Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults

BACKGROUND

It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals.

METHODS

To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects.

RESULTS

Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects.

CONCLUSIONS

Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

The generalizability of empirically derived syndromes of collateral-reported elder psychopathology across 11 societies

The purpose of this study was to test whether a syndrome model of elder psychopathology derived from collateral ratings, such as from spouses and adult children, in the United States would be generalizable in 11 other societies. Societies represented South America, Asia, and Europe. The Older Adult Behavior Checklist (OABCL) was completed by collateral informants for 6141 60- to 102-year-olds. The tested model comprised syndromes designated as Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited. The model was tested using confirmatory factor analyses in each society separately. The primary model fit index showed a good fit for all societies, while the secondary model fit indices showed acceptable to a good fit for all societies. The items loaded strongly on their respective factors, with a median item loading of 0.69 across the 11 societies. By syndrome, the overall median item loadings ranged from 0.47 for Worries to 0.77 for Functional Impairment. The OABCL syndrome structure was thus generalizable across the tested societies. The OABCL can be used for broad assessment of psychopathology for elders of diverse backgrounds in nursing services and research.

The generalizability of Older Adult Self-Report (OASR) syndromes of psychopathology across 20 societies

OBJECTIVES

As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies.

METHODS/DESIGN

The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes.

RESULTS

In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies.

CONCLUSIONS

The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.

Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications

OBJECTIVE

More than 75,000 articles have been published on internalizing and externalizing problems. To advance clinical and research applications of internalizing/externalizing concepts and data, our objectives were as follows: to provide an overview of recent research on internalizing/externalizing problems assessed at ages 1½ to 18 years; to identify issues raised by methods for assessing such problems; and to develop recommendations for more precise, consistent, informative, and productive assessment of such problems.

METHOD

A total of 4,870 peer-reviewed articles published from January 1, 2012 through December 31, 2014 were systematically reviewed and identified by the search terms "internalizing" or "externalizing," followed by detailed coding of 693 articles that reported use of measures meeting criteria for methodologically sound assessment of internalizing/externalizing problems.

RESULTS

Many articles reported data based on measures that did not meet criteria for methodologically sound assessment of internalizing/externalizing problems. The 693 articles that used measures meeting criteria for methodological soundness and that qualified for detailed coding reported findings for 649,457 children living in 65 societies on all inhabited continents. Data were obtained from parents, teachers, children, clinicians, caregivers, and others. Samples included general population, clinical, school, at-risk, multicultural, welfare, and various ethnic/racial and socioeconomic groups. Many analytic methods were used to test associations of diverse variables with internalizing/externalizing problems.

CONCLUSION

The diverse procedures used to assess internalizing/externalizing problems pose challenges for clinical and research applications. To meet the challenges, recommendations are provided for using assessment instruments supported by published standardization, reliability, validity, and normative data to advance clinical services and research.

Problems and Adaptive Functioning Reported by Adults in 17 Societies

This study tested for similarities and differences across societies in self-ratings of problems, personal strengths, and aspects of adaptive functioning on the Adult Self-Report (ASR) for nonclinical samples of adults ages 18 to 59 in 17 societies ( N = 10,197). Results indicated considerable consistency across societies regarding mean ratings on the ASR problem items. Most effect sizes (ESs) for societal differences in problem scales were small (2–5%). Hierarchical linear modeling (HLM) analyses indicated that culture clusters and society accounted for small percentages of variance in Internalizing, Externalizing, and Total Problems scores, with most of the variation accounted for by individual differences within societies. In contrast to the small effects of society on problem scores, for the ASR Personal Strengths scale the societal ES was 34% and culture cluster accounted for 12% of the variance. Worse reported relations with spouse/partner were associated with higher problem scores. Overall, findings indicated considerable similarity but also some important differences in self-reported problems and adaptive functioning across 17 societies.

Syndromes of collateral-reported psychopathology for ages 18-59 in 18 Societies

The purpose was to advance research and clinical methodology for assessing psychopathology by testing the international generalizability of an 8-syndrome model derived from collateral ratings of adult behavioral, emotional, social, and thought problems. Collateral informants rated 8,582 18-59-year-old residents of 18 societies on the Adult Behavior Checklist (ABCL). Confirmatory factor analyses tested the fit of the 8-syndrome model to ratings from each society. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all societies, while secondary indices (Tucker Lewis Index, Comparative Fit Index) showed acceptable to good fit for 17 societies. Factor loadings were robust across societies and items. Of the 5,007 estimated parameters, 4 (0.08%) were outside the admissible parameter space, but 95% confidence intervals included the admissible space, indicating that the 4 deviant parameters could be due to sampling fluctuations. The findings are consistent with previous evidence for the generalizability of the 8-syndrome model in self-ratings from 29 societies, and support the 8-syndrome model for operationalizing phenotypes of adult psychopathology from multi-informant ratings in diverse societies.

Changes in the activity of rat muscle AMP deaminase in relation to the proportion of dietary protein

1. The purine nucleotide cycle has been proposed (Lowenstein, 1972) as an alternative scheme for amino acid deamination in tissues, such as skeletal muscle, having low concentrations of glutamate dehydrogenase (EC1.4.1.2).

2. Activities of AMP deaminase (EC3.5.4.6), one of the enzymes of the cycle, have been measured in soleus, plantaris and extensor digitorum longus muscles of rats maintained for 18 d on diets providing 0, 0·035 or 0·10 net dietary protein energy (energy supplied by utilizable protein: total metabolizable energy, NDp:E), and in rats given the 0·10 NDp:E diet for 3 d after the 0 or 0·035 NDp:E regimens.

3. Concentration of AMP deaminase in the different muscles from the control (0·10 NDp:E diet) rats appeared to bear an inverse relationship to the proportion of mitochondria-rich fibres (i.e. rich in glutamate dehydrogenase) in each muscle.

4. Dietary protein deprivation (0 or 0·035 NDp:E) led to adaptive reductions in AMP-deaminase activity in the soleus and plantaris muscles, but in the extensor muscle the 0·035 NDp:E diet produced no change, while the 0 NDp:E diet caused an increase in activity.

5. Refeeding the 0·10 NDp:E diet to the protein-deprived rats caused reductions of AMP-deaminase activity to lower levels in all three muscles, except in the instance of soleus in rats refed after the 0·035 NPp:E diet.

6. In view of the different responses shown by the three muscles to the dietary treatments, the importance of specifying the particular muscles used in future nutritional studies is emphasized.

7. The adaptive changes in AMP deaminase are discussed in terms of operation of the purine nucleotide cycle for amino acid deamination responding to the changes in amino acid catabolism known to be caused in muscle by these protein-deficient diets.

The effect of unilateral phrenicectomy on the rate of protein synthesis in rat diaphragm in vivo

The fractional rate of protein synthesis (ks) in the denervated rat-diaphragm has been measured in vivo by the continuous amino acid infusion technique at 1, 3, 5 and 10 days after nerve section, and compared with the rate determined in normal rats. Similar rates of protein synthesis, 14% per day, were found for both the left and right hemidiaphragms in the control animals. In the denervated rats, the rates of protein synthesis in the contralateral control hemidiaphragms were significantly increased as soon as 1 day after nerve section. This is considered to be evidence of a compensatory synthesis in the control tissues. In the denervated hemidiaphragm, the rate of protein synthesis had doubled by the third day after nerve section, but by the fifth day had fallen slightly to a value some 50% greater than that of the controls, and remained at this level for a further 5 days. Based on these measured values of protein synthetic rate, calculated estimates have been made of the rate of protein degradation necessary to account for the reported (Turner, L.V. and Manchester, K.L. (1972) Biochem. J. 128, 789-801) changes in mass of the denervated tissue. During the first three days after nerve section, the rate constant for degradation increased to more than twice the normal rate for skeletal muscle, and remained at this value throughout the peak of the hypertrophy.

Effects of denervation on the glycogen content and on the activities of enzymes of glucose and glycogen metabolism in rat diaphragm muscle

1. Changes in the content and concentration of glycogen and in the activity of a number of enzymes involved in glucose and glycogen metabolism were studied in the rat hemidiaphragm after unilateral denervation. 2. After nerve section the tissue hypertrophies; this hypertrophy is said to be confined to the smaller red fibres and not to the white. 3. The total hexokinase activity increases, whereas that of total glycogen phosphorylase decreases. The specific activity of phosphorylase a, determined after Halothane anaesthesia, remains fairly constant. 4. In fed animals the denervated tissue stores less glycogen, but in the early stages its glycogen content does not fall on starvation. 5. The effect of denervation on the specific activities of several other characteristically white-fibre enzymes are not consistent with the response of glycogen phosphorylase; the increase in content of glyceraldehyde 3-phosphate dehydrogenase and lactate dehydrogenase is thought to be related to proliferation of the sarcoplasmic reticulum. 6. The ratio of lactate dehydrogenase M/H subunits increases at the height of the hypertrophy, but then declines as the mass of the tissue falls. 7. The chronology of these changes in enzyme activities suggests a multiplicity of distinct responses after nerve section not consistent with any one model, either specific fibre development or reversion to de-differentiated, foetal-type metabolism.

Effects of denervation on the activities of some tricarboxylic acid-cycle-associated dehydrogenases and adenine-metabolizing enzymes in rat diaphragm muscle

1. The activity of several tricarboxylic acid-cycle-associated dehydrogenases, adenine-metabolizing enzymes and glutathione reductase and the content of myoglobin were measured in rat diaphragm muscle after unilateral nerve section. 2. Consistent with morphological disintegration of the mitochondria there was a rapid diminution in activity of NAD- and NADP-linked isocitrate dehydrogenase, malate dehydrogenase and glutamate dehydrogenase. 3. Creatine phosphokinase and adenylate kinase, by contrast, showed little change in activity; adenylate deaminase and glutathione reductase activities increased during the hypertrophic phase. The concentration of myoglobin at first declined, then increased again. 4. The distribution of enzymes between the left and right hemidiaphragms was found not to be uniform. 5. Activities of adenine-metabolizing enzymes in the diaphragm were as great as in white muscle. It is suggested that their reputedly lower activities in red muscle properly refer to muscle containing a high proportion of intermediate fibres, which is not the case with diaphragm. 6. The possible causes of the transient hypertrophy after nerve section are discussed.