Estimating mental distress in Vietnam: the use of the SRQ-20

Gender-related measurement invariance on the Self-Reporting Questionnaire (SRQ-20) for global mental distress with older adults in Puerto Rico

BACKGROUND

Common mental disorders (CMD) vary by age, gender, and culture. This study: (1) examined the factor structure of the 20-item Self Reporting Questionnaire (SRQ-20) and (2) explored gender-related measurement invariance in the SRQ's performance with older adults in Puerto Rico, a U.S. island territory and associate member of the UN Regional Commissions.

METHODS

We merged data from two cross-sectional studies on mental health status and needs of older adults in Puerto Rico (N = 367). The first study was conducted in 2019, two years after Hurricane María devastated the island (N = 154); the second study, in 2021, assessed knowledge, attitudes and practices (KAP) concerning COVID-19 (N = 213). We used chi-square and t-tests to examine gender differences in each SRQ item and assessed internal consistency reliability with Cronbach's alpha and McDonald's omega (values > 0.70). We ran two CFA models, then multigroup CFA to test for gender-related measurement invariance. We used weighted least square mean and variance adjusted (WLSMV) estimation to account for the binary response options in the SRQ-20 and Mplus version 8.4 for analyses. There were no missing data for any SRQ-20 items.

RESULTS

The SRQ-20 had strong internal consistency reliability (α = 0.89; omega = 0.89). Female scores were higher than males scores (t = -2.159, p = .031). Both unidimensional and two-factor models fit the data well. We selected the more parsimonious unidimensional model, which is most widely used in practice. Standardized factor loadings were 0.548 to 0.823 and all were statistically significant (p < .001). We tested gender invariance with the one-factor model. Our findings did not support invariance.

CONCLUSION

We favored the unidimensional model. First, the SRQ-20 was designed to assess global distress. Also, physical symptoms have both somatic and psychological components, so their co-occurrence makes a single-factor model more meaningful. Finally, since older adults experience more physical health problems, instruments that emphasize both types of distress may provide a more accurate measure than those that exclude somatic symptoms. Using the unidimensional model, the SRQ-20 was not invariant, meaning that it performed differently for male and female participants. Future studies of common mental disorders with older adults in Puerto Rico should consider using the SRQ-20 for research and practice and should determine appropriate threshold scores for men and women.

War-Related Life Course Stress and Late-Life Subjective Age in Northern Vietnam

Background and Objectives

The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life.

Research Design and Methods

We analyzed survey data from the 2018 Vietnam Health and Aging Study involving 2,447 Vietnamese older adults who encountered diverse war-related stressors in early adulthood. The analytical sample (N = 2,341) included 50.9% women and 49.1% men, with an average age of 69.8. 41.1% are military veterans. We conducted survey-adjusted multinomial logistic regression analyses with mediation to predict the probability of feeling younger or older than one's chronological age. We examined how childhood adversity (i.e., childhood hunger and low parental SES) and wartime stressors (i.e., war-related violence, malevolent environment, and military service) influenced late-life subjective age, both directly and as mediated by late-life mental, functional, and physical health.

Results

We found significant associations between early adulthood war-related stressors and subjective age. Formal military service significantly lessened the relative risk of feeling subjectively old, and more plentiful wartime violence exposures significantly increased the risk of feeling younger than one's chronological age. Violence exposure's effects were both direct and indirect through functional and mental health. Conversely, greater exposure to wartime malevolent conditions (e.g., shortages of clean water and evacuations) and multiple episodes of severe hunger in childhood increased the risk of feeling older, effects both direct and mediated by late-life functional and mental health.

Discussion and Implications

Results suggest wartime stressors, especially war's malevolent environments and severe childhood hunger, experienced in many conflict-affected populations globally, have the potential to subjectively "age" survivors. Yet, not all war exposures are equal, and some may yield psychological and socioeconomic resources that support healthy aging.

The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam

Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure's influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.

Impact and differences of illness course perception on the desire for social distance towards people with symptoms of depression or schizophrenia in Hanoi, Vietnam

OBJECTIVES

Public stigma against psychiatric disorders leads to delayed treatment utilization and worsens treatment outcome. This study analyses the impact of expectations regarding the course of illness and attribution as medical illness on the desire for social distance towards schizophrenia and depression in Vietnam.

METHODS

In 2013, a survey (n = 771) using unlabelled vignettes either depicting a person with symptoms typical for schizophrenia or major depression was carried out in Hanoi. All respondents had to indicate whether the person was suffering from a medical illness or not. As an indicator of public stigma, the desire for social distance was measured. A possible correlation between expectations towards the course of illness and social distance was evaluated using a linear regression model.

RESULTS

85 % of respondents endorsed that the person depicted in the schizophrenia vignette had a mental illness, compared to only 60 %, who were confronted with the depression vignette. This attribution of mental illness was correlated with higher levels of desire for social distance only in the schizophrenia vignette. While in the case of schizophrenia negative prognostic perceptions were associated with more desire for social distance, in the event of depression, it was only the expectation of lifelong dependency. Moreover, only for depression, positive expectations towards the course of illness correlated with less desire for social distance.

CONCLUSION

These results indicate an impact of prognostic expectations on the desire for social distance and support strategies that aim at maintaining social integration and strengthening autonomy.

The burden of clinically significant symptoms of common and severe mental disorders among adults in Vietnam: a population-based cross-sectional survey

BACKGROUND

Vietnam has limited evidence about the burden of common and severe mental disorders among adults to inform policy. The aim of this paper was to estimate the prevalence of common and severe mental disorders among adults and factors associated with them in Vietnam.

METHODS

We conducted a cross-sectional household survey among people aged at least 16 years in Thanh Hoa and Ben Tre provinces which are nationally representative of the North and the South of Vietnam. The World Health Organization Self-Reporting Questionnaire 24 was used to screen for clinically significant symptoms of common and severe mental disorders at the individual level. Household characteristics were obtained in face-to-face interviews with the household heads. A multilevel mixed-effects logistic regression model was used to identify associated factors of the common and severe mental disorders.

RESULTS

Among 611 households which included 1528 adults, the point prevalence of clinically significant symptoms was 14.4% for common mental disorders and 8.2% for severe mental disorders after weighting by age groups. Common mental disorders were associated with social factors including lived in a Northern rather than a Southern province, disadvantaged household economic status, in which a family member(s) misused alcohol, the family lacking links to social organisations able to provide instrumental support, and the individual not having completed primary school. Severe mental disorders had fewer associations with social factors compared to common mental disorders, but were associated with living in the Northern province, disadvantaged household economic status, family violence and being older than 50 years.

CONCLUSIONS

The prevalence of clinically significant symptoms of common and severe mental disorders among adults in Vietnam was higher than in high income countries and had a strong association with household characteristics. The result indicates that a community-based approach to reduce household risk factors and to provide instrumental support might be an effective strategy to alleviate the burden of mental health problems in Vietnam.

Education Mitigates the Relationship of Stress and Mental Disorders Among Rural Indian Women

BACKGROUND

Common mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual's sociodemographic characteristics.

OBJECTIVES

To screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics.

METHODS

Cross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities.

FINDINGS

The analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD.

CONCLUSIONS

Our findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women's self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.

Coming of age in a conflict area: Mental health, education, employment, migration and family formation in the southernmost provinces of Thailand

OBJECTIVES

Three southern provinces of Thailand - Pattani, Yala and Narathiwat - have been involved in a long period of unrest. Young people in these provinces have lived with this violence for many years. The objectives of this article are to assess the prevalence of psychiatric symptoms of young adults aged 18-24 years and to examine the perceived effects of the conflict on education, employment, social and religious life.

METHODS

Data were drawn from a probability sample of 2,053 Muslim adults aged 18-59 years conducted in 2014. Mental health was assessed using World Health Organization's (WHO) Self Reporting Questionnaire (SRQ) of 20 questions, the Thai Mental Health questionnaire and a Happiness scale. In-depth interviews with 30 respondents were also used to assess the perceived effects of the conflict on daily life, education, employment and settlement.

RESULTS

Most respondents reported low levels of psychiatric symptoms, though a small proportion reported a large high enough number to be of concern. Most of them also reported high levels of happiness. Respondents who wished to migrate to work in another area reported more psychiatric symptoms and lower levels of happiness. Many respondents reported concerns about the violence in their daily lives, although some may have become habituated to its effects. There were many obstacles reported toward obtaining education including the threat of violence, financial cost and drug use. Male respondents had concerns about consequences of being suspected to be involved in the violence and drug use. The limited employment and the threat of violence were related to the plan to migrate or to settle in the three provinces.

CONCLUSION

In summary, most young people in the area move forward with their lives and many display some habituation to the violence. However, the economic depression due to the violence and the threat of violence often affected their daily lives.

Multisite prospective investigation of psychological outcomes following cataract surgery in Vietnam

Background

Cataract surgery is a low-cost and effective intervention. There is increasing evidence to suggest that cataract surgery is associated with improvements in mobility, overall functioning and reductions in psychological distress. Within low-income and middle-income countries, cataract surgery has also been documented to lead to reductions in psychological distress; however, differences in economic activity and engagement in paid and domestic work in these countries may moderate such reductions. We aimed to examine the psychological outcomes following cataract surgery among a diverse Vietnamese sample.

Methods

We report findings from the VISIONARY study, a 12-month multisite prospective study of cataract surgery outcomes conducted in Vietnam (N=462). Generalised estimating equations (GEEs) were used to identify the variables which were associated with reduced psychological distress.

Results

A high proportion of participants (56.6%) reported psychological distress before surgery and severity of psychological distress had decreased by 12 months following surgery (95% CI (4.13 to 4.95)). There were regional differences in the extent of improvement in psychological distress and change in paid and unpaid work. The extent of improvement in visual acuity, male gender, and increase in paid and unpaid work hours were significant predictors of reductions in psychological distress.

Conclusions

Cataract surgery appears to result in the greatest reductions in psychological distress in communities where work engagement is highest.

Funding

The VISIONARY study was funded by a grant provided by the Fred Hollows Foundation, Australia. During the course of this work, BME was in receipt of an Ian Potter Foundation Fellowship and a National Health and Medical Research Council (NHMRC) fellowship (1072148), SJ received an NHMRC Senior Research Fellowship, MLH was in receipt of a National Heart Foundation Future Leader Fellowship 100034.

Mental health in a conflict area: Migration, economic stress and religiosity in the three southernmost provinces of Thailand

AIM

Three southern provinces of Thailand, Pattani, Yala and Narathiwat, have been involved in a long period of unrest due to differences between the population in the provinces and the Thai government with regard to language, culture and governance. The objectives of this article are to examine the effects of everyday stressors due to the conflict, including economic stress and migration, as well as the effect of religiosity on the reporting of psychiatric symptoms among adults in the three provinces.

METHODS

Data were drawn from a survey conducted in 2014. The survey included a probability sample of 2,053 Muslim adults aged 18-59 years.Mental health was assessed using World Health Organization's (WHO) Self-Reporting Questionnaire (SRQ) of 20 questions. Multilevel models were estimated to examine the influence of economic stress due to the conflict, as well as community and individual aspects of migration and religion on mental health.

RESULTS

The data showed that migration from the household and the community and the economic effects of the unrest were associated with reporting of more psychiatric symptoms among adults in the southern provinces. Religion was related to reporting of fewer psychiatric symptoms at the individual and the community levels.

CONCLUSION

The study documented increased reporting of psychiatric symptoms among persons reporting perceived household economic stress due to the conflict and the migration of family members.

Selection of depression measures for use among Vietnamese populations in primary care settings: a scoping review

Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. We reviewed the validity of the instruments as reported in the studies and qualitatively assessed cultural validity and acceptability for use in primary care. We found much variation in the methods used to validate the measures, with an emphasis on criterion validity and reliability. Enhanced evaluation of content and construct validity is needed to ensure validity within diverse cultural contexts such as Vietnam. For effective use in primary care, measures must be further evaluated for their brevity and ease of use. To identify appropriate measures for use in primary care in diverse populations, assessment must balance standard validity testing with enhanced testing for appropriateness in terms of culture, language, and gender and for acceptability for use in primary care.

Caretaker mental health and family environment factors are associated with adolescent psychiatric problems in a Vietnamese sample

Little is known about risk factors for adolescent mental health in Vietnam. The present study investigated the relationship between caretaker mental health and adolescent mental health in a cross-sectional Vietnamese sample. Primary caretakers completed measures of their own mental distress and general health status using the Self-Reporting Questionnaire-20 (SRQ-20) as well as reports of adolescent mental health using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Multivariate regression models were used to examine the relationships between the caretaker and adolescent health variables. The demographic factors of age, sex, ethnicity, religious affiliation, and household wealth status demonstrated significant relationships with SDQ subscale scores. Caretaker mental health was positively associated with adolescent mental health, and this association remained significant even after accounting for other relevant demographic variables and caretaker general health status. Understanding correlates of adolescent mental health difficulties may help identify youth and families at risk for developing psychiatric problems and inform mental health interventions in Vietnam.

Using the SRQ-20 factor structure to examine changes in mental distress following typhoon exposure

Empirical research is limited regarding postdisaster assessment of distress in developing nations. This study aimed to evaluate the factor structure of the 20-item Self-Reporting Questionnaire (SRQ-20) before and after an acute trauma, Typhoon Xangsane, in order to examine changes in mental health symptoms in an epidemiologic sample of Vietnamese adults. The study examined a model estimating individual item factor loadings, thresholds, and a latent change factor for the SRQ-20's single "general distress" common factor. The covariates of sex, age, and severity of typhoon exposure were used to evaluate the disaster-induced changes in SRQ-20 scores while accounting for possible differences in the relationship between individual measurement scale items and the latent mental health construct. Evidence for measurement noninvariance was found. However, allowing sex and age effects on the pre-typhoon and post-typhoon factors accounted for much of the noninvariance in the SRQ-20 measurement structure. A test of no latent change failed, indicating that the SRQ-20 detected significant individual differences in distress between pre- and post-typhoon assessment. Conditioning on age and sex, several typhoon exposure variables differentially predicted levels of distress change, including evacuation, personal injury, and peri-event fear. On average, females and older individuals reported higher levels of distress than males and younger individuals, respectively. The SRQ-20 is a valid and reasonably stable instrument that may be used in postdisaster contexts to assess emotional distress and individual changes in mental health symptoms.

The Subjective Well-Being of Children in Transnational and Non-Migrant Households: Evidence from Thailand

To date, research that includes children's views on parental migration has been insufficient. Based on the children's assessment of well-being, we use a case study of Thailand to ask whether children of overseas migrant parents are less or more resilient compared to children of non-migrant parents. We make use of data from the Child Health and Migrant Parents in South-East Asia (CHAMPSEA) Project, one of the few studies that provide space for children, both of migrant and non-migrant parents, to voice their views. Our sample includes 496 children aged 9 to 11 years old. The outcome variable captures children's subjective well-being as an indicator of whether they are a resilient child. Our multivariate analysis controls for other potential contributing factors, including the children's individual attributes, carer's mental health, parents' education, family functioning as reported by the children, and household economic status in order to investigate the effects of parental migration. Qualitative information from in-depth interviews with selected carers and group interviews with community leaders are also used to explain the results. Our findings highlight the importance of taking into account children's own perceptions. Compared to children of non-migrant parents, those of migrant parents are more likely to give a positive assessment of their own well-being. The other contributing factors include whether the child sees their family as functioning well. In Thailand, international migration is predominantly undertaken by fathers while childcare remains the responsibility of mothers, and public attitudes towards overseas migration, especially paternal migration, is generally favorable. This may help explain the positive perception of children of migrants towards themselves.

Pre-typhoon socioeconomic status factors predict post-typhoon psychiatric symptoms in a Vietnamese sample

PURPOSE

Exposure to natural disasters has been associated with increased risk for various forms of psychopathology. Evidence indicates that socioeconomic status (SES) may be important for understanding post-disaster psychiatric distress; however, studies of SES-relevant factors in non-Western, disaster-exposed samples are lacking. The primary aim of the current study was to examine the role of pre-typhoon SES-relevant factors in relation to post-typhoon psychiatric symptoms among Vietnamese individuals exposed to Typhoon Xangsane.

METHODS

In 2006, Typhoon Xangsane disrupted a mental health needs assessment in Vietnam in which the Self Reporting Questionnaire-20 (SRQ-20), and the Demographic and Health Surveys Wealth Index, a measure of SES created for use in low-income countries, were administered pre-typhoon. The SRQ-20 was re-administered post-typhoon.

RESULTS

Results of a linear mixed model indicated that the covariates of older age, female sex, and higher levels of pre-typhoon psychiatric symptoms were associated with higher levels of post-typhoon psychiatric symptoms. Analysis of SES indicators revealed that owning fewer consumer goods, having lower quality of household services, and having attained less education were associated with higher levels of post-typhoon symptoms, above and beyond the covariates, whereas quality of the household build, employment status, and insurance status were not related to post-typhoon psychiatric symptoms.

CONCLUSION

Even after controlling for demographic characteristics and pre-typhoon psychiatric symptoms, certain SES factors uniquely predicted post-typhoon psychiatric distress. These SES characteristics may be useful for identifying individuals in developing countries who are in need of early intervention following disaster exposure.

Evaluation of the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) in a sample of Vietnamese adults

PURPOSE

There are significant gaps in the literature on the prevalence of mental health problems and associated needs in Vietnam. A thorough understanding of culture-specific expressions of psychiatric distress is vital for the identification of the mental health needs of a community, and more research on the development and evaluation of culturally-sensitive mental health assessments is warranted. This study aims to evaluate the psychometric properties of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) in an epidemiologic study of Vietnamese adults.

METHODS

A latent variable modeling approach investigated the underlying factor structure of the SRQ-20 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on SRQ-20 item-level data gathered from 4980 participants.

RESULTS

Based on scree plots and EFA results, two latent structures were deemed plausible and were subsequently subjected to further modeling. A bi-factor model (BFM) and a correlated three-factor model solution (Negative Affect, Somatic Complaints, and Hopelessness) provided reasonable fits. The BFM specifies a single dominant General Distress factor (all SRQ-20 items) with orthogonal group factors for the subsets of items: Negative Affect (9 items), Somatic Complaints (8 items), and Hopelessness (3 items). This model fit the data as well or better than the three-factor model. Results also showed differences in endorsement rates of SRQ-20 items among males and females.

CONCLUSIONS

Study results provide an evaluation of the psychometric properties of a commonly used screening tool and offer insight into the presentation of mental distress in a representative sample of Vietnamese adults.

Prevalence and correlates of mental distress among working adults in ethiopia

Objective:

To evaluate the prevalence of mental distress and its correlates among working Ethiopian adults.

Methods:

This cross-sectional study of 2,180 individuals (1,316 men and 864 women) was conducted among working adults in Addis Ababa, Ethiopia. A structured questionnaire was used to collect information on socio-demographic and lifestyle characteristics of participants. Mental distress was assessed using the self-reporting questionnaire (SRQ). Logistic regression was employed to estimate adjusted odds ratios (OR) and 95% confidence intervals (95% CI).

Results:

The prevalence of mental distress in the study sample was 17.7% (25.9% in women and 12.4% in men). Younger participants (age ≤24 years) had the highest prevalence of mental distress (35.5% in women and 16.7% in men). The odds of mental distress was 2.47-fold higher among women as compared with men (OR=2.47, 95% CI 1.97-3.09). Participants reporting excellent health status had a 50% reduced odds of mental distress (OR=0.47; 95%CI: 0.38-0.59); and moderate alcohol consumption was associated with a slight increased odds of mental distress (OR=1.26; 95%CI: 1.00-1.67).

Conclusion:

A high prevalence of mental distress was observed among working adults in Ethiopia. Our findings suggest that the workforce institutions should provide targeted prevention and intervention programs to improve the mental health state of their employees. National mental health policy that clearly outlines and addresses mental distress among working adults is also warranted.