Psychological distress measured by the GHQ-12 and mortality: a prospective population-based study

Effect of psychological distress on oral health: a cross-sectional study

BACKGROUND

Individuals with psychological distress are at significantly higher risk of arthritis, cardiovascular disease, and chronic obstructive pulmonary disease. However, influence of psychological distress on oral health remains a concern. The purpose of this study was to evaluate psychological distress and its relationship with caries, oral hygiene status, gingival health, and other factors among adults.

METHODS

This cross-sectional study included a sample of 558 adult patients at the Dental Hospital College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The World Health Organization criteria were used to perform an oral examination of participants who responded to a self-administered questionnaire. Psychological distress was evaluated by using the General Health Questionnaire-12 (GHQ-12), which consists of 12 items on a 4-point Likert scale and its score ranges from 0 to 36. The oral health of participants was assessed using the DMFT, plaque, gingival, and simplified oral hygiene indices.

RESULTS

In this study, 21.5% of participants demonstrated psychological distress, with 16.80% having mild distress and 4.70% having severe distress. The mean score of GHQ-12 of the study sample was 10.47 ± 5.77. Significantly higher median scores of GHQ-12 were observed among participants over the age of 30 years (p = 0.021), low-income individuals (p = 0.008), smokers (p = 0.019), and those with medical problems (p < 0.001). Participants with psychological distress demonstrated significantly higher caries, poor gingival health, and compromised oral hygiene (p < 0.005). Multiple linear regression models revealed significant relationships between psychological distress and the DMFT index (p < 0.001), plaque index (p < 0.001), gingival index (p < 0.001), and simplified oral hygiene index (p < 0.001) after adjusting for age, sex, nationality, income, and education.

CONCLUSION

Psychological distress was prevalent among the participants. Higher age, low-income status, smoking, and medical problems were significantly related to psychological distress. Additionally, psychological distress was significantly correlated with dental caries experience, gingival health, and oral hygiene.

Impact of psychological distress on mortality in Spain. The importance of early detection and treatment of mental disorders

BACKGROUND

Mental health problems account for 14% of mortality worldwide. The aim of this study was to evaluate the association between psychological distress and mortality in the Spanish adult population.

METHODS

Data came from a longitudinal study in population ≥15 years of age (n=21,005) who participated in the 2011-12 Spanish National Health Survey, which was linked to mortality records as of December 2020. Mental health was assessed with the GHQ-12, defining psychological distress as a dichotomous variable using a GHQ-12 score ≥3 as the cutoff point. Using Poisson regression, standardized mortality rate ratios (SRR) were estimated for all-cause, cardiovascular disease, and tumor-related mortality, adjusting for sociodemographic variables, lifestyles, and comorbidities.

RESULTS

The standardized overall mortality rate in individuals with and without psychological distress was 14.58 and 10.90 per 1000 person-years, respectively, estimating an SRR of 1.34 (95%CI: 1.19-1.50). The SRR for tumor-related mortality was 1.17 (95%CI: 0.90-1.53), and cardiovascular-related mortality was related to higher distress (GHQ-12 ≥ 4): SRR of 1.22 (95%CI: 0.98-1.51). Among psychological distressed individuals, the overall mortality SRR for those with a previous mental disorder diagnosis was 1.18 (95%CI: 0.91-1.53) versus 1.34 (95%CI: 1.18-1.54) for those without such diagnosis (p for interaction=0.067). Similarly, distressed participants taking prescription drugs for mental disorders had a lower mortality risk than those not taking them (p for interaction=0.016).

CONCLUSIONS

Individuals with psychological distress had a higher risk of overall-, cardiovascular disease- and tumor-related mortality. This association was higher among participants not previously diagnosed with a mental disorder and those not taking medication for mental issues.

Psychological distress in community-dwelling individuals living with severe and persistent mental illness

OBJECTIVES

To explore psychological distress levels, using the validated Kessler 6 (K6), as well as the relationship between demographics and K6 scores, and incidence of mental health crises in a cohort of community-dwelling people living with severe and persistent mental illness (SPMI).

METHODS

People living with SPMI taking antipsychotic or mood stabiliser medications were recruited from Australian community pharmacies between September 2020 and Februrary 2021 and completed an electronic survey, including the K6 scale. Pharmacists were interviewed and supplied written reports with details of the consultation when participants obtained 'very high' (⩾19/30) K6 scores. Records were reviewed and coded by an independent coder. Multivariate linear regression was used to determine predictors of K6 scores.

RESULTS

The median K6 score was 16/30 (IQR = 11,21; range = 6-30). Younger age, unemployment and multimorbid mental health diagnoses were significant predictors of higher K6 scores (p < .01; R2 = .24). Fifty-nine (39.3%) consumers scored ⩾19, of which 25/59 (42.4%) were reported to be exhibiting signs of psychological distress and none were experiencing mental health crises.

CONCLUSION

People living with SPMI have high levels of psychological distress as measured by the K6. Further work is needed to understand the prevalence, extent, precipitating factors and impact of psychological distress in people living with SPMI.

Association between attending cultural events and all-cause mortality: a longitudinal study with three measurements (1982-2017)

OBJECTIVES

To examine the association between cultural attendance and all-cause mortality.

DESIGN

A longitudinal cohort study over 36 years (1982-2017) with three 8-year interval measurements of exposure (1982/1983, 1990/1991 and 1998/1999) to cultural attendance and a follow-up period to 31 December 2017.

SETTING

Sweden.

PARTICIPANTS

The study included 3311 randomly selected individuals from the Swedish population with complete data for all three measurements.

PRIMARY OUTCOME MEASUREMENTS

All-cause mortality during the study period in relation to level of cultural attendance. Cox regression models with time-varying covariates were used to estimate HRs adjusted for potential confounders.

RESULTS

The HRs of cultural attendance in the lowest and middle levels compared with the highest level (reference; HR=1) were 1.63 (95% CI 1.34 to 2.00) and 1.25 (95% CI 1.03 to 1.51), respectively.

CONCLUSION

Attending cultural events has a suggested gradient, the lesser cultural exposure the higher all-cause mortality during the follow-up.

Poor psychological health and 8-year mortality: a population-based prospective cohort study stratified by gender in Scania, Sweden

OBJECTIVES

We investigated gender differences in the association between mortality and general psychological distress (measured by 12-item General Health Questionnaire, GHQ-12), as an increased mortality risk has been shown in community studies, but gender differences are largely unknown.

SETTING

We used data from a cross-sectional population-based public health survey conducted in 2008 in the Swedish region of Skåne (Scania) of people 18-80 years old (response rate 54.1 %). The relationship between psychological distress and subsequent all-cause and cause-specific mortality was examined by logistic regression models for the total study population and stratified by gender, adjusting for age, socioeconomic status, lifestyle (physical activity, smoking, alcohol consumption), and chronic disease.

PARTICIPANTS

Of 28 198 respondents, 25 503 were included in analysis by restrictive criteria.

OUTCOME MEASURES

Overall and cause-specific mortality by 31 December 2016.

RESULTS

More women (20.2 %) than men (15.7 %) reported psychological distress at baseline (GHQ ≥3). During a mean follow-up of 8.1 years, 1389 participants died: 425 (30.6%) from cardiovascular diseases, 539 (38.8%) from cancer, and 425 (30.6%) from other causes. The overall association between psychological distress and mortality risk held for all mortality end-points except cancer after multiple adjustments (eg, all-cause mortality OR 1.8 (95 % CI 1.4 to 2.2) for men and women combined. However, stratification revealed a clear gender difference as the association between GHQ-12 and mortality was consistently stronger and more robust among men than women.

CONCLUSION

More women than men reported psychological distress while mortality was higher among men (ie, the morbidity-mortality gender paradox). GHQ-12 could potentially be used as one of several predictors of mortality, especially for men. In the future, screening tools for psychological distress should be validated for both men and women. Further research regarding the underlying mechanisms of the gender paradox is warranted.

Worse health‐related quality of life, impaired functioning and psychiatric comorbidities are associated with excess mortality in patients with severe chronic pain

Background

Severe chronic pain that interferes with daily activities is associated with an increased risk of mortality. We assessed the overall mortality of tertiary chronic pain patients in comparison with the general population, with a special aim to analyse the association of health‐related quality of life (HRQoL) and its dimensions with the risk of death.

Methods

In this prospective observational follow‐up study, patients with non‐cancer chronic pain attended an outpatient multidisciplinary pain management (MPM) episode in a tertiary pain clinic in 2004–2012 and were followed until May 2019. Mortality between the patients and the general population was compared with standardized mortality ratios (SMR) in different age groups. Causes of death and comorbidities were compared among the deceased. Association of mortality and HRQoL and its dimensions, measured with the 15D instrument, was studied with Cox proportional hazards model.

Results

During a mean of 10.4‐year follow‐up of 1498 patients, 296 died. The SMR in the youngest age group (18–49 years) was significantly higher than that of the general population: 2.6 for males and 2.9 for females. Even elderly females (60–69 years) had elevated mortality (SMR 2.3). Low baseline HRQoL at the time of MPM, as well as poor ratings in the psychosocial dimensions of HRQoL, was associated with an increased risk of death.

Conclusions

Our results support the role of HRQoL measurement by a validated instrument such as the 15D in capturing both the physical and the psychological symptom burden, and consequently, an elevated risk of death, in patients with chronic pain.

Significance

Severe chronic pain is associated with elevated mortality. In patients in chronic pain under 50 years old, the mortality was 2.5–3 times higher than in the general population. Psychological distress appears to contribute to the increased mortality. Regular follow‐up by health‐related quality of life (HRQoL) measurement could be useful in identifying patients in chronic pain who are in need of intensive symptom management and to prevent early death.

Air pollution and individuals' mental well-being in the adult population in United Kingdom: A spatial-temporal longitudinal study and the moderating effect of ethnicity

BACKGROUND

Recent studies suggest an association between ambient air pollution and mental well-being, though evidence is mostly fragmented and inconclusive. Research also suffers from methodological limitations related to study design and moderating effect of key demographics (e.g., ethnicity). This study examines the effect of air pollution on reported mental well-being in United Kingdom (UK) using spatial-temporal (between-within) longitudinal design and assesses the moderating effect of ethnicity.

METHODS

Data for 60,146 adult individuals (age:16+) with 349,748 repeated responses across 10-data collection waves (2009-2019) from "Understanding-Society: The-UK-Household-Longitudinal-Study" were linked to annual concentrations of NO2, SO2, PM10, and PM2.5 pollutants using the individuals' place of residence, given at the local-authority and at the finer Lower-Super-Output-Areas (LSOAs) levels; allowing for analysis at two geographical scales across time. The association between air pollution and mental well-being (assessed through general-health-questionnaire-GHQ12) and its modification by ethnicity and being non-UK born was assessed using multilevel mixed-effect logit models.

RESULTS

Higher odds of poor mental well-being was observed with every 10μg/m3 increase in NO2, SO2, PM10 and PM2.5 pollutants at both LSOAs and local-authority levels. Decomposing air pollution into spatial-temporal (between-within) effects showed significant between, but not within effects; thus, residing in more polluted local-authorities/LSOAs have higher impact on poor mental well-being than the air pollution variation across time within each geographical area. Analysis by ethnicity revealed higher odds of poor mental well-being with increasing concentrations of SO2, PM10, and PM2.5 only for Pakistani/Bangladeshi, other-ethnicities and non-UK born individuals compared to British-white and natives, but not for other ethnic groups.

CONCLUSION

Using longitudinal individual-level and contextual-linked data, this study highlights the negative effect of air pollution on individuals' mental well-being. Environmental policies to reduce air pollution emissions can eventually improve the mental well-being of people in UK. However, there is inconclusive evidence on the moderating effect of ethnicity.

Psychological stress, body shape and cardiovascular events: Results from the Whitehall II study

Background and aim

It is known that persistent psychological stress predicts changes in body shape in two different ways: some stressed people lose weight, others gain weight. It is also known that persistent psychological stress predicts adverse health events. But it is unknown what role the body shape plays in this particular network of relationships. We therefore analyzed the Whitehall II dataset to relate body shape to stress and health risk.

Methods

Data of 4969 men and 2138 women from the Whitehall II cohort were analyzed. Psychological stress (General Health Questionnaire) was measured three times in the years 1991 till 2001. Body shape (BMI, waist and hip circumferences) was measured in the years 1991 till 1994. Childhood adversities were retrospectively assessed by questionnaire. Outcomes included the incidence of non-fatal or fatal CHD events (coronary heart disease) collected up to the years 2012 and 2013 and all-cause mortality collected up to July 2015. Cox proportional hazard models were conducted to estimate the relation between psychological stress and CHD events or all-cause mortality.

Results

There was an increase in the expected hazard to develop CHD with high psychological stress (men: Exp (B) = 1.25 (1.06–1.47); P = 0.008; women: Exp (B) = 1.34 (1.05–1.70); P = 0.017). We found a clear dose-response relationship for the association between psychological stress and CHD events in both genders. That is, subjects with consistently high psychological stress in all assessments had a 2.4-fold (men) or 2.3-fold (women) higher risk for later CHD events compared to never-stressed subjects. Moreover, subjects with a high sum score of all 13 childhood experiences had a 10% increased hazard to develop fatal or non-fatal CHD events in adulthood. Although we could not find stress or BMI linked to all-cause mortality, the waist-to-hip ratio contributed to the risk of all-cause mortality in both genders (Exp (B) = 34.66 (6.43–186.92); P < 0.001 for men; Exp (B) = 60.65 (9.33–394.22); P < 0.001 for women).

Conclusion

This analysis supports the notion that psychological stress and childhood adversities are associated with the risk of fatal or non-fatal CHD events. When this relationship is analyzed in more detail, the Whitehall II dataset provides further insights into the role of body shape. That is, stress is also related to changes in body shape, with waist size in particular predicting higher all-cause mortality.

•

We used Whitehall II data and constructed an overall picture of the relations between psychological stress, body shape and adverse health outcomes.

•

We demonstrated a dose-dependent relationship between psychological stress and the risk of fatal or non-fatal CHD events.

•

Stress increases the risk of both CHD events and body shape changes, with waist circumference but not BMI increasing the mortality risk.

•

Body shape –more specifically waist size– is symptomatic of stress and predictive of all-cause mortality.

Sex-specific Relationship between Stress Coping Strategies and All-Cause Mortality: Japan Multi-Institutional Collaborative Cohort Study

BACKGROUND

Stress coping strategies are related to health outcomes. However, there is no clear evidence for sex differences between stress-coping strategies and mortality. We investigated the relationship between all-cause mortality and stress-coping strategies, focusing on sex differences among Japanese adults.

METHODS

A total of 79,580 individuals aged 35-69 years participated in the Japan Multi-Institutional Collaborative Cohort Study between 2004 and 2014 and were followed up for mortality. The frequency of use of the five coping strategies was assessed using a questionnaire. Sex-specific, multivariable-adjusted hazard ratios (HRs) for using each coping strategy "sometimes," and "often/very often" (versus "very few" use) were computed for all-cause mortality. Furthermore, relationships were analyzed in specific follow-up periods when the proportion assumption was violated.

RESULTS

During the follow-up (median: 8.5 years), 1,861 mortalities were recorded. In women, three coping strategies were related to lower total mortality. The HRs (95% confidence intervals) for "sometimes" were 0.81 (0.67-0.97) for emotional expression, 0.79 (0.66-0.95) for emotional support-seeking, and 0.80 (0.66-0.98) for disengagement. Men who "sometimes" used emotional expression and sometimes or often used problem-solving and positive reappraisal had a 15-41% lower HRs for all-cause mortality. However, those relationships were dependent on the follow-up period. There was evidence that sex modified the relationships between emotional support-seeking and all-cause mortality (p for interaction = 0.03).

CONCLUSIONS

In a large Japanese population, selected coping strategies were associated with all-cause mortality. The relationship of emotional support-seeking was different between men and women.

Health Service Use among Individuals with Depression and Psychological Distress: A Population-Based Cohort Study in Ontario, Canada: Utilisation des services de santé par les personnes souffrant de dépression et de détresse psychologique : une étude de cohorte dans la population de l'Ontario, Canada

OBJECTIVES

Relatively little is known about how health-care utilization differs among individuals with psychological distress compared to those with major depressive disorder (MDD).

METHODS

Ontario participants of the Canadian Community Health Survey Cycle 1.2 (2002) were linked to health administrative data to follow their health-care utilization patterns for up to 15 years. Based on their survey responses, we classified individuals hierarchically into Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria MDD, psychological distress (Kessler-6: 8 to 24), or an unexposed group with neither condition. We compared the rates of outpatient and acute care mental and nonmental health-related visits across the 3 groups over time using Poisson regression.

RESULTS

Among the 430 individuals with MDD, 668 with psychological distress, and 9,089 in the unexposed group, individuals with MDD and psychological distress had higher rates of health-care utilization than the unexposed overall and across time. The rates of psychiatrist visits for the MDD group were significantly higher than the other groups initially but declined over the follow-up. Conversely, the rates of psychiatrist visits among the psychological distress group increased over time and converged with that of the MDD group by the end of follow-up (rate ratio_{MDD vs. psychological distress} at 1 year: 4.20 [1.97 to 11.40]; at 15 years: 1.53 [0.54 to 4.08]). Acute care visits were similar between the MDD and psychological distress groups at all time points.

CONCLUSIONS

Individuals with psychological distress required mental health care rivalling that of individuals with MDD over time, suggesting that even a cross-sectional assessment of significant psychological distress is a serious clinical concern.

Work-related physical activity and psychological distress among women in different occupations: a cross-sectional study

BACKGROUND

Recent evidence suggests that work-related physical activity may not have the same mental health benefits as leisure-time physical activity. Further, work-related physical activity is likely to include a variety of different behaviours for people with different occupations. As such, the aim of this study was to determine if occupation type moderated the association between work-related physical activity and psychological distress.

METHODS

A randomly selected sample of 1080 women from Melbourne, Australia completed the International Physical Activity Questionnaire (IPAQ) and General Health Questionnaire (GHQ-30), and reported their current occupation.

RESULTS

Linear regression analyses indicated that occupation significantly moderated the association between work-related walking and psychological distress (F [8, 55] = 2.26, p = .036). Given evidence of moderation, we fitted linear regression models to test the associations between work-related physical activity and psychological distress for three separate groups; professionals, sales and services workers, and tradespersons. Female tradespersons who engaged in a low (B = - 3.81, p = .006) or high amount of work-related walking (B = - 3.23, p = .029), had significantly lower psychological distress symptoms than those who engaged in no work-related walking. There were no significant associations between work-related physical activity of any intensity and psychological distress for professionals, or sales and service workers.

CONCLUSIONS

Given the relationship does not exist across all occupations, work-related physical activity should not be promoted above and beyond leisure-time physical activity. However, walking at work may be important in reducing psychological distress for some people and should therefore, not be discounted.

Poor psychological health and 5-year suicide mortality: A population-based prospective cohort study

OBJECTIVE

The objective was to investigate associations between the General Health Questionnaire with twelve sub-items (GHQ-12) and prospective five-year suicide mortality. The two commonly used GHQ-12 cut-offs (2/3 and 3/4) were analyzed.

METHOD

The 2008 public health survey, which was conducted in the autumn of 2008 in Scania, southern Sweden, is based on a postal questionnaire answered by 28,198 participants, aged 18 to 80. GHQ-12 was assessed from the baseline questionnaire, and five-year prospective register data on causes of death were connected to the baseline survey. In total, 21 persons died from intentional self-inflicted injuries, and twenty of them had complete answers regarding GHQ-12. Hazard rate ratios (HRR) were analyzed in survival (Cox-) regression analyses, adjusted for age, sex, marital status and socioeconomic status (SES).

RESULTS

The prevalence of poor psychological health according to GHQ-12 with the 2/3 cut-off was 14% among men and 18% among women, and with the 3/4 cut-off it was 11% among men and 15% among women. The 2/3 cut-off yielded a HRR of 3.02 (1.14-7.98, 95% CI) which decreased to 2.44 (0.92-6.49) when adjusted for marital status and SES, and a 3/4 cut-off HRR of 3.97 (1.51-10.47) which decreased to 3.23 (1.22-1.22-8.56) when adjusted for marital status and SES.

CONCLUSION

The results indicate high effect measures (HRRs) between GHQ12 with both cut offs and five-year suicide mortality.

Developing the perceived social support scale for older adults: A mixed-method study

Social support has an important impact on the well-being of the elderly. Some studies have shown that perceived social support is more important than received social support. Perceived social support has different definitions across different age groups and cultures. So, this sequential exploratory mixed-method study was designed to develop and validate a perceived social support scale for community-dwelling elderly. In the qualitative phase, the perspectives of the elderly on perceived social support were defined through directed content analysis. Then, an extensive item pool was designed based on the elderly's perception and review of the literature. In the quantitative phase, the validity (content, face, and construct) and reliability (internal consistency, stability) of the newly developed scale was assessed using the sampling of five hundred elderly. The final scale consists of 34 items with domains of “emotional support”, “practical support”, “spiritual support”, “negative interactions” and “satisfaction with support received” that explained 58% of the total variance of the scale. The internal consistency varied from Cronbach's α = 0.70 to 0.87 for the subscales and as 0.92 for the whole scale. The study showed that the scale as a valid and reliable instrument can be used for the proper measurement of perceived social support among the elderly.

Psychological distress and mortality among US adults: prospective cohort study of 330 367 individuals

BACKGROUND

Previous studies have shown inconsistent findings on the association between psychological distress and risk of mortality. This study aimed to address this inconsistent association using a large US population-based cohort.

METHODS

This study used data from 1997 to 2009 US National Health Interview Survey, which were linked with National Death Index through 31 December 2011. Psychological distress was measured using Kessler-6 scale and was categorised into six groups based on scores as 0, 1-3, 4-6, 7-9, 10-12 and ≥13. Main outcomes were all-cause, cancer-specific and cardiovascular disease (CVD)-specific mortality. Analyses were completed in 2019. Cox proportional hazards models were used to determine the association between psychological distress and mortality.

RESULTS

A total of 330 367 participants aged ≥18 years were included. During a mean follow-up of 8.2 years, 34 074 deaths occurred, including 8320 cancer-related and 8762 CVD-related deaths. There was a dose-response association between psychological distress and all-cause mortality. Compared with the 0 score category, adjusted HRs (95% CIs) for other categorical psychological distress scores, that is, 1-3, 4-6, 7-9, 10-12 and ≥13, were 1.09 (1.05 to 1.12), 1.22 (1.17 to 1.27), 1.38 (1.31 to 1.46), 1.49 (1.40 to 1.59) and 1.57 (1.47 to 1.68), respectively. Corresponding values for cancer-specific mortality were 1.06 (0.99 to 1.12), 1.13 (1.04 to 1.23), 1.27 (1.14 to 1.42), 1.38 (1.22 to 1.57) and 1.32 (1.15 to 1.51), respectively; those for CVD-specific mortality were 1.11 (1.05 to 1.18), 1.22 (1.12 to 1.32), 1.30 (1.17 to 1.45), 1.38 (1.20 to 1.58), and 1.46 (1.27 to 1.68), respectively.

CONCLUSIONS

We found a dose-response relationship between psychological distress and all-cause and cause-specific mortality, emphasising the need for early prevention strategies among individuals with potential psychological distress.

Exercise Counteracts the Cardiotoxicity of Psychosocial Stress

Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.

Psychometric Properties and Convergent Validity of the Shirom-Melamed Burnout Measure in Two German-Speaking Samples of Adult Workers and Police Officers

Burnout is considered an occupation-related psychological syndrome consisting of emotional, physical, and cognitive exhaustion. To assess dimensions of burnout, the Shirom-Melamed Burnout Measure (SMBM) is widely used, but its validity and reliability have rarely been examined in adult samples. The aim of this study is to examine the psychometric properties of the German version of the SMBM in two independent samples of adults. In total, 311 adult workers and 201 police officers completed the SMBM, and questionnaires related to perceived stress and mental well-being. Descriptive statistics, internal consistency, convergent validity, and factorial validity were assessed for both samples, separately for male and female participants. The German SMBM had adequate psychometric properties and sufficient convergent validity. In confirmatory factor analyses, we found a good fit for both the first- and second-order model. Furthermore, measurement invariance across gender was observed in both samples. Although the SMBM is a popular instrument among burnout researchers, this study demonstrates for the first time that the SMBM can be considered a valid and reliable tool to assess burnout symptoms in both male and female adults and across different professional groups. Furthermore, with its 14 items, the SMBM is a succinct and economic self-assessment tool for symptoms of burnout.

Does Cardiorespiratory Fitness Moderate the Association between Occupational Stress, Cardiovascular Risk, and Mental Health in Police Officers?

Background: Chronic exposure to occupational stress may lead to negative health consequences. Creating less stressful work environments and making employees physically and psychologically more resilient against stress are therefore two major public health concerns. This study examined whether cardiorespiratory fitness moderated the association between occupational stress, cardiovascular risk, and mental health. Methods: Stress was assessed via the Effort-Reward Imbalance and Job Demand-Control models in 201 police officers (36% women, Mage = 38.6 years). Higher levels of blood pressure, blood lipids, blood sugar, and unfavorable body composition were considered as cardiovascular risk factors. Burnout, insomnia and overall psychological distress were used as mental health indicators. Cardiorespiratory fitness was assessed with a submaximal bicycle test. Results: High cardiorespiratory fitness levels were associated with a reduced cardiometabolic risk, whereas high stress levels were associated with better mental health. Among participants who perceived a high Effort-Reward Imbalance, those with high fitness levels showed lower overall cardiovascular risk scores than their colleagues with low fitness levels. Conclusions: Work health programs for police officers should consider the early screening of burnout, sleep disturbances, and overall mental wellbeing. To increase cardiovascular health, including fitness tests in routine health checks and promoting physical activity to further increase cardiorespiratory fitness appears worthwhile.

Mortality risk associated with psychological distress and major depression: A population-based cohort study

BACKGROUND

Few studies have examined the impact of psychological distress on mortality. We aimed to estimate mortality rates of psychological distress and major depressive disorder (MDD) compared to a referent group with no MDD or psychological distress.

METHODS

Our study population (N = 10 181) consisted of respondents from the Canadian Community Health Survey Cycle 1.2 linked to Ontario health administrative databases followed for up to 11 years. We used Cox proportional hazards models to assess overall, sex-specific, as well as short-term (within two years of follow-up) and long-term (follow-up ≥ two years) mortality among those with DSM-criteria MDD and psychological distress independent of MDD adjusted for socio-demographic, lifestyle and clinical factors.

RESULTS

Individuals with psychological distress (n = 666) had a similar mortality rate as those with MDD (n = 428) and significantly greater adjusted hazards of death than the referent group (hazard ratio = 1.57, 95% CI = 1.14-2.15). The risk of death was greatest in the short-term among those with MDD, however, we observed a persistent 1.6-fold increased risk in both the short- and long-term among those with psychological distress compared to the referent. Women with MDD had the greatest mortality rate and died a median of 15 years earlier than women in the referent group.

LIMITATIONS

Psychological distress and MDD were ascertained at baseline with small number of deaths in the early follow-up period. Survey variables were prone to self-report bias with a possibility of residual confounding.

CONCLUSIONS

Focused longitudinal research and targeted management strategies for those with psychological distress and women with MDD are warranted.

Depressive and anxious symptoms and 20-year mortality: Evidence from the Stirling County study

BACKGROUND

Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality.

METHOD

This study considers respondents from the 1970 (n = 1203) and 1992 (n = 1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.

RESULTS

Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51).

CONCLUSIONS

This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.

Association between psychological distress and mortality: the case of Israel

BACKGROUND

Previous studies have demonstrated the association between psychological distress (measured by the 12-item General Health Questionnaire, GHQ-12) and risks of all-cause mortality and deaths from cardiovascular, cancer and other causes. We hypothesised that in the Israeli population permanently exposed to war/terror stressors, this relationship is absent.

METHODS

We performed an analysis of data from participants in the Israel National Health Survey conducted in 2003-2004, who died during the follow-up decade. Subjects were assigned to groups based on GHQ-12 score: 0-10 (asymptomatic), 11-14 (subclinically symptomatic), 15-19 (symptomatic) and 20-36 (highly symptomatic). Data were weighted to the total population.

RESULTS

We analysed data from 4843 individuals, median age 40.5 (IQR 28-54); 473 participants died during the follow-up. We found a significant increase in total mortality, cardiovascular and other causes of mortality (but not cancer deaths) with increase in GHQ-12 score (P for linear trend of ungrouped GHQ scores <0.0001, 0.0015 and <0.0001, respectively). The age-sex-adjusted HR for the highest GHQ-12 compared with the lowest asymptomatic category was 2.1 (95% CI 1.6 to 2.7) for all-cause deaths, 2.3 (95% CI 1.3 to 4.1) for cardiovascular disease deaths and 2.7 (95% CI 1.9 to 3.9) for other deaths. The HR remained significant after adjustment for education, smoking, alcohol consumption and diabetes. The HR even increased after excluding participants with baseline cardiovascular diseases and cancer.

CONCLUSION

Contrary to our hypothesis, psychological distress was associated with all-cause and cardiovascular but not cancer mortality. The absence of reverse causality provides evidence for the direct deleterious effects of psychological distress on mortality outcomes.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation

BACKGROUND

Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training.

PATIENTS AND METHODS

We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index.

RESULTS

Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04).

CONCLUSIONS

After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.

Loneliness in Professional Caring Relationships, Health, and Recovery

This study investigated patients' experiences of loneliness in professional caring relationships and their associations with perceived recovery, health, psychological distress, and general loneliness in life. The sample consisted of 406 patients who had undergone breast cancer or heart surgery 6 months earlier. The data were collected in May 2014-March 2015 using a postal survey including the Caring Loneliness Scale (CARLOS), questions concerning perceived health and recovery, 12-item General Health Questionnaire (GHQ-12), and a question concerning perceived general loneliness in life. Data analysis was done using Mann-Whitney U test and Kruskal-Wallis test. The variables showing a statistically significant association with professional caring loneliness were perceived health, recovery, psychological distress, and general loneliness in life. It is necessary for health care professionals to identify the phenomenon of this dimension of loneliness because it is bound to affect patients' experiences. Further studies with different patient groups are required.

Mental health problems among youth in India and its correlates

Purpose

– The purpose of this paper is to assess the prevalence and socio-economic determinants of common mental disorders among youth in India.

Design/methodology/approach

– The study utilizes data from “Youth in India: Situation and Needs 2006-2007”. One-way analysis of variance is used to compare different groups. Poisson regression models are used to test the relationship of household, parental, and individual factors with mental health problems.

Findings

– An estimated 11-31 million youth suffer from reported mental health problems in India. Results suggest that the household and individual factors like place of residence, wealth quintile, age, education, and occupation are the most important determinants of mental health problems among Indian youth. Parental factors lose their statistical significance once individual factors are controlled.

Research limitations/implications

– Little is known about correlates of mental health among youth. Strengthening on-going programmes and creating awareness about mental health issues through various programmes may help improve scenario. The two limitations of the study are: first, data covering all the states would have given a broader and clear picture of the issue; and second, due to cross-sectional nature of the data the study is not able to look into the cause-effect relationship.

Originality/value

– There are few studies which have explored mental health problems covering smaller areas in India. This is the first and the largest study conducted on a representative population of Indian youth to determine the correlates of reported mental health problems using General Health Questionnaire-12.

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study

OBJECTIVES

This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples.

METHODS

A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models.

RESULTS

Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury.

CONCLUSION

Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources.

Factor structure of the Iranian version of 12-item general health questionnaire

BACKGROUND

The 12-Item General Health (GHQ-12) questionnaire is one of the most commonly used instruments in screening studies on mental health.

OBJECTIVES

The current study aimed to examine the factor structure of the GHQ-12 questionnaire among the students in Iran.

MATERIALS AND METHODS

It was a cross-sectional study in which 428 university students were recruited and completed the GHQ-12. Reliability of the GHQ-12 was evaluated using the Cronbach's alpha and the split-half method by applying the Spearman-Brown coefficient. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was conducted to assess how well the EFA extracted model fitted the observed data.

RESULTS

The mean age of the participants was 22.83 years (SD = 3.09). Most of them were female (56.1%) and 81% were unemployed. The Cronbach's alpha coefficient for the Iranian version of GHQ-12 was 0.85. Using the split-half method, the alpha for the social dysfunction was found to be 0.77; it was 0.76 for the psychological distress. The principal component analysis revealed a two-factor structure for the questionnaire including social dysfunction and psychological distress that explained 48% of the observed variances. The confirmatory factor analysis was showed fit for the data.

CONCLUSIONS

The current study findings confirm that the Iranian version of GHQ-12 has a good factor structure and is a reliable and valid instrument to measure psychological distress and social dysfunction.

Impact of physical activity on psychological distress: a prospective analysis of an Australian national sample

OBJECTIVES

We analyzed the individual-level associations between participation in moderate to vigorous physical activity (MVPA) and psychological distress levels using a large, nationally representative, longitudinal sample and multivariable panel regression models.

METHODS

We used 3 waves of panel data from the Household, Income and Labour Dynamics in Australia Survey, consisting of 34 000 observations from 17 000 individuals and covering 2007, 2009, and 2011. We used fixed-effects panel regression models accounting for observable and unobservable confounders to examine the relationships between the weekly frequency of MVPA and summary measures of psychological distress based on the Kessler Psychological Distress Scale.

RESULTS

We found substantial and highly statistically significant associations between the frequency of MVPA and different indicators of psychological distress. Frequent participation in MVPA reduces psychological distress and decreases the likelihood of falling into a high-risk category.

CONCLUSIONS

Our findings underscore the importance of placing physical activity at the core of health promotion initiatives aimed at preventing and remedying psychological discomfort.

Level of distress predicts subsequent survival in successfully treated head and neck cancer patients: a prospective cohort study

CONCLUSION

Our findings indicate a unique survival prediction from general health questionnaire (GHQ) sum scores in successfully treated head and neck squamous cell carcinoma (HNSCC) patients and also to some extent with inclusion of health-related quality of life (HRQoL) scores.

OBJECTIVE

To examine the survival prediction from the level of distress, measured by GHQ scores obtained from at inclusion successfully treated HNSCC patients.

METHODS

Structured interviews were conducted for 135 successfully treated cognitive functioning HNSCC patients 67 ± 31 (mean ± SD) months after diagnosis following a regular follow-up visit. GHQ scores, alcohol consumption history, smoking status, present comorbidities, level of neuroticism, choice of psychological coping with the cancer disease, and HRQoL scores (EORTC QLQ-C30 and -H&N35) were determined. The TNM stage, treatment provided and tumour site were obtained from the hospital records. Forty-three deaths were noted during a minimum 8.5 years of observation.

RESULTS

The GHQ sum scores predicted survival in univariate (p < 0.05) and multivariate analyses with the above-mentioned covariates included (p < 0.01). Using clinically relevant cut-off levels, GHQ scores predicted survival in both univariate (hazard ratio (HR) 1.9; p = 0.05) and multivariate Cox regression analyses (HR 3.8; p = 0.001). We also demonstrated survival prediction from GHQ scores when adjusted by HRQoL scores.

Testing Psychometric Properties of the 30-Item General Health Questionnaire

This study aimed to evaluate the psychometric properties of the General Health Questionnaire (GHQ-30) given conflicting findings in the literature. A cross-sectional, nonexperimental research was used with a convenience sample of 271 American female health care professionals. Data were collected by using self-reported questionnaires. A series of exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and structural equation modeling (SEM) were performed to examine underlying dimensions of the GHQ-30.Results from EFAs and CFAs revealed the three-factor composition (positive affect, anxiety, and depressed mood). All factor loadings were statistically significant, and one pair of error variance was allowed to be correlated. All factors contained questionnaire items with acceptable face validity and demonstrated good internal consistency reliability. Results from SEM further confirmed underlying constructs of the scale. To our knowledge, this is the first study that extensively tested the psychometric properties of the GHQ-30, taking both statistical and substantive issues into consideration.

BMI and psychological distress in 68,000 Swedish adults: a weak association when controlling for an age-gender combination

Background

Study results concerning associations between body mass index (BMI) and psychological distress are conflicting. The purpose of this study was to describe the shape of the association between BMI and psychological distress in a large sample of Swedish adults.

Methods

Data was measured with the General Health Questionnaire-12 (GHQ-12), in 68,311 adults aged 18–74. Self-reported data was derived from a merger of the 2000, 2004 and 2008 Life and Health (Liv och Hälsa) questionnaires focusing general perceived distress as well as living conditions. Logistic regression analysis was used to describe the association between BMI and psychological distress when controlled for age and gender in combination.

Results

Women reported an overall higher psychological distress than men. A significant pattern of decreasing psychological distress with increasing age emerged among women in all BMI categories. Trends of this same pattern showed for men. Small or no differences were seen in psychological distress between those in normal weight, overweight, and obesity I categories (among women: 20.4%, 18.4%, 20.5%; among men: 12.8%, 11.2%, 12.9%). For both genders, any notable increase in psychological distress appeared first in the obesity II category (among women: 27.2%. Among men: 17.8%).

Conclusions

Psychological distress decreases with increasing age regardless of BMI; a pattern more obvious for women. Being categorized with obesity II leads to a markedly higher psychological distress than being categorized with normal weight, overweight or obesity I. From this, we suggest that future obesity research focusing on psychological distress could investigate the role of stigma and norm susceptibility in relationships where people are evaluated through the eyes of the other.

Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies

OBJECTIVE

To quantify the link between lower, subclinically symptomatic, levels of psychological distress and cause-specific mortality in a large scale, population based study.

DESIGN

Individual participant meta-analysis of 10 large prospective cohort studies from the Health Survey for England. Baseline psychological distress measured by the 12 item General Health Questionnaire score, and mortality from death certification.

PARTICIPANTS

68,222 people from general population samples of adults aged 35 years and over, free of cardiovascular disease and cancer, and living in private households in England at study baseline.

MAIN OUTCOME MEASURES

Death from all causes (n = 8365), cardiovascular disease including cerebrovascular disease (n = 3382), all cancers (n = 2552), and deaths from external causes (n = 386). Mean follow-up was 8.2 years (standard deviation 3.5).

RESULTS

We found a dose-response association between psychological distress across the full range of severity and an increased risk of mortality (age and sex adjusted hazard ratio for General Health Questionnaire scores of 1-3 v score 0: 1.20, 95% confidence interval 1.13 to 1.27; scores 4-6: 1.43, 1.31 to 1.56; and scores 7-12: 1.94, 1.66 to 2.26; P<0.001 for trend). This association remained after adjustment for somatic comorbidity plus behavioural and socioeconomic factors. A similar association was found for cardiovascular disease deaths and deaths from external causes. Cancer death was only associated with psychological distress at higher levels.

CONCLUSIONS

Psychological distress is associated with increased risk of mortality from several major causes in a dose-response pattern. Risk of mortality was raised even at lower levels of distress.