The East York Health Needs Study. I: Prevalence of DSM-III-R psychiatric disorder in a sample of Canadian women

To transplant or not? The importance of psychosocial and behavioural factors before lung transplantation

The gratifying results of lung transplantation in terms of survival and quality of life stimulate the referral of an ever-increasing number of patients with end-stage lung disease. This in turn compounds the organ shortage, which is the limiting factor in the transplantation rate. In the absence of good alternative treatment modalities, an evidence-based pretransplant screening process is a prerequisite to detennine which patients will benefit most from transplantation. Within this evidence-based screening process, medical selection criteria are well established. There is a growing awareness that psychosocial and behavioural factors may determine outcome after transplantation as well. This paper reviews the available evidence for psychosocial and behavioural factors in the screening process for lung transplantation. The relation of various factors with post-transplant outcome was explored. Psychosocial characteristics before transplantation consist of 1) anxiety and depression, 2) personality disorders, 3) neurocognitive problems, and 4) lack of social support. Pretransplant behavioural factors include 1) noncompliance with medication, 2) alcohol abuse or dependence, 3) smoking, 4) noncompliance with dietary guidelines, and 5) noncompliance with monitoring of vital parameters and infections. It appears that the lack of rigorous studies limit the feasibility of an evidence-based screening process. Prospective studies are crucial to this further investigation of the relationship between psychosocial and behavioural determinants before transplantation and outcomes after transplantation, in terms of compliance, morbidity, and mortality. Identification of modifiable risk factors for poor outcome before transplantation is a first step in developing interventions.

Short and Long-Term Effects of Compromised Birth Weight, Head Circumference, and Apgar Scores on Neuropsychological Development

Background

Low birth weight (LBW, <2500 g) is an adverse perinatal risk that may reflect a poor intrauterine environment. While LBW has been a well-known predictor of physical, neurological, cognitive and psychological deficits later in life, minimal research has been done on small head circumference and low 5 minute Apgar scores, and their association with subsequent developmental abnormalities.

Objective

The current study aims to demonstrate that small head circumference and low 5-minute Apgar scores are predictors for developmental abnormalities throughout childhood and later.

Methods

Using a longitudinal design, 2,151 individuals' physical, neurological, and cognitive functioning in childhood, as well as psychological functioning in adulthood, was assessed as a function of three perinatal risk factors: LBW, small head circumference and low Apgar scores.

Results

Similar to findings with LBW, small head circumference or a low Apgar score were associated with increased number of hospital visits (p<0.0001 and p=0.005 respectively) and neurological abnormalities (p<0.0001 and p=0.001 respectively) at age 1. Intelligence quotient (IQ) scores at ages 4 and 7 were significantly lower for those born with small head circumference (p<0.0001) or low Apgar scores (p=0.002). Finally, the incidence of anxiety in adulthood was significantly higher for those born with small head circumference (p=0.03) or low Apgar scores (p=0.004) compared to their counterpart.

Conclusion

Small head circumference and low a Apgar score are predictors of later physical, neurological, cognitive and psychological abnormalities, and can complement LBW, a more frequently used perinatal risk factor, and thus be used to screen for future developmental deficits, together with LBW.

Prevalence, comorbidity, and correlates of DSM-IV axis I mental disorders among female university students

This cross-sectional study evaluated the prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), axis I mental disorders among Spanish female students and investigated their psychiatric comorbidity and correlates. 1054 female students with a mean age of 22.2 years were randomly selected, with stratification by academic seniority and the type of academic discipline. The cases of mental disorder were identified by clinically trained interviewers with the aid of the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version. The lifetime prevalence of the targeted psychiatric disorders was 50.8%, and its point prevalence was 37.3%. The commonest disorders were nicotine dependence, depression, and generalized anxiety disorder. Nearly 37% of subjects with a psychiatric disorder had two or more diagnoses. Mental illness was associated with family income, financial independence, type of academic discipline, violence from men, social support, and self-esteem. Psychiatric disorders are common among female university students. Serious attention should be paid to preventive and therapeutic programs in this group.

Functional limitations and depression after traumatic brain injury: examination of the temporal relationship

OBJECTIVE

To examine the temporal relationship between self-reported injury-related functional limitations and depressive symptomatology after traumatic brain injury (TBI).

DESIGN

A longitudinal cohort study with 3 evaluation points.

SETTING

A level I trauma center.

PARTICIPANTS

Adolescents and adults (N=135) with complicated mild to severe TBI (72% had complicated mild injuries) who were recruited within 24 hours of injury and then completed the measure at all 3 time points.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Sickness Impact Profile and Center for Epidemiological Studies-Depression Scale.

RESULTS

Individuals who reported more depressive symptomatology consistently endorsed more injury-related difficulties, showing the strong relationship between depression and perceived psychosocial functioning. Examination of these relationships over time revealed that increased depressive symptomatology follows higher levels of perceived injury-related changes but that reports of injury-related changes are not associated with earlier depression. These findings suggest a unidirectional temporal relationship between these variables.

CONCLUSIONS

Perceived changes in daily functioning appear to influence emotional well-being over time after TBI. However, depressive symptoms do not appear to negatively impact individuals' perception of later functioning. These results further our understanding of the complicated relationship between these variables and may have important implications for treatment of depression after TBI.

The role of perinatal problems in risk of co-morbid psychiatric and medical disorders in adulthood

BACKGROUND

Perinatal problems may be associated with an increased risk for psychological and physical health problems in adulthood, although it is unclear which perinatal problems (low birthweight, preterm birth, low Apgar scores, and small head circumference), or what clusters of problems, are more likely to be associated with later health problems. It is also not known whether perinatal problems (singly or together) are associated with co-morbidity between psychological and physical health problems.

METHOD

A regional random sample (from Baltimore) of mothers and their children (n=1525) was followed from birth to adulthood (mean age 29 years). Perinatal conditions were measured at delivery. Psychological problems (depression and suicidal ideation) were measured with the General Health Questionnaire-28 (GHQ-28) and physical problems (asthma and hypertension) with the RAND-36 Health Status Inventory.

RESULTS

Children with perinatal problems were generally at increased risk for depression, suicidal ideation and hypertension, and co-morbid depression and hypertension even after controlling for confounders. One possible underlying condition, preterm low birthweight (LBW), extracted by cluster analysis, considering all of the four perinatal problems, was associated with increased risk for psychological and physical health outcomes as well as co-morbidity of the two.

CONCLUSIONS

LBW, preterm birth and small head circumference singly increased the risk for both psychological and physical health problems, as well as co-morbid depression and hypertension, while low Apgar scores were only associated with psychological problems. Delineating different etiological processes, such as preterm LBW, considering various perinatal problems simultaneously, might be of benefit to understanding the fetal origin of adult illness and co-morbidity.

Conjoined effects of low birth weight and childhood abuse on adaptation and well-being in adolescence and adulthood

OBJECTIVE

To characterize the conjoined effects of low birth weight (LBW) and childhood abuse on impaired adaptation and illness in adolescence and adulthood.

DESIGN

Longitudinal study of a birth cohort.

SETTING

Baltimore, Md.

PARTICIPANTS

Children (N = 1748) were followed from birth to adulthood (mean age, 26 years) as part of the Johns Hopkins Collaborative Perinatal Study.

MAIN EXPOSURES

Childhood abuse and LBW.

MAIN OUTCOME MEASURES

Indicators of adaptation were delinquency, school suspension, repeating grades, academic honors, quality of life, and socioeconomic status. Indicators of psychiatric and medical problems were depression, social dysfunction, somatization, asthma, and hypertension.

RESULTS

Participants with both LBW and subsequent childhood abuse, relative to those with neither risk, were at a substantially elevated risk for psychological problems: 10-fold for depression; nearly 9-fold for social dysfunction, and more than 4-fold for somatization. However, they were not at an elevated risk for medical problems in adulthood. Those exposed to childhood abuse were more likely to report delinquency, school suspension, repeating grades during adolescence, and impaired well-being in adulthood, regardless of LBW status. For those with LBW alone, the prevalence of those problems was comparable with that of individuals without either risk factor.

CONCLUSIONS

Children with LBW and childhood abuse are at much greater risk for poor adaptation and psychiatric problems than those with LBW alone and those with neither risk. Preventive interventions should target families with LBW children who are at greater risk for childhood abuse.

An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18-34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's alpha=0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.

Natural history of depression in traumatic brain injury11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To examine prospectively the rates, risk factors, and phenomenology of depression over 3 to 5 years after traumatic brain injury (TBI).

DESIGN

Inception cohort longitudinal study.

SETTING

Level I trauma center.

PARTICIPANTS

Consecutive admissions of 283 adults with moderate to severe TBI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Center for Epidemiologic Studies Depression (CES-D) Scale.

RESULTS

The rates of moderate to severe depression ranged from 31% at 1 month to 17% at 3 to 5 years. With 1 exception, the relation between brain injury severity and depression was negligible. Less than high school education, preinjury unstable work history, and alcohol abuse predicted depression after injury. Examination of CES-D factors indicate that, in addition to somatic symptoms, both depressed affect and lack of positive affect contribute to elevated CES-D scores.

CONCLUSIONS

High rates of depressive symptoms cannot be dismissed on grounds that somatic symptoms related to brain injury are mistaken for depression. Depressed affect and lack of positive affect are also elevated in persons with TBI. Preinjury psychosocial factors are predictive of depression and knowing them should facilitate efforts to detect, prevent, and treat depression after TBI.

Confirmatory factor analysis of the GHQ-12: can I see that again?

OBJECTIVE

This paper reviews research relating to the factor analysis of the GHQ-12. We explore the question of whether there is a consistent replicable structure to the GHQ-12 using: (i) a comparative analysis of fit between identified factor models; and (ii) a confirmatory factor analysis of GHQ-12 data from our own study.

METHOD

The factor models proposed from the literature were reviewed. The published factor loadings were used to carry out a factor matching analysis to identify similarities between the various factor models that have been identified. In addition, 490 patients visiting their general practitioner completed the General Health Questionnaire (GHQ-12) in the first phase of a longitudinal study evaluating service delivery to rural Tasmania. Three different methods for scoring the GHQ-12 were utilized and each resultant data set was analysed using a Confirmatory Factor Analysis (CFA) to establish which of the various factor models provided the most consistent description of the data.

RESULT

None of the complete factor models that have been proposed have been consistently replicated across studies. Isolated factors were replicated between some studies but no single factor structure was replicated across all studies. All of the models had adequate fit to the Tasmanian data when the usual scoring was used. However, only one model had a consistently high 'goodness of fit' across scoring methods.

CONCLUSION

It was concluded that the 'best fit' was achieved by a model based on an early factor analytic study using an Australian sample. It was suggested that researchers wanting to extract scales from the GHQ-12 could use this model.

Mothers' psychological adjustment following disaster affecting their children

The authors investigated the psychological adjustment of 37 British women whose adolescent children survived the cruise ship Jupiter's sinking in 1988, about 6 years previously. They compared these women with a group of widows (N = 18) and a group of women who had suffered no major negative life event (N= 15). Psychological adjustment of the 37 women was assessed with the Schedule for Affective Disorders and Schizophrenia Lifetime Version (SADS-L; R. L. Spitzer & J. Endicott, 1975) and various standard questionnaires. The women whose children had been involved in the disaster were found to have suffered a greater number of incidents of psychological distress in the period since the disaster than the women who had suffered no major negative life events but fewer incidents of psychological distress than the widows. The significance of these findings and clinical implications are discussed.

Effects of combining public assistance and employment on mothers and their young children

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 1/2 to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.

Psychosocial and behavioral selection criteria for solid organ transplantation

An evidence-based selection process for organ transplantation may be a valuable approach to improve posttransplant outcomes. This paper reviews state-of-the-art psychosocial and behavioral selection criteria and assesses their validity in view of predicting outcomes after transplantation. Psychosocial factors addressed are psychiatric disorders, mental retardation, irreversible cognitive dysfunction, and lack of social support. Behavioral selection criteria discussed are alcoholism, smoking, drug abuse, and obesity. This review reveals that the evidence concerning these selection criteria in scarce. There is a definite need for more longitudinal research to strengthen the scientific basis of the psychosocial and behavioral dimension of transplantation.

Mental health status of the South Australian population

OBJECTIVE

To determine, by the use of a telephone survey, the mental health status of SA adults (18+ years) using the GHQ-28, SF-12 and self-report as indicators of mental health, and to examine risk factors for mental health morbidity.

SAMPLE

A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 2,501 interviews were conducted (74.0% response rate).

RESULTS

Overall, 19.5% of respondents had a mental health problem as determined by the GHQ-28, 11.8% as determined by the mental health component summary score of the SF-12 and 11.9% self-reported a mental health condition. The percentage of people with a mental health problem who had used a psychologist or a psychiatrist in the previous 12 months was 9.6% for people diagnosed by the GHQ-28, 16.2% by SF-12 and 23.7% for self-report. The logistic regression analyses undertaken to describe people with a mental health problem as determined by the GHQ-28 and to describe people who visited a psychologist or psychiatrist produced different age categories, demographic and co-morbidity indicators. Variables found in both analyses included living in the metropolitan area, being economically inactive and being a high user of health services.

CONCLUSIONS

One in five South Australian adults has a mental problem. Although the prevalence is higher for younger age groups, older adults are more likely to visit a psychologist or a psychiatrist.

IMPLICATIONS

Telephone interviewing produces robust indicators of the prevalence of mental health problems and is a cost-effective way of identifying prevalence estimates or tracking changes over time.

Screening for depression in the elderly: a study on misclassification by screening instruments and improvement of scale performance

1. The study compares the psychometric performance of the CES-D and the GHQ-12 in a sample of elderly community residents. Misclassification rates of the questionnaires were analyzed and suggestions for improvement of scale performance are made. 2. 287 subjects out of the general population aged 60-99 years were personally interviewed with standardized diagnostic tools and completed both the GHQ-12 and the CES-D. Best-estimate diagnoses served as standards for receiver operating characteristics (ROC) analysis. 3. Both the GHQ-12 and the CES-D discriminated well between depressive and nondepressive subjects (AUROC = 0.794 and AUROC = 0.782, respectively). The amount of false positive results was high for both questionnaires (GHQ-12: 80.6%, CES-D: 90.1%). Increasing age led to more false positive results on the GHQ-12, whereas the CES-D yielded more false positive results in subjects living in an old age residence or together with family members when compared to those living together with their spouse. 4. The GHQ-12 and the CES-D were valid screening instruments for depression in a community sample of elderly subjects. However, both questionnaires yielded a considerable proportion of false positive results. Elevation of the cut-off score may reduce the misclassification rate of the GHQ-12 but not that of the CES-D.

Application of the Center for Epidemiologic Studies Depression Scale among first-visit psychiatric patients: a new approach to improve its performance

BACKGROUND

Although the Center for Epidemiologic Studies Depression Scale (CES-D) is an internationally popular self-rating scale for depression both in community and clinical settings, extant literature concerning its validity has several shortcomings. The present paper aimed to overcome these problems.

METHODS

We applied newer assessment technology of receiver operating characteristics (ROC) analyses and stratum-specific likelihood ratios (SSLRs) and cross-validated the results in the 'training' and 'testing' data sets of 591 patients representing various clinical settings all over Japan.

RESULTS

The ROC analyses demonstrated that the CES-D had moderate convergent and discriminant validity to detect major depressive episodes among first-visit psychiatric patients. Selecting single optimal cutoffs, however, failed to arrive at consistent results across various settings. The efficacy of the instrument was most conveniently transportable into clinical practices when converted into SSLRs, which were 0.35 (95% CI: 0.25-0.49) for the score range 0-29, 2.3 (1.8-3.1) for the score range 30-49, and 11.7 (3.1-44.0) for the scores above 50. In addition, the SSLRs proved to be generalizable not only across various clinical settings in our sample but also across psychiatric, primary care and community samples in the published reports.

CONCLUSION

Clinicians and clinical epidemiologists can apply the SSLRs of the CES-D to various settings to estimate the probability of suffering from a major depressive episode in a convenient and intuitive manner.