Age, period, and cohort effects in psychological distress in the United States and Canada

Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage

PURPOSE

Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress.

METHODS

We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models.

RESULTS

There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status.

CONCLUSION

The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.

An integrative literature review of birth cohort and time period trends in adolescent depression in the United States

PURPOSE

The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022.

METHODS

We conducted an integrative systematic literature review. Three reviewers participated at different stages of article review. Of the 2234 articles identified in three databases (Pubmed, ProQuest Central, Ebscohost), 10 met inclusion criteria (i.e., adolescent aged United States populations, included information about birth cohort and survey year, focused on depressive symptoms/disorders).

RESULTS

All 10 articles observed increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, declining mental health stigma, increased treatment, and, in more recent years, the COVID-19 pandemic.

CONCLUSIONS

Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991 to 2020. Mechanisms driving this increase are still unknown. Research to identify these mechanisms is needed to inform depression screening and intervention efforts for adolescents.

Gender differences in the prevalence of mental distress in East and West Germany over time: a hierarchical age-period-cohort analysis, 2006-2021

PURPOSE

Mental distress has become a major public health concern. Temporal trends in psychological distress are complex and depend on numerous factors. In this study, we examined age-period-cohort effects for mental distress including gender and German region over a 15 years' time span.

METHODS

Data on mental distress from ten cross-sectional surveys of the general German population, covering the years from 2006 to 2021, was used. Hierarchical age-period-cohort analyses including gender and German region as predictors were performed to disentangle age, period, and cohort effects. The Patient Health Questionnaire-4 was used as a brief screener for mental distress.

RESULTS

We found significant period and cohort effects, with peek values for mental distress in the years 2017 and 2020 and for the oldest birth cohort (born before 1946). Age did not affect mental distress when cohort- and period effects as well as gender and German region were considered. An interaction effect for gender and the German region was found. Women in West Germany reported significantly higher mental distress compared to women in East Germany. Compared to men, women reported the highest prevalence in both regions.

CONCLUSION

Important political events as well as major crises can lead to an increase of mental distress in societies. Furthermore, an association between birth cohort and mental distress could be linked to socialization effects of that certain time, causing traumatic experiences or a specific coping style within this cohort group. Prevention and intervention strategies could benefit from acknowledging structural differences linked to period and cohort effects.

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

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

Unpacking Psychological Vulnerabilities in Deaths of Despair

Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.

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

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

Age, Period, and Cohort Trends in Perceived Mental Health Treatment Need and Differences by Mental Health Severity in the United States, 2008-2019

Identifying age, period, and cohort trends in perceived mental health treatment need over time by mental illness severity is important to identify where to focus early intervention efforts. We included adults who did not report receiving past-year mental health treatment in the 2008-2019 National Survey on Drug Use and Health (N = 364,676). Hierarchical age-period-cohort models were used to assess perceived mental health treatment need, adjusting for demographics stratified by mental illness severity (none, any but not severe [AMI], severe [SMI]). Median odds ratios estimated cohort and period variance. Cohort effects explained a significant portion of the variance over time; period effects were minimal. Perceived mental health treatment need was highest among adults with AMI from recent birth cohorts (2000-2002: β = 1.12; 95% CI = 0.96, 1.28). Efforts are needed to address increases in perceived mental health treatment need in younger birth cohorts, such as removing structural barriers (e.g., healthcare system barriers).

[Mental health surveillance at the Robert Koch Institute - strategies for monitoring the mental health of the population]

The continuous and systematic surveillance of the health of populations is fundamental for effective public health practice. In light of the growing importance of mental health within population health, a Mental Health Surveillance for Germany is being established at the Robert Koch Institute. Its aim is to continually provide reliable information on the current state and development of the mental health of the population.Three surveillance strategies are currently being pursued: 1) Regular comprehensive assessments aim to describe the mental health status of the population using a wide range of indicators and data sources and to observe long-term developments. They build on existing work in epidemiology and health services research. 2) High-frequency monitoring of a selection of indicators is used for the early detection of trends. 3) A continuous literature review collates current findings on mental health developments in the COVID-19 pandemic on a monthly basis. The latter two strategies were implemented in response to new information needs in the pandemic.This paper describes and discusses these three strategies and their functions, limitations, and potential for development. Their results are communicated through different forms of reporting and serve to identify needs for action and research in public mental health. The further development and long-term operation of the Mental Health Surveillance as a whole has the potential to facilitate the achievement of public mental health objectives and to contribute on different levels to the improvement of population health.

A Parent-Targeted Group Intervention for Pediatric Pain Delivered In-Person or Virtually: Feasibility, Acceptability, and Effectiveness

OBJECTIVES

Parents play integral roles in their youth's chronic pain and can experience elevated distress related to caregiving. This study examined a cognitive-behavior therapy-based parent-targeted group intervention, including understudied/novel resilience/risk (eg, distress, parenting self-regulation), and compared the effect of in-person versus virtual delivery format.

HYPOTHESES

(1) Adequate feasibility and acceptability (enrolment>33%, attendance >60%, attrition <25%, satisfaction ratings >90%), with higher indicators of feasibility in the virtual groups; (2) Significant improvements in parent psychological flexibility, protectiveness, distress, and parenting self-regulation at posttreatment that were maintained at follow-up, with no difference between delivery type.

METHODS

Parents were enroled from an outpatient pediatric chronic pain clinic and participated in the group intervention in-person or virtually; questionnaires were completed at baseline, posttreatment, and 3-month follow-up.

RESULTS

Enrolment (55% in-person, 65% virtual) and attendance (86% in-person, 93% virtual) were higher, and attrition was lower than expected (4% in-person, 7% virtual). Satisfaction was high (4.95/5 in-person, 4.85/5 virtual); on written feedback, parents enjoyed connecting with other parents (27/56, 48%) the most. The least preferred were the virtual format (5/36, 14%) and timing of the group (6/52, 12%). There were no differences between delivery formats in feasibility/acceptability. The intervention significantly improved parents' psychological flexibility, protectiveness, distress, and parenting self-regulation over time. A small group difference favored the in-person format for psychological flexibility, and an interaction effect for parenting self-regulation was found.

DISCUSSION

This standalone parent-targeted group intervention had positive effects on parent outcomes delivered either in-person or virtually.

Loneliness, ageism, and mental health: The buffering role of resilience in seniors

Introduction

Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.

Aim

To assess the potential mediator role of resilience between the effects of ageism and loneliness on PD in seniors.

Methods

A sample of 349 Portuguese seniors aged 60 years and over was collected through an online survey and during the COVID-19 pandemic period. Seniors completed the Kessler Psychological Distress Scale (K6), the Short-Form of UCLA Loneliness Scale (USL-6), the Ambivalent Ageism Scale (AAS) and the Connor-Davidson Resilience Scale (CD-RISC-10). A mediation analysis model was developed with resilience as a mediating variable.

Results

There were moderate to high levels of PD and moderate levels of ageism, loneliness and resilience. Resilience fully mediated the effect of ageism on PD and partially mediated the effect of loneliness on PD.

Conclusions

Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.

Prevalence of internalizing disorders, symptoms, and traits across age using advanced nonlinear models

BACKGROUND

Most epidemiological studies show a decrease of internalizing disorders at older ages, but it is unclear how the prevalence exactly changes with age, and whether there are different patterns for internalizing symptoms and traits, and for men and women. This study investigates the impact of age and sex on the point prevalence across different mood and anxiety disorders, internalizing symptoms, and neuroticism.

METHODS

We used cross-sectional data on 146 315 subjects, aged 18-80 years, from the Lifelines Cohort Study, a Dutch general population sample. Between 2012 and 2016, five current internalizing disorders - major depression, dysthymia, generalized anxiety disorder, social phobia, and panic disorder - were assessed according to DSM-IV criteria. Depressive symptoms, anxiety symptoms, neuroticism, and negative affect (NA) were also measured. Generalized additive models were used to identify nonlinear patterns across age, and to investigate sex differences.

RESULTS

The point prevalence of internalizing disorders generally increased between the ages of 18 and 30 years, stabilized between 30 and 50, and decreased after age 50. The patterns of internalizing symptoms and traits were different. NA and neuroticism gradually decreased after age 18. Women reported more internalizing disorders than men, but the relative difference remained stable across age (relative risk ~1.7).

CONCLUSIONS

The point prevalence of internalizing disorders was typically highest between age 30 and 50, but there were differences between the disorders, which could indicate differences in etiology. The relative gap between the sexes remained similar across age, suggesting that changes in sex hormones around the menopause do not significantly influence women's risk of internalizing disorders.

Polygenic risk scores for schizophrenia and major depression are associated with socio-economic indicators of adversity in two British community samples

Schizophrenia (SCZ) and major depressive disorder (MDD) are complex psychiatric disorders which contribute substantially to the global burden of disease. Both psychopathologies are heritable with some genetic overlap between them. Importantly, SCZ and MDD have also been found to be associated with environmental risk factors. However, rather than being independent of genetic influences, exposure to environmental risk factors may be under genetic control, known as gene-environment correlation (rGE). In this study we investigated rGE in relation to polygenic risk scores for SCZ and MDD in adults, derived from large genome-wide association studies, across two different British community samples: Understanding Society (USoc) and the National Child Development Study (NCDS). We tested whether established environmental risk factors for SCZ and/or MDD are correlated with polygenic scores in adults and whether these associations differ between the two disorders and cohorts. Findings partially overlapped between disorders and cohorts. In NCDS, we identified a significant correlation between the genetic risk for MDD and an indicator of low socio-economic status, but no significant findings emerged for SCZ. In USoc, we replicated associations between indicators of low socio-economic status and the genetic propensity for MDD. In addition, we identified associations between the genetic susceptibility for SCZ and being single or divorced. Results across both studies provide further evidence that the genetic risk for SCZ and MDD were associated with common environmental risk factors, specifically MDD's association with lower socio-economic status.

The Contribution of Health Behaviors to Depression Risk Across Birth Cohorts

BACKGROUND

More recent birth cohorts are at a higher depression risk than cohorts born in the early 20th century. We aimed to investigate to what extent changes in alcohol consumption, smoking, physical activity, and obesity contribute to these birth cohort variations.

METHODS

We analyzed panel data from US adults born 1916-1966 enrolled in the Health and Retirement Study (N = 163,760 person-years). We performed a counterfactual decomposition analysis by combining age-period-cohort models with g-computation. We thereby compared the predicted probability of elevated depressive symptoms (CES-D 8 score ≥3) in the natural course to a counterfactual scenario where all birth cohorts had the health behaviors of the 1945 birth cohort. We stratified analyses by sex and race-ethnicity.

RESULTS

We estimated that depression risk of the 1916-1949 and 1950-1966 birth cohort would be on average 2.0% (-2.3 to -1.7) and 0.5% (-0.9 to -0.1) higher with the alcohol consumption levels of the 1945 cohort. In the counterfactual with the 1945 BMI distribution, depression risk is on average 2.1% (1.8 to 2.4) higher for the 1916-1940 cohorts and 1.8% (-2.2 to -1.5) lower for the 1950-1966 cohorts. We find no cohort variations in depression risk for smoking and physical activity. The contribution of alcohol is more pronounced for Whites than for other race-ethnicity groups, and the contribution of BMI more pronounced for women than for men.

CONCLUSION

Increased obesity levels were associated with exacerbated depression risk in recent birth cohorts in the United States, while drinking patterns only played a minor role.

The Birth Cohorts Difference in Depression

Cohort effect refers to the social phenomenon that a certain event manifests differently depending on a group that is born in the same year or a similar time period. It is important to understand adolescents' depressive symptoms vary from generation to generation. We studied the changes of the depressive symptoms during the eighth to tenth grade and examined the difference between the 1997-birth cohort and 2000-birth cohort. The study included 2,070 students (2014-2016 of 2000-birth-cohort data, from 8th to 10th grade, mean age = 12.95-14.95 years) and 2,278 students (2011-2013 of 1997-birth-cohort data, from 8th to 10th grade, mean age = 12.90-14.90 years) who participated in the Korean Children and Youth Panel Survey. Latent growth curve modeling and multi-group analysis were used to compare depressive symptom trajectories between cohorts. The result of comparing the depression levels of the cohorts showed the initial values and change rates verifying the presence of a significant cohort effect-the depression level of the 2000-birth-cohort (initial value = 17.75) was significantly lower than the depression level of the 1997-birth-cohort (initial value = 19.49). This study has significance in that adolescents' depression has both age and cohort effects. It is speculated that the cohort effect may have been impacted by two major events: The Children Problem-Behavior Screening Questionare Test (mental health screening test), implemented nationwide in 2012, and the Sewol Ferry Disaster, which occurred in 2014. Based on the results, suggestions for future research were discussed.

Job loss and psychological distress during the COVID-19 pandemic: Longitudinal Analysis from residents in nine predominantly African American low-income neighborhoods

While psychological distress is a common sequelae of job loss, how that relationship continued during the COVID-19 pandemic is unclear, for example, given higher health risk to working due to disease exposure. This paper examines changes in psychological distress depending on job loss among a cohort of randomly selected residents living in nine predominantly African American low-income neighborhoods in Pittsburgh PA across four waves between 2013 and 2020. Between 2013 and 2016, we found an increase in psychological distress after job loss in line with the literature. In contrast, between 2018 and 2020 we found change in psychological distress did not differ by employment loss. However, residents who had financial concerns and lost their jobs had the largest increases in psychological distress, while residents who did not have serious financial concerns-potentially due to public assistance-but experienced job loss had no increase in distress, a better outcome even than those that retained their jobs. Using partial identification, we find job loss during the pandemic decreased psychological distress for those without serious financial concerns. This has important policy implications for how high-risk persons within low-income communities are identified and supported, as well as what type of public assistance may help.

Psychological Distress Among Asian Indians and Non-Hispanic Whites in the United States

Introduction

The prevalence of psychological distress (PD) among Asian Indians is unknown. This study estimated and compared moderate-serious PD in Asian Indians and non-Hispanic Whites (NHWs) in the United States.

Methods

We used a cross-sectional design using the National Health Interview Survey (2012-2017). Adult (age >18 years) NHWs and Asian Indians (N=2,218) were included. PD was measured using the six-item Kessler (K6) scale. We used multivariable logistic regression to determine the association of Asian Indian ethnicity with PD.

Results

In the analysis, 19.9% of NHWs and 11.0% of Asian Indians reported moderate-serious PD. Asian Indians were less likely to report PD in both unadjusted (unadjusted odds ratio=0.50; 95% confidence interval [CI]=0.42-0.58) and fully adjusted (adjusted odds ratio=0.7; 95% CI 0.59-0.82) models.

Conclusions

Asian Indians had a lower prevalence of PD than NHWs, likely due to multiple protective factors such as high socioeconomic status and lower multimorbidity.

Mental distress among young adults in Great Britain: long-term trends and early changes during the COVID-19 pandemic

PURPOSE

In Great Britain, few studies documented mental health trends in young adults in the years preceding 2020, the mental health dimensions affected, and how these compare with changes observed during the COVID-19 pandemic.

METHODS

Long-term trends in mental health among 16-34 year old men and women between 1991 and 2018, and changes between 2018-19 and July-September 2020 were examined using all waves from the British Household Panel Study (1991-2008), the UK Household Longitudinal Study (2009-20), and the first five UKHLS COVID-19 waves administered in April, May, June, July, and September 2020. Findings are based on the GHQ-12 continuous score (0-36), clinically significant cases (4 + /12) and severe cases (7 + /12) for mental distress, and item endorsements.

RESULTS

Between 1991 and 2018, the prevalence of cases (4 + /12) increased from 14-22% to 19-32% across groups. Increases were largest in women aged 16-24. In April 2020, the risk of caseness (4 + /12) increased across groups by 55% to 80% compared to the 2018-19 baseline. This increase, however, rapidly diminished over time: in July-September 2020, there was only a higher risk of caseness (4 + /12) in men aged 25-34 (prevalence ratio = 1.29, 95% CI 1.01-1.65) compared to the 2018-19 baseline.

CONCLUSION

Whereas distress surged in April 2020, its return to pre-pandemic levels by September 2020 highlights the nuanced impact that the pandemic may have over time. Given the magnitude of the decline in mental health over the past decade, attention must be given to young adults once the pandemic ends.

Psychological distress from early adulthood to early old age: evidence from the 1946, 1958 and 1970 British birth cohorts

BACKGROUND

Existing evidence on profiles of psychological distress across adulthood uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to study the profile of psychological distress within the same individuals from early adulthood to early old age across three British birth cohorts.

METHODS

We used data from three British birth cohorts: born in 1946 (n = 3093), 1958 (n = 13 250) and 1970 (n = 12 019). The profile of psychological distress - expressed both as probability of being a clinical case or a count of symptoms based on comparable items within and across cohorts - was modelled using the multilevel regression framework.

RESULTS

In both 1958 and 1970 cohorts, there was an initial drop in the probability of being a case between ages 23-26 and 33-34. Subsequently, the predicted probability of being a case increased from 12.5% at age 36 to 19.5% at age 53 in the 1946 cohort; from 8.0% at age 33 to 13.7% at age 42 in the 1958 cohort and from 15.7% at age 34 to 19.7% at age 42 in the 1970 cohort. In the 1946 cohort, there was a drop in the probability of caseness between ages 60-64 and 69 (19.5% v. 15.2%). Consistent results were obtained with the continuous version of the outcome.

CONCLUSIONS

Across three post-war British birth cohorts midlife appears to be a particularly vulnerable phase for experiencing psychological distress. Understanding the reasons for this will be important for the prevention and management of mental health problems.

An Age-Period-Cohort Approach to Analyse Late-Life Depression Prevalence in Six European Countries, 2004-2016

Late-life depression is a condition that affects an ever-growing share of the population in ageing societies. While depression prevalence varies across countries for a myriad of reasons, generational factors, expressed in the shared experience of birth cohorts, may also play a part in such differentials. This paper describes the presence of age, period, and cohort (APC) effects in late-life depression prevalence trends (for adults aged 50 and above) for selected countries in Europe, using the Survey of Health and Ageing and Retirement of Europe (SHARE). We analysed six countries during the 2004-2016 period: Denmark, Sweden, and Germany, with a lower baseline prevalence, and Italy, Spain, and France, with a higher baseline prevalence. By applying a set of APC statistical models to visualise linear and nonlinear effects, we found that all countries followed a J-shaped curve when describing the transversal and longitudinal age trajectories of late-life depression. We also found a combination of nonlinear effects present in Germany, France and Sweden in males, indicating that younger male cohorts had a higher relative risk of depression. In females, we found nonlinear cohort effects, indicating that younger and older cohorts presented a higher risk of depression in Sweden and Germany and a lower risk in Spain. The presence of an increased risk for younger male cohorts may be indicative of a new trend in some countries, which may reduce the sex gap in prevalence. Future analysis should focus on the causes and mechanisms that lead to differential risks across cohorts.

Transition milestones and life satisfaction at ages 25/26 among cohorts born in 1970 and 1989-90

The transition to adulthood has become more prolonged, complex, and risk-laden over the past two decades. These changes may contribute to the decline in wellbeing observed among young adults. We test the role of reaching different transition milestones on life satisfaction by ages 25-26 among men and women born 20 years apart in 1970 and 1989-90, using data from the 1970 British Cohort (men n = 3764, women n = 4568) and Next Steps (men n = 3246, women n = 4281) studies. We regressed life satisfaction on education, housing tenure, cohabitation with parents, economic activity, relationship status, and parenthood, and tested the role of changes in the prevalence and association of milestones in explaining cohort differences in life satisfaction using decomposition analyses. Home ownership, full-time employment, cohabitation with a partner, and marriage were robust predictors of life satisfaction in both cohorts. Comparing cohorts, the association of milestones with life satisfaction was stable among men but differed among women: in the later-born cohort, women no longer benefitted from higher education and further suffered from not being in full-time employment. The findings shed new light on the relationships between young adult transitions and life satisfaction during the third decade of life. These support the argument that decreases in wellbeing may be driven by changes in the prevalence and meaning of these milestones over time, particularly among women.

Age, Period, and Cohort Effects of Internalizing Symptoms Among US Students and the Influence of Self-Reported Frequency of Attaining 7 or More Hours of Sleep: Results From the Monitoring the Future Survey 1991-2019

Adolescent internalizing symptoms have increased since 2010, whereas adequate sleep has declined for several decades. It remains unclear how self-reported sleep attainment has affected internalizing-symptoms trends. Using 1991-2019 data from the Monitoring the Future Study (n ~ 390,000), we estimated age-period-cohort effects in adolescent internalizing symptoms (e.g., loneliness, self-esteem, self-derogation, depressive affect) and the association with yearly prevalence of a survey-assessed, self-reported measure of attaining ≥7 hours of sleep most nights. We focused our main analysis on loneliness and used median odds ratios to measure variance in loneliness associated with period differences. We observed limited signals for cohort effects and modeled only period effects. The feeling of loneliness increased by 0.83% per year; adolescents in 2019 had 0.68 (95% CI: 0.49, 0.87) increased log odds of loneliness compared with the mean, which was consistent by race/ethnicity and parental education. Girls experienced steeper increases in loneliness than boys (P < 0.0001). The period-effect median odds ratio for loneliness was 1.16 (variance = 0.09; 95% CI: 0.06, 0.17) before adjustment for self-reported frequency of getting ≥7 hours sleep versus 1.07 (variance = 0.02; 95% CI: 0.01, 0.03) after adjustment. Adolescents across cohorts are experiencing worsening internalizing symptoms. Self-reported frequency of <7 hours sleep partially explains increases in loneliness, indicating the need for feasibility trials to study the effect of increasing sleep attainment on internalizing symptoms.

Time trends and disparities in anxiety among adolescents, 2012-2018

PURPOSE

Prior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups.

METHODS

Weighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012-2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups.

RESULTS

The prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4-34.9) in 2012 to 44% (95% CI 43.2-44.7) in 2018 (OR for trend = 1.07, P for trend < 0.001). The trend remained significant after adjusting for known confounds (AOR for trend = 1.07, P for trend < 0.001). Anxiety increased significantly for several subgroups and widening disparities were documented among females relative to males (P < 0.001), and sexual minority youth relative to heterosexual youth (P = 0.003). In addition, Black youth did not increase at the same swift rate as White youth over the study period (P < 0.001).

CONCLUSION

This study reports recent data on anxiety time trends and finds that among a geographically representative sample of adolescents, anxiety prevalence is rising. Findings provide new evidence documenting increased anxiety prevalence among sexual minority youth relative to their peers. Results highlight the need to bolster public health interventions focused on adolescent mental health, with tailored interventions for vulnerable groups.

How is the distribution of psychological distress changing over time? Who is driving these changes? Analysis of the 1958 and 1970 British birth cohorts

AIMS

The main objective of this study was to investigate distributional shifts underlying observed age and cohort differences in mean levels of psychological distress in the 1958 and 1970 British birth cohorts.

METHODS

This study used data from the 1958 and 1970 British birth cohorts (n = 24,707). Psychological distress was measured by the Malaise Inventory at ages 23, 33, 42 and 50 in the 1958 cohort and 26, 34, 42 and 46-48 in the 1970 cohort.

RESULTS

The shifts in the distribution across age appear to be mainly due to changing proportion of those with moderate symptoms, except for midlife (age 42-50) when we observed polarisation in distress- an increase in proportions of people with no symptoms and multiple symptoms. The elevated levels of distress in the 1970 cohort, compared with the 1958 cohort, appeared to be due to an increase in the proportion of individuals with both moderate and high symptoms. For instance, at age 33/34 42.3% endorsed at least two symptoms in the 1970 cohort vs 24.7% in 1958, resulting in a shift in the entire distribution of distress towards the more severe end of the spectrum.

CONCLUSIONS

Our study demonstrates the importance of studying not only mean levels of distress over time, but also the underlying shifts in its distribution. Due to the large dispersion of distress scores at any given measurement occasion, understanding the underlying distribution provides a more complete picture of population trends.

Trends in young adults' mental distress and its association with employment: Evidence from the Behavioral Risk Factor Surveillance System, 1993-2019

Few have examined how employment is linked to trends in mental health among young adults across economic contexts in more recent years. To better understand the burden of non-employment and mental distress in this age group, this study examines the association of short-term (<1 year) and long-term (1+ year) out-of-work status with mental health across three recessions among young men and women ages 18-34. We report sex-stratified estimates of frequent mental distress (FMD), out-of-work status, and their association through adjusted prevalence ratios across 27 cycles of the U.S. Behavioral Risk Factor Surveillance System (1993-2019). We found that FMD increased by 112% in men and 120% in women between 1993 and 2019, with 55% (men) and 44% (women) of this increase occurring between 2016 and 2019. Short-term (PR men = 1.53, 95%CI 1.46-1.61; PR women = 1.34, 95%CI 1.29-1.40) and long-term (PR men = 1.61, 95%CI 1.51-1.71; PR women = 1.28, 95%CI 1.22-1.34) out-of-work status were each associated with a higher risk of FMD during this period. The magnitude of associations between long-term out-of-work status and FMD significantly varied across cycles, and was strongest after the 1991 recession in men and the 2008 recession in women. Whereas employment represents an important determinant of mental health among young adults, particularly during economic downturns, it did not suffice to explain the rise in mental distress in this age group in more recent years.

Prediction of Probable Major Depressive Disorder in the Taiwan Biobank: An Integrated Machine Learning and Genome-Wide Analysis Approach

In light of recent advancements in machine learning, personalized medicine using predictive algorithms serves as an essential paradigmatic methodology. Our goal was to explore an integrated machine learning and genome-wide analysis approach which targets the prediction of probable major depressive disorder (MDD) using 9828 individuals in the Taiwan Biobank. In our analysis, we reported a genome-wide significant association with probable MDD that has not been previously identified: FBN1 on chromosome 15. Furthermore, we pinpointed 17 single nucleotide polymorphisms (SNPs) which show evidence of both associations with probable MDD and potential roles as expression quantitative trait loci (eQTLs). To predict the status of probable MDD, we established prediction models with random undersampling and synthetic minority oversampling using 17 eQTL SNPs and eight clinical variables. We utilized five state-of-the-art models: logistic ridge regression, support vector machine, C4.5 decision tree, LogitBoost, and random forests. Our data revealed that random forests had the highest performance (area under curve = 0.8905 ± 0.0088; repeated 10-fold cross-validation) among the predictive algorithms to infer complex correlations between biomarkers and probable MDD. Our study suggests that an integrated machine learning and genome-wide analysis approach may offer an advantageous method to establish bioinformatics tools for discriminating MDD patients from healthy controls.

Importance of personality and coping expectancy on patient-reported hearing disability, quality of life and distress level: a study of patients referred to an audiology service

Purpose

According to the World Health Organization (WHO), hearing loss (HL) affects up to 15% of the world’s adult population. Coping and personality are hypothesized to underlie quality of life (QoL) and distress scores. We aimed to study the importance of personality and coping in persons with HL for self-reported hearing disability, QoL, and distress.

Methods

A cross-sectional survey was carried out, including one hundred and fifty-eight adults seeking hearing aids. Pure-tone average hearing thresholds (PTA) were determined for each ear. A revised version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) served as a measure of self-reported hearing disability. Further, the generic part of the European Organization for Research and Treatment (EORTC) QoL questionnaire and the General Health Questionnaire (GHQ) (distress measure) were answered. Levels of neuroticism and the Theoretically Originated Measure of the Cognitive Activation Theory of Stress (TOMCATS) coping expectancy were determined.

Results

Hearing disability was determined by PTA (better ear) and level of neuroticism. Distress and QoL were determined by neuroticism and coping.

Conclusion

More neuroticism was associated with worse outcome for the variables hearing disability, distress, and QoL. Helplessness and hopelessness were associated with worse hearing disability, increased distress, and lowered QoL. Patient reported hearing disability was also associated with PTA (better ear). There is a need to investigate further the associations between hearing disability and QoL to psychosocial parameters.

Disentangling trait, occasion-specific, and accumulated situational effects of psychological distress in adulthood: evidence from the 1958 and 1970 British birth cohorts

BACKGROUND

The trajectories of psychological distress differ between individuals, but these differences can be difficult to understand because the measures contain both consistent and situational features; however, in longitudinal studies these sources of information can be disentangled. In addition to occasion-specific features, interindividual differences can be decomposed into two sources of information: trait and carry-over effects between neighboring occasions that are not related to the trait (i.e. accumulated situational effects).

METHODS

To disentangle these three sources of variance throughout adulthood, the consistency (trait and accumulated situational effects) and occasion specificity of nine indicators of psychological distress from the Malaise Inventory were examined in two birth cohorts, the 1958 National Child Development Study (NCDS58), and the 1970 British Cohort Study (BCS70).

RESULTS

The scale was administered at ages 23, 33, 42, and 50 in NCDS58 (n = 7147), and at ages 26, 30, 34, and 42 in BCS70 (n = 6859). For each psychological symptom, more variance was consistent than occasion-specific. The majority of the consistency was due to trait variance as opposed to accumulated situational effects, indicating that an individual predisposed to be distressed at the beginning of the study remained more likely to be distressed over the whole period. Symptoms of rage were notably more consistent among males than females in both cohorts (78.1% and 81.3% variance explained by trait in NCDS58 and BCS70, respectively), and among females in the NCDS58 (69%).

CONCLUSIONS

Symptoms of psychological distress exhibited high stability throughout adulthood, especially among men, due mostly to interindividual trait differences.

An age-period-cohort analysis for prevalence of common psychiatric disorders in Japan, 1999-2017

PURPOSE

This study aimed to analyze the prevalence of common psychiatric disorders in Japan via an age-period-cohort (APC) analysis.

METHODS

Data were used on the prevalence of schizophrenia, schizotypal, and delusional disorders; mood [affective] disorders (mood disorders, hereafter); and neurotic, stress-related, and somatoform disorders from the 1999-2017 Patient Survey in Japan. The age group was defined as 20-89 years with 5-year increments; the cohort was assigned for each age group of each year with a 1-year shift. A Bayesian APC analysis was used to decompose changes in prevalence into three effects: age, period, and cohort.

RESULTS

The APC analysis revealed that the peaks of age effect varied among sexes and diseases. The period effects for all the diseases showed increasing trends over the analyzed years. Although the cohort effect for the prevalence of schizophrenia, schizotypal, and delusional disorders increased until the 1960s, it decreased afterwards. On the other hand, the cohort effects for the prevalence of mood disorders and neurotic, stress-related, and somatoform disorders increased from around the 1950s, and it indicates the prevalence increased particularly in young ages over the years. Also, the trends of each effect were relatively similar between mood disorders and neurotic, stress-related, and somatoform disorders.

CONCLUSION

Increase in public awareness and psychological stress associated with a change in a social environment is thought to affect the period and cohort effects on the prevalence of mood disorders and neurotic, stress-related, and somatoform disorders.

Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability sample

During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956-1963), visibility (born 1974-1981), and equality (born 1990-1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors-both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities.

Applying Structural Equation Modeling to Measure Violence Exposure and Its Impact on Mental Health: Malawi Violence Against Children and Young Women Survey, 2013

This study examines exposure to multiple forms of violence among Malawian children and youth and their association with mental health outcomes. The Malawi Violence Against Children and Young Women Survey was conducted among a nationally representative sample of males and females aged 13 to 24 years (n = 2,162) in Malawi in 2013. The experience of sexual, physical, and emotional violence prior to age 18 and during the past 12 months and associated health outcomes were ascertained using a comprehensive interview. Latent factors of sexual violence, physical violence, and emotional violence as well as psychological distress were constructed. We examined whether the experience of violence was related to psychological distress after controlling for age and gender. Violence exposure prior to age 18 (early life) and during the past 12 months (proximal) were valid indicators for a latent factor representing overall lifetime violence exposure. Females were more likely to experience sexual violence, whereas males were more likely to experience physical violence. Experience of any type of violence decreased with age whereas experience of psychological distress increased with age. Current psychological distress was directly associated with exposure to sexual and emotional violence recently or during childhood. Exposure to multiple forms of violence during lifetime was related to two to seven folds higher odds of experiencing psychological distress compared with those who had never experienced violence. Future intervention strategies should address three forms of violence against children simultaneously in light of the associated adverse mental health outcomes.

Examining Mental Health Differences Between Transgender, Gender Nonconforming, and Cisgender Young People in British Columbia

Foundry is an integrated service network delivering services to young people across British Columbia, Canada. To better understand the needs of transgender and gender nonconforming young people accessing Foundry-this study compares rates of mental health distress between transgender and gender nonconforming young people and cisgender young people accessing services and examines the extent to which race may have amplified the association between transgender and gender nonconforming identity and mental health distress. We analyzed the difference using a two-sample t-test. We used stratified simple linear regression to test the association of race with transgender and gender nonconforming identity and mental health distress. Participants were recruited from a network of community health centers in British Columbia, Canada. The quantitative sample (n = 727) had a mean age of 21 years (SD = 2), 48% were non-white, 51% were white, and 77% were from Metro Vancouver. Compared to cisgender young people, transgender and gender nonconforming young people reported significantly higher levels of mental health distress. Transgender and gender nonconforming youth were more distressed than cisgender youth across both race strata but non-white transgender and gender nonconforming young people were not more distressed than white transgender and gender nonconforming young people. The findings from this study emphasize the need for increased education and understanding of transgender and gender nonconforming concepts and health concerns as well as on promoting intersectoral collaboration of social services organizations beyond simply health care.

Secular trends in adolescents' diagnosed health status and healthcare consultation: examinations of Canadian national surveys from 2007 to 2016

OBJECTIVES

The objective of this study was to investigate secular trends in adolescent health status and healthcare consultations.

STUDY DESIGN

The design of this study is cross-sectional comparisons of population survey outcomes.

METHODS

Canadian national population data from 2007 to 2016 (T1 N = 14,223; T2 N = 14,247; T3 N = 13,532; T4 N = 13,184; T5 N = 11,122; Total N = 66,308) were examined to find trends in health diagnosis (chronic illnesses and mental disorders) and healthcare consultation (general health practitioners and mental health professionals). Controlling demographics, Multivariate analysis of covariances (MANCOVAs) and correlations were carried out to compare differences by age group (A1: 12-14 years N = 25,180; A2: 15-17 years N = 25,825; A3: 18-19 years N = 15,303) and gender (girls N = 32,388; boys N = 33,920) across survey years.

RESULTS

Steady increases were found in diagnosed mental disorders and consultations with a mental health professional (MP) for girls, while chronic illnesses remained stable and general practitioner consultations declined for all adolescents over these years. Gender disparity in MP consultations grew with age, much more in recent years, whereas chronic illness diagnoses curved down for all in midadolescence. More integrated relations between health status and healthcare utilization were noted in T5 than in T1.

CONCLUSIONS

Differential secular trends were shown for adolescent physical versus mental health statuses and relevant healthcare consultations. Although girls' and older adolescents' mental health declined over the years, a positive direction was also found for improved awareness of mental health.

Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students

Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.

Age, sex and period estimates of Australia's mental health over the last 17 years

OBJECTIVE

Describing the long-term mental health of Australians is limited as many reports rely on cross-sectional studies which fail to account for within-person changes and age-related developmental processes which may bias estimates which ignore these phenomena. We examined the 17-year trajectories of mental health in 27,519 Australian adults.

METHODS

Household panel data of 27,519 participants aged 18 years and over from the Household, Income and Labour Dynamics in Australia Survey provided at least one observation of mental health over a 17-year period from 2001. On average, participants reported 7.6 observations. Mental Health was assessed annually using the Short-Form Health Survey-36 mental health scale.

RESULTS

Over time, there were only very small changes in mental health and only for the youngest and oldest adults. Over time, there was consistent evidence for better metal health with increasing age, although for the very old, there appear to be substantial declines. These patterns were consistent between sex. In line with an existing literature, males reported better mental health over life span, although the declines of mental health in very-late-life are particularly pronounced for males.

CONCLUSION

Decline in mental health was only reported by the youngest and oldest respondents, and was notable only in the last 4-5 years. However, the magnitude of the decline was small and further follow-up will be needed to determine whether this is a trend of substantive declining mental health for these specific age cohorts. In contrast, the more consistent finding is that there has been no substantive change in the level of mental health in Australia over the last 17 years. Analysis of the mental health trajectories of baseline age-cohorts confirmed that age differences are consistent over time.

Associations between demographic factors and psychological distress among Chinese residents in Hong Kong: beyond socioeconomic classes

Most studies highlighted the association between psychological distress and socioeconomic status (SES). There were weaker explanations for distress found in the middle classes, especially in Asian countries. We conducted a questionnaire survey with 1626 adult Chinese primary-care attenders from 13 private and 6 public clinics in different districts of Hong Kong. Their demographic background and distress level measured by GHQ-12 were analysed. We found that respondents with younger age, better education, and lower income were more likely to be distressed. In a multiple logistic regression model, age and income, but not education, were significant predictors for distress. Highest rates of distress were found among the unemployed (45.5%) and the students (37.1%), followed by service workers and shop sales workers (33.0%), associate professionals (32.0%), and clerks (29.2%). Craftworkers (9.1%), plant and machine operators (11.5%), and retired people (12.8%) were least likely to be distressed, followed by professionals (21.0%). Apart from SES, the findings suggest that young age, academic and job stressors, and low self-esteem are significant factors for distress. These factors may be intensified in a Chinese context by peer comparison resulting in a state of relative deprivation.

Cohort effects associated with reduced sleep duration in adolescents

OBJECTIVE

The purpose of this study is to examine how the sleep duration changes during adolescence across the seventh, eighth, ninth, and 10th grade periods, and to determine whether there is a difference between the cohorts.

METHOD

For these purposes, we used the latent growth curve modeling and the multi-group analysis involving 2081 students (2000-birth cohort data) and 2254 students (1997-birth cohort data) who participated in the Korean Children and Youth Panel Survey. The data were collected using a stratified multistage cluster sampling method.

RESULTS

Sleep duration became shorter as age increased. Furthermore, the sleep duration of the 2000-birth cohort became shorter than the sleep duration of the 1997-birth cohort. Specifically, the mean value of the initial sleep duration of the 2000-birth cohort was 8.09 h, which was significantly shorter than the initial value 8.36 h of the sleep duration of the 1997-birth cohort. In addition, multi-group analysis revealed that the trajectories of sleep duration and its predictors were varied by cohort. Specifically, parent supervision, peer relationship, and electronic media factors (smartphone overuse, time spent on using computer and playing games) explained the cohort effect.

CONCLUSION

These findings suggest that environmental factors such as increasing use of electronic media or pressure regarding higher education to adolescents could be associated with reduced sleep duration.

Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans

Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.

Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population

The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.

Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018

BACKGROUND

Mental health problems and mental health related mortality have increased among adolescents, particularly girls. These trends have implications for etiology and prevention and suggest new and emerging risk factors in need of attention. The present study estimated age, period, and cohort effects in depressive symptoms among US nationally representative samples of school attending adolescents from 1991 to 2018.

METHODS

Data are drawn from 1991 to 2018 Monitoring the Future yearly cross-sectional surveys of 8th, 10th, and 12th grade students (N = 1,260,159). Depressive symptoms measured with four questions that had consistent wording and data collection procedures across all 28 years. Age-period-cohort effects estimated using the hierarchical age-period-cohort models.

RESULTS

Among girls, depressive symptoms decreased from 1991 to 2011, then reversed course, peaking in 2018; these increases reflected primarily period effects, which compared to the mean of all periods showed a gradual increase starting in 2012 and peaked in 2018 (estimate = 1.15, p < 0.01). Cohort effects were minimal, indicating that increases are observed across all age groups. Among boys, trends were similar although the extent of the increase is less marked compared to girls; there was a declining cohort effect among recently born cohorts, suggesting that increases in depressive symptoms among boys are slower for younger boys compared to older boys in recent years. Trends were generally similar by race/ethnicity and parental education, with a positive cohort effect for Hispanic girls born 1999-2004.

CONCLUSIONS

Depressive symptoms are increasing among teens, especially among girls, consistent with increases in depression and suicide. Population variation in psychiatric disorder symptoms highlight the importance of current environmental determinants of psychiatric disorder risk, and provide evidence of emerging risk factors that may be shaping a new and concerning trend in adolescent mental health.

Depression and neuroticism decrease among women but not among men between 1976 and 2016 in Swedish septuagenarians

OBJECTIVES

We evaluated birth-cohort differences in depressive symptom burden, prevalence of depression diagnoses, and neuroticism, among Swedish 70-year-olds examined between 1976 and 2016.

METHODS

We used a repeated cross-sectional design examining four representative population samples of Swedish 70-year-olds (total n = 2279) with identical methods in 1976-77 (n = 392), 1992-93 (n = 226), 2000-02 (n = 487), and 2014-16 (n = 1166). Depressive symptom burden was rated with the Montgomery Åsberg Depression Rating Scale. Major depression was diagnosed according to DSM-5, and minor depression according to DSM-IV-TR research criteria. Neuroticism was rated with the Eysenck Personality Inventory.

RESULTS

For women in 2014-16, MADRS score (4.4 vs. 6.1 vs. 5.8; P < 0.05) and neuroticism (6.6 vs. 7.7 vs. 9.2; P < 0.05) were lower compared with 1992-93 and 1976-77, and the prevalence of any depression was lower compared with 2000-02 and 1992-93 (10.9% vs. 16.9% vs. 18.1%; P < 0.05). For men, we observed no birth-cohort differences in depression, while neuroticism was found to be lower in 2014-16 compared with 1976-77 among men without depression (5.1 vs. 5.9; P < 0.01). The sex difference for MADRS and neuroticism declined between 1976-77 and 2014-16 (cohort*sex P < 0.05).

CONCLUSIONS

Depressive burden and neuroticism decreased in 70-year-old women between 1976 and 2016.

Generic quality of life in persons with hearing loss: a systematic literature review

Background

To the best of our knowledge, no empirically based consensus has been reached as to if, and to what extent, persons with hearing loss (HL) have reduced generic Quality of life (QoL). There seems to be limited knowledge regarding to what extent a hearing aid (HA) would improve QoL. The main aim of the present study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL.

Methods

Literature databases (Cinahl, Pub Med and Web of Science) were searched to identify relevant journal articles published in the period from January 2000 to March 17, 2016. We performed a primary search pertaining to the relationship between HL, HA and QoL (search number one) followed by a supporting search pertaining to the relationship between distress/mood/anxiety and HL (search number two). After checking for duplications and screening the titles of the papers, we read the abstracts of the remaining papers. The most relevant papers were read thoroughly, leaving us with the journal articles that met the inclusion criteria.

Results

Twenty journal articles were included in the present review: 13 were found in the primary search (HL and QoL), and seven in the supporting search (HL and distress). The literature yields equivocal findings regarding the association between generic QoL and HL. A strong association between distress and HL was shown, where distressed persons tend to have a lowered generic QoL. It is suggested that QoL is lowered among HL patients. Some studies suggest an increased generic QoL following the use of HA, especially during the first few months after initiation of treatment. Other studies suggest that HA use is one of several possible factors that contribute to improve generic QoL.

Conclusions

The majority of the studies suggest that HL is associated with reduced generic QoL. Using hearing aids seem to improve general QoL at follow-up within the first year. HL is a risk factor for distress. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.

Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up

BACKGROUND

Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing.

METHODS

Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906-1915 (n=899), 1925-1934 (n=906), 1944-1953 (n=1154), 1957-1966 (n=923) and 1970-1981 (n=1199). The participants were 15-62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations.

RESULTS

All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45-64 years, and then they decreased. Relative inequalities were large already in individuals aged 15-25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life.

CONCLUSION

Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.

The mental health of adolescents with and without mild/moderate intellectual disabilities in England: Secondary analysis of a longitudinal cohort study

BACKGROUND

Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents.

METHODS

Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records.

RESULTS

Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities.

CONCLUSIONS

These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health.

Longitudinal trends in self-reported anxiety. Effects of age and birth cohort during 25 years

BACKGROUND

Anxiety has been suggested to increase among young individuals, but previous studies on longitudinal trends are inconclusive. The aim of this study was to analyze longitudinally, the changes over time of prevalence of self-reported anxiety in the Swedish population between 1980/1981 and 2004/2005, in different birth cohorts and age groups.

METHODS

A random sample of non-institutionalized persons aged 16-71 years was interviewed every eighth year. Self-reported anxiety was assessed using the question" Do you suffer from nervousness, uneasiness, or anxiety?" (no; yes, mild; yes, severe). Mixed models with random intercepts were used to estimate changes in rates of anxiety (mild or severe) within different age groups and birth cohorts and in males and females separately. In addition to three time-related variables - year of interview, age at the time of the interview, and year of birth -the following explanatory variables were included: education, urbanization, marital status, smoking, leisure time physical activity and body mass index.

RESULTS

Overall prevalence of self-reported anxiety increased from 8.0 to 12.4% in males and from 17.8% to 23.6% in females, during the 25-year follow-up period. The increasing trend was found in all age groups except in the oldest age groups, and the highest increase was found in young adults 16-23 years, with more than a three-fold increase in females, and a 2.5-fold increase in males, after adjustments for covariates.

CONCLUSIONS

Between 1980/81 and 2004/05, there was an increasing prevalence of self-reported anxiety in all age groups except in the oldest, which indicates increased suffering for a large part of the population, and probably an increased burden on the health care system. Clinical efforts should focus particularly on young females (16-23 years), where the increase was particularly large; almost one third experienced anxiety at the end of the 25-year follow-up.

Prodromal psychotic symptoms and psychological distress among secondary school students in Abeokuta, Nigeria

OBJECTIVE

This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents.

METHOD

Students (n=508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student.

RESULTS

The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174-0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain.

CONCLUSION

The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence.

Differences in Obesity Rates Among Minority and White Women: The Latent Role of Maternal Stress

White and minority women experience different rates of obesity in the United States. Yet our understanding of the dynamics that give rise to this gap remains limited. This article presents a conceptual framework that considers pathways leading to these different rates. It draws upon the life-course perspective, allostatic load, and the weathering hypothesis to identify pathways linking childbearing, stress, and obesity. This conceptual framework extends prior work by identifying age at first birth as an important parameter that influences these pathways. Empirical evidence to test these pathways is needed.