contains supplementary material, which is available to authorized users.

Area-level deprivation, neighbourhood factors and associations with mental health

The COVID-19 pandemic saw residential neighbourhoods become more of a focal point in people's lives, where people were greater confined to living, working, and undertaking leisure in their locality. This study investigates whether area-level deprivation and neighbourhood conditions influence mental health, accounting for demographic, socio-economic and health circumstances of individuals. Using nationally representative data from Ireland, regression modelling revealed that area-level deprivation did not in itself have a discernible impact on mental health status (as measured using the Mental Health Inventory-5 instrument and the Energy and Vitality Index), or likelihood of having suffered depression in the previous 12 months. However, positive perceptions of area safety, service provision, and area cleanliness were associated with better mental health, as was involvement in social groups. Broad ranging policies investing in neighbourhoods, could have benefits for mental health, which may be especially important for deprived communities.

Contributing risk factors of common psychiatric disorders in the Pakistani population

With an increasing incidence of psychiatric disorders worldwide, there is a need for a better understanding of the population-specific contributing risk factors that are associated with common psychiatric conditions. This study aimed to assess the correlation between socioeconomic, environmental and clinical features associated with major depression (MDD n = 479), bipolar disorder (BD n = 222) and schizophrenia (SHZ n = 146), in the Pakistani population. Multinomial logistic regression and Pearson's correlation were applied to assess the association and correlation between demographic, socioeconomic, environmental, and clinical features of MDD, BD and SHZ. In the present study, MDD was found to be more prevalent than BD and SHZ. The average age at onset (AAO), was observed to be earlier in females with BD and SHZ, in addition, females with a positive family history of MDD, BD and SHZ also had an earlier AAO. The fitted multinomial logistic regression model indicated a significant association of; aggression, tobacco use, drugs abuse, history of head injuries and family history with BD as compared to MDD, while insomnia and suicidality were significantly associated with MDD. Strong positive correlations were observed mainly between age/AAO, AAO/tobacco use and aggression/insomnia in all three cohorts. In conclusion, the present study identifies possible contributing socio-demographic, biological and environmental factors that are correlated and associated with the psychiatric conditions in the Pakistani population.

Conceptualising public mental health: development of a conceptual framework for public mental health

Background

Numerous determinants have been linked to public mental health; however, they have not been brought together in a comprehensive conceptual framework. The goal of this work was to bring together academic research, practitioner expertise, and public perspectives to create a public mental health conceptual framework.

Methods

The development process proceeded in four stages. First, we identified a comprehensive list of potential determinants through a state-of-the-art academic literature review, grey literature review, and created mind maps created by peer researchers. Next, we conducted in-person workshops, consultations, and an online survey with academics, practitioners, policy makers, and members of the public to review the potential determinants, nominate additional determinants, and prioritise determinants by importance for understanding public mental health. This iterative process resulted in the final list of determinants contained in the framework. We then conducted rapid reviews to define each determinant and to identify key research, interventions, and resources. Finally, we worked with a design team to visualise the conceptual framework as an online tool and printable infographic.

Results

We found substantial overlap between sources reflecting a shared understanding of the key drivers of public mental health. The unique determinants that emerged from each data source highlighted the importance of using multiple sources to create a comprehensive model. 72 potential determinants were prioritised through stakeholder consultations, resulting in a final list of 55 determinants and organised into four levels: individual, family, community, and structural.

Conclusions

This is the most complete conceptual framework for public mental health to date, bringing together academic research, policy and practitioner views, and lived experience perspectives. The co-production processes and tools we used provides a template for researchers looking to include multiple perspectives in their research.

The conceptual framework draws together current knowledge on each determinant, but also highlights areas where further research is needed to better understand the relationship between each factor and mental health, which can inform the research agenda. This online tool and infographic can be used by practitioners to identify interventions for promoting mental health, and by the general public as a resource to increase awareness of the broad factors which shape public mental health.

Mortality in people with mental disorders in Poland: A nationwide, register-based cohort study

BACKGROUND

Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries.

METHODS

The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009-2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population.

RESULTS

The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00-3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06-2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08-2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86-2.94).

CONCLUSIONS

In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

Conceptualising public mental health: development of a conceptual framework for public mental health

BACKGROUND

Numerous determinants have been linked to public mental health; however, they have not been brought together in a comprehensive conceptual framework. The goal of this work was to bring together academic research, practitioner expertise, and public perspectives to create a public mental health conceptual framework.

METHODS

The development process proceeded in four stages. First, we identified a comprehensive list of potential determinants through a state-of-the-art academic literature review, grey literature review, and created mind maps created by peer researchers. Next, we conducted in-person workshops, consultations, and an online survey with academics, practitioners, policy makers, and members of the public to review the potential determinants, nominate additional determinants, and prioritise determinants by importance for understanding public mental health. This iterative process resulted in the final list of determinants contained in the framework. We then conducted rapid reviews to define each determinant and to identify key research, interventions, and resources. Finally, we worked with a design team to visualise the conceptual framework as an online tool and printable infographic.

RESULTS

We found substantial overlap between sources reflecting a shared understanding of the key drivers of public mental health. The unique determinants that emerged from each data source highlighted the importance of using multiple sources to create a comprehensive model. 72 potential determinants were prioritised through stakeholder consultations, resulting in a final list of 55 determinants and organised into four levels: individual, family, community, and structural.

CONCLUSIONS

This is the most complete conceptual framework for public mental health to date, bringing together academic research, policy and practitioner views, and lived experience perspectives. The co-production processes and tools we used provides a template for researchers looking to include multiple perspectives in their research. The conceptual framework draws together current knowledge on each determinant, but also highlights areas where further research is needed to better understand the relationship between each factor and mental health, which can inform the research agenda. This online tool and infographic can be used by practitioners to identify interventions for promoting mental health, and by the general public as a resource to increase awareness of the broad factors which shape public mental health.

Strategic Assessment of Neighbourhood Environmental Impacts on Mental Health in the Lisbon Region (Portugal): A Strategic Focus and Assessment Framework at the Local Level

Scientific evidence shows that each place/environment generates specific conditions with associated impacts on the mental health and well-being of the population. A holistic, multilevel and integrated environmental approach to mental health enhances the understanding of this phenomena, supporting the local decision-making processes to improve spatial planning of neighbourhood environments. The aim of this study is to develop a strategic assessment framework, based on four municipalities in the Lisbon Region (Portugal), that explores policy and planning initiatives capable of generating favourable neighbourhood environmental conditions for mental health while also detecting risks. Using baseline results of significant statistical associations between individuals’ perceptions of their neighbourhood environment and their mental health in the Lisbon Region, a Strategic Focus on Environmental and Mental Health Assessment framework (SEmHA) was built, by applying the methodology “Strategic Thinking for Sustainability” in Strategic Environmental Assessment, developed by Partidário in 2012. Taking into account the promotion of the population’s mental health, four critical decision factors of neighbourhood environments were identified: (1) public space quality (e.g., improving sense of place), (2) physical environment quality (e.g., low levels of noise exposure), (3) professional qualification and creation of economic activities (e.g., attracting new economic activities), and (4) services and facilities (e.g., improving access to health and education services). The proposed strategic focus and assessment framework contributes to ensuring that interventions in neighbourhood environments truly achieve community mental health benefits and reduce inequalities, thus helping policy makers to assess impacts at the local level.

Impact of the fear of catching COVID-19 on mental health in undergraduate students: A Predictive Model for anxiety, depression, and insomnia

Most studies only describe mental health indicators (anxiety, depression, insomnia, and stress) and the risk factors associated with these indicators during the pandemic (sex, student status, and specific physical symptoms). However, no explanatory studies have been found that assess the impact of variables associated with COVID-19. Against this background, the objective of the study was to evaluate the impact of the fear of catching COVID-19 on the level of anxiety, depression, and insomnia in 947 university students of both sexes (41.6% males and 58.4% females) between the ages of 18 and 35 (M = 21.6; SD = 3.4). The Fear of catching COVID-19 Scale, the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), and the Insomnia Severity Index (ISI) were used to measure the variables. The results of the study show that the fear of catching COVID-19 significantly influences the level of anxiety (β = .52; p < .01), insomnia (β = .44; p<.01), and depression (β = .50; p < .01) experienced by university students (χ2 = 2075.93; df = 371; p = .000; RMSEA = .070 [CI 90% .067-.073]; SRMR = .055; CFI = .95; TLI = .94). The descriptive results show that a notable percentage of university students present significant symptoms of anxiety (23%), depression (24%), and insomnia (32.9%). It is concluded that the fear of catching COVID-19 is a serious health problem since it influences the appearance of anxiety, depression and insomnia symptoms.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

The 5Cs of Positive Youth Development, Purpose in Life, Hope, and Well-Being Among Emerging Adults in Malaysia

A substantial body of evidence supports Lerner and colleagues' 5Cs model of positive youth development (PYD) in the United States (U.S.). Nonetheless, it remains unclear whether the 5Cs can be used to identify positive development in the under-researched Asian contexts, such as Malaysia. Thus, this study examined the 5Cs of PYD (competence, confidence, character, connection, and caring) and their importance to purpose in life, hope, and well-being in a sample of emerging adult undergraduate university students in Malaysia. Data were collected from 400 participants from 15 Malaysian universities (132 males, 268 females; ages ranged from 18 to 26 years old, M = 22). A hierarchical multiple regression analysis indicated that two of the 5Cs of PYD (confidence and connection) as well as hope were important to explaining variation in well-being. The findings imply that there are strong links between PYD, especially confidence and connection, and well-being, while purpose in life and hope were indirectly related to the 2Cs (confidence and connection) of PYD and well-being. Therefore, mental health professionals are encouraged to review and redefine their treatment design to include confidence, connection, purpose in life and hope when working with Malaysian emerging adult university students.

Coronavirus Awareness and Mental Health: Clinical Symptoms and Attitudes Toward Seeking Professional Psychological Help

The current study analyzed the relationship between Coronavirus (COVID-19) Awareness, mental health, and willingness to seek professional psychological help. This was made through a quantitative approach, using online questionnaires to collect data from 855 subjects. The questionnaires included the Brief Symptom Inventory (BSI-53) to measure mental health indicators, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Coronavirus Awareness Scale-10 (CAS-10). An Exploratory Factor Analysis suggests that three factors underlie the CAS-10: Coronavirus Concern, Exaggerated Perception, and Immunity Perception. Results indicate a significant positive correlation between Coronavirus Concern and both general anxiety and phobic anxiety symptoms. Immunity Perception is positively related to paranoid ideation and psychotic symptoms. A Mediation Analysis determined that Coronavirus Concern has a significant positive direct effect on Openness to Seeking Psychological Treatment (OSPT), while Exaggerated Perception and Immunity Perception scores have significant direct negative effects on the Value and Need in Seeking Treatment (VNST) scores. Indirectly, the relationship between Coronavirus Concern and OPST is significantly mediated by anxiety symptoms. Similar results were found for the VNST subscale. There is a negative significant effect of Immunity Perception over OSPT mediated by Paranoid Ideation. However, the overall model only achieved small r 2 coefficients for the OSPT (0.060) and VNST (0.095) scores. Comparisons in Coronavirus Awareness between sex, age, and the presence of children and older adults at home were also made. These results are discussed regarding their practical implications for mental health providers and policymakers.

Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

INTRODUCTION

Poor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients' mental health status may improve the identification of cases in need of mental healthcare.

OBJECTIVES

To investigate the extent of initiation of mental healthcare after identification of poor mental health and to identify factors associated with non-initiation.

DESIGN

Prospective cohort study with 1-year follow-up.

SETTING

In a population-based health preventive programme, Check Your Health, we conducted a combined mental and physical health check in Randers Municipality, Denmark, in 2012-2015 in collaboration with local GPs.

PARTICIPANTS

Participants were 350 individuals aged 30-49 years old with screen-detected poor mental health who had not received mental healthcare within the past year. The cohort was derived from 14 167 randomly selected individuals of whom 52% (n=7348) participated. Mental health was assessed by the mental component summary score of the 12-item Short-Form Health Survey.

OUTCOME

The outcome was initiation of mental healthcare. Mental healthcare included psychometric testing by GP, talk therapy by GP, contact with a psychologist, contact with a psychiatrist and psychotropic medication.

RESULTS

Within 1 year, 22% (95% CI 18 to 27) of individuals with screen-detected poor mental health initiated mental healthcare. Among individuals who initiated mental healthcare within follow-up, one in six had visited their GP once or less in the preceding year. Male sex (OR: 0.49 (95% CI 0.28 to 0.86)) and less impaired mental health (OR: 0.93 (95% CI 0.89 to 0.98)) were associated with non-initiation of mental healthcare. We found no overall association between socioeconomic factors and initiating mental healthcare.

CONCLUSION

Systematic provision of mental health test results to GPs may improve the identification of cases in need of mental healthcare, but does not translate into initiation of mental healthcare. Further research should focus on methods to improve initiation of mental healthcare, especially among men.

TRIAL REGISTRATION NUMBER

NCT02028195.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

PURPOSE

Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.

METHODS

Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.

RESULTS

In total, 30 RCTs met the review's inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants' characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.

CONCLUSION

The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

Factors Associated with Parent-Child Discrepancies in Reports of Mental Health Disorders in Young Children

The study compares parent and child reports of child mental health to determine the relationship between parent-child disagreement and parental psychological and attitudinal factors, and to determine how parent-child disagreement is associated with the use of specialized services. A cross-sectional study was conducted with 1268 children aged 6-11 years using the Dominic Interactive and the Strengths and Difficulties Questionnaire. Psychological distress and negative parental attitudes were associated with greater reporting of mental health problems, leading to greater parent-child agreement on symptom presence, and to parental over-reporting of symptoms. Parent/child agreement was associated with 43.83% of contact with a mental health provider for externalizing and 33.73% for internalizing problems. The contribution of key parental psychological and attitudinal factors in parent-child disagreement on child mental health status may prove helpful in improving the identification of children in need of specialized services.

Physical activity and mental health in an Irish population

BACKGROUND

Physical activity represents a modifiable behaviour which may be associated with increased likelihood of experiencing positive mental health.

AIMS

The aim of this study was to examine the association between self-rated physical activity and subjective indicators of both positive and negative mental health in an Irish adult population.

METHODS

Based on data from a population-based, observational, cross-sectional study, participants were categorised using the International Physical Activity Questionnaire (IPAQ) into those who reported that they did and did not meet recommended physical activity requirements. Self-reported positive and negative mental health indicators were assessed using the Energy and Vitality Index (EVI) and the Mental Health Index-5 (MHI-5) from the SF-36 Health Survey Instrument, respectively. Binary logistic regression was used to identify variables independently associated with self-reported positive and negative mental health.

RESULTS

A total of 7539 respondents were included in analysis. Overall, 32% reported that they met recommended minimal physical activity requirements. Self-reported positive and negative mental health were reported by 16 and 9% of respondents, respectively. Compared with those who reported meeting-recommended physical activity requirements, those performing no physical activity were three times less likely to report positive mental health (adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.28-0.55) and three times more likely to report negative mental health (OR 3.27, 95% CI 2.38-4.50).

CONCLUSION

Compared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes.

Mental health assessment in health checks of participants aged 30-49 years: A large-scale cohort study

Mental distress is an independent risk factor for illness related impairment. Awareness of mental health (MH) allows prevention, but early detection is not routinely performed in primary care. This cohort study incorporated MH assessment in a health promoting programme. We described the level of poor MH among health check participants, explored the potential for early intervention, and the potential for reducing social inequality in MH. The study was based on 9767 randomly selected citizens aged 30-49 years invited to a health check in Denmark in 2012-14. A total of 4871 (50%) were included; 49% were men. Poor MH was defined as a mental component summary score of ≤ 35.76 in the SF-12 Health Survey. Data was obtained from national health registers and health check. Participants with poor MH (9%) were more socioeconomic disadvantaged and had poorer health than those with better MH. Two thirds of men (64%) and half of women (50%) with poor MH had not received MH care one year before the health check. Among those with (presumably) unrecognized MH problems, the proportion of participants with disadvantaged socioeconomic characteristics was high (43-55%). Four out of five of those with apparently unacknowledged poor MH had seen their GP only once or not at all during the one year before the health check. In conclusion, MH assessment in health check may help identify yet undiscovered MH problems.

Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor

OBJECTIVE

To investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these.

METHOD

We analysed baseline data from the Mitchelstown (Ireland) 2010-2011 cohort of 2047 men and women aged 50-69 years. Self-reported measures included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale) and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by ACE scores and ACE subtypes abuse, neglect and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors. We tested whether the estimated associations varied across levels of PSS (poor, moderate and strong).

RESULTS

23.7% of participants reported at least one ACE (95% CI 21.9% to 25.6%). ACE exposures (overall, subtype or ACE scores) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. Exposure to any ACE (vs none) was associated with almost three times the odds of depressive symptoms (adjusted OR 2.85; 95% CI 1.64 to 4.95) among individuals reporting poor PSS, while among those reporting moderate and strong PSS, the adjusted ORs were 2.21 (95% CI 1.52 to 3.22) and 1.39 (95% CI 0.85 to 2.29), respectively. This pattern of results was similar when exposures were based on ACE subtype and ACE scores, though the interaction was clearly strongest among those reporting abuse.

CONCLUSIONS

ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms, particularly among those with poor PSS. Interventions that enhance social support, or possibly perceptions of social support, may help reduce the burden of depression in older populations with ACE exposure, particularly in those reporting abuse.

Mental health care in Athens: Are compulsory admissions in Greece a one-way road?

Involuntary hospitalization has long been a contentious issue worldwide. In Greece, the frequency of compulsory admissions is assumed to be alarmingly high; however, no study has systematically investigated this issue. In line with this, the present study aims to estimate the frequency of compulsory admissions in a psychiatric hospital and to explore its underpinnings. All individuals who were admitted to the Psychiatric Hospital of Attica during June-October 2011 were included into the study. Information about their socio-demographic and clinical characteristics as well as their previous contact with mental health services was obtained from interviewing the patient and his/her physician. Furthermore, information about the initiation of the process of compulsory admission as well as patient's referral upon discharge was retrieved from patients' administrative record. Out of the 946 admissions 57.4% were involuntary. A diagnosis of unipolar depression, high social support and previous contact with community mental health services were found to yield a protective effect against involuntary hospitalization. Moreover, 69.8% of civil detentions were instigated by close relatives and 30.2% ex officio. These two groups differed in patients' social support levels and in medication discontinuation being the reason for initiation of the process. Lastly, only 13.8% of patients were referred to community mental health services at discharge. Our findings suggest that civil detentions are deeply entrenched in clinical routine in Greece. Moreover, poor coordination among services and relatives' burden seem to contribute substantially to the elevated rates.

Association Between Depression and Elder Abuse and the Mediation of Social Support: A Cross-Sectional Study of Elder Females in Mexico City

OBJECTIVE

We assessed the association between depression and elder abuse, and the mediation effect of social support among elder women in Mexico City.

METHOD

A total of 526 noninstitutionalized elder women, residing in Mexico City and attending public community centers were selected. Logistic regressions and structural equation models (SEM) were estimated.

RESULTS

One fifth of the elderly women were at risk of depression, one third suffered some type of abuse in the past 12 months, and 82% reported low social support. Logistic models confirmed that depression was statistically associated with elder abuse and vice versa (odds ratio [OR] = 1.97 and 1.96, respectively). In both models, social support significantly reduced the association between these variables leading to study these associations through SEM. This approach highlighted that social support buffers the association between depression and elder abuse.

DISCUSSION

Findings underline the relevance of programs and strategies targeted at increasing social support among urban older adults.

Factors associated with suicidal ideation disclosure: Results from a large population-based study

BACKGROUND

It is crucial for clinicians and researchers to understand the factors associated with the disclosure of suicidal ideation. Describing the characteristics of those who do not disclose their suicidal ideation or who disclose their ideation only to close others, to health professionals or to both may help researchers and clinicians in their preventive efforts to treat persons at risk for suicidal behavior.

METHODS

The sample was drawn from a large cross-sectional survey (n=22,138) on mental health in France. The analyses were based on the 4,156 persons (17.1%) who endorsed lifetime suicidal ideation with or without a history of suicide attempt and who indicated whether and to whom they disclosed their ideation. Socio-demographics, current mental disorders, and social connectedness were assessed.

RESULTS

Half of those with suicidal ideation had not shared their ideation with anyone, 6.3% did so with health professionals only, 20% with friends or family only, and 20% with both healthcare professionals and close others. Male gender, older age, lower education level and poor social connectedness were associated with greater odds of non-disclosure. Adjusting for socio-demographics and social connectedness, suicidal behavior and mental disorders were overall associated an increased likelihood of sharing suicidal ideation with health professionals.

LIMITATIONS

Cross-sectional survey assessing lifetime suicidal ideation and disclosure.

CONCLUSIONS

The findings provide important insight into the individual and social factors to take into account in suicidal ideation disclosure.

Monitoring positive mental health and its determinants in Canada: the development of the Positive Mental Health Surveillance Indicator Framework

INTRODUCTION

The Mental Health Strategy for Canada identified a need to enhance the collection of data on mental health in Canada. While surveillance systems on mental illness have been established, a data gap for monitoring positive mental health and its determinants was identified. The goal of this project was to develop a Positive Mental Health Surveillance Indicator Framework, to provide a picture of the state of positive mental health and its determinants in Canada. Data from this surveillance framework will be used to inform programs and policies to improve the mental health of Canadians.

METHODS

A literature review and environmental scan were conducted to provide the theoretical base for the framework, and to identify potential positive mental health outcomes and risk and protective factors. The Public Health Agency of Canada's definition of positive mental health was adopted as the conceptual basis for the outcomes of this framework. After identifying a comprehensive list of risk and protective factors, mental health experts, other governmental partners and non-governmental stakeholders were consulted to prioritize these indicators. Subsequently, these groups were consulted to identify the most promising measurement approaches for each indicator.

RESULTS

A conceptual framework for surveillance of positive mental health and its determinants has been developed to contain 5 outcome indicators and 25 determinant indicators organized within 4 domains at the individual, family, community and societal level. This indicator framework addresses a data gap identified in Canada's strategy for mental health and will be used to inform programs and policies to improve the mental health status of Canadians throughout the life course.

The perceived constraints subscale of the Sense of Mastery Scale: dimensionality and measurement invariance

PURPOSE

A number of studies have reported differences in sense of mastery and perceived control across different subgroups. Yet, few have examined measurement invariance, an important prerequisite for valid comparisons. This study examines the factorial structure and measurement invariance of the perceived constraints (PC) facet of Pearlin and Schooler's (1981) Sense of Mastery Scale (SM) which is a commonly used short form of the widely used SM scale.

METHODS

Confirmatory factor analyses using AMOS and Mplus were conducted to explore dimensionality and test for measurement invariance in factor structure, factor loadings, intercepts, and residual variances across gender, age, education, income, and employment status in a large (N = 19,858), nationally representative sample of Norwegian males and females aged 16-100.

RESULTS

The data supported a modified unidimensional model specifying correlations between the error terms of items 4 and 5, or possibly two highly correlated dimensions (r = 0.90). Metric invariance of the scale was shown for age, education, and employment, whereas invariance at the strong and strict levels was shown for gender and income. Partial invariance at the strong level was shown for age.

CONCLUSIONS

This Norwegian study supported a modified unidimensional structure for the abbreviated SM scale. Invariance testing indicated that comparisons across genders and income levels are unproblematic, whilst comparing mean scores across education and employment status is not justified. Latent, but not sum score means are comparable across age. Future studies using all 7 items of SM scale should provide more information on dimensionality and measurement invariance.

Is time spent playing video games associated with mental health, cognitive and social skills in young children?

BACKGROUND

Video games are one of the favourite leisure activities of children; the influence on child health is usually perceived to be negative. The present study assessed the association between the amount of time spent playing video games and children mental health as well as cognitive and social skills.

METHODS

Data were drawn from the School Children Mental Health Europe project conducted in six European Union countries (youth ages 6-11, n = 3195). Child mental health was assessed by parents and teachers using the Strengths and Difficulties Questionnaire and by children themselves with the Dominic Interactive. Child video game usage was reported by the parents. Teachers evaluated academic functioning. Multivariable logistic regressions were used.

RESULTS

20 % of the children played video games more than 5 h per week. Factors associated with time spent playing video games included being a boy, being older, and belonging to a medium size family. Having a less educated, single, inactive, or psychologically distressed mother decreased time spent playing video games. Children living in Western European countries were significantly less likely to have high video game usage (9.66 vs 20.49 %) though this was not homogenous. Once adjusted for child age and gender, number of children, mothers age, marital status, education, employment status, psychological distress, and region, high usage was associated with 1.75 times the odds of high intellectual functioning (95 % CI 1.31-2.33), and 1.88 times the odds of high overall school competence (95 % CI 1.44-2.47). Once controlled for high usage predictors, there were no significant associations with any child self-reported or mother- or teacher-reported mental health problems. High usage was associated with decreases in peer relationship problems [OR 0.41 (0.2-0.86) and in prosocial deficits (0.23 (0.07, 0.81)].

CONCLUSIONS

Playing video games may have positive effects on young children. Understanding the mechanisms through which video game use may stimulate children should be further investigated.

Regional disparities in psychiatric distress, violent behavior, and life satisfaction in Iranian adolescents: the CASPIAN-III study

OBJECTIVES

The purpose of this study was to assess the prevalence of violence behaviors, psychiatric distress, and life satisfaction among 10- to 18-year-old Iranian adolescents at national and regional disparities.

METHODS

In this national survey, 5570 students of age 10 to 18 years from urban and rural regions of 27 provinces of Iran were selected through stratified multistage sampling method. Violence behaviors, psychiatric distress, and life satisfaction were assessed by a questionnaire that was prepared based on WHO global school-based student health survey and the WHO-stepwise approach to noncommunicable diseases (Tools version 9.5). The country classification into 4 subnational regions was done based on combination of geography and socioeconomic status (SES). The data were analyzed by the SPSS software.

RESULTS

The prevalence of emotional, depressive, and anxiety problem among Iranian students was 17.7%, 16.3%, and 5.7%, respectively. The percentage of emotional and depressive problem differed significantly between different SES distress (p value <.001). The prevalence of bullying, victim, and physical fight was 27.1%, 32.7%, and 50.6% among students aged 10 to 18 years, respectively. Bullying and victim experience were linearly associated with regions' SES. Students who were living in the north-northeast region had maximum self-rated health and life satisfaction in Iran.

CONCLUSIONS

The results declared that psychiatric distress was more frequent in high SES distress, whereas violence behavior was more frequent in the lowest SES distress. Therefore, in communities with large variations in health and SES in regional level, health policies for primordial and primary prevention of mental and behavioral distress have to be made at regional levels.

Delayed school progression and mental health problems in adolescence: a population-based study in 10,803 adolescents

BACKGROUND

Accumulating evidence suggests that several adult mental disorders, particularly psychoses, are preceded by impairments in cognitive function, reflected in scholastic underachievement. This study investigates the association between scholastic underachievement and general mental health problems in adolescence, using delay in school progression as a marker of poor scholastic performance.

METHOD

Cross-sectional secondary school survey comprising 10,803 adolescents. Participants completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health problems. The association of delayed school progression with the SDQ was investigated using logistic regression with SDQ as outcome and delayed school progression as primary exposure of interest while adjusting for socio-demographic characteristics, adverse life events, school-related factors, risk taking behaviour, healthy lifestyle and physical health.

RESULTS

Unadjusted analysis showed an association between delayed school progression and total mental health problems (OR 1.83, 95% CI 1.27-2.63) in adolescents. After adjusting for other risk factors (socio-demographic factors and life events) in a logistic regression model the association between delayed school progression en mental health problems was attenuated (OR 1.33, 95% CI 0.86-2.05).

CONCLUSION

Delayed school progression is associated with general mental health problems in adolescence, but this relationship is heavily confounded by other factors. A causal relationship between impaired cognitive function such as poor scholastic performance and general mental health at adolescence is less likely and delayed school progression may merely be considered an indicator of risk for mental health problems.

What characterizes persons with poor mental health? A nationwide study in Denmark

BACKGROUND

The aim of the study was to identify and characterize groups with poor mental health defined by the SF-12 Mental Component Summary (MCS-12) scale.

METHODS

The study is based on the Danish Health and Morbidity Survey 2005 and includes 10,082 participants (16 years or older). Data were analysed by means of logistic regression models.

RESULTS

Men and women with poor mental health are characterized by being single, having a long-term illness, not being able to rely on help from others in case of illness and by feeling that family and friends demand too much of them. Men with poor mental health were further characterized by being a heavy smoker, and having a BMI below 25. Women with poor mental health were further characterized by being 16-44 years old and sedentary in leisure time.

CONCLUSIONS

The prevalence of poor mental health is higher among women than men, and different factors characterize men and women with poor mental health. The present findings support the notion that both socio-demographics and lifestyle factors are independently related with poor mental health. We suggest taking into account all these areas of life when planning activities to prevent poor mental health and when promoting mental health.

Psychological distress in French college students: demographic, economic and social stressors. Results from the 2010 National Health Barometer

Background

Psychological distress (PD) in students is under-investigated, since its prevalence can be high in certain subgroups of students and it has been seen to be associated with other mental health issues and academic achievement. In a sample of French college students, this study investigated factors associated with PD, and looked more closely at the impact of social and interpersonal variables.

Methods

Data were extracted from the 2010 French “National Health Barometer”. 946 students were interviewed. Mental health was assessed using the MH-5 five-item scale.

Results

The PD rate in this sample was 13.8% (7.2% in males, 19.5% in females). Low income, nonsexual assault in the last 12 months, studying law and low social participation were associated with PD in multivariate analyses.

Conclusions

French students show specific characteristics that are discussed in order to explain the relatively low rate of PD observed. The impact of loneliness and social isolation are a major focus for preventive policies based on community resources and early detection of the symptoms of PD.

Indicators of mental health in various Iranian populations

Background:

Promoting mental health and preventing mental disorders are of the main concerns for every country. Achieving these goals requires effective indexes for evaluating mental health. Therefore, to develop mental health enhancement programs in Iran, there is a need to measure the state of mental health in Iran.

Objectives:

This study aimed to select a set of mental health indicators that can be used to monitor the status of mental health in Iran.

Materials and Methods:

This research work used Q-methodology which combines both quantitative and qualitative research methods for establishment of mental health indicators in Iran. In this study, 30 participants were chosen by purposive sampling from different types of professionals in the field of mental health.

Results:

Twenty seven mental health indicators were obtained from the Q-methodology. The most important indicators obtained in this study are as follows: annual prevalence of mental disorders, suicide rates, number of mental health professionals, mental health expenditures and suicide related deaths.

Conclusions:

This study provides mental health indices for measuring mental health status in Iran. These mental health indices can be used to measure progress in the reform policies and community mental health services.

The relationship between negative life events, psychological distress and life satisfaction: a population-based study

PURPOSE

Negative life events may increase psychological distress and reduce life satisfaction (LS). This study investigates associations between negative life events and both positive and negative indicators of mental health and explores the extent to which these associations are buffered by sense of mastery and perceived social support.

METHODS

Data were obtained from a large (N = 4,823), nationally representative sample of Norwegians aged 16 and older. Psychological distress was measured by The Hopkins Symptom Check List (HSCL-25), LS by a single question on overall satisfaction with life and negative life events by a 12-item list of threatening experiences. Moderating variables, sense of mastery and social support, were measured using standard instruments.

RESULTS

Adjusting for age, sex, education and income, all of the negative life events were significantly associated with both psychological distress and LS, with the exception of events pertinent to bereavement. Of the life events examined, financial strain constituted the strongest predictor. Overall, negative life events were more closely associated with psychological distress than LS. Altogether, negative life events explained 22.3 and 11.4 % of the variance in psychological distress and LS, respectively. Sense of mastery, but not perceived social support, emerged as a moderating factor between financial strain and both psychological distress and LS.

CONCLUSION

Negative life events are associated with higher psychological distress and lower LS, but the strength of the associations varies across events. The impact of financial strain and conflict appears particularly strong, but may be moderated by self-perceived mastery.

The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study

BACKGROUND

Little is known of the importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home. The objectives of the present study were to investigate the associations of social support, somatic health problems and socio-economic factors with psychological distress. We also examined changes in the association of somatic health problems and socio-economic factors with psychological distress after adjusting for social support.

METHODS

A random sample of 4,000 persons aged 65 years or more living at home in Oslo was drawn. Questionnaires were sent by post, and the total response was 2,387 (64%). Psychological distress was assessed using Hopkins Symptom Checklist (HSCL-10) and social support with the Oslo-3 Social Support Scale (OSS-3). A principal component analysis (PCA) included all items of social support and psychological distress. Partial correlations were used, while associations were studied by logistic regression.

RESULTS

After adjusting for socio-demographics and somatic health problems, we reported a statistically significant association between psychological distress and social support: "Number of close friends", OR 0.61; 95% CI 0.47-0.80; "Concern and interest", OR 0.68; 95% CI 0.55-0.84. A strong association between lack of social support and psychological distress, irrespective of variables adjusted for, indicated a direct effect. The associations between psychological distress and physical impairments were somewhat reduced when adjusted for social support, particularly for hearing, whereas the associations between somatic diagnoses and psychological distress were more or less eliminated. Income was found to be an independent determinant for psychological distress.

CONCLUSIONS

Lack of social support and somatic health problems were associated with psychological distress in elders. Social support acted as a mediator, implying that the negative effect of somatic health problems, especially hearing, on psychological distress was mediated by low social support. We hypothesize that physical impairments reduced social support, thereby increasing psychological distress to a greater extent than the selected diagnoses. The combination of poor social support, poor somatic health and economic problems may represent a vulnerable situation with respect to the mental health of older persons. Free interventions that highlight social support should be considered in mental health promotion.

A randomized controlled trial of a senior centre group programme for increasing social support and preventing depression in elderly people living at home in Norway

BACKGROUND

Late-life depression is a common condition and a challenging public health problem. A lack of social support is strongly associated with psychological distress. Senior centres seem to be suitable arenas for community-based health promotion interventions, although few studies have addressed this subject. The objectives were to examine the effect of a preventive senior centre group programme consisting of weekly meetings, on social support, depression and quality of life.

METHODS

A questionnaire was sent to a random sample of 4,000 persons over 65 in Oslo, and a total of 2,387 completed questionnaires were obtained. These subjects served as a basis for recruitment of participants for a trial, with scores on HSCL-10 being used as a main inclusion criterion. A total of 138 persons were randomized into an intervention group (N = 77) and control group (N = 61). Final analyses included 92 persons. Social support (OSS-3), depression (BDI), life satisfaction and health were measured in interviews at baseline and after 12 months (at the end of the intervention programme). Perceptions of benefits from the intervention were also measured. Mean scores, SD, SE and CI were used to describe the changes in outcomes. Effect sizes were calculated based on the original scales and as Cohen's d. Paired sample tests and ANOVA were used to test group differences.

RESULTS

There was an increase in social support in both groups, but greatest in the intervention group. The level of depression increased for both groups, but more so in the control than the intervention group. There was a decrease in life satisfaction, although the decrease was largest among controls. There were almost no differences in reported health between groups. However, effect sizes were small and differences were not statistically significant. In contrast, most of the participants said the intervention meant much to them and led to increased use of the centre.

CONCLUSIONS

In all probability, the intervention failed to meet optimistic targets, but possibly met quite modest ones. Since intention-to-treat analysis was not possible, we do not know the effect on the intervention group as a whole. A further evaluation of these programmes is necessary to expand the group programme. For the depressed, more specialized programmes to cope with depression may be a more appropriate intervention.

TRIAL REGISTRATION

DRKS00003120 on DRKS.

Predictors of stigmatizing attitudes towards people with mental disorders in a general population in Finland

BACKGROUND

For planning effective and well-targeted initiatives to reduce stigma, we need to identify which factors are associated with stigmatizing of people with mental disorders.

AIMS

This study examined how well a combination of variables predicts stigmatizing attitudes and discrimination in a general population.

METHODS

A survey questionnaire was sent to 10,000 persons aged 15-80 years residing in western Finland. Attitudes were measured using a scale consisting of negative stereotypes about people with depression and stereotypical beliefs connected with mental problems, while discrimination was measured by a social distance scale. Predictors included demographic variables, mental health resources, personal experience of depression or psychological distress, knowing someone who suffers from mental health problems, and negative stereotypical beliefs.

RESULTS

Although 86% of the population thought that depression is a real medical condition, the majority of respondents believed that people with depression are responsible for their illness. Social discrimination was significantly associated with respondents' age, gender, native language, sense of mastery, depression, stereotypical beliefs and familiarity with mental problems.

CONCLUSIONS

The results suggest that the need to address stigma is higher among men, older people and those without familiarity with mental problems. When planning interventions to shape stereotypes, the need for change is highest among those with a low sense of life control and poor social networks. Direct interactions with persons who have mental problems may change the stereotypical beliefs and discriminative behaviour of those who do not have familiarity with mental problems.

European comparisons between mental health services

When developing accessible, affordable and effective mental health systems, exchange of data between countries is an important moving force towards better mental health care. Unfortunately, health information systems in most countries are weak in the field of mental health, and comparability of data is low. Special international data collection exercises, such as the World Health Organization (WHO) Atlas Project and the WHO Baseline Project have provided valuable insights in the state of mental health systems in countries, but such single-standing data collections are not sustainable solutions. Improvements in routine data collection are urgently needed. The European Commission has initiated major improvements to ensure harmonized and comprehensive health data collection, by introducing the European Community Health Indicators set and the European Health Interview Survey. However, both of these initiatives lack strength in the field of mental health. The neglect of the need for relevant and valid comparable data on mental health systems is in conflict with the importance of mental health for European countries and the objectives of the 'Europe 2020' strategy. The need for valid and comparable mental health services data is today addressed only by single initiatives, such as the Organisation for Economic Co-operation and Development work to establish quality indicators for mental health care. Real leadership in developing harmonized mental health data across Europe is lacking. A European Mental Health Observatory is urgently needed to lead development and implementation of monitoring of mental health and mental health service provision in Europe.

Validity across translations of short survey psychiatric diagnostic instruments: CIDI-SF and CIS-R versus SCID-I/NP in four European countries

OBJECTIVES

The aims of the study are: first, to compare two short diagnostic instruments, CIDI-SF and CIS-R, with respect to the structured clinical interview for non-patient (SCID-I/NP) for anxiety and depressive disorders; and second, to evaluate the influence of four languages, Italian, Romanian, Spanish and French, on the concordance tests.

METHODS

A total of 120 participants from Italy and Romania, 119 from Spain and 141 from France (N = 500) were recruited randomly in a local primary care research centre (GPs or medical centres). The instruments were administered during a unique session: the lay instruments by students in psychology and the SCID by experienced psychiatrists. Kappa, sensitivity/specificity/negative (NPV) and positive predictive values (PPV), ROC curve (AUC) and the Youden Index (Y) were calculated.

RESULTS

Results were better for the CIDI-SF than the CIS-R for anxious disorders, depressive disorders and any of them. The results were identical to that obtained by the CIDI 3.0 for the three categories and constant across the languages except for depressive disorders in Romania and France.

CONCLUSIONS

CIDI-SF is a cost-effective instrument and could be easily integrated into health surveys; its performance values are better across languages than values proposed by the CIS-R and could be increased by inclusion of few additional information.

Socio-demographic, psychosocial and health characteristics of Norwegian senior centre users: a cross-sectional study

AIMS

The senior centre is the only welfare service in Norwegian elder care serving both fit and less functional pensioners over 65 years. The aim of the study was to determine the socio-demographic, psychosocial and health characteristics of users of the senior centres in relation to non-users in order to find out who can benefit from the senior centre service.

METHODS

Data was collected from the Population Register for all persons living at home over 65 years in two municipal districts in Oslo. A random sample was drawn limited to 4,000 of the total number of residents over 65 years, 2,000 from each district. Questionnaires were sent by post. The response rate was 64% (n = 2,387). Psychological ailments were assessed using Hopkins Symptom Checklist-10 and social support with Oslo-3 Social Support Scale.

RESULTS

The percentage of users was 44 among the survey respondents. Age was the most significant variable explaining use of the senior centre; increased age led to greater use. Single women used the senior centre more than married women while single men used it less than married men. Other predictors for women included osteoporosis, memory impairment and participation/interest from others. Memory impairment was a predictor for men.

CONCLUSIONS

High age and specific health problems led to increased use. Living alone predicted greater use among women but less use among men. The association with age could not be explained through socio-demographic, psychosocial or health variables.

Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking

PURPOSE

Few studies have explored the prevalence of psychiatric disorders (PD) among university students. This article aims to study 12-month prevalence of PD in university students, their socio-economic correlates, impairment in daily life and help-seeking behaviours.

METHODS

Cross-sectional study of randomly selected first-year students aged 18-24 years, enrolled in one of the six universities in south-eastern France in 2005-2006. We used the WHO CIDI-Short Form to derive DSM-IV diagnoses and the Sheehan disability scale to evaluate impairment. We studied their correlates with multiple logistic regressions.

RESULTS

The 12-month prevalence of major depressive disorder (MDD), anxiety disorders (AD) and substance use disorders (SUD) were 8.9% (95% CI: 7.2-10.9), 15.7% (95% CI: 13.5-18.2) and 8.1% (95% CI: 6.7-9.8), respectively. MDD was associated with precarious economic situation (OR = 1.83; 95% CI: 1.03-3.23), AD with a precarious job or unemployment of the father (OR = 2.08; 95% CI: 1.04-4.14) and SUD with higher educational level of father (OR = 2.17; 95% CI: 1.28-3.67) or having a paid job (OR = 1.82; 95% CI: 1.06-3.13). "Marked" or "extreme" impairment (score > or =7 for at least one of the domains in the Sheehan scale) was noted for 51.7% of students presenting a PD and was even more frequent in the presence of MDD/AD comorbidity. Only 30.5% of the students with a PD had sought professional help in the past 12 months.

CONCLUSIONS

This study provides new results regarding university students suggesting a link between precarious economic situations and MDD. The frequent impairment arising from PD alongside low rates of help-seeking suggests that PD could be one of the factors in academic failure in first year of university. These results should be used to improve prevention and care of PD in university students in France.

Psychometric properties of the Dominic Interactive in a large French sample

OBJECTIVES

To examine the psychometric properties of the Dominic Interactive (DI) in school-aged children in a different cultural environment than Quebec.

METHODS

In a large French region, 100 schools and 25 children (aged 6 to 11 years) per school were randomly selected. Data were collected using self-administered questionnaires to children (DI), parents (sociodemographic characteristics, mental health services use), and teachers (child school achievement). DI psychometric properties were assessed by examining: the distribution of each DI diagnosis; comorbidity between diagnoses; alpha coefficients measuring internal consistency; and correlates of psychopathologies with sociodemographic status and health care services use. Estimates of DI properties were compared with those from a sample of community children in Quebec.

RESULTS

Complete data were available for 1274 children (54.4%). The internal consistency of each DI diagnosis of the French version was reasonable, with Cronbach's alpha coefficients ranging from 0.62 to 0.89. The psychometric properties and comorbidity were consistent with the version from Quebec.

CONCLUSIONS

The satisfactory psychometric properties of the DI along with other demonstrated advantages of this instrument (children enjoy the activity, parents approve of it, and it is cost-effective) and its cultural adaptability support the consideration of the DI for epidemiologic studies in diverse cultures.

Mental health symptoms in relation to socio-economic conditions and lifestyle factors--a population-based study in Sweden

BACKGROUND

Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990 s. There is a need for a better understanding of the area for planning preventive activities and health care.

METHODS

The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18-84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models.

RESULTS

About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65-74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms.

CONCLUSION

Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

Psychological distress in first year university students: socioeconomic and academic stressors, mastery and social support in young men and women

PURPOSE

Little is known about the role of stressors associated with university life on psychological distress (PD). The aims of this article are to: (1) assess the prevalence of PD among students during their first year of university; (2) study its associations with stressors (socioeconomic and university-related) and protective factors (mastery, social support); and (3) to compare these factors according to gender.

METHODS

Cross-sectional study of a random sample of students aged 18-24 years, in their first year of university in 2005-2006, enrolled in the 6 universities of southeastern France. Standardised questionnaire, by self-administration or telephone interview. Overall, 1,743 students agreed to participate (71.0%).

RESULTS

PD prevalence was estimated at 15.7% (95% CI: 12.9-18.5) among the young men and 33.0% (95% CI: 30.2-35.9) among the young women. Multiple logistic regressions adjusted for social and demographic variables, mode of questionnaire administration, psychiatric history, and recent adverse life events, showed that among men PD was associated with lack of adjustment to the university academic environment (OR = 1.08; 95% CI: 1.00-1.17, P = 0.04), and mastery (OR = 0.73; 95% CI: 0.68-0.79). Among women, the prevalence of PD was associated with medical studies (OR = 2.46; 95% CI: 1.50-4.05), lack of adjustment to the university academic environment (OR = 1.07; 95% CI: 1.03-1.12), mastery (OR = 0.78; 95% CI: 0.75-0.82), and social support (OR = 0.68; 95% CI: 0.54-0.85), with a strong negative statistical interaction between mastery and lack of adjustment.

CONCLUSIONS

This study shows an intermediate prevalence of PD among French first-year university students compared with those observed in university students in other countries. It suggests that PD is related to university-related stressors but failed to find a relation to socioeconomic factors. Risk and protective factors for PD in first-year university students differed somewhat according to gender. However, mastery appeared to have a protective role in both genders. Further research is necessary to confirm these results in other universities and years.

Antonovsky's sense of coherence scale and its relation with quality of life: a systematic review

The aim of this paper is to synthesise findings on the salutogenic concept, sense of coherence (SOC), and its correlation with quality of life (QoL). This study is descriptive and analytic, with a systematic integration of the contemporary knowledge base on the salutogenic research published in 1992-2003. This review includes 458 scientific publications and 13 doctoral theses on salutogenesis. In all, 32 papers had the main objective of investigating the relationship between SOC and QoL. This study is based on scientific publications in eight authorised databases, doctoral theses and available books. The SOC seems to have an impact on the QoL; the stronger the SOC, the better the QoL. Furthermore, longitudinal studies confirm the predictive validity of the SOC for a good QoL. The findings correspond to the core of the Ottawa Charter--that is, the process of enabling people to live a good life. Therefore, a certain possibility to modify and extend the health construct is becoming discernible, implicating a construct including salutogenesis and QoL. The SOC concept is a health resource, influencing QoL.

What makes people decide who to turn to when faced with a mental health problem? Results from a French survey

BACKGROUND

The unequal use of mental health care is a great issue, even in countries with universal health coverage. Better knowledge of the factors that have an impact on the pathway to mental health care may be a great help for designing education campaigns and for best organizing health care delivery. The objective of this study is to explore the determinants of help-seeking intentions for mental health problems and which factors influence treatment opinions and the reliance on and compliance with health professionals' advice.

METHODS

441 adults aged 18 to 70 were randomly selected from the general population of two suburban districts near Paris and agreed to participate in the study (response rate = 60.4%). The 412 respondents with no mental health problems based on the CIDI-SF and the CAGE, who had not consulted for a mental health problem in the previous year, were asked in detail about their intentions to seek help in case of a psychological disorder and about their opinion of mental health treatments. The links between the respondents' characteristics and intentions and opinions were explored.

RESULTS

More than half of the sample (57.8%) would see their general practitioner (GP) first and 46.6% would continue with their GP for follow-up. Mental health professionals were mentioned far less than GPs. People who would choose their GP first were older and less educated, whereas those who would favor mental health specialists had lower social support. For psychotherapy, respondents were split equally between seeing a GP, a psychiatrist or a psychologist. People were reluctant to take psychotropic drugs, but looked favorably on psychotherapy.

CONCLUSION

GPs are often the point of entry into the mental health care system and need to be supported. Public information campaigns about mental health care options and treatments are needed to educate the public, eliminate the stigma of mental illness and eliminate prejudices.

Education, sense of mastery and mental health: results from a nation wide health monitoring study in Norway

BACKGROUND

Earlier studies have shown that people with low level of education have increased rates of mental health problems. The aim of the present study is to investigate the association between level of education and psychological distress, and to explore to which extent the association is mediated by sense of mastery, and social variables like social support, negative life events, household income, employment and marital status.

METHODS

The data for the study were obtained from the Level of Living Survey conducted by Statistics Norway in 2002. Data on psychological distress and psychosocial variables were gathered by a self-administered questionnaire, whereas socio-demographic data were based on register statistics. Psychological distress was measured by Hopkins Symptom Checklist 25 items.

RESULTS

There was a significant association between low level of education and psychological distress in both genders, the association being strongest in women aged 55-67 years. Low level of education was also significantly associated with low sense of mastery, low social support, many negative life events (only in men), low household income and unemployment,. Sense of mastery emerged as a strong mediating variable between level of education and psychological distress, whereas the other variables played a minor role when adjusting for sense of mastery.

CONCLUSION

Low sense of mastery seems to account for much of the association between low educational level and psychological distress, and should be an important target in mental health promotion for groups with low level of education.

Admission of mentally disordered offenders to specialized forensic care in fifteen European Union member states

OBJECTIVE

Despite a high ranking on the public and political agenda, across Europe and all over the world there is a surprising shortage of basic information and evidence on the quantity and quality of services available for mentally disordered or ill offenders, the frequency of cases in specialized forensic facilities or the effectiveness of provided care in the various countries. Against poor evidence the rapid European integration and the strive for models of good practice require valid and reliable international overviews, sound studies and profound analyses of this most controversial issue.

AIMS

To harmonize and give an overview of prevalence and incidence data of persons in forensic psychiatric care available from official sources across fifteen European Union-Member States.

METHOD

Data was gathered and provided by forensic experts from each included country.

RESULTS

Total numbers as well as prevalence and incidence on persons placed or treated under legal forensic regimes vary remarkably across the EU, although a tendency of constantly, but slowly rising rates from 1990 onwards may be concluded from available time series. However, variation supports the hypothesis of a variety of unknown influencing factors, which need to be analysed for each country separately.

CONCLUSIONS

Common EU-wide patterns of psychiatric forensic prevalence or incidence rates can hardly be detected from available administrative data. Results show the necessity for international harmonization of definitions or indicators as a basic requirement for strongly needed further research in this crucial field.

Level of positive mental health in the European Union: results from the Eurobarometer 2002 survey

Background

Few epidemiological studies have focused on the occurrence of positive mental health, and those comparing several countries practically non-existent. This study presents comparative findings of positive mental health in 11 EU countries or regions, based on the Eurobarometer 2002 (autumn) survey.

Method

The sample (n = 10,878) represents the general population, aged 15 or over, of 11 European countries or regions (all old EU Member States except Denmark, Greece, Ireland, Finland and Great Britain which had to be excluded because of poor response rate, less than 45%). The method of opinion survey was applied using face-to-face interviews. The Energy and Vitality Index (EVI) from the SF-36 questionnaire was use as measure of positive mental health.

Results

Overall, there were between-country differences in the gender- and age-adjusted EVI mean scores. In general, poorer mental health was found in women, older age groups, those in poor economic position and those experiencing weak social support.

Conclusion

Methodological biases cannot be fully excluded, and thus, one has to take the presented results with certain caution, especially when comparing the results from the different countries. On the other hand, the results on the determinants of positive mental health are in concordance with most previous studies.