Socioeconomic status and the risk of depression among UK higher education students

Background

Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable.

Methods

The study was a cross-sectional online survey of 923 undergraduate students attending 6 UK Universities in the academic year 2009–2010 who completed a modified version of the Zagazig Depression Scale (ZDS).

Results

Overall, 58.1 % of female and 59.9 % of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control.

Conclusion

Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one’s life may be protective.

Application

Since depression has strong impact on students’ learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.     

Reliability of a shortened version of the Zagazig Depression Scale and prevalence of depression in an Egyptian university student sample

BackgroundThere is some evidence that university students are at higher risk of depression; but rates have been found to vary widely across different countries, and there have been few surveys in representative samples. This study was carried out to assess the reliability of the Arabic-language Zagazig Depression Scale (ZDS) in a sample of Egyptian university students and to use the ZDS to assess the prevalence of depression.MethodsThe study was a cross-sectional survey of a representative sample of 988 undergraduate students from Assiut University, Egypt (response rate, 82.3%). Prevalence of depressive symptoms was assessed using the ZDS, a self-report Arabic-language version of the Hamilton Rating Scale, modeled on the Carroll Rating Scale for Depression.ResultsParticipants had a mean ZDS score of 17.8 (±9.0) out of a possible maximum score of 46. Using the recommended cutoffs for the ZDS, 37.6% of the students were found to have at least moderate depression, with 71% exceeding the cutoff for mild depression. The internal consistency of the ZDS was excellent (Cronbach α = 0.904), as was the split-half correlation coefficient.ConclusionThis survey revealed a worryingly high rate of depressive symptoms in a representative sample of Egyptian university students. The ZDS is a reliable and acceptable tool for assessing mental health in a university population.     

Caregiver strain and symptoms of depression among principal caregivers of patients with schizophrenia and bipolar affective disorder in Sri Lanka

Introduction

Data on caregiver strain and depression of principal caregivers of patients with mental illnesses are few in developing countries. Findings from developed countries cannot be applied directly to developing countries as culture specific factors may influence the outcome.

Methods

A prospective study was carried out in the University Psychiatry Unit of the National Hospital of Sri Lanka (NHSL) to identify symptoms of depression, caregiver strain and dissatisfaction with life in caregivers of patients with schizophrenia and bipolar affective disorder. Participants were assessed using the Center for Epidemiological Studies – Depression Scale, Satisfaction with Life Scale and the Modified Caregiver Strain Index.

Results and discussion

Eighty caregivers were interviewed (males; 36, 45%). Symptoms of depression were significant in 37.5%, while 48.8% had unsatisfactory scores on the Satisfaction with Life Scale. Depression and higher caregiver strain were associated with spending more time with the patient, interruption to work, disputes with relations, being assaulted by patient and self admission of needing professional help to overcome mental stress.

Conclusion

This study identified several associations for depression and increased caregiver strain among caregivers in a subset of patients with mental disorder in Sri Lanka. These can be used as markers to screen and increase pretest probability to identify caregivers needing help rather than applying the cumbersome questionnaires to all.     

Risk factors for mental disorder among university students in Australia: findings from a web-based cross-sectional survey

Purpose

To identify variables associated with common mental disorders in an Australian university population.

Methods

We invited all Australia-based students from a large public university (N = 24,209) to participate in a web-based student mental health survey. Outcome measures included the patient health questionnaire depression, anxiety, and eating disorders modules, and the alcohol use disorders identification test. Explanatory variables of interest included gender, age, year of study, degree type, financial means, parental education, domestic/international status, and sexual orientation. Multiple logistic regression analysis was used to estimate independent associations with the four outcomes.

Results

Complete responses were received from 6,044 students (25 %). Proportions reporting depression, anxiety, eating disorders, and harmful drinking were 8, 13, 14, and 8 %, respectively, while 30 % had at least one of these disorders. The groups with the highest rates of disorder were women, 25–34-year-olds, students on low income, and homosexual or bisexual students. Parental education was not associated with disorder, nor was international/domestic status.

Conclusion

This is the first study examining mental disorders in a population-based sample of university students in Australia. Given increasing student numbers and participation of students from lower socio-economic backgrounds, policy is urgently needed to promote better mental health in this population, to routinely identify vulnerable students, and to intervene early. Groups in particular need are women, students on low incomes, and homosexual or bisexual students.     

Mental disorders in primary care in Israel: prevalence and risk factors

Objective

Psychiatric morbidity is common among patients in primary care services and leads to disability and increased use of medical services. Comparison of primary care and community prevalence data is of interest in relation to the health services planning for mental disorders. The aim of the present study was to measure prevalence of mental disorders in six primary care clinics in Israel and to assess risk factors for these disorders.

Method

Prevalence of mental disorders was measured in a sample of 2,948 primary care consecutive attendees, using two-stage stratified sampling with the General Health Questionnaire 12 (GHQ-12) and the Composite International Diagnostic Interview (CIDI).

Results

A high rate (46.3 %) of current mental disorders was found, with rates of current depressive episode, generalized anxiety disorder, somatization disorder, and neurasthenia being relatively high in comparison with rates in other countries. Low education was a risk factor for all categories of disorders, unemployment a risk factor for depressive disorders, and parenthood was protective for most categories of disorders.

Conclusions

High rates of mental disorders were found in this Israeli primary care sample as compared to other countries, while in the community the rates were midrange as compared to other countries, pointing to a relatively higher use of primary care services by patients with mental disorders in Israel than in other countries.     

Adolescent non-suicidal self-injury (NSSI) in German-speaking countries: comparing prevalence rates from three community samples

Purpose

Non-suicidal self-injury (NSSI) has been recognized as a significant mental health problem in adolescence with high prevalence rates. To date, there are few studies that compare rates of adolescent NSSI between different countries. Thus far no prevalence rates of adolescent NSSI have been reported for Austrian or Swiss community samples.

Methods

This study aimed to assess and compare rates of adolescent NSSI in school samples from Austria, Germany and Switzerland using the same assessment instrument (Ottawa Self-Injury Inventory; OSI).

Results

Within these countries, 6-month prevalence rates between 7.6 and 14.6 % were found, with rates showing significant differences between countries (χ² = 16.54, p = 0.02).

Conclusions

These results demonstrate with some variability the significant rates of NSSI in youth in a cross-country study.     

Prevalence of mental health disorders among low-income African American adolescents

Purpose

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population.

Methods

Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city.

Results

Based on the C-DISC, 3.8, 5.1 and 7.7 % of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders.

Conclusions

Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.     

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

Purpose

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

Methods

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

Results

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

Conclusions

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens’ mental health.     

Depressive and anxiety disorders in different ethnic groups

Introduction

To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxiety disorders among different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences.

Methods

A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese/Antilleans was interviewed by well-trained bilingual interviewers, using the CIDI 2.1. Educational level and income were used as indicators of socio-economic status.

Results

The weighed 1-month prevalence of depressive and/or anxiety disorders was 6.6% (Dutch), 18.7% (Turkish), 9.8% (Moroccans) and 1.2 % (Surinamese/Antilleans). Among Moroccans, the prevalence of affective disorders seemed higher in men than in women, among the Turkish the opposite was observed. Ethnic differences in prevalence could not be explained by socioeconomic differences.

Conclusion

Turkish women and men and Moroccan men in Amsterdam seem to have a higher risk of current affective disorders. Ethnicity is an independent predictor of common mental disorders in the Netherlands.     

Socioeconomic status and beliefs about depression, schizophrenia and eating disorders

Purpose

The association between socioeconomic status (SES) and knowledge/belief about depression, schizophrenia and eating disorders will be analysed.

Methods

Data stem from a telephone survey in two large German cities (Hamburg and Munich, n = 2,014, response rate 51 %). Written vignettes with typical signs and symptoms suggestive of a depression, schizophrenia and eating disorders were presented to the respondents. Respondents were then asked about knowledge/belief about causes, symptoms, prevalence and treatment using a standardised questionnaire. Education, occupational position and income were used as SES indicators.

Results

Results of mixed hierarchal logistic regression analyses show that individuals with a low SES know less about symptoms and prevalences of depression, schizophrenia and eating disorders. Moreover, people with a high SES are more likely to consider medication as effective in case of depression and schizophrenia, but are less likely to believe that activities such as sports or relaxation are an effective measure to treat the three mental disorders under study. Respondents with a high SES are less likely to believe that a weak will is a possible cause of depression, schizophrenia and eating disorders. We found large similarities in the associations between SES and beliefs across the three mental disorders. Finally, associations of beliefs about mental disorders with education are stronger and more consistent than with income and occupational position.

Conclusions

Results indicate an inequality in mental health literacy and underline that information campaigns on causes, symptoms, prevalence and treatment of mental disorders should consider information needs of people with a low SES.     

Personality-related factors as predictors of help-seeking for depression: a population-based study applying the Behavioral Model of Health Services Use

Background

Although the prevalence of mental disorders and the demand for mental health services are increasing, little is known about the impact of personality-related factors on help-seeking among depressive individuals. We, therefore, investigated the relationship between the “Big Five” personality traits, resilience, alexithymia, childhood neglect or abuse, and help-seeking among depressive individuals.

Methods

We used data from 354 persons with a diagnosis of major depression from the population-based cohort study of health in Pomerania within the theoretical framework of the Andersen Behavioral Model of Health Services Use.

Results

Using stepwise regression techniques, we found that older age, higher education, more perceived social support, presence of childhood abuse, higher levels of conscientiousness, lower levels of resilience, and more severe depression were associated with help-seeking for depression. In contrast, gender, extraversion, openness, agreeableness, neuroticism, and alexithymia did not significantly predict help-seeking. In addition, no evidence for gender-specific effects was observed.

Conclusion

Personality-related predisposing factors are important predictors of help-seeking. The influence of resilience on help-seeking among depressed individuals merits further exploration.     

Depression among physicians working in public healthcare in Belo Horizonte,Brazil

Purpose

Prevalence of depressive disorders has been reported among physicians in a number of different settings. The aim of the present study is to assess the prevalence of self-reported depression and its associated factors among physicians working in the public healthcare system of Belo Horizonte, Minas Gerais state, Brazil.

Methods

A cross-sectional survey was carried out in 2009 to investigate individual and occupational dimensions of depressive disorders in a group of physicians working at several municipal healthcare units. The percentage of physicians that self-reported a confirmed diagnosis of depression by another physician was used as the prevalence proportion; the Poisson regression univariate and multivariate models were applied to study factors associated with depression.

Results

The response rate was 81.2 %, of which 12.0 % reported depression confirmed by another physician. Reports of RSI/WMSD (p < 0.001) and passive work (p < 0.05) were positively and independently associated with the outcome.

Conclusions

Our data bring valuable information that may help guide interventions and health-promoting activities for physicians by indicating concrete measures to change working conditions that affect mental health.     

A UK population-based study of the relationship between mental disorder and victimisation

Purpose

To establish the prevalence of victimisation in a UK population-based sample and to investigate the association between mental disorder and victimisation in both cross-sectional and prospective manner, whilst adjusting for potential confounds.

Methods

Data from the National Child Development Study (NCDS) were used to examine criminal victimisation, violent victimisation, and mental disorder at age 46?yerars, and also to measure history of mental disorder, when cohort members were aged 23, 33 and 42?years. Variables considered to be potential confounders or mediators of the association, including socio-economic status, family income, financial strain, education, housing ownership status, heavy drinking and gender, all measured at age 46?years, were considered in multivariate analyses.

Results

The prevalence of criminal victimisation amongst cohort members in the 12?months preceding interview was 15%; 2.2% of the participants reported experiencing violent victimisation in the past year. Mental disorder at age 46 was significantly associated with criminal and violent victimisation, even after adjusting for potential confounds. A prior history of mental disorder was found to be a robust predictor of criminal and violent victimisation.

Conclusions

This study provides evidence that those with a mental disorder are at elevated risk of victimisation, including violent victimisation. That such an association might reflect an underlying causal relationship is further supported by the confirmation that the association holds true when mental disorder is measured well before the assessment of victimisation risk, and that it persists despite adjustment for a number of potential confounding factors.     

The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review

Background

Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan).

Methods

Help seeking Afghan women (N = 61), who were diagnosed with mental health symptoms by local physicians either received routine medical treatment(treatment as usual) or psychosocial counselling (5-8 sessions) following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms.

Results

At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment.

Conclusion

These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments.

Trial registration

NCT01155687     

Factors associated with the development of self-harm amongst a socio-economically deprived cohort of adolescents in Santiago,Chile

Purpose

Studies carried out in the West indicate that the incidence of self-harm (SH) is particularly high amongst adolescents, but few studies have investigated its incidence and aetiology in low-income countries. The purpose of this study was to investigate risk factors associated with new onset episodes of SH, amongst Chilean adolescents from low socio-economic backgrounds.

Methods

Prospective cohort study nested within a cluster randomised controlled trial. A 6-month follow-up for 2,042 adolescents, median age 14 years, from socio-economically deprived areas of Santiago, Chile.

Results

The lifetime prevalence of SH was 23 %. The incidence rate of SH at 6 months was 14 % amongst those reporting no SH at baseline. In multivariable analyses, risk factors for incident SH include depressive symptoms, suicidal thoughts, poor problem-solving skills and cannabis misuse.

Conclusions

The prevalence and incidence of SH in this socio-economically deprived sample differed highly according to gender. Poor problem-solving skills, suicidal thoughts, and cannabis misuse were associated with onset of SH.     

Impact of demographic factors on recognition of persons with depression and anxiety in primary care in Slovenia

Background

Studies investigating the prevalence of postnatal depression (PND) show rates ranging from 5% to 36.7%. The investigation of age, race, educational levels, religion and income as risk factors for PND has yielded conflicting results. The aim of this study is to investigate the prevalence of PND in women residing in Southern Brazil and the associated risk factors.

Methods

This is population-based cross-sectional study of women residing in Porto Alegre who delivered in June 2001. A sample of 271 participants were selected from the Record of Living Newborn Infants of the State Health Department (the official Brazilian database and stores the name and address of all women who give birth to living newborn infants) using a process based on pseudo-random numbers which choose a random sample from 2.000 records. Once the addresses were identified, the women were visited at their place of residence (home, hotel, boarding house and prison), with the interviews taking place between the 6^th and the 8^th week after delivery. The association between the risk factors and PND was investigated through bivariate analysis using Pearson's chi-square test. Student's t-test was used to analyze the continuous variables. To identify independent risk factors, multivariate analysis was performed using hierarchical levels with a predefined model that took into account the time relationship between PND and the risk factors. Cox's regression was used to calculate the prevalence ratios.

Results

The PND prevalence rate found was 20.7% (CI 95% 15.7 – 25.7). After adjusting for confounding variables, per capita income was found to have a significant association with PND.

Conclusion

The prevalence of PND is higher than the figures found in most developed countries and similar to the figures found in developing countries. Differences in PND by regions or countries can be partially explained by the effect of income on the mediation of risk factors. In low income populations, women should be routinely evaluated for postnatal depression, and those with no partner or spouse are likely to require further care from health services and should be given the benefit of mental health prevention programs.     

Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan

Background

The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables.

Methods

In this cross-sectional community study (n?=?1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors.

Results

The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD?=?12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD.

Conclusion

In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.     

Social capital and reported discrimination among people with depression in 15 European countries

Purpose

Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels.

Method

A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network.

Results

Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination.

Conclusions

Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.     

Association of childhood adversities with the first onset of mental disorders in Spain: results from the ESEMeD project

Purpose

Childhood adversities (CAs) have consistently been associated with mental health problems in childhood and adulthood. However, few studies have employed appropriate statistical methods that take into account overlap among CAs, and many of the ones that did so were based on insufficiently complex models. The present paper studies the prevalence of a wide variety of CAs, as well as their relationship to the onset of mental disorders in a representative sample of a Spanish population.

Methods

The study is part of the ESEMeD-Spain project, a cross-sectional household survey, which included a nationally representative sample of the Spanish adult population. CAs’ associations with lifetime prevalence of mental disorders were estimated using discrete-time survival analysis with person-years as the unit of analysis.

Results

Of our sample, 20.6 % reported at least one CA, of whom 24 % reported more than one CA. Parental death, parental mental disorder, family violence, economic adversity, physical and sexual abuse were associated with different groups of mental disorders. CAs were associated with the onset of mental disorders during several stages of life. Simulations suggest that CAs were associated with 12.6 % of all disorders, 10.8 % of mood disorders, 5.8 % of anxiety disorders, 27 % of substance disorders and 29.7 % of externalising disorders.

Conclusions

Prevalences of CAs in the Spanish population are lower than those found in other high-income countries, especially when compared to the USA. In Spain, different CAs were associated with the onset of a number of mental disorders, although these associations were not as frequent as in other countries. Although lower than in other countries, the association between CAs and mental health in Spain should be considered relevant. Specific health policies and prevention programmes are needed in order to decrease this burden.