The effect of social networks and social support on common mental disorders following specific life events

Maulik PK, Eaton WW, Bradshaw CP. The effect of social networks and social support on common mental disorders following specific life events. Objective: This study examined the association between life events and common mental disorders while accounting for social networks and social supports. Method: Participants included 1920 adults in the Baltimore Epidemiologic Catchment Area Cohort who were interviewed in 1993–1996, of whom 1071 were re‐interviewed in 2004–2005. Generalized estimating equations were used to analyze the data. Results: Social support from friends, spouse or relatives was associated with significantly reduced odds of panic disorder and psychological distress, after experiencing specific life events. Social networks or social support had no significant stress‐buffering effect. Social networks and social support had almost no direct or buffering effect on major depressive disorder, and no effect on generalized anxiety disorder and alcohol abuse or dependence disorder. Conclusion: The significant association between social support and psychological distress, rather than diagnosable mental disorders, highlights the importance of social support, especially when the severity of a mental health related problem is low.     

Validation study of a nonspecific psychological distress scale

Background Psychological distress scales are often used in national epidemiological surveys to monitor the mental health status and predict demands in mental health services. These scales have the advantage of being easy to administer and inexpensive to use. The goal of this study is to assess the clinical validity of the Psychological Distress Manifestations Measure Scale (PDMMS) by comparing it to a standard criterion. Method The validation study is based on data from a large-scale mental health survey conducted in 1999 in the Montreal area (Canada). The target population was constituted of adults living in private households. A telephone survey was carried out with a probability sample of 4,704 respondents using the Composite International Diagnostic Interview Simplified (CIDIS) to detect mental disorders. Then, subsequent face-to-face interviews with a subsample of 359 of these respondents were conducted to validate other measures for assessing mental health needs for care and services including the PDMMS. Results Our study showed that high psychological distress is highly associated with mental disorder (OR=5.94). However, a large majority of the people in the high psychological distress category does not have a known mental problem. Conclusions These data confirm that like other psychological distress scales, the PDMMS is not a diagnostic tool. Rather, it is designed to explore comorbidity among symptoms, independent of caseness. The prevalence of psychological distress in the population allows us to identify people who have subclinical symptoms substantial enough to precipitate dysfunctioning in everyday life and who utilize health services more frequently. The use of this tool for epidemiological surveys is useful for mental health service planning because it provides information on the needs of individuals whose state of mental health affects social functioning even though they do not suffer from pathology.     

Psychosocial Functioning of Youth Receiving Mental Health Services in the Schools Versus Community Mental Health Centers

Evaluated psychosocial differences between youthreceiving mental health services in Community MentalHealth Centers (CMHCs; n = 79) as compared to youthreceiving services from a program operating in 10 Baltimore schools (n = 186). Racial and genderdifferences were shown, with more African American youthand females in the School than CMHC sample. Multivariateanalyses that controlled for these racial and gender differences failed to revealsignificant effects, indicating comparable functioningon measures of life stress, violence exposure, familysupport, self-concept, and emotional/behavioral problems for youth from the two samples. However,particularly for those with internalizing disturbances,youth in the School sample were less likely to havereceived prior mental health services than youth from the CMHCs. Findings support the conclusion thatschool-based mental health programs are reaching youthwho need mental health services, who otherwise may notreceive them.     

Mental distress, economic hardship and expectations of life in Canada among Sudanese newcomers

As part of a settlement needs assessment of 220 recently arrived Sudanese refugees and immigrants in seven cities, we examined overall health status, indicators of mental distress, economic hardship and expectations of life in Canada. Data were collected in a community-based study using qualitative and quantitative techniques. Results indicate that those Sudanese for whom life in Canada was not what they expected and those who experienced economic hardship as measured by worry over having enough money for food or medicine experienced poorer overall health and reported a greater number of symptoms of psychological distress. After controlling for demographic and related variables, we found that individuals who were experiencing economic hardship were between 2.6 and 3.9 times as likely to experience loss of sleep, constant strain, unhappiness and depression, and bad memories as individuals who do not experience hardship. Healthcare providers should be aware of how postmigration social disadvantages may increase the risk of mental distress particularly among refugees.     

Characteristics of patients presenting for emergency psychiatric assessment at an English hospital

OBJECTIVE: The needs and characteristics of patients who are referred for psychiatric emergency services vary by the source of referral. Such differences have wider implications for the functioning of the mental health care system as a whole. This study compared three groups of patients in a two-month cohort of 189 patients who were referred for emergency psychiatric assessment at a hospital in England: those who were referred by general practitioners (family physicians), those who were receiving specialist services from community mental health teams, and those who arrived at the hospital from the broader community. METHODS: The three groups were compared on demographic characteristics, clinical and service use variables, risk to self or others, factors that contributed to the emergency presentation, and ratings on standardized scales of functioning. RESULTS: The patients who were receiving specialist services from community mental health teams had high rates of psychosis, often relapsed, and had a history of contact with a psychiatrist. These patients were the most likely to be admitted to the hospital after emergency assessment. The patients who had been referred by general practitioners tended to have fewer indicators of social problems and were more likely to be experiencing a new episode of mental illness. Their referral to the emergency department was most likely to be deemed inappropriate by emergency department clinicians. The patients who came from the broader community were more likely to be male and to exhibit self-harming behavior, substance misuse, and behavioral difficulties. CONCLUSIONS: The rate of emergency referral is one indicator of the functioning of the service system as a whole. Improvements to the system should include better access to community mental health team services and a greater capacity of the primary care system to manage mental health crises. Services need to be developed that are acceptable to male patients who are experiencing social and behavioral problems.     

Discrimination and victimization as mediators between social support and psychological distress in autistic adults

BackgroundThe mental health of autistic adults is a critical concern. The aim of this study is to gain a better understanding of how access to professional and social support combines with the experience of discrimination and victimization to explain psychological distress in autistic adults.MethodA cross-sectional online survey was conducted to provide information on psychological distress (Kessler K6), characteristics of the personal social support network, utilization and access to social and professional support, diagnosis and health conditions, and socio-demographic characteristics of the respondents. Two-hundred and twenty-two (222) autistic adults from Quebec (Canada) completed the survey.ResultThe results indicate high rates of psychological distress (51%), significant unmet support needs and many barriers to accessing psychosocial and health services. Four independent serial multiple mediator models confirm that social support and experiences of discrimination and victimization statistically mediate the relationship between professional support and psychological distress.ConclusionsThis study contributes to the understanding of the role of social support in the development of mental health difficulties in autistic people. Several courses of action are proposed, such as the implementation of structural corrective measures for access to services (e.g., limiting waiting times), design of service settings to limit possible sources of hypersensitivity, diversification of appointment methods (telehealth), making general service providers aware of the specific realities and characteristics of autism, greater consideration of the social aspects that influence mental health, the development of peer support programs, and the adoption of a positive and non-ableist view of autism in training programs.     

The Psychological and Physical Health of Hospice Caregivers

This study explores the psychological distress of caring for a dying family member and examines the differences in depression, anxiety, health, social and occupational functioning, and social support among hospice caregivers and community controls. It compares psychological functioning of spousal and adult child hospice caregivers. Caregivers of terminally ill hospice patients were assessed prior to death as a part of a longitudinal bereavement study. Caregivers reported experiencing higher levels of depression, anxiety, anger, and health problems than controls. Hospice caregiving was associated with deterioration in physical health and in social and occupational functioning. The comparisons between adult children and spouse caregivers revealed that levels of psychological and physical morbidity were very similar for the two generations of caregivers. An awareness of distress symptoms among hospice caregivers could lead to timely proactive clinical intervention that may prevent bereavement complications.     

Role of perceived family support in psychological distress for pregnant women during the COVID-19 pandemic

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic has caused major public panic in China. Pregnant women may be more vulnerable to stress, which may cause them to have psychological problems. AIMTo explore the effects of perceived family support on psychological distress in pregnant women during the COVID-19 pandemic.METHODSA total of 2232 subjects were recruited from three cities in China. Through the online surveys, information on demographic data and health status during pregnancy were collected. Insomnia severity index, generalized anxiety disorder 7-item scale, patient health questionnaire-9, somatization subscale of the symptom check list 90 scale, and posttraumatic stress disorder checklist were used to assess the psychological distress.RESULTSA total of 1015 (45.4%) women reported having at least one psychological distress. The women who reported having inadequate family support were more likely to suffer from multiple psychological distress (≥ 2 psychological distress) than women who received adequate family support. Among the women who reported less family support, 41.8% reported depression, 31.1% reported anxiety, 8.2% reported insomnia, 13.3% reported somatization and 8.9% reported posttraumatic stress disorder (PTSD), which were significantly higher than those who received strong family support. Perceived family support level was negatively correlated with depressive symptoms (r = -0.118, P < 0.001), anxiety symptoms (r = -0.111, P < 0.001), and PTSD symptoms (r = -0.155, P < 0.001). CONCLUSIONFamily support plays an important part on pregnant women’s mental health during the COVID-19 pandemic. Better family support can help improve the mental health of pregnant women.     

Determinants Associated with the Utilization of Primary and Specialized Mental Health Services

The study aims to compare variables associated with the exclusive and joint use of primary and specialized care for mental health reasons by individuals diagnosed with a mental disorder in a Montreal/Canadian catchment area. Data were collected from a random sample (2,443 individuals). Among 406 people, diagnosed with a mental disorder 12 months pre-interview, 212 (52%) reported having used healthcare services. Compared to users of primary care only, people who sought both primary and specialized care presented more mental disorders and lower quality of life. People using only specialized healthcare received significantly less social support than persons using primary care exclusively and lived in neighborhoods with a high proportion of rental housing. Healthcare service provision should favor social networking and enable social cohesion and integration, particularly in neighborhoods with a high proportion of rental housing. Shared care and enhanced collaboration with other public and community-based resources should be encouraged.     

Factors Influencing Report of Common Mental Health Problems Among Psychologically Distressed Adults

This study investigates the sociodemographic factors associated with self-report of common mental problems by the psychologically distressed in order to gain insight into the profile of the population subgroups least likely to receive mental health support whenever needed. Data from the 2006–2008 french National Survey on Health, Health Care and Insurance, were used, measuring psychological distress based on the Mental Health Inventory MHI-5. The patterns associated with education, employment situation and living arrangement were investigated in a sample of 11,543 subjects aged 30–54 years. Men with lower educational level were found to be doubly disadvantaged, as they were more subjected to distress than those with higher educational level and at the same time less likely to report common mental problems whenever distressed. While in both genders subjects not living with a spouse and non-employed subjects were also more subjected to distress, they were more likely than the others to report common mental problems in presence of distress. The findings were discussed in terms of living conditions, stigma, mental health literacy and help-seeking behaviour. Mental health promotion programmes should aim at educating the public, and particularly men and the lower educated public, on the signs of distress and their significance.     

Help seeking by persons of Mexican origin with functional impairments

OBJECTIVE: Mexican Americans have low rates of service utilization for mental health problems. This study examined the use of health services by persons who have symptoms of mental distress that they say impair their ability to function. METHODS: A stratified field survey was conducted in central California to select a probabilistic sample of persons of Mexican origin. A multinomial logistic regression was used for the analysis. RESULTS: Among respondents who reported functional impairments attributable to their symptoms, 58 percent met diagnostic criteria for a mental disorder. Of that group, 69 percent did not use any health services. Respondents who sought medical services for mental health symptoms were more likely to be women and to meet diagnostic criteria for a mental disorder. Respondents who sought mental health services for their symptoms were more likely to be female, to be unmarried, and to have had 12 or more years of education. Health insurance status was not associated with type of service used. CONCLUSIONS: Even among Mexican Americans who met diagnostic criteria for a mental illness, most did not use services of any sort, and many of those who sought treatment for their symptoms turned to medical and informal services.     

Distressed women's clinic patients: preferences for mental health treatments and perceived obstacles

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women's clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women's clinic patients are discussed.     

Health beliefs and help seeking for depressive and anxiety disorders among urban Singaporean adults

OBJECTIVE: This study examined whether help seeking for mental problems was predicted by beliefs about mental illness and services and by family and social support. METHODS: Singaporean adults (N= 2,801) were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry and with questions on mental health status, beliefs about the curability of mental illness, embarrassment and stigma, ease of discussing mental problems, effectiveness and safety of treatment, and trust in professionals. RESULTS: Although 10% of respondents had a depressive or anxiety disorder or combination, only 3% acknowledged having mental problems, 5% rated their mental health as fair or poor, and 6% sought help for their mental health problems. Help seeking was predicted by poor self-rated mental health and acknowledged mental illness but not by health beliefs and social support. CONCLUSIONS: Self-rated mental health status was predictive of help seeking, but other health beliefs and social support were neither strong nor robust predictors.     

Psychological health of men with partners who have post-partum depression

OBJECTIVE: To compare the psychological health of men with partners who have post-partum depression (PPD; index group) with that of men with partners without PPD (comparison group). METHOD: Using a cross-sectional survey, psychological symptoms and disturbances of index group men (n = 58) and comparison group men (n = 116) were compared. Validated self-report measures were used to assess five key areas of mental health: depression, anxiety, non-specific psychological impairment, aggression and alcohol use. RESULTS: Index group men had more symptoms of depression, aggression and non-specific psychological impairment, and had higher rates of depressive disorder, non-specific psychological problems and problem fatigue than comparison group men. Index group men were also more likely to have three or more comorbid psychological disturbances. There was no difference between the groups on measures of anxiety and alcohol use. CONCLUSIONS: Although many men in the postnatal period experience a variety of mental health problems, those who have a partner with PPD are themselves at increased risk for experiencing psychological symptoms and disturbances. Differentiation of psychological syndromes is important; higher rates of depressive disorder, non-specific psychological problems and problem fatigue were found, but rates of anxiety disorder and hazardous alcohol use did not differ between the groups. More attention from health professionals to men's mental health in the postnatal period may be beneficial to the entire family system.     

Actions taken to deal with mental health problems in Australian higher education students

Aims: With approximately 50% of young people aged 18–24 in tertiary education, these are potential settings for programmes to improve mental health literacy. A survey was carried out with students and staff of a tertiary education institution to investigate psychological distress, actions to deal with mental health problems and first‐aid behaviours. Methods: Telephone interviews were carried out with 774 students of an Australian metropolitan university (with 422 staff as a comparison group). They answered questions relating to psychological distress, actions to deal with mental health problems and first‐aid behaviours. Results: Students were more likely to be psychologically distressed than staff (21% vs. 13%) and 27% reported experiencing a problem similar to that described in a depression vignette. The most common actions taken were talking to a close friend, physical activity and talking to close family. Over 72% of students with a problem had sought professional help, most often from a general practitioner or counsellor. Only 10% reported seeking help from a student counsellor. Helpful first‐aid behaviours were common and were seen in over 90% of students who had a family member or close friend with a similar problem. Conclusions: There is a need for further investigation of levels and factors associated with psychological distress in higher education students along with an exploration of barriers to and enablers of use of student counselling services. High levels of help seeking from friends and first‐aid behaviours provided point to the need for effective peer‐to‐peer education.     

Detecting psychological distress among patients attending secondary health care clinics : Self-report and physician rating

A study was conducted to determine the prevalence of psychological distress, as reported by patients and their physicians, in orthopedic, neurology, dermatology, and ophthalmology clinics; to study their accuracy in detecting psychological distress; and to determine if there is any connection among psychological distress, accuracy of detecting distress, and use of mental health and primary health care physicians' prognosis for the somatic complaints. Five hundred and fifty-six patients, ages 18–21, responded to the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D), a measure of psychological distress, and to questions about their mental health and use of mental health and primary health services. Physicians, who were blind to patients' responses, were asked to what extent they thought the cause of patients' complaints was physical and to what extent they thought it was psychological in nature, and to prognosticate. Based on the PERI-D, about 25% of patients were distressed, this was less for females than males and varied between clinics. Based on self-reporting, about 14% of patients (males and females) were distressed. Based on physician reporting, about 17% (males less) were distressed. Physicians identified 35% of the PERI-D-distressed cases and 79% of nondistressed cases. About 66% of patients identified their distress and 83% their lack of distress. Increased use of primary health care and mental health care was related to distress. The prognosis was negatively related to distress. Based on this study, there is a need for more attention to psychological distress among secondary health care patients. Patients' ability to identify their distress suggests the importance of involving the patient in the diagnostic process. Correct detection of distress alone does not appear to decrease the use of primary medical and mental health services.     

Psychological distress among homeless adults

Recent studies have reported a high prevalence of mental illness among the homeless. As part of a community-based survey of 529 homeless adults, we developed and tested a model to increase our understanding of the factors related to their psychological distress. Using a previously validated and reliable scale of perceived psychological distress, we found that homeless adults were more likely to report psychological distress than the general population (80% vs. 49%). Distress levels were not associated with most demographic or homeless characteristics or general appearance. However, distress was related to unemployment, greater cigarette and alcohol use, worse physical health, fewer social supports, and perceived barriers to obtaining needed medical care. Since mental, physical, and social health are strongly related among homeless adults, alleviating distress among them may be most effectively done by implementing a broad-based health services package coupled with employment programs provided in an accessible service delivery setting.     

Use of health care services for psychological distress by immigrants in an urban multicultural milieu.

OBJECTIVE: Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system. METHODS: A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events. RESULTS: Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help. CONCLUSION: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.