The Australian National Survey of Mental Health and Well-Being. Common psychological symptoms and disablement

Testing the Impact of Variations in Administration on the Kessler Psychological Distress Scale (K10)

Self-report measures are useful in psychological research and practice, but scores may be impacted by administration methods. This study investigated whether changing the recall period (from 30 to 7 days) and response option order (from ascending to descending) alters the score distribution of the Kessler Psychological Distress Scale (K10). Participants were presented with the K10 with either different recall periods or different response option orders. There was weak evidence of lower mean K10 scores when using a 7-day recall period than when using the 30-day recall period (B = 1.96, 95% CI [0.04-3.90]) but no evidence of a change in the estimated prevalence of very high psychological distress. Presenting the response options in ascending order did not affect mean scores, but there was weak evidence of reduced prevalence of very high distress relative to the descending order (incidence rate ratio [IRR] = 0.60, 95% CI [0.36-0.98]). These findings suggest that varying the administration method may result in minor differences in population estimates of very high psychological distress when using the K10.

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population

BACKGROUND AND OBJECTIVE

Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population.

METHODS

A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools.

RESULTS

Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk.

CONCLUSION

This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors.

TRIAL REGISTRATION

PROSPERO Registration: CRD42023395990.

Psychological distress and mental health diagnoses in adults by disability and functional difficulty status: Findings from the 2021 national health interview survey

BACKGROUND

Evidence suggests that disabled people have worse mental health than non-disabled people, but the degree to which disability contributes to mental health is unclear.

OBJECTIVE

This paper uses 2021 National Health Interview Survey (NHIS) data to estimate the association between disability and depression and anxiety diagnoses as well as psychological distress among adults.

METHODS

We calculated disability population prevalence and mental health diagnoses and associated symptoms among 28,534 NHIS respondents. Logistic regressions estimated the odds of depression or anxiety diagnoses and recent psychological distress, controlling for disability and mental health diagnoses. We measured disability using binary and continuum measures of functional disability with the Washington Group Short Set on Functioning.

RESULTS

Disabled people have significantly greater odds of both depression and anxiety diagnoses compared to non-disabled people. Those with high functional disability have 552 % greater odds of an anxiety diagnosis (95 % CI: 5.61-7.58; p < 0.01) and 697 % greater odds of a depression diagnosis (95 % CI: 6.97-9.12; p < 0.01) compared to those with no functional disability. Similarly, those with any level of functional disability are more likely to have elevated psychological distress in the past 30 days compared to those with no functional disability.

CONCLUSIONS

Findings support the idea that mental health is worse for disabled people compared to non-disabled people, with increasing functional disability associated with worse mental health. This suggests that mental health is not being adequately addressed for those with the greatest functional disability. Future work should seek to better understand the systemic causes of disparities.

“It’s important to manage our stress”: Mental health advice in the Australian print news media during the COVID-19 pandemic

The COVID-19 pandemic has heightened existing concerns about mental health and illness in Australia. The news media is an important source of health information, but there has been little research into how advice about mental health is communicated to the public via the news media. In this study, we examined how advice about building and maintaining mental health was discursively constructed in the news media during the COVID-19 pandemic. A discourse analytic approach informed by critical discursive psychology was employed to analyse 436 articles published in daily newspapers in Australia between 1 January and 31 December 2020, which contained references to mental health and the COVID-19 pandemic. Three main interpretative repertoires were identified – negative emotions are a risk to mental health and must be managed; risky emotions should be managed by being controlled (based around a ‘border control’ metaphor); and risky emotions should be managed by being released (based around a ‘pressure cooker’ metaphor). This study demonstrates that, amid the COVID-19 pandemic, advice constructed negative emotions as risky and problematic; and normalized the habitual management of emotions by individuals through strategies of control and release. Potential implications of such discourses for goals of improving population mental health are discussed.

Mental Health in Australia: Psychological Distress Reported in Six Consecutive Cross-Sectional National Surveys From 2001 to 2018

PURPOSE

To examine Australian psychological distress trends from 2001 to 2017/18, including analysis by age, sex, location, and household income.

METHODS

Secondary analysis of the working age population (18-64 years) in six successive representative national health surveys. Measures were prevalence of psychological distress at very-high symptom level (defined by a Kessler Psychological Distress Scale (K10) score of 30 or more) and combined high/very-high level (K10 score of 22 or more). Very-high K10 scores are associated with mental health problems meeting diagnostic thresholds in past year.

RESULTS

From 2001 to 2017/18 Australian rates of K10 very-high distress rose significantly from 3.8 to 5.1% and combined high/very-high from 13.2 to 14.8%. In women aged 55-64, very-high distress rose significantly and substantially from 3.5 to 7.2% and high/very-high distress from 12.4 to 18.7%. In men aged 25-34, very-high distress increased from 2.1 to 4.0% and high/very-high from 10.6 to 11.5%. Income was strongly and inversely associated with distress (lowest vs. highest quintile adjusted OR 11.4). An apparent association of increased distress with regional location disappeared with adjustment for income.

CONCLUSION

Australia's population level of psychological distress increased significantly from 2001-2017/18, with levels highest in women and with rates inversely associated with income. This is likely to be indicative of increased community rates of mental disorders. Given that this has occurred whilst mental healthcare expenditure has increased, there is an urgent need to reconsider how best to respond to mental illness, including targeting the most vulnerable based on social determinants such as age, gender, and lower incomes.

Gendered working environments as a determinant of mental health inequalities: a systematic review of 27 studies

BACKGROUND

'Gendered working environments' describes the ways in which (1) differential selection into work, (2) variations in employment arrangements and working hours, (3) differences in psychosocial exposures and (4) differential selection out of work may produce varied mental health outcomes for men and women. The aim of this study was to conduct a systematic review to understand gender differences in mental health outcomes in relation to the components of gendered working environments.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in 2008-2018. The protocol for the review was prospectively registered with PROSPERO (CRD42019124066).

FINDINGS

Across the 27 cohort studies included in the review, we found that (1) there was inconclusive evidence on the effect of occupational gender composition on the mental health of men and women, (2) women's mental health was more likely to be affected by long working hours than men's; however, precarious employment was more likely to be negatively associated with men's mental health, (3) exposure to traditional constructs of psychosocial job stressors negatively affected the mental health of both women and men, and (4) unemployment and retirement are associated with poorer mental health in both genders.

INTERPRETATION

The findings from this review indicate that gendered working environments may affect the mental health of both men and women, but the association is dependent on the specific exposure examined. There is still much to be understood about gendered working environments, and future research into work and health should be considered with a gender lens.

Impact of concussion and severe musculoskeletal injuries on the onset of mental health symptoms in male professional rugby players: a 12-month study

Objective

This study explored the association between concussion or musculoskeletal injuries, and the onset of mental health symptoms (MHS) in male professional rugby players over a 12-month period.

Methods

Observational prospective cohort study with three measurements over a follow-up period of 12 months. At baseline, 573 participants provided informed consent. A total of 327 male professional rugby players (62% forwards, 38% backs) completed all follow-up assessments at baseline, 6 months and 12 months. The mean (±SD) age, height and weight of the participants at baseline was 25.9 (±4.4) years, 184.9 (±8.7) cm and 101.5 (±14.6) kg, respectively. Number of musculoskeletal injuries and number of confirmed concussions were assessed through single questions. Symptoms of distress, anxiety/depression, sleep disturbance, adverse alcohol use and eating disorders were assessed using validated questionnaires.

Results

Professional rugby players who sustained a concussion within 12 months of baseline were more likely to develop MHS with ORs ranging from 1.5 (95% CI 1.0 to 2.1) for distress to 2.0 (1.2 to 3.6) for adverse alcohol use. Players who sustained a severe injury within 12 months of baseline were more likely to develop symptoms anxiety/depression with an OR of 1.5 (1.1 to 2.0). There was no significant association in both groups for other MHS.

Conclusions

Rugby players who sustained concussion or severe injuries are up to two times more likely to develop symptoms of distress, adverse alcohol use or anxiety/depression.

Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis

Objectives

To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane.

Eligibility criteria for selecting studies

We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders.

Results

Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression.

Conclusions

Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.

Disabling working environments and mental health: A commentary

Employment is a fundamental Social Determinant of Health known to have large impacts on mental health and other health outcomes. Across many countries of the world, people with disabilities are much more likely to be unemployed and looking for work than those without disabilities. The deprivation of employment opportunities is likely to have notable impacts on the health of people with disabilities. In this commentary, we outline the concept of "disabling working environments," which are defined as the range of experiences that affect the likelihood of people with disabilities in obtaining and maintaining quality employment which may then affect a disabled person's health. Disabling working environments are comprised of the following three mutually reinforcing components: 1) Differential selection into work; 2) Selection into certain types of jobs and exposure to poor psychosocial working environments when in employment, and; 3) Differential selection out of work (e.g., leaving employment at an earlier age than those who do not have a disability). We argue that policy and intervention design should consider the life course effects of employment on the mental health of people with disabilities.

Gendered Working Environments as a Determinant of Mental Health Inequalities: A Protocol for a Systematic Review

Both gender and employment are critical and intersecting social determinants of mental and physical health. This paper describes the protocol used to conduct a systematic literature review of the relationship between "gendered working environments" and mental health. Gendered working environments (GWE) are conceptualised as involving: (1) differences in selection into work, and more specifically, occupations; (2) variation in employment arrangements and working hours; (3) disparities in psychosocial exposures at work, and; (4) differences in selection out of work. Methods/design: The review will adhere to a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search procedure. Key words will be identified that are specific to each of the four domains of GWE. The databases used for the search will be Scopus, Pubmed, Proquest, and Web of Science. Keywords will be adapted for the specific requirements of each electronic database. Inclusion criteria are: Using a validated scale to measure mental health (outcome); including exposures related to the four domains of GWE; reporting estimates for both men and women; and use of a cohort, case-control, or cross-sectional design. Studies will be excluded if they were published more than 10 years ago, are not in English or do not present extractable data on the relationship between GWE and mental health. Discussion: The proposed review will provide evidence about the numerous and complex ways in which employment and gender intersect (and are reinforced) to influence mental health over the life course.

Criminal Justice Contact and Health Service Utilization among Women across Health Care Settings: Analyzing the Role of Arrest

BACKGROUND

It is well-established in the United States that incarceration negatively influences women's health, and researchers have called for examinations of the health effects of criminal justice contact more broadly. This study uses the behavioral model for vulnerable populations to document the prevalence of illness and health risks for recently arrested women, and examines potential ways that illness and health risks are associated with health service use across health care settings.

METHODS

We conducted a mediation analysis using pooled data from the National Survey on Drug Use and Health (2010-2014).

RESULTS

These findings reveal that recent arrest is associated with different types of health care use among women. Specifically, women recently arrested are hospitalized and seek care at the emergency department at higher rates than non-recently arrested women and this may be associated with their vulnerable mental and behavioral health status.

CONCLUSIONS

The findings suggest an increasing overlap between criminal justice and public health sectors. Increased access to appropriate health services is a necessary strategy to reduce resource intensive hospitalizations and emergency department use among women experiencing a recent arrest.

The VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP): Rationale and design of a large-scale ancillary study evaluating vitamin D and marine omega-3 fatty acid supplements for prevention of late-life depression

RATIONALE

Depression is a leading cause of disease burden and disability for older adults; thus, prevention is a priority. Biologic and observational data support potential mental health benefits of vitamin D and omega-3 fatty acids; however, it is unclear whether these supplements can prevent late-life depression.

DESIGN

We describe the novel methodology of a large-scale study: VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary to the VITAL trial. Primary Aims of VITAL-DEP are to determine effects on prevention of depression and on trajectory of mood symptoms of long-term (mean=5years) supplementation with vitamin D (vitamin D3 [cholecalciferol], 2000IU/day) and marine omega-3 fatty-acids (eicosapentaenoic acid + docosahexaenoic acid, 1g/day), in a 2×2 factorial design, among 25,874 older adults. Secondary Aims will evaluate: vitamin D's effects among African-Americans (an at-risk group for vitamin D deficiency); both agents' effects among those with high-risk factors or sub-syndromal depression in a sub-set of ~1000 participants with detailed examinations at baseline and 2-year follow-up; whether baseline nutrient levels influence depression risk and/or modify agents' effects. Additional planned analyses will use pre-randomization blood samples available in ~17,000 participants to address whether key biomarkers and factors influence long-term mood and depression risk and/or the agents' effects.

CONCLUSION

VITAL-DEP applies all modalities of state-of-the-art prevention research - universal, selective and indicated. VITAL-DEP will clarify effects of supplemental vitamin D and/or omega-3 on mood, and inform clinical care and public health guidelines on the use of these agents for prevention of depression in mid-life and older adults.

Exposure to physical and psychosocial stressors in relation to symptoms of common mental disorders among European professional football referees: a prospective cohort study

Objectives

The study aim was to explore the association of physical and psychosocial stressors (severe injuries, surgeries, recent life events, social support) with one-season onset of symptoms of common mental disorders (CMDs) among European professional football referees.

Methods

An observational prospective cohort study over a follow-up period of one season (2015-2016) was conducted among professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Based on physical and psychosocial stressors as well as symptoms of CMD, an electronic questionnaire in English and French was set up and distributed by eight football federations involved.

Results

The prevalence of symptoms of CMD ranged from 5.9% for distress to 19.2% for eating disorders. A higher number of severe injuries and a lower degree of satisfaction about social support were significantly related to the occurrence of symptoms of CMD with an OR of 2.63 and an OR of 1.10, respectively.

Conclusion

A higher number of severe injuries and a lower degree on satisfaction about social support were found to be significantly associated with the onset of symptoms of CMD among European professional football referees. Referees suffering from severe injuries were nearly three times more likely to report symptoms of anxiety and depression. Referees who reported a low satisfaction of social support were significantly more likely to report symptoms of eating disorder.

Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey

AIMS

While epidemiological surveys worldwide have found a considerable proportion of people using mental health services not to have a diagnosis of a mental disorder, with possible implications of service overuse, other work has suggested that most people without a current diagnosis who used services exhibited other indicators of need. The aims of the present study were, using somewhat different categorisations than previous work, to investigate whether: (1) Australians without a diagnosis of a mental disorder who used mental health services had other indicators of need; and (2) how rate and frequency of service use in Australia related to level of need, then to discuss the findings in light of recent developments in Australian Mental Health Policy and other epidemiological and services research findings.

METHODS

Data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) 2007 was analysed.

RESULTS

Most people using mental health services had evident indicators of need for mental health care (MHC), and most of those with lower evident levels of need did not make heavy use of services. Only a small proportion of individuals without any disorders or need indicators received MHC (4%). Although this latter group comprises a fair proportion of service users when extrapolating to the Australian population (16%), the vast majority of these individuals only sought brief primary-care or counselling treatment rather than consultations with psychiatrists. Access and frequency of MHC consultations were highest for people with diagnosed lifetime disorders, followed by people with no diagnosed disorders but other need indicators, and least for people with no identified need indicators. Limitations include some disorders not assessed in interview and constraints based on survey size to investigate subgroups defined, for instance, by socioeconomic advantage and disadvantage individually or by characteristics of area.

CONCLUSIONS

MHC for individuals with no recognised disorders or other reasonable need for such care may be occurring but if so is likely to be an area-specific phenomenon. Rather than revealing a large national pool of treatment resources being expended on the so-called 'worried well', the findings suggested a generally appropriate dose-response relationship between need indicators and service use. Definitive ascertainment of area-specific disparities in this national pattern would require a different survey approach. Government proposals for widespread introduction of stepped-care models that may seek to divert patients from existing treatment pathways need to be implemented with care and well informed by local data.

Symptoms of common mental disorders among professional football referees: a one-season prospective study across Europe

OBJECTIVE

The primary aim of this study was to determine the prevalence and one-season incidence of symptoms of common mental disorders (CMD; distress, anxiety/depression, sleep disturbance, eating disorders, adverse alcohol use) among European professional football referees. A secondary aim was to explore the view of European professional football referees on consequences, support and needs related to these symptoms.

METHODS

An observational prospective cohort study with three measurements over a follow-up period of one season (2015-2016) was conducted among central or assistant professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Using validated questionnaires to assess symptoms of CMD (self-reported and not clinically diagnosed), an electronic questionnaire in English and French was set up and distributed by the eight football federations involved.

RESULTS

A total of 391 referees (mean age of 33 years old; mean career duration of 7 years) were enrolled, of which 292 completed the follow-up period. Baseline 4-week prevalence rates were 6% for distress, 12% for anxiety/depression, 9% for sleep disturbance, 19% for eating disorders and 17% for adverse alcohol use. The one-season incidence of symptoms of CMD was 10% for distress, 16% for anxiety/depression, 14% for sleep disturbance, 29% for eating disorders and 8% for adverse alcohol use.

CONCLUSION

While symptoms of CMD occur among professional football referees and can influence negatively refereeing performances, the development of specific support measures for referees are needed in order to manage properly these symptoms of CMD.

The prevalence and risk indicators of symptoms of common mental disorders among current and former Dutch elite athletes

The aim of the study was to determine the prevalence and comorbidity of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, eating disorders, adverse alcohol use) among current and former Dutch elite athletes, and to explore the inference between potential risk indicators (severe injury, surgery, life events, sport career dissatisfaction, social support) and the outcomes measures under investigation. Cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among 203 current and 282 former elite Dutch athletes (response rate: 28% among current athletes and 95% among former athletes). Based on validated scales, an electronic questionnaire was set up and distributed. Prevalence (4-week) ranged from 6% for adverse alcohol use to 45% for anxiety/depression among current elite athletes, and from 18% for distress to 29% for anxiety/depression among former elite athletes. A higher number of past severe injuries, higher number of past surgeries, higher number of recent life events, higher level of career dissatisfaction and lower level of social support were related to the occurrence of symptoms of common mental disorders among both current and former elite athletes. On average, the 4-week prevalence of common mental disorders as shown in our study among current and former Dutch elite athletes were similar to the ones found among athletes from other sports disciplines and does compare with the lifetime prevalence estimates in the general population of the Netherlands.

The interactive role of income (material position) and income rank (psychosocial position) in psychological distress: a 9-year longitudinal study of 30,000 UK parents

PURPOSE

Parents face an increased risk of psychological distress compared with adults without children, and families with children also have lower average household incomes. Past research suggests that absolute income (material position) and income status (psychosocial position) influence psychological distress, but their combined effects on changes in psychological distress have not been examined. Whether absolute income interacts with income status to influence psychological distress are also key questions.

METHODS

We used fixed-effects panel models to examine longitudinal associations between psychological distress (measured on the Kessler scale) and absolute income, distance from the regional mean income, and regional income rank (a proxy for status) using data from 29,107 parents included in the UK Millennium Cohort Study (2003-2012).

RESULTS

Psychological distress was determined by an interaction between absolute income and income rank: higher absolute income was associated with lower psychological distress across the income spectrum, while the benefits of higher income rank were evident only in the highest income parents. Parents' psychological distress was, therefore, determined by a combination of income-related material and psychosocial factors.

CONCLUSIONS

Both material and psychosocial factors contribute to well-being. Higher absolute incomes were associated with lower psychological distress across the income spectrum, demonstrating the importance of material factors. Conversely, income status was associated with psychological distress only at higher absolute incomes, suggesting that psychosocial factors are more relevant to distress in more advantaged, higher income parents. Clinical interventions could, therefore, consider both the material and psychosocial impacts of income on psychological distress.

Are Level of Education and Employment Related to Symptoms of Common Mental Disorders in Current and Retired Professional Footballers?

BACKGROUND

Mental disorders have become a topic of increasing interest in research due to their serious consequences for quality of life and functioning.

OBJECTIVES

The objective of this study was to explore the relationship of level of education, employment status and working hours with symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol behaviour, smoking, adverse nutritional behaviour) among current and retired professional footballers.

MATERIALS AND METHODS

Cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among current and retired professional footballers. Based on validated scales, an electronic questionnaire was set up and distributed by players' unions in 11 countries across three continents.

RESULTS

A total of 607 current professional footballers (mean age of 27 years) and 219 retired professional footballers (mean age of 35 years) were involved in the study. Among retired professional footballers, statistically significant negative correlations were found between employment status and symptoms of distress and anxiety/depression (P < 0.05), as well as between number of working hours and symptoms of anxiety/depression (P < 0.05). No other statistically significant associations were found among retired players. Among current professional footballers, level of education was not associated with symptoms of common mental disorders.

CONCLUSIONS

Among retired professional footballers, employment status as well as a higher number of working hours was weakly correlated to symptoms of distress and anxiety/depression. Combining a football career with sustainable attention for educational and career planning might be important and of high priority.

Few middle-aged women with severe mental symptoms use psychotropic drugs: The Women's Health in Lund Area (WHILA) Study

Aims: In a population of middle-aged women a survey was carried out to ascertain the prevalence of mental symptoms and psychotropic drug use, and further to investigate whether severe mental symptoms are associated with social situation, alcohol consumption, smoking, and physical health. Methods: All women (n=10,766) aged 50—59 years and living in the Lund area were invited to the WHILA study, a health survey including laboratory examinations and a self-administered questionnaire; 6,917 (64.2%) participated. This study is based on the questionnaire only. Results: During the past three months 25.4% (n=1,709) had been troubled by none or 1 mental symptom (labelled ``absent/slight''), 52.8% (n=3,555) by 2—6 mental symptoms (``moderate'') and 21.8% (n=1,471) by 7—10 mental symptoms (``severe''). Among women with severe mental symptoms 15.4% regularly used psychotropic drugs, mainly antidepressants. A multiple logistic regression analysis showed that women with severe mental symptoms had higher odds for living alone (OR 1.7; CI 1.3—2.2) or as single parents (OR 2.1; CI 1.2—3.6), being university-educated (OR 1.5; CI 1.1—2.0), being on long-term sick-leave (OR 8.8; CI 3.0—25.5), using hormone replacement therapy (OR 1.3; CI 1.1—1.6), and having severe physical symptoms (136.8; CI 89.2—209.7) compared with women with absent/slight mental symptoms. Conclusion: Mental symptoms were common among the participating women. The presence of severe mental symptoms was strongly associated with severe physical symptoms. Few women with severe mental symptoms used psychotropic drugs. Middle-aged women with severe mental symptoms need to be identified and provided with appropriate psychopharmacological, hormonal, and/or psychosocial treatment.

Epidemiology of symptoms of common mental disorders among elite Gaelic athletes: a prospective cohort study

OBJECTIVE

Scientific knowledge about symptoms of common mental disorders among elite Gaelic athletes is lacking. Consequently, this study aimed to (i) determine the prevalence, comorbidity and 6-month incidence of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol use) among elite Gaelic athletes and (ii) evaluate their association with potential stressors (severe musculoskeletal injuries, surgeries, recent life events, career dissatisfaction).

METHODS

An observational prospective cohort study by means of questionnaires was conducted over six months among elite Gaelic athletes (N=204). Using validated questionnaires to assess symptoms of common mental disorders as well as several stressors, an electronic questionnaire was set up and distributed by the Gaelic Players' Association.

RESULTS

Prevalence ranged from 23% for adverse alcohol use to 48% for anxiety/depression. Around 24% of the participants reported at baseline two symptoms. Six-month incidence ranged from 11% for sleep disturbance to 21% for anxiety/depression. Severe musculoskeletal injury, surgery, recent life events and career dissatisfaction led to an increased risk for common mental disorders.

CONCLUSION

Our findings indicate that raising the self-awareness of all stakeholders in Gaelic sports about common mental disorders should be prioritized, as well as the evidence-based development and application of adequate preventive and supportive measures.

Blurred lines: Performance Enhancement, Common Mental Disorders and Referral in the U.K. Athletic Population

Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMD. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually evolving and reconfiguring to ensure that it continues to meet the demands of its clients.

Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population

OBJECTIVES

The 12-item version of the General Health Questionnaire (GHQ-12) is frequently used to measure common mental disorder in public health surveys, but few population-based validations have been made. We validated the GHQ-12 against structured psychiatric interviews of depression using a population-based cohort in Stockholm, Sweden.

METHODS

We used a population-based cohort of 484 individuals in Stockholm, Sweden (participation rate 62%). All completed the GHQ-12 and a semi-structured psychiatric interview. Last month DSM-III-R symptoms were used to classify major and minor depression. Three scoring methods for GHQ-12 were assessed, the Standard, Likert and Corrected method. Discriminatory ability was assessed with area under the receiver operating characteristic (ROC) curve.

RESULTS

A total of 9.5% had a major or minor depression. The area under the ROC curve was for the Standard method 0.73 (0.65-0.82), the Likert method 0.80 (0.72-0.87) and the Corrected method 0.80 (0.73-0.87) when using major or minor depression as standard criterion. Adequate sensitivity and specificity for separating those with or without a depressive disorder was reached at ≥12 Likert scored points (80.4 and 69.6%) or ≥6 Corrected GHQ points (78.3 and 73.7%). Sensitivity and specificity was at ≥2 Standard scored points 67.4% and 74.2%.

CONCLUSION

When scored using the Likert and Corrected methods, the GHQ-12 performed excellently. When scored using the Standard method, performance was acceptable in detecting depressive disorder in the general population. The GHQ-12 appears to be a good proxy for depressive disorder when used in public health surveys.

Symptoms of Common Mental Disorders and Adverse Health Behaviours in Male Professional Soccer Players

To present time, scientific knowledge about symptoms of common mental disorders and adverse health behaviours among professional soccer players is lacking. Consequently, the aim of the study was to determine the prevalence of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance) and adverse health behaviours (adverse alcohol behaviour, smoking, adverse nutrition behaviour) among professional soccer players, and to explore their associations with potential stressors (severe injury, surgery, life events and career dissatisfaction). Cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among male professional players. Using validated questionnaires to assess symptoms of common mental disorders and adverse health behaviours as well as stressors, an electronic questionnaire was set up and distributed by players' unions in 11 countries from three continents. Prevalence of symptoms of common mental disorders and adverse health behaviours among professional soccer players ranged from 4% for smoking and 9% for adverse alcohol behaviour to 38% for anxiety/depression and 58% for adverse nutrition behaviour. Significant associations were found for a higher number of severe injuries with distress, anxiety/depression, sleeping disturbance and adverse alcohol behaviour, an increased number of life events with distress, sleeping disturbance, adverse alcohol behaviour and smoking, as well as an elevated level of career dissatisfaction with distress, anxiety/depression and adverse nutrition behaviour. Statistically significant correlations (p<0.01) were found for severe injuries and career dissatisfaction with most symptoms of common mental disorders. High prevalence of symptoms of common mental disorders and adverse health behaviours was found among professional players, confirming a previous pilot-study in a similar study population.

Prevalence and determinants of symptoms of common mental disorders in retired professional Rugby Union players

The primary aim of this study was to determine the prevalence of symptoms of common mental disorders (CMD) (distress, anxiety/depression, sleeping disturbance, adverse nutrition behaviour, adverse alcohol behaviour and smoking) among retired professional Rugby Union players. The secondary aim was to explore the associations between stressors (life events, Rugby Union career dissatisfaction) and the health conditions under study. Therefore, cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study of retired professional Rugby Union players. An electronic questionnaire was established using validated questionnaires to assess symptoms of CMD and stressors. The electronic questionnaire was subsequently distributed to retired players by the national Rugby Union players' associations in France, Ireland and South Africa. Among 295 retired professional Rugby Union players (mean age of 38 years), prevalence rates were 25% for distress, 28% for anxiety/depression, 29% for sleeping disturbance, 62% for adverse nutrition behaviour, 15% for smoking and 24% for adverse alcohol behaviour. A higher number of life events were associated with distress (OR = 1.2; 95% CI 1.1-1.4), anxiety/depression (OR = 1.6; 95% CI 1.2-2.1), sleeping disturbance (OR = 1.6; 95% CI 1.2-2.1) and adverse nutrition behaviour (OR = 1.8; 95% CI 1.3-2.5). A higher level of dissatisfaction of the player's Rugby Union career was associated with distress (OR = 0.9; 95% CI 0.8-1.0), sleeping disturbance (OR = 0.9; 95% CI 0.9-1.0), smoking (OR = 0.9; 95% CI 0.9-1.0) and adverse nutrition behaviour (OR = 0.9; 95% CI 0.8-0.9). In conclusion, our study suggests that prevalence of symptoms of CMD is high among retired professional Rugby Union players, being associated with both a higher number of life events and a higher level of Rugby Union career dissatisfaction.

An Instrumental Variable Probit (IVP) analysis on depressed mood in Korea: the impact of gender differences and other socio-economic factors

BACKGROUND

Depression is a mental health state whose frequency has been increasing in modern societies. It imposes a great burden, because of the strong impact on people's quality of life and happiness. Depression can be reliably diagnosed and treated in primary care: if more people could get effective treatments earlier, the costs related to depression would be reversed. The aim of this study was to examine the influence of socio-economic factors and gender on depressed mood, focusing on Korea. In fact, in spite of the great amount of empirical studies carried out for other countries, few epidemiological studies have examined the socio-economic determinants of depression in Korea and they were either limited to samples of employed women or did not control for individual health status. Moreover, as the likely data endogeneity (i.e. the possibility of correlation between the dependent variable and the error term as a result of autocorrelation or simultaneity, such as, in this case, the depressed mood due to health factors that, in turn might be caused by depression), might bias the results, the present study proposes an empirical approach, based on instrumental variables, to deal with this problem.

METHODS

Data for the year 2008 from the Korea National Health and Nutrition Examination Survey (KNHANES) were employed. About seven thousands of people (N= 6,751, of which 43% were males and 57% females), aged from 19 to 75 years old, were included in the sample considered in the analysis. In order to take into account the possible endogeneity of some explanatory variables, two Instrumental Variables Probit (IVP) regressions were estimated; the variables for which instrumental equations were estimated were related to the participation of women to the workforce and to good health, as reported by people in the sample. Explanatory variables were related to age, gender, family factors (such as the number of family members and marital status) and socio-economic factors (such as education, residence in metropolitan areas, and so on). As the results of the Wald test carried out after the estimations did not allow to reject the null hypothesis of endogeneity, a probit model was run too.

RESULTS

Overall, women tend to develop depression more frequently than men. There is an inverse effect of education on depressed mood (probability of -24.6% to report a depressed mood due to high school education, as it emerges from the probit model marginal effects), while marital status and the number of family members may act as protective factors (probability to report a depressed mood of -1.0% for each family member). Depression is significantly associated with socio-economic conditions, such as work and income. Living in metropolitan areas is inversely correlated with depression (probability of -4.1% to report a depressed mood estimated through the probit model): this could be explained considering that, in rural areas, people rarely have immediate access to high-quality health services.

CONCLUSION

This study outlines the factors that are more likely to impact on depression, and applies an IVP model to take into account the potential endogeneity of some of the predictors of depressive mood, such as female participation to workforce and health status. A probit model has been estimated too. Depression is associated with a wide range of socio-economic factors, although the strength and direction of the association can differ by gender. Prevention approaches to contrast depressive symptoms might take into consideration the evidence offered by the present study.

Antecedents of Attitudes to Aging: A Study of the Roles of Personality and Well-being

PURPOSE OF THE STUDY

Little research has examined factors that contribute to the formation of attitudes toward one's own aging. The current study aimed to examine personality as defined by the Five-Factor model of personality as an antecedent of attitudes, while taking into account demographic and health factors known to be relevant to such attitudes.

DESIGN AND METHODS

Participants aged 60 years or older (N = 421) were part of a longitudinal study of health and well-being in Australia, and completed a postal survey comprising measures of personality, the Attitudes to Ageing Questionnaire, the SF-12 health survey, and the Satisfaction with Life Scale.

RESULTS

Higher levels of neuroticism were associated with less positive attitudes toward old age as a time of psychological growth, and higher extraversion and agreeableness were significant predictors of less negative attitudes toward psychosocial loss. Baseline measures of self-reported mental and physical health, as well as change in those scores, also made significant contributions to attitudes toward aging.

IMPLICATIONS

Personality was a significant antecedent of attitudes towards aging, as were mental and physical health. The data highlight the role of potentially modifiable factors, such as mental and physical health. If these factors act as resources that shape an individual's attitudes during the aging process, then one potential foundation for holding positive attitudes to aging is to maintain physical and mental health. This requires interventions and policies that are effective in encouraging health-promoting behaviors.

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study

BACKGROUND

Workforce participation is a key feature of public mental health and social inclusion policies across the globe, and often a therapeutic goal in treatment settings. Understanding the reciprocal relationship between participation and mental health has been limited by inadequate research methods. This is the first study to simultaneously examine and contrast the relative effects of unemployment on mental health and mental health on employment status in a single general population sample.

METHOD

Data were from working-age respondents (20 to 55 years at baseline) who completed nine waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (N=7176). Cross-lagged path analyses were used to test the lagged and concurrent associations between unemployment and mental health over time, adjusting for sociodemographic characteristics.

RESULTS

Mental health was shown to be both a consequence of and risk factor for unemployment. Thus, the poorer mental health observed amongst people who are not working is attributable to both the impact of unemployment and existing mental health problems. While the strength of these two effects was similar for women, the results for men suggested that the effect of unemployment on subsequent mental health was weaker than the effect of mental health on subsequent risk of unemployment.

CONCLUSION

Disentangling the reciprocal links between mental health and workforce participation is central to the development and success of clinical goals and health and social policies that aim to promote either aspect. This study demonstrates that both effects are important and supports concurrent responses to prevent a cycle of disadvantage and entrenched social exclusion.

Stability and change in level of probable depression and depressive symptoms in a sample of middle and older-aged adults

BACKGROUND

Findings from studies investigating depression in adults in late life are mixed due to a lack of large longitudinal studies with the power necessary to yield reliable estimates of stability or change. We examined the long-term stability of probable depression and depressive symptomology over a 13-year period in the Dynamic Analyses to Optimize Ageing (DYNOPTA) project.

METHODS

Community-living participants (N = 35,200) were aged 45-103 at baseline, predominantly female (79%), partnered (73%), and educated to secondary school only (61%) and followed for up to 13 years.

RESULTS

At baseline, increased age was associated with lower prevalence of probable depression and depressive symptomology. Over time, prevalence of probable depression was stable while levels of depressive symptomology reported a small decline. However, this finding was not consistent for all age groups; there was evidence for increasing levels of depressive symptomology, but not probable depression, as individuals aged. This effect was particularly notable among males aged 70 plus years.

CONCLUSIONS

These results answer important questions relating to the longitudinal prevalence of probable depression and depressive symptomology in a sample of older Australians. These findings have policy implications for mental health service provision for older adults.

Maternal mental health: pathways of care for women experiencing mental health issues during pregnancy

Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study ( Epstein, 2010 ) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported ( Buist et al., 2002 ), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy ( Vilder, 2006 ) and suggest the need for change to systems that work to support women's perinatal mental health.

The relationship between attitudes to aging and physical and mental health in older adults

BACKGROUND

Attitudes are known to exert a powerful influence on a range of behaviors. The objective of this study was to investigate the contribution of attitudes toward one's own aging to satisfaction with life and physical and mental health measured in a sample of community-dwelling older adults.

METHODS

Adults who were part of a larger study of health and well-being in rural and regional Australia aged ≥60 years (N = 421) completed a cross-sectional postal survey comprising the Attitudes to Aging Questionnaire, the 12-Item Short Form Health Survey (SF-12), the Satisfaction with Life Scale, the Geriatric Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale.

RESULTS

Overall, attitudes to aging were positive in this sample. More positive attitudes to aging were associated with higher levels of satisfaction with life, better self-report physical and mental health on the SF-12, and lower levels of anxiety and depression, after controlling for confounding variables. Better financial status and being employed were both associated with more positive attitudes to aging and better self-reported physical health. Relationship status was also significantly associated with mental health and satisfaction with life, but not physical health.

CONCLUSION

The promotion of successful aging is increasingly becoming important in aging societies. Having positive attitudes to aging may contribute to healthier mental and physical outcomes in older adults. Overcoming negative stereotypes of aging through change at the societal and individual level may help to promote more successful aging.

Comparing the health burden of eating-disordered behavior and overweight in women

OBJECTIVE AND METHODS

We compared the health burden of eating-disordered behavior with that of overweight in a community-based sample of women aged 18-42 years residing in the Australian Capital Territory region of Australia. Participants (n = 4643) completed self-report measures of eating disorder psychopathology, health-related quality of life and health service utilization. Body mass index (BMI) was derived from self-reported height and weight.

RESULTS

Overweight was associated with marked impairment in physical health functioning and comparatively little impairment in psychosocial functioning, whereas eating-disordered behavior was associated with marked impairment in psychosocial functioning and comparatively little impairment in physical health functioning. Further, (1) impairment in psychosocial functioning associated with eating-disordered behavior was greater than impairment in physical health functioning associated with overweight, and (2) impairment in physical health functioning associated with eating-disordered behavior was greater than impairment in psychosocial functioning associated with overweight. Overweight and eating-disordered behavior were associated with similarly elevated rates of primary care consultations during the past 6 months and of lifetime treatment from a health professional for an eating or weight problem.

CONCLUSIONS

In young adult women, the health burden of eating-disordered behavior may be more substantial than previously recognized. Better information concerning the spectrum of disordered eating that exists at the population level needs to be made available. Eating-disordered behavior warrants greater attention when considering the public health burden of obesity and in developing programs to reduce this burden.

Deriving prevalence estimates of depressive symptoms throughout middle and old age in those living in the community

BACKGROUND

There is considerable debate about the prevalence of depression in old age. Epidemiological surveys and clinical studies indicate mixed evidence for the association between depression and increasing age. We examined the prevalence of probable depression in the middle aged to the oldest old in a project designed specifically to investigate the aging process.

METHODS

Community-living participants were drawn from several Australian longitudinal studies of aging that contributed to the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Different depression scales from the contributing studies were harmonized to create a binary variable that reflected "probable depression" based on existing cut-points for each harmonized scale. Weighted prevalence was benchmarked to the Australian population which could be compared with findings from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB).

RESULTS

In the DYNOPTA project, females were more likely to report probable depression. This was consistent across age levels. Both NSMHWB surveys and DYNOPTA did not report a decline in the likelihood of reporting probable depression for the oldest old in comparison with mid-life.

CONCLUSIONS

Inconsistency in the reports of late-life depression prevalence in previous epidemiological studies may be explained by either the exclusion and/or limited sampling of the oldest old. DYNOPTA addresses these limitations and the results indicated no change in the likelihood of reporting depression with increasing age. Further research should extend these findings to examine within-person change in a longitudinal context and control for health covariates.

Nutrition status of primary care patients with depression and anxiety

The objective of this study was to evaluate the nutrition status of people referred to a nutrition and physical activity program for the management of mental health in general practice. Patients currently being treated for depression and/or anxiety were referred by their GPs to a lifestyle intervention program. The nutrition status was assessed during a comprehensive assessment at the commencement of the program. The lifestyle intervention program, including all assessments, was offered at multiple sites including GP clinics in the Illawarra, and in clinic rooms at the University of Wollongong. Thirty-two men and seventy-seven women completed the assessment. Patients were referred with depression (52%), anxiety (19%) or both (28%). Eighty percent of participants were overweight or obese. All participants completed an assessment that included a diet history, anthropometric measurements and the completion of several questionnaires including the Depression, Anxiety and Stress Scale (DASS). Nutrition status was assessed using mean nutrient intakes and Australian modified Healthy Eating Index scores evaluated against the National Nutrition Survey intakes and DASS scores. Participants met the estimated average requirements for all nutrients except folate (17%), magnesium (78%) and calcium (57%). Intakes were similar to those reported in the National Nutrition Survey. Only magnesium intakes were significantly related to depression (r = –0.26). Australian modified Healthy Eating Index scores were significantly negatively correlated with DASS scores (P < 0.01). The associations presented here support the existing body of literature. Nutrition recommendations for patients with depression and anxiety should be based on the Australian Guide to Healthy Eating with particular attention to fruit, vegetables and wholegrains.

Impact of common mental disorders on sickness absence in an occupational cohort study

OBJECTIVES

Common mental disorders are associated with impaired functioning and sickness absence. We examine whether sub-clinical as well as clinical psychiatric morbidity predict long spells of sickness absence for both psychiatric and non-psychiatric illness. We also examine whether recent common mental disorders and those present on two occasions have a stronger association with sickness absence than less recent and single episodes of disorder.

METHODS

Common mental disorders measured by the General Health Questionnaire were linked with long spells of sickness absence in 5104 civil servants from the longitudinal Whitehall II Study. Negative binomial models were used to estimate rate ratios for long spells of sickness absence with and without a psychiatric diagnosis (mean follow-up 5.3 years).

RESULTS

Clinical but not sub-threshold common mental disorders were associated with increased risk of long spells of psychiatric sickness absence for men, but not for women, after adjusting for covariates (rate ratios (RR) 1.67, 95% CI 1.13 to 2.46). Risk of psychiatric sickness absence was associated with recent common mental disorders (RR 2.08, 95% CI 1.29 to 3.35) and disorder present on two occasions (RR 1.65, 95% CI 0.98 to 2.71) for men only. Common mental disorders were not associated with increased risk of non-psychiatric sickness absence after adjustment for covariates.

CONCLUSIONS

Identification and treatment of common mental disorders may reduce the economic burden of long term psychiatric sickness absence. Our results suggest that public health and clinical services should focus on the identification of workers with elevated mental health symptoms. Studies are needed of the efficacy of early identification and management of mental health symptoms for the prevention of long spells of sickness absence.

Comparison of the Composite International Diagnostic interview (CIDI-Auto) with clinical diagnosis in a suicidal population

The objective was to examine agreement between routine clinician diagnoses of DSM-IV Anxiety, Depressive, Substance-Use disorders with diagnoses generated by CIDI-Auto Version 2.1, administered by trained interviewers. Subjects were 329 deliberate self poisoning patients at a tertiary referral center in Australia. Tests of agreement were: percentage agreement, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and Cohen's kappa coefficients, for 1 month and 12 month CIDI diagnoses. Agreement was poor (kappa <0.40) for Anxiety, Depressive and Substance-Use disorders. Since diagnosis largely determines subsequent treatment, these findings did not support the use of the less expensive CIDI-Auto procedure to replace clinical diagnosis by experienced clinicians for this group of patients exhibiting suicidal behavior.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

Understanding the causes of depression among prostate cancer patients: development of the Effects of Prostate Cancer on Lifestyle Questionnaire

OBJECTIVE

Depression among prostate cancer patients remains a major source of distress for them and their families, has been linked with suicide, and has been shown to contribute to poorer longterm treatment outcomes. Most psychological assessment strategies focus upon the presence of depressive symptomatology without identifying the specific causal antecedents that lead to depression among this patient group, although this underlies effective individually-oriented treatment planning and delivery.

METHOD

150 prostate cancer patients completed self reports on anxiety, depression and lifestyle changes that they had experienced as a result of receiving a diagnosis of, and treatment for their cancer. The principal instrument being investigated was a measure of 50 lifestyle changes that had been developed from previous interviews with prostate cancer patients.

RESULTS

Data indicated significant relationships between depression scores and the frequency of unpleasant lifestyle changes and the ratings that participants gave to these changes, supporting a model of depression as an adaptive withdrawal from noxious stimuli and environments. Psychometric data provided a method of deleting several items so that a clinical analysis and a research scale of 36 items was developed for use with prostate cancer patients.

CONCLUSION

Implications for treatment are discussed in terms of accurate identification of antecedents that lead to a further understanding of depression as an 'adaptive' response of active withdrawal from noxious environments.

Psychometric properties of the Hospital Anxiety and Depression Scale in family caregivers of palliative care patients

The Hospital Anxiety and Depression Scale (HADS) has been used extensively as a screening tool for anxiety and depression in clinical and nonclinical groups. A number of published studies have provided support for the original bidimensional structure of the HADS; however, others have reported irregularities in the factor structure. This study investigated the psychometric properties of the HADS in 106 family caregivers caring for a patient dying of cancer. Caregivers had been recruited to a randomized controlled trial conducted to gain a longitudinal understanding of caregivers' appraisal of their role. Exploratory factor analysis and internal consistency reliability statistics were used to investigate the underlying structure of the HADS. Descriptive statistics were calculated for author-defined subscale scores to assess levels of anxiety and depression among family caregivers. Two- and three-factor models were explored; however, the two-factor model, which closely resembled the intended bidimensional structure, was preferred. Mean author-defined subscale scores indicated higher levels of anxiety and depression in family caregivers than those previously reported for various general population, general practice, and cancer patient samples. Routine screening of anxiety and depression in family caregivers appears warranted based on the results of this study. The HADS may be a suitable screening tool, as indicated by its bidimensional structure; however, further research is required to establish its diagnostic efficiency in this population.

Psychological Distress among Prostate Cancer Patients: Fact Or Fiction?

Although the detrimental effect upon psychological well-being of receiving a diagnosis of, or treatment for, cancer has been demonstrated across many different types of cancer, three recent reviews of the psychological health of prostate cancer patients have produced contradictory conclusions. In order to elucidate the reasons for these apparent different conclusions, each of these reviews is described, with principal methods and findings summarised. Actual data, methodology used to select/reject research studies for inclusion in reviews, plus the validity of strict methodological culling of some research studies are discussed. Several extra studies and commentaries are also described, and a resolution of the apparent contradictory review conclusions is offered.

Capturing complexity: The case for a new classification system for mental disorders in primary care

Primary care differs considerably from specialist mental health settings: problems are presented in undifferentiated forms, with consequent difficulties in distinguishing between distress and disorder, and a complex relationship between psychological, mental and social problems and their temporal variations.

Existing psychiatric diagnostic systems, including ICD-10-PHC and DSM-IV-PC, are often difficult to apply in primary care. They do not adequately address co-morbidity, the substantial prevalence of sub-threshold disorders or problems with cross-cultural applications. Their focus on diagnosis may be too restrictive, with a need to consider severity and impairment separately.

ICPC-2, a classification system created specifically for use in primary care, provides advantages in that it allows for simple linkage between reason for encounter, diagnosis and intervention.

It is both necessary and feasible to develop a classification system for mental health in primary care that can meet four basic criteria: (1) characterized by simplicity; (2) addressing not only diagnosis but also severity, chronicity and disability; (3) feasible for routine data gathering in primary care as well as for training; and (4) enabling efficient communication between primary and specialty mental health care.

The contribution of pre-existing depression to the acute cognitive sequelae of mild traumatic brain injury

PRIMARY OBJECTIVE

To determine the effect of pre-existing depression on the cognitive sequelae of mild traumatic brain injury (mTBI) within 24 hours of injury.

RESEARCH DESIGN

A 2 x 2 between-subjects design was used to examine the effect of depression and injury type on neuropsychological test performance. The independent variables were the injury type (mTBI or control) and the presence of depression (depressed or not depressed).

METHODS AND PROCEDURES

Participants who had sustained mTBI (30 with depression, 30 without depression) within the previous 24 hours and control participants (19 with depression, 30 without depression) were assessed on the Digit Symbol Substitution Test (DSS), Hopkins Verbal Learning Test (HVLT) and the Speed of Comprehension Test.

RESULTS

Participants with mTBI performed worse than controls on the tests, particularly HVLT delayed recall and DSS total correct. Participants with depression did not perform worse than participants without depression. However, there was a significant univariate interaction for HVLT recognition, participants who had sustained mTBI and were classified in the depressed group exhibited worse recognition compared to mTBI participants without depression.

CONCLUSIONS

The results indicate that depression may interact with mTBI to impair word recognition during the acute phase after a head injury.

Common mental disorders in adolescents: a population based cross-sectional study

OBJECTIVE

To assess the prevalence and the factors associated with common mental disorders among adolescents in Pelotas, a southern Brazilian city.

METHOD

A population based cross-sectional study was carried out in the urban area of Pelotas. Multi-stage sampling was used to obtain a sample of adolescents aged between 15 and 18 years. Adolescents were interviewed using a self-report confidential questionnaire. The presence of common mental disorders was assessed using the Self-Reporting Questionnaire 20 (SRQ-20). Multivariate analysis was carried out using the Poisson regression with a robust adjustment of variance and control for design effect.

RESULTS

Nine hundred and sixty adolescents were interviewed. The prevalence of common mental disorders was 28.8%. Adolescents aged 17 years showed prevalence of 1.37 (95% CI 1.06-1.78) times greater than the 15 year olds. Adolescents whose mothers had between 5 and 8 years of schooling had a prevalence 1.42 (95% CI 1.01-1.51) times greater than those whose mothers had more than 8 years of schooling. Smoking and sedentary behavior were also associated with an increased prevalence of common mental disorders. Those who were dissatisfied with their body image showed a prevalence of 1.47 (95% CI 1.07-2.02).

CONCLUSIONS

Maternal schooling, tobacco smoking, sedentary behavior and body image dissatisfaction were factors associated with the presence of common mental disorders.

Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population

This study assessed the screening utility of the 12-item Short-Form Health Survey's (SF-12) mental health component scale (MCS-12) for diagnosable depression and anxiety disorders in a general population sample, and thus, the validity of this scale as a measure of mental health in epidemiological research. Data were from the Australian National Survey of Mental Health and Wellbeing (N=10,504). Diagnoses were made using the Composite International Diagnostic Interview. The MCS-12 was compared to other brief scales: the RAND Mental Health Component scale (RAND MHC-12, an alternative scoring method for the MCS-12), the 12-item General Health Questionnaire (GHQ-12), the Kessler Psychological Distress Scale (K10 and K6), and an estimate of the Mental Health Inventory (MHI-5). The MCS-12 and RAND MHC-12 were equally able to discriminate respondents with the target diagnoses. The MCS-12 performed better than the GHQ-12, and equally to the K6 for diagnoses of depression, though not anxiety disorders, where the K6 showed greater utility. The K10 out-performed the MCS-12 for all diagnoses. Areas under receiver operating characteristics curves (AUC) indicated that the MCS-12 is valid measure of mental health in epidemiological research, and a useful screening tool for both depression (AUC=0.92) and anxiety disorders (AUC=0.83).

Measuring physical and mental health using the SF-12: implications for community surveys of mental health

OBJECTIVE

The effects of using different approaches to scoring the SF-12 summary scales of physical and mental health were examined with a view to informing the design and interpretation of community-based survey research.

METHOD

Data from a population-based study of 7485 participants in three cohorts aged 20-24, 40-44 and 60-64 years were used to examine relationships among measures of physical and mental health calculated from the same items using the SF-12 and RAND-12 approaches to scoring, and other measures of chronic physical conditions and psychological distress.

RESULTS

A measure of physical health constructed using the RAND-12 scoring showed a monotonic negative association with psychological distress as measured by the Goldberg depression and anxiety scales. However, a non-monotonic association was evident in the relationship between SF-12 physical health scores and distress, with very high SF-12 physical health scores corresponding with high levels of distress. These relationships highlight difficulties in interpretation that can arise when using the SF-12 summary scales in some analytical contexts.

CONCLUSIONS

It is recommended that community surveys that measure physical and mental functioning using the SF-12 items generate summary scores using the RAND-12 protocol in addition to the SF-12 approach. In general, researchers should be wary of using factor scores based on orthogonal rotation, which assumes that measures are uncorrelated, to represent constructs that have an actual association.

The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context

BACKGROUND

Lack of mental health specialists in rural and remote communities suggest that rural communities depend more on general practitioners (GPs) for mental health care. Residents of rural communities are less likely than urban residents to seek help from their GPs for mental health issues. The aim of the current study was to examine whether attitudinal factors including perceived stigma, influenced rural residents seeking help from GPs.

METHOD

Help-seeking for psychological issues was retrospectively reported by 300 community residents in rural north-west Victoria. Current distress levels, functional disability, and current or lifetime syndromal disorder were recorded. Attitudes towards seeking professional psychological help, perceptions of stigma about mental illness, and belief in helpfulness of GPs, were also measured.

RESULTS

Having a positive attitude towards seeking professional help, and believing that a GP would be helpful, were significant predictors of ever having sought help from a GP for mental health problems. Other independent predictors of help-seeking included having a mood, anxiety or substance use disorder, higher distress levels, and greater functional disability due to physical problems.

CONCLUSIONS

Seeking help from a GP for psychological problems was predicted by having a positive attitude towards seeking professional psychological help as well as believing a GP would be helpful in treating psychological problems. Illness variables were also strong predictors of help-seeking behaviour. Contrary to expectations, perceived stigma did not influence help-seeking. The findings of this study highlight the important role of GPs in the treatment of mental health problems in the rural community.

Psychiatric/Mental health nursing education in Victoria, Australia: barriers to specialization

The introduction of undergraduate comprehensive nursing education in Victoria, Australia, during the 1990s has resulted in significant changes in undergraduate preparation for psychiatric/mental health nursing. Comprehensive programs became charged with the responsibility of preparing graduates to provide care for people experiencing a mental illness across a broad range of health-care settings, as well as providing a pathway for graduates with an interest in specialist practice in this field. The aim of this article is to clearly articulate the issues associated with psychiatric/mental health nursing education at the undergraduate level, including prevalence of mental illness, the inadequacy of psychiatric/mental health nursing theory and practice at undergraduate level, the negative attitudes of students toward this field of practice, and the subsequent failure of nursing education and practice initiatives to provide a clear mechanism for specialization in this important area of nursing practice. Throughout the article, the distinction between generalist and specialist preparation is argued and accompanied by a call for nursing education to recognize and address the issues associated with both domains.