Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway

Mind at rest, mind at risk: A prospective population-based study of sleep and subsequent mental disorders

Background

Depression and anxiety disorders are highly prevalent among young adults, with evidence suggesting sleep problems as key risk factors.

Objective

This study aimed to examine the association between insomnia and sleep characteristics with major depressive episode (MDE) and anxiety disorders, and the association after accounting for baseline mental health symptoms.

Methods

We conducted a prospective cohort study using data from the Students' Health and Wellbeing Study (SHoT), surveying Norwegian higher education students aged 18 to 35 (N = 53,362). A diagnostic assessment of 10,460 participants was conducted in 2023. Self-reported insomnia, sleep duration, sleep onset latency, and wake after sleep onset were recorded in 2022. MDE and five types of anxiety disorders were assessed after one year using a self-administered CIDI 5.0. Analyses adjusted for age, sex, baseline mental health symptoms, and somatic conditions.

Results

Insomnia in young adults was associated with a significantly increased risk of MDE (adjusted RR = 3.50, 95 % CI = 3.18-3.84) and generalized anxiety disorder (GAD) (adjusted RR = 2.82, 95 % CI = 2.55-3.12) one year later. Sleep duration showed a reversed J-shaped association with mental disorders, with both short and, to a lesser extent, long sleep durations linked to elevated risks, even after adjusting for baseline mental health symptoms and somatic conditions. Although the associations were attenuated after adjustment, they remained statistically significant.

Conclusion

Sleep disturbances, including insomnia and abnormal sleep durations, predict mental health issues in young adults, even after accounting for baseline mental health and somatic health. Addressing sleep problems early may help prevent subsequent mental health conditions in this population.

Mental and somatic health burdens of hypochondriacal disorder in higher education: national study among Norwegian students

BACKGROUND

Hypochondriacal disorder involves persistent anxiety about suffering from an undetected serious medical condition, despite medical reassurance. Hypochondriacal disorder significantly affects social relationships, occupational functioning and personal well-being. In university settings, where mental health concerns are prevalent, insights into prevalence of hypochondriacal disorder and associations with depression and other health challenges are essential.

AIMS

This study examines the prevalence and correlates of hypochondriacal disorder among Norwegian university students, focusing on its associations with depression, mental distress and somatic symptom burden.

METHOD

The 2022 Students' Health and Wellbeing Study, a national survey of Norwegian higher education students, included 59 536 participants aged 18-35. Participants were categorised based on a pre-defined diagnostic list of mental and somatic concerns, and participants were grouped as follows: hypochondriacal disorder only, depression only, comorbid hypochondriacal disorder and depression and controls. Validated instruments included the Somatic Symptom Scale-8, the Hopkins Symptoms Checklist, the Satisfaction With Life Scale, an abbreviated version of the University of California, Los Angeles, Three-Item Loneliness Scale and four items on suicidal ideation.

RESULTS

Hypochondriacal disorder was reported by 0.86% (n = 457) of participants, with 52% also reporting depression. Those with hypochondriacal disorder had significantly worse mental and somatic health outcomes, especially when comorbid with depression, including elevated distress, suicidality, insomnia and poor quality of life.

CONCLUSION

Although uncommon, hypochondriacal disorder is linked to severe mental and somatic health burdens, particularly when co-occurring with depression. These findings highlight the need for integrated mental health strategies in academic settings to address hypochondriacal disorder and its frequent comorbidities.

The Ability of the Hopkins Symptom Checklist-5 to Identify Generalized Anxiety Disorder and Major Depressive Disorder in the General Population

Background: The Hopkins Symptom Checklist (HSCL) is a widely used measure of anxiety and depression symptoms. The short form HSCL-5 is especially suitable for large population-based studies, but its ability to detect mental disorders in the general population remains unknown. The aim of the study was to assess how well the HSCL-5 identified cases of generalized anxiety disorder (GAD) and major depressive disorder (MDD) measured by the Composite International Diagnostic Interview (CIDI) 5.0 and to find the optimal sex-specific cut-off levels of the HSCL-5. Methods: Participants from the population-based Trøndelag Health Study (HUNT) in Norway were recruited for the current study. Between April and September 2020, 1343 participants (64% women) aged 20-65 years completed the CIDI, followed by the HSCL-5. The overall agreement between the HSCL-5 and GAD or MDD measured by CIDI was examined with Receiver Operator Characteristics (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for different cut-off levels were assessed. Results: The area under the curve for GAD or MDD was 0.90 (CI 95% = 0.85-0.95) for women and 0.85 (CI 95% = 0.68-1.00) for men. For women, a cut-off level of ≥1.80 had the best balance between sensitivity (85%) and specificity (84%), while the corresponding numbers were ≥2.00, 73%, and 93% for men. The global PPV was 21%, while the NPV was 99%. Conclusions: The HSCL-5 has high sensitivity and specificity for identifying cases of GAD or MDD. In the current study, the positive predictive value of HSCL-5 was low.