DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being

BACKGROUND: This paper reports population data on DSM-IV generalized anxiety disorder from the Australian National Survey of Mental Health and Well-Being. METHODS: The data were obtained from a nationwide household survey of adults using a stratified multi-stage sampling process. A response rate of 78.1% resulted in 10,641 persons being interviewed. Diagnoses were made using the Composite International Diagnostic Interview. The interview was computerized and conducted by trained lay interviewers. RESULTS: Prevalence in the total sample was 2.8% for 1-month GAD and 36% for 12-month GAD. Persons over 55 years of age were less likely to have GAD than those in the younger age groups. Logistic regression analysis also showed that a diagnosis of GAD was significantly associated with being of younger to middle age, being separated divorced or widowed, not having tertiary qualifications or being unemployed. Co-morbidity with another affective, anxiety, substance use or personality disorders was common, affecting 68% of the sample with 1-month DSM-IV GAD. GAD was associated with significant disablement, and 57% of the sample with DSM-IV GAD had consulted a health professional for a mental health problem in the prior 12 months. CONCLUSIONS: The survey provides population data on DSM-IV GAD and its correlates. GAD is a common disorder that is accompanied by significant morbidity and high rates of co-morbidity with affective and anxiety disorders, and is associated with marital status, education, employment status, but not sex. Changes to DSM-IV diagnostic criteria did not appear to affect the prevalence rate compared to previous population surveys.     

监狱警察社会支持、主观幸福感与心理健康的关系

目的探讨监狱人民警察的社会支持、主观幸福感和心理健康之间的关系。方法采用社会支持量表、主观幸福感量表和症状自评量表（SCL-90）,通过整群随机抽样法选取147名男性狱警进行调查。结果男性狱警在主观支持、主观幸福感、心理健康上存在来源地、工龄、工作岗位的显著差异性;男性狱警的主观幸福感、心理健康和社会支持之间存在显著相关。结论男性狱警的主观幸福感是社会支持和心理健康之间的中介变量。     

The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being

BACKGROUND: The present paper aimed to: (a) provide Australian estimates of the population-level association between psychotic 'caseness' and substance use; (b) examine liability to problematical substance use according to 'caseness' via the conditional prevalence (prevalence among users); and (c) examine associations between problematical substance use and the number of psychotic symptoms using ordinal logistic regression. METHOD: Data were from the National Survey of Mental Health and Well-Being (NSMHWB), a stratified multi-stage probability sample of Australian adults, using a subset of persons under the age of 50 years (N = 6722). A screener assessed the presence of characteristic psychotic symptoms. Associations between 'case' status and DSM-IV alcohol, cannabis and other drug use disorders were examined. Ordinal logistic regressions predicting psychosis scores were carried out, including demographic, mental health and drug use variables. RESULTS: Ninety-nine persons (1.2%) screened positively for psychosis. Regular tobacco, alcohol and cannabis use were much more common among persons screening positively, as were alcohol, cannabis and other drug use disorders. Among alcohol and cannabis users, psychosis 'cases' were much more likely to be dependent. Ordinal logistic regressions revealed that regular tobacco use, cannabis and alcohol dependence, and opiate abuse were predictors of psychosis scores. CONCLUSIONS: The mental health risks of problematical substance use need to be disseminated to persons at risk of, or suffering from, psychotic illness, and to heavy substance users. Work is needed to develop effective treatment approaches for problematical substance use among persons with psychosis.     

The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being

BACKGROUND: Two new screening scales for psychological distress, the K6 and K10, have been developed but their relative efficiency has not been evaluated in comparison with existing scales. METHOD: The Australian National Survey of Mental Health and Well-Being, a nationally representative household survey, administered the WHO Composite International Diagnostic Interview (CIDI) to assess 30-day DSM-IV disorders. The K6 and K10 were also administered along with the General Health Questionnaire (GHQ-12), the current de facto standard of mental health screening. Performance of the three screening scales in detecting CIDI/DSM-IV mood and anxiety disorders was assessed by calculating the areas under receiver operating characteristic curves (AUCs). Stratum-Specific Likelihood Ratios (SSLRs) were computed to help produce individual-level predicted probabilities of being a case from screening scale scores in other samples. RESULTS: The K10 was marginally better than the K6 in screening for CIDI/DSM-IV mood and anxiety disorders (K10 AUC: 0.90, 95%CI: 0.89-0.91 versus K6 AUC: 0.89, 95%CI: 0.88-0.90), while both were significantly better than the GHQ-12 (AUC: 0.80, 95%CI: 0.78-0.82). The SSLRs of the K10 and K6 were more informative in ruling in or out the target disorders than those of the GHQ-12 at both ends of the population spectrum. The K6 was more robust than the K10 to subsample variation. CONCLUSIONS: While the K10 might outperform the K6 in screening for severe disorders, the K6 is preferred in screening for any DSM-IV mood or anxiety disorder because of its brevity and consistency across subsamples. Precision of individual-level prediction is greatly improved by using polychotomous rather than dichotomous classification.     

Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being.

BACKGROUND: We report on the epidemiology of post-traumatic stress disorder (PTSD) in the Australian community, including information on lifetime exposure to trauma, 12-month prevalence of PTSD, sociodemographic correlates and co-morbidity. METHODS: Data were obtained from a stratified sample of 10,641 participants as part of the Australian National Survey of Mental Health and Well-being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of PTSD, as well as other DSM-IV anxiety, affective and substance use disorders. RESULTS: The estimated 12-month prevalence of PTSD was 1-33%, which is considerably lower than that found in comparable North American studies. Although females were at greater risk than males within the subsample of those who had experienced trauma, the large gender differences noted in some recent epidemiological research were not replicated. Prevalence was elevated among the never married and previously married respondents, and was lower among those aged over 55. For both men and women, rape and sexual molestation were the traumatic events most likely to be associated with PTSD. A high level of Axis 1 co-morbidity was found among those persons with PTSD. CONCLUSIONS: PTSD is a highly prevalent disorder in the Australian community and is routinely associated with high rates of anxiety, depression and substance disorders. Future research is needed to investigate rates among other populations outside the North American continent.     

Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Well-being

BACKGROUND: The Australian National Survey of Mental Health and Well-being was designed to detect and describe psychiatric morbidity, associated disability, service use and perceived need for care. The survey employed a single-phase interview methodology, delivering a field questionnaire to a clustered probability sample of 10,641 Australians. Perceived need was sampled with an instrument designed for this survey, the Perceived Need for Care Questionnaire (PNCQ). This questionnaire gathers information about five categories of perceived need, assigning each to one of four levels of perceived need. Reliability and validity studies showed satisfactory performance of the instrument. METHODS: Perceived need for mental health care in the Australian population has been analysed using PNCQ data, relating this to diagnostic and service utilization data from the above survey. RESULTS: The survey findings indicate that an estimated 13.8% of the Australian population have perceived need for mental health care. Those who met interview criteria for a psychiatric diagnosis and also expressed perceived need make up 9.9% of the population. An estimated 11.0% of the population are cases of untreated prevalence, a minority (3.6% of the population) of whom expressed perceived need for mental health care. Among persons using services, those without a psychiatric diagnosis based on interview criteria (4.4% of the population), showed high levels of perceived met need. CONCLUSIONS: The overall rate of perceived need found by this methodology lies between those found in the USA and Canada. The findings suggest that service use in the absence of diagnosis elicited by survey questionnaires may often represent successful intervention. In the survey, untreated prevalence was commonly not accompanied by perceived need for mental health care.     

The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being

BACKGROUND: Suicide is a leading cause of death worldwide but information about it is sparse in Sub-Saharan Africa. Suicide-related behaviours can provide an insight into the extent of this compelling consequence of mental illness. METHOD: Face-to-face interviews were conducted with a representative sample of persons aged 18 years and over (n=6752) in 21 of Nigeria's 36 states (representing about 57% of the national population). Suicide-related outcomes, mental disorders, as well as history of childhood adversities were assessed using the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). RESULTS: Lifetime prevalence estimates of suicide ideation, plan and attempts were 3.2% [95% confidence interval (CI) 1.4-6.5], 1.0% (95% CI 0.4-7.5) and 0.7% (95% CI 0.5-1.0) respectively. Almost two of every three ideators who made a plan went on to make an attempt. The highest risks for transition from ideation to plan and from plan to attempt were in the first year of having ideation or plan respectively. Mental disorders, especially mood disorders, were significant correlates of suicide-related outcomes. Childhood adversities of long separation from biological parents, being raised in a household with much conflict, being physically abused, or being brought up by a woman who had suffered from depression, anxiety disorder, or who had attempted suicide were risk factors for lifetime suicide attempt. CONCLUSIONS: History of childhood adversities and of lifetime mental disorders identify persons at high-risk for suicide-related outcomes. Preventive measures are best delivered within the first year of suicide ideation being expressed.     

Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

BACKGROUND: Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R). METHOD: The NCS-R is a nationally representative household survey fielded in 2001-2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia. RESULTS: The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose-response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment. CONCLUSIONS: Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.     

大学生主观幸福感与心理健康的相关研究

目的 探讨大学生主观幸福感与心理健康的关系。方法 采用人胆量表和症状自评量表对289名大学生进行测验。结果 大学生的主观幸福感呈右偏态分布趋势，主观幸福感与心理健康有显著性相关。结论 心理健康是影响大学生主观幸福感的因素之一，积极开展大学生的心理健康教育和心理咨询工作，对提高大学生的主观幸福感感有积极意义。     

增补后的一般健康问卷在精神疾病流行病学调查中的应用

目的:了解增补后的一般健康问卷12项(The General Health Questionnair,GHQ-12)在河北省18岁以上人群各类精神疾病流行病学调查中的灵敏度和特异度.方法:以增补后的一般健康问卷12项(GHQ-12)为筛选工具,以美国精神疾病诊断与统计手册第四版(DSM-Ⅳ)为诊断标准,进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID).结果:共20716人完成了增补后的GHQ-12调查,重测一致性r=0.82(P＜0.01),灵敏度为98.3%,特异度为44.8%,12种常见精神疾病的灵敏度均在93%以上.结论:增补后的一般健康问卷12项具有较好的灵敏度,是较好的精神疾病流行病学调查的筛选工具.     

宽恕与心理健康

一般说来,宽恕包含三个层面,即宽恕他人、宽恕自己与寻求宽恕.宽恕他人是指受害者受到他人的伤害后,自愿停止敌视侵犯者,并善待侵犯者的心理过程.宽恕自己是指个人饶恕自己所犯的错误或罪孽,由憎恨自己转变为关爱自己的心理过程.寻求宽恕指侵犯者在伤害他人后,主动承担道德责任并尽力寻求受害者宽容饶恕自己的心理过程.当前,国外对宽恕他人研究的较多,发展出了两个主要的临床干预模式且有不少研究发现宽恕对人的心理健康有影响.     

Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey.

BACKGROUND: General population data were used to study co-morbidities between lifetime social phobia and mood disorders. METHODS: Data come from the US National Comorbidity Survey (NCS). RESULTS: Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2.9), dysthymia (2.7) and bipolar disorder (5.9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10-15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders. CONCLUSIONS: Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.     

民办高校新生心理健康状况调查与分析

目的探讨民办高校新生SCL-90异常因子与心理问题严重者(≥3)分布情况,不同类型大学新生在SCL-90因子分上的差异及家庭因素对新生心理健康的影响。方法采用自编的民办高校新生基本资料调查表和症状自评量表(SCL-90),在西北地区某大城市中随机选取某民办高校08级新生113名进行测量。结果 1在SCL-90因子中,检出率最高的因子依次为:强迫症、人际敏感、抑郁和敌对(并列第3),至少1个因子≥3的学生总体检出率为15.04%;2不同性别的新生仅在恐怖因子上存在显著差异(t=2.41,P0.05);来自不同生源地的新生仅在人际敏感因子上存在显著差异(F=3.35,P0.05);独生子女与非独生子女在SCL-90各因子及总分上均不存在显著差异(t=1.57或0.50,P0.05);3父母文化程度、家庭经济状况等家庭因素对新生的心理健康水平没有显著影响(F=1.49或0.02,P0.05)。结论民办高校学生的心理健康水平相对较低。研究者未来应探讨新生个体内的心理健康素质,以及学校因素或社会微环境对民办高校新生心理健康的影响。     

2007级大学新生心理健康状况调查分析

目的了解2007级大学新生心理健康状况。方法采用大学生人格问卷（UPI）对刚入学的某高校大学新生进行整体施测,并对测量结果进行统计分析。结果“一类学生”共有230人,占施测总人数的11．6％。经X^2检验,“一类学生”中,男大学生存在心理问题的比例低于女大学生（P〈0．01）。文、理科及艺术、体育大学生的心理健康状况存在显著差异（P〈0．01）。结论2007级大学新生总体心理健康状况良好,心理健康水平存在性别和学科差异。     

Levels of disability in major depression: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

BACKGROUND: Information on the distribution of disability associated with major depression (MD) across different groups of patients is of interest to health policy and planning. We examined the associations of severity and type (a single or recurrent episode) of MD with disability in a Dutch general population sample. METHODS: We used data from the first wave (1996) of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). MD 'severity' and 'type' were diagnosed with the help of the Composite International Diagnostic Interview according to DSM-III-R criteria. SF-36 scores, days ill in bed and days absent from work were taken as indicators of disability. The differences in these variables were studied by means of variance and regression analysis. RESULTS: Recurrent MD was found not to be associated with more disability than single episode MD. Higher 'severity' classes were associated with more disability. However, the degree of disability between 'moderate' and 'severe' MD differed only very slightly. The difference in disability between non-depressed and mildly depressed individuals had a larger effect than between each successive pair of 'severity' classes. CONCLUSIONS: Three groups of MD can be distinguished based on the associated degree of disability: 'mild', 'moderate to severe' and 'severe with psychotic features'. In the future, these groups can be used to describe the distribution of disability in the depressed population. The marked difference between 'mild' MD and no MD suggests that 'mild' cases should be considered relevant.