Psychological Distress in the Hospital Setting: A Comparison between Native Dutch and Immigrant Patients

Complications and Healthcare Consumption of Pregnant Women with a Migrant Background: Could There be an Association with Psychological Distress?

Objective

Previous studies reported less prenatal healthcare consumption and more perinatal complications in women with a migrant background. Hence, we investigated in a country with free healthcare access whether women with a migrant background differed with respect to pregnancy complications, healthcare consumption and in terms of associations with psychological distress in comparison to native Dutch.

Methods

We included 324 native Dutch and 303 women with a migrant background, who visited two hospitals in Amsterdam for antenatal care between 2014 and 2015. Participants completed the Edinburgh Postnatal Depression Scale, the Hospital Depression and Anxiety Scale, and sociodemographic questions. Complications and healthcare consumption during pregnancy were extracted from medical records. Regression analyses were used with adjustment for covariates.

Results

Except for gestational diabetes [adjusted OR = 3.09; 95% CI = (1.51, 6.32)], no differences were found between groups in perinatal complications [OR = 1.15; 95% CI = (0.80, 1.64)], nor in healthcare consumption [OR = 0.87; 95% CI = (0.63, 1.19)].

Women with a migrant background reported more depressive symptoms [Cohen’s d = 0.25; 95% CI = (0.10, 0.41)], even after adjustment for socio-economic factors. Psychological distress was associated with more hospital admissions during pregnancy. When experiencing depressive symptoms, women with a migrant background had an increased risk to be admitted [OR = 1.11; 95% CI = (1.01, 1.21)].

Conclusions for Practice

This cohort study found no differences in pregnancy-related complications, except for diabetes, nor different healthcare consumption, in women with a migrant background versus native Dutch, in a country with free health care access. However, women with a migrant background experienced more depressive symptoms, and when depressed their risk for hospital admission increased. Additional research is warranted to improve healthcare for this population.

Measuring psychological distress using the K10 in Kenya

BACKGROUND

The Kessler psychological distress scale (K10) is a brief screening tool that assesses psychological distress in both clinical and epidemiological settings. Despite wide applicability of the K10 globally, there are no data on psychometric properties of the K10 in Kenya. This study investigated the reliability, factor structure, and construct validity of the K10 as a measure of psychological distress among adults in Kenya.

METHODS

A total of 2556 adults attending 11 outpatient clinics in the western and coastal regions of Kenya without a history or clinical diagnosis of psychotic disorders were included. Data were collected on demographic characteristics of the participants and the K10. Internal consistency was evaluated using Cronbach's alpha. Construct validity and factor structures of the K10 were evaluated using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches.

RESULTS

The mean K10 score was 3.4 and Cronbach's alpha was 0.85, indicating good internal consistency (reliability). EFA resulted in a two-factor solution that accounted for 67.6% of variance. CFA results indicated that a unidimensional model with correlated errors best fit the data.

LIMITATIONS

The K10 was only administered to a control group of our study population, which had low levels of psychological distress.

CONCLUSION

The K10 has good construct validity and reliability for use as a broad measure of psychological distress in Kenyan adults and may be useful in general medical setting to assess anxiety and depressive disorders.

Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients

BACKGROUND

Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients.

METHODS

A multi-ethnic cohort in 10 dialysis centers included 687 dialysis patients between 2012 and 2017, with an average follow-up of 3.2 years. Depressive symptoms were measured using the Beck Depression Inventory. Interaction was assessed by investigating excess risk on an additive scale using both absolute rates and relative risks. Multivariable regression models included demographic, social, and clinical variables.

RESULTS

Adverse outcomes are more pronounced in native patients, compared to immigrant patients. The risk for mortality and hospitalization is considerably higher in native patients compared to immigrants. An excess risk on an additive scale indicates the presence of possible causal interaction.

CONCLUSIONS

Depressive symptoms are a risk factor for hospitalization and mortality, especially in native dialysis patients. Adverse clinical events associated with depressive symptoms differ among ethnic groups. This differential association could play a role in the conflicting findings in literature. Ethnicity is an important factor when investigating depressive symptoms and clinical outcome in dialysis patients. Future research should focus on the possible mechanisms and pathways involved in these differential associations.

Religiousness and Symptoms of Depression in Native and Immigrant Chronic Dialysis Patients in the Netherlands

For immigrant chronic dialysis patients, religious behavior and religious coping may have a different impact on depressive symptoms compared to native patients. This study aims to describe both cross-sectional and longitudinal associations between religious behavior and coping with symptoms of depression for 281 native and 277 immigrant dialysis patients in the Netherlands. A higher prevalence of depressive symptoms was found in immigrant compared to native patients (49% vs. 36%). No significant cross-sectional or longitudinal associations were found in both groups between religious behavior and positive religious coping with depressive symptoms. Strong significant cross-sectional associations were found between negative religious coping items and depressive symptoms in both groups, while no longitudinal associations were found. So, similar impact of religiousness on the presence of depressive symptoms was found for both native and immigrant dialysis patients. Therefore, these results do not explain the higher prevalence of depressive symptoms found in immigrant chronic dialysis patients compared to native patients.

Les traits d'identité culturelle en lien avec le statut d'immigrant et l'ethnicité : quel lien avec les symptômes de détresse psychologique et les symptômes dépressifs dans la main-d'œuvre canadienne? Résultats des neuf cycles de l'ENSP

PURPOSE

This study investigated variations over time of psychological distress and depressive symptoms among working Canadians according to two cultural identity traits: ethnicity and immigration status.

METHOD

Data came from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 7069 workers, multiple regressions analyses and multilevel regressions models were carried out. Analyses were adjusted for confounders such as age, gender, marital status, household income, social support outside the workplace, level of education, presence of children between 0 and 5 years of age and presence of children from 6 to 11 years of age.

RESULTS

Over time, and after accounting for potential confounders, immigration status is not associated with psychological distress or depressive symptoms. Ethnicity is associated with depressive symptoms, but not with psychological distress symptoms. Visible minorities have less depressive symptoms compared to Caucasians.

CONCLUSION

Unlike immigration status, ethnicity seems to explain a portion of mental health inequities among workers. One area to be explored in future researches is whether in the Canadian workforce, work conditions could explain ethnic inequalities in mental health.

Ethnic Minorities with Diabetes Differ in Depressive and Anxiety Symptoms and Diabetes-Distress

Objective. To determine the association between ethnicity, diabetes-distress, and depressive and anxiety symptoms in adult outpatients with diabetes. Research Design and Methods. Diabetes-distress (Problem Areas in Diabetes Scale, PAID5), depressive and anxiety symptoms (Extended Kessler-10, EK10), and quality of life (Short-Form 12, SF12) were assessed in an ethnic diverse diabetes outpatient population of a teaching hospital in Amsterdam. Descent of one's parents and self-classified ethnicity were obtained to define ethnicity. HbA1c, clinical data, and socioeconomic status were derived from the medical charts. Based on established cut-offs for PAID5- and EK10-scores, emotional distress was dichotomized for the purpose of logistic regression analyses. Results. Of 1007 consecutive patients approached, 575 participated. Forty-nine percent were of non-Dutch ethnicity and 24.7% had type 1 diabetes. Diabetes-distress was reported by 12.5% of the native Dutch patients and by 22.0%, 34.5%, and 42.6% of the Surinamese, Turkish, and Moroccan patients, respectively. Prevalence of depressive symptoms was 9.4% in native Dutch patients and 20.4%, 34.5%, and 27.3% in the other groups mentioned. Diabetes-distress and Moroccan origin were significantly associated (OR = 3.60, p < .01) as well as depressive symptoms and Turkish origin (OR = 4.23, p = .04). Conclusions. Different ethnic minorities with diabetes vary in their vulnerability for emotional distress, warranting clinical attention. Future research should elucidate explanatory factors and opportunities for tailored interventions.

Correction: Psychological Distress in the Hospital Setting: A Comparison between Native Dutch and Immigrant Patients

[This corrects the article DOI: 10.1371/journal.pone.0130961.].