Validation study of REM Sleep Behavior Disorder Questionnaire – Hong Kong (RBDQ-HK) in East China

ObjectiveTo validate the REM Sleep Behavior Disorder (RBD) Questionnaire – Hong Kong (RBDQ-HK) in polysomnography (PSG)-confirmed RBD and non-RBD subjects, and to evaluate its usefulness in different clinical populations.MethodsIn total, 325 subjects (115 RBD and 210 controls) from East China were enrolled. After patients had finished the structured interview, and completed the RBDQ-HK and video-PSG test, we evaluated the reliability of RBDQ-HK (areas under the curves (AUC), the best cut-off values, factor 2 of RBDQ-HK, and overall scale) and validated the usefulness of RBDQ-HK between the Parkinson disease (PD) and obstructive sleep apnea (OSA) groups.ResultsThe best cut-off values for factor 2 of RBDQ-HK were located at 7/8 with a sensitivity of 90% and specificity of 82% (AUC = 0.911), and for RBDQ-HK overall scale were located at 17 with a sensitivity of 85% and specificity of 81% (AUC = 0.892) in all subjects. Both factor 2 and overall scale of RBDQ-HK are valid in all subjects (PD and OSA patients), with a higher accuracy given by factor 2 of RBDQ-HK.ConclusionsRBDQ-HK and its factor 2 are useful and validated RBD screening instruments, and could be used as a tool for screening RBD in patients with PD and OSA.     

Use of patient-controlled psychiatric hospital admissions: mental health professionals’ perspective

Background: In a patient-controlled admission (PCA) programme, the decision about hospital admission is made solely by the patient, with no gatekeeper function allocated to the mental health professionals (MHPs). Current knowledge about how MHPs experience and evaluate PCA is sparse.

Aims: This Danish multi-centre study examined the MHP assessment of the PCA programme in daily clinical practice, and compared PCA evaluations made by MHPs and patients.

Methods: A questionnaire was developed and a survey conducted over the course of a year at all Danish mental health units included in the PCA programme. MHPs made an overall evaluation of the PCA programme. At each unique PCA, both patient and MHP evaluated the specific admission when the patient entered the unit and at discharge.

Results: In total, 546 questionnaires were included in the survey, based on 252 unique MHPs. The MHPs rated the PCA programme positively. The MHPs believed that PCA helped patients receive early help and avoid long admissions. Overall, agreement was poor when comparing patients’ and MHPs’ evaluation of the same PCA.

Conclusion: MHPs (and patients) seem to be in favour of implementing the PCA programme. However, results revealed that MHPs and patients have different views of what caused the patient to admit themselves and why patients were discharged.

Clinical implications: MHPs should be aware that patients might have other reasons for admitting and discharging themselves than what seems most obvious to the MHP.     

Therapists’ characteristics associated with the (non-)use of exposure in the treatment of anxiety disorders in youth: A survey among Dutch-speaking mental health practitioners

IntroductionAlthough there is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Previous research pointed to therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety as important factors in the underusage of exposure in the treatment of adult anxiety disorders. This study examined what therapist characteristics may be involved in the (non-)use of exposure in treating childhood anxiety disorders.MethodsAn internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety, depression and stress.ResultsThe current survey showed that therapists used exposure in about half of their cases of childhood anxiety and that the non-use was independently associated with the relatively strong negative beliefs about exposure, therapists’ age, and non-CBT orientation.DiscussionFindings point to the importance of addressing negative beliefs about exposure in therapists’ training and supervision to resolve therapy drift away from exposure, and consequently improve utilization and delivery of exposure-based therapy for childhood anxiety disorders.     

The geography of mental health: an established field?

PURPOSE OF REVIEW: The purpose of this review is to offer an outline introduction to a field of inquiry known as the geography of mental health (or mental health geographies). Since this is the first time the field has been reviewed in this journal, attention will be paid to the history of the field, not just recent findings. RECENT FINDINGS: Research has chiefly, but not exclusively, tackled (i) the spatial epidemiology of mental ill-health and (ii) the changing locational associations of mental health care. SUMMARY: This review has concentrated chiefly on contributions to this field of inquiry made by researchers with a background in the academic discipline of geography. While there are 'geographical' contributions made by workers from other disciplinary backgrounds, there is arguably something distinctive, particularly in the most recent scholarship, arising from a theorized sensitivity to the entangled relations of mental health, society, space and environment.     

Psychosocial risk factors associated with fathers’ mental health in the postnatal period: results from a population-based study

Purpose

Fathers’ psychological distress in the postnatal period can have adverse effects on their children’s wellbeing and development, yet little is known about the factors associated with fathers’ distress. This paper examines a broad range of socio-demographic, individual, infant and contextual factors to identify those associated with fathers’ psychological distress in the first year postpartum.

Methods

Secondary analysis of data from 3,219 fathers participating in the infant cohort of the Longitudinal Study of Australian Children at wave 1 when children were 0–12 months of age.

Results

Approximately 10 % of fathers reported elevated symptoms of psychological distress. Logistic regression analyses revealed that the risk factors were poor job quality, poor relationship quality, maternal psychological distress, having a partner in a more prestigious occupation and low parental self-efficacy.

Conclusion

These findings provide new information to guide the assessment of fathers’ risk for psychological distress in postnatal period. There are also important social policy implications related to workplace entitlements and the provision of services for fathers.     

What is a case? A 45-year study of psychiatric impairment within a college sample selected for mental health

Six different models for assessing psychiatric impairment were applied to 188 men who had been studied prospectively for half a century. The six models were categorical DSM-III diagnosis by a senior psychiatrist; objective evidence of impairment in working and loving; relative maturity of ego mechanisms of defense; the Health Sickness Rating Scale; the Global Assessment Scale (Axis V of DSM-III-R); and a "research" scale designed to provide a consensual definition of "caseness." As a test of predictive validity of our impairment measures, assessments before the age of 50 years were used to predict psychosocial adjustment and physical health assessed 15 years later. All six models were highly intercorrelated and proved equally effective in predicting future impairment. Procedures to establish construct validity suggested that the presence of a DSM-III diagnosis was a valid categorical definition of case, and that Axis V of DSM-III-R was a valid dimensional measure of impairment.     

Health-related quality of life of children with epilepsy in Hong Kong: How does it compare with that of youth with epilepsy in Canada?

OBJECTIVE: The primary aim of our study was to compare the health-related quality of life (HRQL) of children with epilepsy in Hong Kong with that of children with epilepsy in Canada, and to explore possible factors affecting these findings. A second interest was to determine agreement between proxy reports and self-ratings among children with epilepsy in Hong Kong, compare these with findings in Canada, and identify factors that influence the concordance. METHODS: Child self-report and parent-proxy questionnaires on an epilepsy-specific HRQL measure, appropriately translated and validated in Chinese, were administered to 266 Hong Kong children and their parents. An unpaired t test was used to compare the scores with published results from 381 Canadian children and their parents, who used the original English version of the measure. Demographic characteristics of the two groups were compared using t tests, chi2 tests, and Fisher's exact tests. Agreement between parents' and children's scores was evaluated with intraclass correlation coefficients (ICCs) and standardized response means (SRMs). The total HRQL score differences between parents and children in Hong Kong were compared with those in Canada using an unpaired t test. Factors that might affect the parent-child score difference were studied using Pearson correlation analysis, chi2 test, and analysis of variance. Factors studied included: sex, current age, age at diagnosis, duration of epilepsy, number of antiepileptic drugs used, type of seizure, seizure severity, cognition of the child, the type of school attended, presence of neurological problems, presence of behavioral problems, recent health care usage, education and employment status of both parents, housing status of the family, and relationship of the proxy respondent to the child. RESULTS: (1) In contrast to the Canadian sample, Hong Kong children with epilepsy were older (P<0.01), had a longer duration of epilepsy (P<0.01) and less severe seizures (P<0.01), and were more likely to attend normal schools (P<0.01). Children in Hong Kong reported more interpersonal/social difficulties (P<0.01), more worries (P<0.01), and more secrecy about their epilepsy (P<0.01). Parents in Hong Kong believed that their children perceived more worries (P<0.01) and were more secretive about their epilepsy (P<0.01). (2) Moderate to good agreement between parent-proxy response scores and child self-report scores was demonstrated (ICC=0.50-0.69, SRM=0.19-0.33). The total HRQL score differences between parent and child in Hong Kong were not different from those in Canada. None of the factors studied were related to the parent-child score difference. CONCLUSIONS: Youth with epilepsy in Hong Kong and their parents reported poorer quality of life than children with epilepsy in Canada. Further studies are necessary to identify the determinants of HRQL in children with epilepsy in different cultures. Acceptable agreement between the two ratings suggests that proxy reports can be used when child self-reports cannot be obtained.     

Can general practice help address youth mental health? A retrospective cross‐sectional study in Dublin's south inner city

Aims: With general practice potentially having an important role in early intervention of mental and substance use disorders among young people, we aim to explore this issue by determining the prevalence of psychological problems and general practice/health service utilization among young people attending general practice. Methods: A retrospective cross‐sectional study of patients attending three general practices in Dublin city. Results: Among a sample of young people (mostly women, 44% general medical services (GMS) eligible), we observed considerable contact with general practice, both lifetime and for the 2 years of the study. The mean consultation rate was 3.9 consultations in 2 years and psychosocial issues (most commonly stress/anxiety and depression) were documented in 35% of cases. Identification of psychosocial issues was associated with GMS eligibility, three or more doctor consultations, and documentation of smoking and drinking status. Conclusions: Psychosocial issues are common among young people attending general practice and more work on their epidemiology and further identification in general practice are advocated.     

Improving early detection of childhood depression in mental health care: The Children׳s Depression Screener (ChilD-S)

Diagnosing childhood depression can pose a challenge, even for mental health specialists. Screening tools can aid clinicians within the initial step of the diagnostic process. For the first time, the Children?s Depression Screener (ChilD-S) is validated in a mental health setting as a novel field of application beyond the previously examined pediatric setting. Based on a structured interview, DSM-IV-TR diagnoses of depression were made for 79 psychiatric patients aged 9–12, serving as the gold standard for validation. For assessing criterion validity, receiver operating characteristic (ROC) curves were calculated. Point prevalence of major depression and dysthymia was 28%. Diagnostic accuracy in terms of the area under the ROC curve was high (0.97). At the optimal cut-off point ≥12 according to the Youden?s index, sensitivity was 0.91 and specificity was 0.81. The findings suggest that the ChilD-S is not only a valid screening instrument for childhood depression in pediatric care but also in mental health settings. As a brief tool it can easily be implemented into daily clinical practice of mental health professionals facilitating the diagnostic process, especially in case of comorbid depression.     

What drives changes in institutionalised mental health care? A qualitative study of the perspectives of professional experts

Background

Since 1990, the provision of mental healthcare has changed substantially across Western Europe. There are fewer psychiatric hospital beds and more places in forensic psychiatric hospitals and residential facilities. However, little research has investigated the drivers behind these changes. This study explored qualitatively the perspectives of mental health professional experts on what has driven the changes in Western Europe.

Methods

In-depth interviews were conducted with twenty-four mental health experts in England, Germany and Italy, who as professionals had personal experiences of the changes in their country. Interviewees were asked about drivers of changes in institutionalised mental health care from 1990 to 2010. The accounts were subjected to a thematic analysis.

Results

Four broad themes were revealed: the overall philosophy of de-institutionalisation, with the aim to overcome old-fashioned asylum style care; finances, with a pressure to limit expenditure and an interest of provider organisations to increase income; limitations of community mental health care in which most severely ill patients may be neglected; and emphasis on risk containment so that patients posing a risk may be cared for in institutions. Whilst all themes were mentioned in all three countries, there were also differences in emphasis and detail.

Conclusions

Distinct factors appear to have influenced changes in mental health care. Their precise influence may vary from country to country, and they have to be considered in the context of each country. The drivers may be influenced by professional groups to some extent, but also depend on the overall interest and attitudes in the society at large.

     

The Ilha de Maré study: a survey of child mental health problems in a predominantly African-Brazilian rural community

BACKGROUND: There have been very few Brazilian epidemiological surveys of child mental health problems. The only recent survey to have used internationally recognised measures and diagnostic criteria was carried out in Southeast Brazil in a relatively prosperous setting where the population was predominantly urban and white. METHODS: The setting was an island community in Northeast Brazil that is rural, relatively poor and has a strong African heritage. In an initial phase, a simple random sample of 519 children aged 5-14 was assessed by screening questionnaires completed by parents, teachers and older children. In a second phase, a sub-sample of 100 children was selected for more detailed diagnostic assessments. RESULTS: Conduct and hyperactivity problems were commoner in boys; emotional symptoms were commoner in girls; and hyperactivity declined with age. By contrast with previously collected data from Southeast Brazil, there were more reported symptoms, but less resultant impact. Using a variety of indices, the rate of disorder on Ilha de Maré was around half that previously found in Southeast Brazil. CONCLUSION: The measures and diagnostic criteria that were employed appeared valid for use in Northeast Brazil, though there was evidence for consistent over-reporting of symptoms on the screening questionnaire. Rates of child mental health problems appear to differ substantially between sites, confirming the need for a multi-site Brazilian study of the prevalence of child psychiatric disorders.     

Lost in transition? Perceptions of health care among young people with mental health problems in Germany: a qualitative study

Background

The transitioning of young patients from child and adolescent to adult mental health services when indicated often results in the interruption or termination of service. The personal views of young service users on current clinical practice are a valuable contribution that can help to identify service gaps. The purpose of this qualitative study was to explore the perceptions of health care of young people with mental health problems in the transition age range (16–25 years), and to better understand health behaviour, care needs and the reasons for disengaging from care at this point in time.

Methods

Seven group discussions and three interviews were conducted with 29 young people in this age range. Discussions were audio-taped, transcribed verbatim and analysed following the reconstructive approach of R. Bohnsack’s documentary method.

Results

An overarching theme and nine subthemes emerged. Participants displayed a pessimistic and disillusioned general attitude towards professional mental health services. The discussions highlighted an overall concern of a lack of compassion and warmth in care. When they come into contact with the system they often experience a high degree of dependency which contradicts their pursuit of autonomy and self-determination in their current life stage. In the discussions, participants referred to a number of unmet needs regarding care provision and strongly emphasised relationship issues. As a response to their care needs not being met, they described their own health behaviour as predominantly passive, with both an internal and external withdrawal from the system.

Conclusions

Research and clinical practice should focus more on developing needs-oriented and autonomy-supporting care practice. This should include both a shift in staff training towards a focus on communicative skills, and the development of skills training for young patients to strengthen competences in health literacy.

     

Do children of parents with mental illness have lower survival rate? A population-based study

Objective

The objective of this study was to investigate the incidence of mortality risk among children of parents with mental illness.

Method

The study sample comprised all women giving birth in Taiwan between 1999 and 2001; the dataset was created by linking birth certificate, death certificate, and National Health Insurance research databases. The deaths of the subjects were classified into 5 groups: stillbirths, early neonatal death, late neonatal death, postneonatal death, and early childhood death. A Cox proportional hazard regression was then performed on a pooled 3-year population-based dataset to examine the relationship between parental mental status and survival rates for children younger than 3 years, with the crude and adjusted hazard ratios (HRs) being calculated.

Results

Around 2316 affected children were compared with a general population of 605?107. No stillbirths were observed among any children of parents with schizophrenia or affective disorder. Mothers with affective disorder are prone to higher risk of child death, with a crude HR of 4.86 (95% confidence interval, 3.06-7.73), and a reduced adjusted HR of 3.51 (95% confidence interval, 2.22-5.57). However, fathers with affective disorder played no role. Children born to schizophrenic women have a significant higher risk of child death with a crude HR of 2.47, whereas those born to schizophrenic fathers have a similarly high risk with a crude HR of 2.69.

Conclusion

A focus needs to be placed on the identification and treatment of parental schizophrenia and affective disorder through antenatal and postnatal intervention, so as to reduce mortality risks for children exposed to risk during their first 3 years of life.     

The Icelandic child mental health study. An epidemiological study of Icelandic children 2–18 years of age using the Child Behavior Checklist as a screening instrument

The purpose of this study was to test the applicability of a standardised procedure for assessing Icelandic children's behaviour/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist (CBCL) by Achenbach to estimate the reported prevalence by parents and adolescents of emotional and behaviour problems in children from 2–16 years of age and self-reported prevalence of adolescents from 11–18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing checklists with a letter to parents of children 2–10 years of age. The checklists for adolescents 11–18 years of age were distributed by teachers in school. Those adolescents who were not in school received the checklists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2–3 year old children; 943 parents of 4–16 year old children, and 545 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group, 47%, but increased to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons with the Child Behavior Checklist from this study are presented with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries on the behaviour/emotional problems reported.

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Zusammenfassung Der Zweck dieser Studie war es, die Anwendbarkeit eines standardisierten Instruments zur Erfassung von Verhaltensauffälligkeiten, emotionalen Problemen und Kompetenzen auf isländische Kinder zu testen und Unterschiede zu erfassen, die auf demographische Variablen zurückzuführen sind. Diese Studie konzentriert sich auf die Methode der Anwendung der CBCL von Achenbach bei Zufallsstichproben aus der Allgemeinbevölkerung sowohl städtischer als auch ländlicher Regionen, um die von Eltern und Jugendlichen berichteten Prävalenzraten emotionaler Probleme bzw. Verhaltensauffälligkeiten von Kindern im Alter von 2–16 Jahren und von selbst berichteten Prävalenzraten von Jugendlichen zwischen 11 und 18 Jahren einzuschätzen. Um die entsprechenden Informationen zu gewinnen, wurden die CBCL-Fragebögen zusammen mit einem Begleitbrief an Eltern von 2–10jährigen Kindern versandt. Die Fragebögen für die Jugendlichen zwischen 11 und 18 Jahren wurden von Lehrern in der Schule verteilt. Denjenigen Jugendlichen, die nicht in der Schule waren, wurden die Fragebögen per Post nach Hause gesandt. Die CBCL-Fragebögen, die zur Auswertung kamen, wurden von 109 Eltern von 2–3jährigen Kindern, von 943 Eltern von 4–16jährigen Kindern und von 545 nicht überwiesenen Jugendlichen aus der Allgemeinbevölkerung ausgefüllt. Die Rücklaufquote war am niedrigsten bei der jüngsten Altersgruppe (47%) und wuchs mit zunehmendem Alter des Kindes auf 62% an. Die Rücklaufquote unter den Jugendlichen, die den Youth Self Report ausgefüllt hatten, betrug 64%. Es werden Vergleiche zwischen den Ergebnissen dieser Studie mit Stichproben aus den Niederlanden, Amerika, Frankreich, Kanada, Deutschland und Chile angestellt, wobei sich auffallende Ähnlichkeiten in vier dieser Länder im Hinblick auf die berichteten Verhaltens- und emotionalen Probleme ergeben.

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Résumé Le but de cette étude est de tester l'applicabilité d'une procédure standardisée dont le but est, d'une part, d'évaluer les problèmes et capacités aussi bien émotionnels que comportementaux ainsi que, d'autre part, d'identifier les différences dûes aux variables démographiques. Cette étude se concentre sur la méthode d'utilisation de la liste de contrôle (Child Behavior Checklist) selon Aschenbach afin d'évaluer la prépondérance des problèmes émotionnels et comportementaux chez les enfants de 2 à 16 ans rapportés par les parents et adolescents, et celle rapportée par des adolescents de 11 à 18 ans eux-mêmes, sélectionnés de manière arbitraire dans l'ensemble de la population, aussi bien en milieu rural qu'urbain. Les informations ont été obtenues grâce à l'envoi de listes accompagnées d'une lettre à un certain nombre de parents d'enfants agès de 2 à 10 ans. Les listes concernant les adolescents agés de 11 à 18 ans furent distribuées dans les écoles par les enseignants. Les jeunes gens qui ne se trouvaient pas à l'école ont reçu la liste chez eux par courrier. Les listes de contrôle utilsées dans le cadre de l'analyse ont été complétées par 109 parents d'enfants agés de 2 à 3 ans, 943 parents d'enfants de 4 à 16 ans ainsi que 545 adolescents issus de l'ensemble de la population et à l'age resté indéterminé. Le taux de réponses s'est avéré plus faible pour le groupe d'age le plus bas, 47%, lequel cependant s'est accru à 62% avec l'age des enfants concernés. Le taux de réponse au rapport sur la jeunesse par elle-même (Youth Self Report) parmis les adolescents fût de 64%. Des comparaisons avec les listes de contrôle du comportement enfantin ont été rendues possible par l'existence de sondages hollandais, américains, français, canadiens, allemands et chiliens, lesquelles montrent des similitudes notables quant aux problèmes émotionnels et comportementaux dans quatre de ces pays.