Self-rated mental health in socio-structural contexts: an examination with Korean American older adults

Objectives: Following the socio-structural framework of health, the study examined the role of social/interpersonal and environmental/neighborhood factors in predicting self-rated mental health (SRMH) in Korean American older adults.

Method: Using the survey data from 420 older Korean Americans (mean age = 71.6, SD = 7.59), multivariate models of SRMH was estimated with sets of predictors: (1) background information (demographic characteristics and chronic conditions), (2) mental health symptom measures (depressive symptoms and anxiety), (3) social/interpersonal factors (social network and filial satisfaction), and (4) environmental/neighborhood factors (neighborhood safety and residential satisfaction).

Results: Social/interpersonal and environmental/neighborhood factors were found to make a significant contribution to the predictive model even after controlling for background information and mental health symptom measures. Those with higher levels of filial satisfaction and more favorable perceptions of neighborhood safety were likely to have positive ratings of SRMH.

Conclusion: Findings supported the importance of considering socio-structural contexts in the assessment of SRMH and provided implications for mental health services for the target population.     

Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

Background

Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.

Methods

The entire school population of 16–17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991–1993 (n?=?2300). Adolescents with positive screenings (n?=?307) and matched non-depressed controls (n?=?302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17–19 years after the baseline study (n?=?375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants’ ages of 18 and 35 years.

Results

Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose–response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR?=?1.63, CI 0.55–4.85; 2–4 symptoms: OR?=?2.77, 95% CI 1.04–7.39;?≥?5 symptoms: OR?=?5.75, 95% CI 1.98–16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p?<?0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose–response relationship (p?<?0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p?<?0.05).

Conclusions

Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

     

Characteristics of Type D personality in Korean adolescents

To examine the prevalence of the Type D construct using the Korean version of the Type D Personality-14 (DS14) on the Korean youth population and to identify relationships between the Type D construct and other mental health measures. Adolescent participants aged 13?C18?years were recruited from 12 schools (7 middle schools and 5 high schools) in Ansan city, located in the southwest area of Gyeonggi-do province, Korea. A total of 4,899 students were assessed with the Korean version of the DS14, Beck depression inventory (BDI), Korean Eppendorf Schizophrenia Inventory (K-ESI), Adolescent Mental health Problem behavior Questionnaire (AMPQ), and Alcohol Use Disorders Identification Test-Korean version (AUDIT-K). We found significant differences in all the measured scales and subscale scores between two groups, those with Type D personality and those without (BDI: p?<?0.001, K-ESI: p?<?0.001, AMPQ: p?<?0.001, AUDIT-K: p?<?0.001). When comparing the distributions of the high risk participants identified by the results of BDI, K-ESI, AMPQ, and AUDIT-K between participants with either Type D or non-Type D personality, a significantly higher proportion of high risk participants were in the Type D personality group according to all measures (BDI: p?<?0.001, K-ESI: p?<?0.001, AMPQ: p?<?0.001, AUDIT-K: p?<?0.001). In conclusions, Type D adolescents experience various and more severe mental health problems. Type D personality was more related with internalizing symptoms in Korean adolescents. DS14 can be useful in a community mental health program designed for adolescents.     

The association between self-rated mental health and symptoms of depression in Korean American older adults

Objective: The study examined the association of self-rated mental health (SRMH) with three measures of depressive symptoms (the short form CES-D, GDS-SF, and PHQ-9) in Korean American older adults.

Method: The sample consisted of 420 community-dwelling Korean American older adults (M _age?=?71.6, SD?=?7.59) in the New York City metropolitan area. Hierarchical regression models of SRMH were estimated with an array of predictors: (a) sociodemographic characteristics, (b) physical health-related variables, and (c) each of the three depressive symptom measures.

Results: The three measures of depressive symptoms were interrelated, and each of them made a significant contribution to the multivariate models of SRMH. The amount of variance explained by the short-form CES-D, GDS-SF, and PHQ-9 was 11%, 10%, and 16%, respectively.

Conclusion: Findings show a moderately strong linkage between the measures of depressive symptoms and SRMH and invite further research on SRMH in diverse populations.     

An examination of the effects of intra and inter-individual changes in wellbeing and mental health on self-rated health in a population study of middle and older-aged adults

Purpose

Self-rated health is frequently used as an indicator of health and quality of life in epidemiological studies. While the association between self-rated health and negative mental health is well established, associations with indictors of positive wellbeing are less clear. Data from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project were used to compare the effects of vitality and mental health on self-rated health.

Methods

Participants (n = 40,712) provided information on vitality, mental health and self-rated health, were aged 45–95 years at baseline, and were followed between 1 and 10 years (M = 5.6; SD = 2.9).

Results

In comparison with mental health, multi-level modelling indicated between- and within-person change in vitality was more strongly associated with self-rated health. Bivariate dual change score modelling of the cross-lagged associations between vitality and self-rated health indicated vitality to be a stronger predictor of change in self-rated health. Self-rated health was unrelated to change in vitality.

Conclusion

Vitality accounted for most of the mental health effect on self-rated health and was identified as a significant predictor of change in self-rated health over a 10-year period. Promoting wellbeing and psychological functioning may have significant protective effects on negative health outcomes throughout the adult lifespan and into late life.     

A comparison of health-related quality of life in autonomic disorders: postural tachycardia syndrome versus vasovagal syncope

Purpose

Postural tachycardia syndrome (POTS) and vasovagal syncope (VVS) are two disorders of orthostatic intolerance which are often misdiagnosed as the other. In each case, patients experience a reduced health-related quality of life (HRQoL) compared to healthy populations. This study was conducted to test the hypothesis that HRQoL is worse in POTS.

Methods

POTS patients were recruited from the Dysautonomia International Annual Patient and Caregiver Conference. VVS patient data came from those enrolled in the Second Prevention of Syncope Trial. Participants aged?≥?18 years (177 POTS and 72 VVS) completed the RAND 36-Item Health Survey, a generic and coherent health-related quality of life survey.

Results

POTS patients reported reduced HRQoL compared to VVS patients in physical functioning (42.5?±?1.7 vs. 76.5?±?2.9, p?<?0.001), role limitations due to physical health (11.4?±?1.9 vs. 33.0?±?5.0, p?<?0.001), energy and fatigue (27.2?±?1.3 vs. 50.7?±?2.6, p?<?0.001), social functioning (45.2?±?1.8 vs. 71.2?±?2.9, p?<?0.001), pain (48.8?±?1.9 vs. 67.7?±?2.9, p?<?0.001), and general health (31.2?±?1.5 vs. 60.5?±?2.6, p?<?0.001) domains. Scores did not differ significantly in the role limitations due to emotional health (p?=?0.052) and emotional well-being (p?=?0.271) domains. Physical and general health composite scores were lower in the POTS population, while mental health composite scores were not different.

Conclusion

Differences in HRQoL exist between these patient populations. POTS patients report lower scores in physical and general health domains than VVS patients, but emotional health domains do not differ significantly. Targeting physical functioning in these patients may help improve quality of life.

     

Access to Secondary Mental Health Services in a Cohort of New Zealand Mothers

To explore access to secondary mental health services for New Zealand women during pregnancy and for up to 1 year post-delivery. A retrospective cohort analysis of public hospital maternity data linked to mental health collections. 27 in 1000 pregnancies were associated with access to secondary mental health services (736/27,153). Independent of ethnicity, young age (<20 years) was associated with access (RR1.84; 95?%CI 1.42–2.38; P?<?.0001). Smoking (1.48; 1.24–1.78; P?<?.0001), alcohol (1.3; 0.97–1.71; P?<?.0001) and substance use (3.57; 2.61–4.88; P?<?.0001) during pregnancy were independent risk factors associated with access. Antenatal period provides an opportunity for navigating to services to ensure timely access to secondary mental health services.     

Fatigue,not self-rated motor symptom severity,affects quality of life in functional motor disorders

While fatigue is found to be an impairing symptom in functional motor disorders (FMD) in clinical practice, scientific evidence is lacking. We investigated fatigue severity and subtypes in FMD compared to organic neurological disease. Furthermore, the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated. Data from 181 patients participating in the self-help on the internet for functional motor disorders, randomised Trial were included. Data from 217 neurological controls with neuromuscular disorders (NMD) originated from a historical cohort. Fatigue was measured using the checklist individual strength (CIS). Motor symptom severity, depression and anxiety were correlated to fatigue. For multivariable regression analyses, physical functioning and pain were additionally taken into account. Severe fatigue was, respectively, present in 78 and 53% of FMD and NMD patients (p?<?0.001). FMD patients scored higher than NMD patients on all fatigue subdomains (p?<?0.001). In the FMD group, fatigue subdomains were correlated to depression, anxiety and partly to motor symptom severity. Quality of life was negatively associated with fatigue [OR 0.93 (0.90–0.96), p?<?0.001] and depression [OR 0.87 (0.81–0.93), p?<?0.001], but not self-rated motor symptom severity. Self-rated health was negatively associated with fatigue [OR 0.92 (0.88–0.96), p?<?0.001] and pain [OR 0.98 (0.97–0.99), p?<?0.001]. Fatigue was found to be a prevalent problem in FMD, more so than in organic neurological disease. It significantly affected quality of life and self-rated health, while other factors such as motor symptom severity did not. Fatigue should be taken into account in clinical practice and treatment trials.     

Racial/Ethnic Differences in the Association Between Symptoms of Depression and Self-rated Mental Health Among Older Adults

The study examined racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Data came from the first wave of the National Social Life, Health, and Aging Project, a population-based study of non-institutionalized older adults aged 57 to 85. The sample consisted of non-Hispanic Whites (n = 2,110), Blacks (n = 509), and Hispanics (n = 304). The association between symptoms of depression and self-rated mental health was weaker among minority groups than that among non-Hispanic Whites. Tests of interaction effects showed that the predictability of depressive symptoms to self-rated mental health was substantially weakened among Blacks of advanced ages and Hispanics with multiple chronic conditions. The study explored potential sources of racial/ethnic differences in subjective reports of mental health and called attention to older minorities with advanced ages and cormorbid conditions in mental health services and interventions.     

Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control

Self-injury is common in autism spectrum disorder (ASD); however few studies have investigated correlates of self-injury or the putative associations with self-restraint. Questionnaire data on self-injury, self-restraint, health conditions, overactivity/impulsivity and repetitive/restricted behavior were collected on 208 children and 216 adults with ASD (mean age?=?24.10, range 6–61). Self-injury and self-restraint were frequent and significantly associated in both children (45.7% and 40.9%, p?<?0.001) and adults (49.1, and 42.6%, p?<?0.001). Severe self-injury was predicted by lower ability, health conditions and overactivity/impulsivity in children (p?<?0.001) and repetitive/restricted behavior and overactivity/impulsivity in adults (p?<?0.001). These data provide preliminary support for a developmental model of self-injury and self-restraint in which painful health conditions and compromised behavioral control influence the presence and trajectory of self-injury in ASD.     

A Successful Implementation Strategy to Support Adoption of Decision Making in Mental Health Services

Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centers (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilization of components of the toolkit improved significantly over time (p?<?.0001). Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model.     

Successful Treatment Response with Aripiprazole Augmentation of SSRIs in Refractory Obsessive–Compulsive Disorder in Childhood

The aim of this study is to evaluate the aripiprazole augmentation of selective seratonine reuptake inhibitors (SSRIs) in children and adolescents with treatment-resistant OCD. Forty-eight children and adolescents (14 girls, 34 boys), who are non-responders to treatment with at least two types of SSRIs and CBT, were administered a 12-week of augmentation. Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression-Severity and Improvement (CGI-S and CGI-I) sub-scales were used for evaluation of the treatment outcomes. The results showed that total CY-BOCS scores were decreased from 33.3?±?7.5 to 11.7?±?9.3 (p?<?0.001), CGI-S scores decreased from 6.3?±?0.9 to 2.7?±?1.6 (p?<?0.001), and CGI-I scores improved from 4.3?±?0.6 to 2.2?±?1.1 (p?<?0.001). Sensitivity analyses in 29 patients without SSRI dose escalation along with aripiprazole augmentation have also revealed that improvement effect was still significant, and CY-BOCS scores were improved from 34.2?±?7.9 to 13?±?10.3, CGI-S improved from 6.4?±?1.0 to 3.0?±?1.7, and CGI-I improved from 4.4?±?1.0 to 2.3?±?1.1 (p?<?0.001 for all). Analyses revealed that a significant clinical improvement has been observed with aripiprazole augmentation. Aripiprazole augmentation of SSRIs is a promising strategy in the management of treatment-refractory OCD children and adolescents.     

Validity of PTSD in a sample of refugee children: can a separate diagnostic entity be justified?

The objective of this study was to examine the construct validity of PTSD in a sample of refugee children from the Middle East – more specifically, to assess whether associations between traumatic events and specific PTSD symptoms were more outspoken than (1) the associations of PTSD symptoms with non‐traumatic exposures, and (2) the associations of violent exposures with symptoms other than PTSD‐symptoms. Parents of 311 refugee children from the Middle East were interviewed concerning their children's traumatic experiences and mental health symptoms. The specific PTSD symptoms did not cluster in a factor analysis. The PTSD symptom complex was significantly predicted not only by violent exposures (mother tortured, OR 8.2, p < 0.005; father disappeared OR 3.2, p < 0.05) but also by indicators of family interaction and parents' occupational situation. The two identified violent exposures had significant independent associations with a series of symptoms including symptoms other than those of PTSD (r_s ranging from 0.25 to 0.44, p < 0.001). Thus it does not seem sufficient to focus solely on PTSD symptomatology when assessing the mental health needs of refugee children. Copyright © 2006 John Wiley & Sons, Ltd.     

Risk factors of cognitive impairment in pediatric epilepsy patients with focal cortical dysplasia

Objective

The purpose of this study was to identify the risk factors of cognitive impairment in pediatric epilepsy patients with focal cortical dysplasia (FCD).

Mental Health First Aid is an effective public health intervention for improving knowledge,attitudes, and behaviour: A meta-analysis

Abstract

Mental Health First Aid (MHFA) is a standardized, psychoeducational programme developed to empower the public to approach, support and refer individuals in distress by improving course participants’ knowledge, attitudes and behaviours related to mental ill-health. The present paper aims to synthesize published evaluations of the MHFA programme in a meta-analysis to estimate its effects and potential as a public mental health awareness-increasing strategy. Fifteen relevant papers were identified through a systematic literature search. Standardized effect sizes were calculated for three different outcome measures: change in knowledge, attitudes, and helping behaviours. The results of the meta-analysis for these outcomes yielded a mean effect size of Glass’s Δ = 0.56 (95% CI = 0.38 – 0.74; p < 0.001), 0.28 (95% CI = 0.22 – 0.35; p < 0.001) and 0.25 (95% CI = 0.12 – 0.38; p < 0.001), respectively. Results were homogenous, and moderator analyses suggested no systematic bias or differences in results related to study design (with or without control group) or ‘publication quality’ (journal impact factor). The results demonstrate that MHFA increases participants’ knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems. The MHFA programme appears recommendable for public health action.     

A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention

Purpose

Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility.

Methods

A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them.

Results

In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p < 0.001), getting along with others (p < 0.001), life activities (p < 0.001) and participation in the society (p < 0.001). The factors that were significantly associated with disability in the two groups (BAD and schizophrenia) were: unemployment status (p < 0.001) and remittance source of income (p < 0.001), while those that spent not more than ?2,000 (13 dollars) per month on treatment (p = 0.004) were observed to be less disabled.

Conclusions

Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated.     

Quality of life in patients with MuSK positive myasthenia gravis

It is believed that myasthenia gravis (MG) with antibodies to muscle-specific tyrosine kinase (MuSK) is the most severe form of the disease, especially in the first years of the disease. The aim of our study was to investigate quality of life (QoL) in a population of patients with MuSK MG compared to those with MG who have antibodies to acetylcholine receptor (AChR) in their sera. The study group consisted of 35 MuSK MG patients (28 females and 7 males), while the control group included 38 AChR MG patients matched for gender, age, and duration of the disease. SF-36 questionnaire was used to evaluate the health-related QoL. Following scales were also used: Hamilton’s scales for depression and anxiety, the Multidimensional Scale of Perceived Social Support, and the Acceptance of Illness Scale. Physical domain scores of QoL were similarly affected in both MuSK and AChR groups, while mental domain and total SF-36 scores were even better in MuSK MG patients. Social support was better in the MuSK group (77.3?±?9.3 vs. 70.6?±?14.1, p?<?0.05). SF-36 total score correlated with depression (rho?=?0.54, p?<?0.01), anxiety (rho?=?0.49, p?<?0.01), and MSPSS (rho?=???0.35, p?<?0.05), and depression was an independent predictor of worse QoL. Besides therapy of weakness, psychiatric treatment and different forms of psychosocial condition should be part of regular therapeutic protocols for MG. Adequate team work of health professionals and family can provide a healthy mental environment in which a MuSK MG patient would feel more comfortable in spite of the disease.     

The Impact of the Covid-19-Related Transition to Telehealth on Visit Adherence in Mental Health Care: An Interrupted Time Series Study

Covid-19 has led to an unprecedented shift to telemental health (TMH) in mental healthcare. This study examines the impact of this transition on visit adherence for mental health services in an integrated behavioral health department. Monthly visit data for 12,245 patients from January, 2019 to January, 2021 was extracted from the electronic medical record. Interrupted time series (ITS) analysis examined the impact of the Covid-19 transition to TMH on immediate level and trend changes in the percentage of cancelled visits and no shows in the 10 months following the transition. ITS also compared changes across the three largest services types: adult, pediatric, and substance use. Following the TMH-transition, completed visits increased by 10% amounting to an additional 3644 visits. In April, 2020, immediately following the TMH-transition, no shows increased by 1.4%, (95% CI 0.1, 2.7, p?<?0.05) and cancellations fell by 13.5% (95% CI ? 17.9, ? 9.0, p?<?0.001). Across the 10-month post-TMH period, 18.2% of visits were cancelled, compared to 28.3% across the 14-month pre-TMH period. The proportion of no-shows remained the same. The pattern was similar for pediatric and adult sub-clinics, but no significant changes in cancellations or no shows were observed in the substance use sub-clinic. TMH during the Covid-19 pandemic is associated with improved visit adherence over time and may be a promising model for improving the efficiency of mental health care delivery once it is safe to resume in person care.

     

Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

Purpose

Ongoing armed conflicts, like the one in Colombia, have forcibly displaced millions of people including many young children. This study aimed to assess the mental health of internally displaced preschoolers in Bogotá Colombia and to identify correlates of mental health in these children.

Methods

Cross-sectional study conducted among 279 children attending four kindergartens in a deprived neighbourhood in Bogotá. Child mental health was assessed with the Child Behaviour Checklist (CBCL) 1.5–5 years, a parent-report. Univariate analyses and multivariate logistic regressions were performed to assess the association between displacement and child mental health and to identify correlates of mental health in displaced children.

Results

Displaced children (n = 90) more often met borderline cut-off scores for the CBCL scales than non-displaced children (n = 189) (e.g. total problems 46.7 vs. 22.8 %; p < 0.001). The association between displacement and presence of CBCL total problems remained after adjustment for socio-demographic factors (Adjusted OR 3.3, 95 % CI 1.5; 6.9). Caretaker’s mental health partly explained the association. In displaced children, caretaker’s mental health (p < 0.01) and family functioning (p < 0.01) were independently associated with child mental health. Exposure to traumatic events and social support was also associated with child mental health; however, associations were not independent.

Conclusion

In this deprived neighbourhood in Bogotá, preschool children registered as internally displaced presented worse mental health than non-displaced peers. Family functioning and caretaker’s mental health were strongly and independently associated with displaced children’s mental health.     

Availability of Youth Services in U.S. Mental Health Treatment Facilities

Despite concern about access to mental health (MH) services for youth, little is known about the specialty treatment infrastructure serving this population. We used national data to examine which types of MH treatment facilities (hospital- and community-based) were most likely to offer youth services and which types of communities were most likely to have this infrastructure. Larger (p < 0.001) and privately owned (p < 0.001) facilities were more likely to offer youth services. Rural counties, counties in which a majority of residents were nonwhite, and/or counties with a higher percentage of uninsured residents were less likely to have a community-based MH treatment facility that served youth (p < 0.001).