Psychological distress and premature mortality in the general population: a prospective study

PURPOSE: To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship. METHODS: We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models. RESULTS: Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22). CONCLUSIONS: The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.     

Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia

ABSTRACT: BACKGROUND: Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied. METHODS: Using data on 13 urban HIV treatment facilities in Zambia, we use multivariate regression models to assess the impact of structural determinants on health workers' adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program. RESULTS: CD4 tests were more routinely ordered during initial history and physical (IHP) than followup (FUP) visits (85.5 % vs. 93.0 %; p < 0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p <0.05) and WHO staging in IHP visit (OR 0.90; p < 0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p < 0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p < 0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p < 0.05) and CD4 test in IHP visit (OR 0.78; p < 0.05). CONCLUSION: Physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here.     

Prevalence and factors associated with social avoidance of recovered SARS patients in the Hong Kong general population

The study investigated the general population's perceived infectivity of asymptomatic and recovered severe acute respiratory syndrome (SARS) patients and factors associated with avoidance and discriminatory attitudes, including demographic background, SARS-related perceptions and emotional response to the SARS epidemic. A population-based survey was conducted in Hong Kong during 3 December 2003 through 4 January 2004; 475 Hong Kong Chinese adults participated in the survey. Perceptions of the infectivity and health conditions of recovered SARS patients and avoidance and discrimination towards them were measured. Of the respondents, 75.7% and 16.2%, respectively, believed that SARS could be transmitted via asymptomatic SARS patients and those patients who have recovered from SARS for 18 months; 72.7% of the respondents believed that the health of SARS patients would severely and permanently be damaged; 16.6% showed some tendency of avoiding recovered SARS patients and 35.7% expressed some sort of job-related discriminatory attitudes. Perceived infectivity of asymptomatic and recovered SARS patients, health sequelae and emotional distress from SARS were independently associated with avoidance and discriminatory attitudes. The study showed that misconceptions about the infectivity of asymptomatic and recovered SARS patients were common. Recovered SARS patients may also be facing avoidance and discrimination.     

Social comparison of distress and mental health help-seeking in the US general population

The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio=1.84) or to perceive an unmet need for such help (adjusted odds ratio=1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need-as measured by non-compared distress-and help-seeking in the general population.     

Social comparison of distress and mental health help-seeking in the US general population

The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio = 1.84) or to perceive an unmet need for such help (adjusted odds ratio = 1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need—as measured by non-compared distress—and help-seeking in the general population.     

大学生社交回避、苦恼现况及影响因素分析

目的了解大学生社交回避及苦恼现状及其影响因素.方法 采用整群抽样方法对1 937名广州市大学生进行问卷调查.结果 大学生社交回避及苦恼总分为(76.92±13.70)分,二、三、四年级大学生社交回避、苦恼均高于其他年级学生(F=3.579;F=10.162,均P＜0.05),三年级社交回避、苦恼得分最高,分别为(39.94±5.77)、(39.84±6.52)分;港澳台生社交苦恼及总得分最高,分别为(39.34±8.11)、(78.85±14.49)分,高于国内生、境外生(F=5.999,F=4.184,均P＜0.05);月生活费越低的大学生社交回避越严重(F=2.852,P＜0.05),月生活费＞1 500元的学生社交回避得分最低,为(37.63±7.26)分;内向学生社交回避、苦恼明显高于外向生(t=12.385,t=11.292,均P＜0.05),社交回避、苦恼得分分别为(41.36±6.64)、(40.54±7.39)分;父母教养方式主要影响大学生社交回避,经历生活负性事件的大学生社交回避及苦恼状况均较未经历过的学生严重,父母亲文化程度为中学、技校的学生社交回避及苦恼得分较高;分类树结果显示,性格和父亲文化程度是社交回避及苦恼的主要影响因素,内向且父亲文化程度是小学及以下、初中、高职技校或中专的学生社交回避及苦恼总得分最高.结论 大学生社交回避及苦恼受年级、月生活费、生源地、性格、父母亲教养方式及文化程度、生活负性事件等因素的影响.     

39例吸毒合并HIV感染者心理健康与社会支持的调查

滥用毒品直接损害人类的身心健康，而静脉吸毒又是导致艾滋病快速传播的因素之一。本研究旨在调查吸毒合并HIV感染者的社会支持与心理健康状况，为提高该人群的心理健康水平提供科学依据。     

Paternal and maternal alcohol abuse and offspring mental distress in the general population: The Nord-Trondelag Health Study

ABSTRACT: BACKGROUND: The degree to which parental alcohol abuse is a risk factor for offspring mental distress is unclear, due to conflicting results of previous research. The inconsistencies in previous findings may be related to sample characteristics and lack of control of confounding or moderating factors. One such factor may be the gender of the abusing parent. Also, other factors, such as parental mental health, divorce, adolescent social network, school functioning or self-esteem, may impact the outcome. This study examines the impact of maternal and paternal alcohol abuse on adolescent mental distress, including potentially confounding, mediating or moderating effects of various variables. METHOD: Data from the Nord-Trondelag Health Study (HUNT), a Norwegian population based health survey, from 4012 offspring and their parents were analyzed. Parental alcohol abuse was measured by numerical consumption indicators and CAGE, whereas offspring mental distress was measured by SCL-5, an abbreviated instrument tapping symptoms of anxiety and depression. Statistical method was analysis of variance. RESULTS: Maternal alcohol abuse was related to offspring mental distress, whereas no effect could be shown of paternal alcohol abuse. Effects of maternal alcohol abuse was partly mediated by parental mental distress, offspring social network and school functioning. However, all effects were relatively small. CONCLUSION: The results indicate graver consequences for offspring of alcohol abusing mothers compared to offspring of alcohol abusing fathers. However, small effect sizes suggest that adolescent offspring of alcohol abusing parents in general manage quite well.     

Impact of whole-body MRI in a general population study

This study examined the long-term impact of whole-body MRI and the disclosure of incidental findings on quality of life (QoL) and depressive symptoms in a general population cohort. Analyses were conducted among 4420 participants of the Study of Health in Pomerania SHIP-Trend cohort, of which 2188 received a whole-body MRI examination. A 2.5-year postal follow-up of SHIP-Trend (response: 86 %) included the Short Form Health Survey (SF-12), based on which the Mental Health Component Summary Score (MCS), and Physical Health Component Summary Score (PCS) were computed. The Patient Health Questionnaire (PHQ-9) was applied to assess depressive symptoms. Generalized estimation equation models were used to assess intervention effects, and statistical weights were applied to account for selective attrition. MRI participants had higher levels of education and employment than nonparticipants. Mean QoL indicators differed little at baseline between MRI participants and nonparticipants. Intervention effects per year on depression and QoL were negligible in (1) MRI participants versus nonparticipants [PCS: unstandardized β = ?0.06 (95 % CI ?0.30 to 0.18); MCS: β = ?0.01 (95 % CI ?0.29 to 0.29); PHQ-9: 0.08 (?0.03 to 0.18)], and (2) MRI participants with a disclosed incidental finding versus those without [PCS: β = ?0.03 (?0.39 to 0.33); MCS: β = ?0.26 (95 % CI ?0.65 to 0.13); PHQ-9: 0.03 (?0.10 to 0.15)]. The body site of the finding had only minor effects on the course of our studied outcomes. Whole-body MRI can be implemented in a population-based study without long-term effects on QoL indicators and depressive symptoms. This does not exclude the possibility of effects on more subtle psychosocial outcomes, such as health concerns or health behaviour, all of which require further attention.     

Migraine and tension-type headache in a general population: psychosocial factors.

In a cross-sectional study of headache disorders in a representative general population, the prevalence of migraine and tension-type headache was assessed in relation to various psychosocial factors. The random sample comprised 1000 25-64 year old men and women of whom 740 attended the investigation. The headache disorders were classified on the basis of a clinical interview, a physical and a neurological examination using the operational diagnostic criteria of the International Headache Society. None of the sociodemographic variables: marital status, cohabitation, educational level, occupational category or employment status were significantly associated with migraine or tension-type headache. In the univariate analyses tension-type headache was significantly associated with a high Neuroticism score on the Eysenck Personality Questionnaire whereas migraine was not. Variables on work conditions and psychosocial factors significantly associated with the headache disorders in univariate analyses were subjected to multivariate analysis. Migraine was significantly associated with exposure to chemicals and fumes at work in women and poor self-appraisal of health in men. In the univariate analyses tension-type headache was significantly related to a series of psychosocial variables. In the multivariate analyses it remained associated with a current feeling of fatigue in both sexes, time-pressure at work in women and exposure to fumes in men.     

泸州市老年人心理健康状况及影响因素分析

目的随着老龄化问题的突出,老年人心理健康成为社会现实问题。本研究旨在了解泸州市老年人心理健康现状,分析泸州市老年人心理健康的影响因素,为老年人心理健康服务实践提供参考依据。方法采用便利抽样方法,选取2018-10-23-2018-11-08泸州市2个社区≥60岁老年人进行调查。采用基本情况调查表(包括性别、年龄、婚姻状况、居住状况、文化程度、子女数、月收入状况、慢性病情况和家庭关系)及简版心理健康连续体量表(mental health continuum short form,MHC-SF)(成人版)〔包括(情绪性安康、心理性安康和社会性安康)3个维度〕进行问卷调查。由统一培训的调查员进行入户问卷调查。结果回收问卷150份,其中有效142份,有效率为94.67%。MHC-SF总均分(t=28.233,P0.001)、情绪性安康(t=24.255,P0.001)、社会性安康(t=32.329,P0.001)和心理性安康得分(t=17.066,P0.001)均高于国内常模。泸州市老年人婚姻状况(t=2.952,P0.01)、文化程度(F=6.362,P0.01)、子女数(F=4.63,P0.05)及家庭关系(t=-3.998,P0.001)对心理健康影响,差异有统计学意义。多因素线性回归分析显示,自变量对因变量的解释率为26.6%,受教育程度、婚姻状况、子女数及家庭关系是泸州市老年人心理健康状况的影响因素。结论泸州市老年人的心理健康状况较好。教育程度、家庭人际关系与家庭支持对泸州市老年人心理健康的影响大。     

Neighbourhood social capital and common mental disorder: testing the link in a general population sample

General population multilevel studies of social capital and mental health are few in number. This multilevel study examined external measures of neighbourhood social capital and common mental disorders (CMD). Main effects and stress buffering models were tested. Based on data from over 9000 residents in 239 neighbourhoods in England and Scotland, there was no evidence of a main effect of social capital. For people living in deprived circumstances only, associations between neighbourhood social capital and CMD were seen. Elements of bridging social capital (contact amongst local friends) were associated with lower reporting of CMD. Elements of bonding social capital (attachment to neighbourhood) were associated with higher reporting of CMD. Findings provide some support for the hypothesis that social capital may protect against CMD, but indicate that initiatives should be targeted to deprived groups, focus on specific elements of social capital and not neglect the important relationship between personal socioeconomic disadvantage and CMD.     

Psychological distress among HIV adolescents in the REACH study: effects of life stress, social support, and coping

Purpose: To investigate the effects of life events, social support, and coping on anxiety and depression among human immunodeficiency virus (HIV)-infected adolescents. It was hypothesized that higher levels of stressful events would be associated with higher levels of anxiety and depression, but that this association would be moderated by satisfaction with social support and by adaptive coping.

Methods: HIV-infected adolescents from 16 locations in 13 U.S. cities (N = 230, median age 16.09 years, standard deviation 1.2, range 13–19; 77% females) were recruited into the Reaching for Excellence in Adolescent Care and Health (REACH) project. REACH is the first large-scale disease progression study of HIV⁺ adolescents infected through sexual behavior or injection drug use. The adolescent assessment was conducted by audio-computer assisted self-interview. Least squares regressions were used to test hypotheses.

Results: Life events with high impact were associated with higher levels of depression and anxiety. Frequently reported events included: being prescribed medications (74%), family financial problems (61%), and parental alcohol abuse (20%). Contrary to expectations, the buffering hypotheses of social support and adaptive coping were not supported. Satisfaction with social support and adaptive coping methods were both associated directly with lower levels of depression, but no association was detected between these two measures and anxiety.

Conclusions: Although life event distress was directly associated with psychological distress, neither social support nor adaptive coping seemed to moderate this association. However, both satisfaction with support and adaptive coping were associated directly with depression in HIV-infected adolescents.     

HIV behavioral surveillance among the U.S. general population

HIV behavioral surveillance in the United States is conducted among three groups: infected populations, high-risk populations, and the general population. We describe the general population component of the overall U.S. HIV behavioral surveillance program and identify priority analyses. This component comprises several data systems (ongoing, systematic, population-based surveys) through which data on risk behaviors and HIV testing are collected, analyzed, and disseminated. Multiple data systems are needed to balance differences in scope and purpose, as well as strengths and weaknesses of the sampling frames, mode of administration, and frequency of data collection. In a concentrated epidemic, such as in the United States, general population data play a small but important role in monitoring the potential spread of infection more broadly, particularly given increases in HIV transmission through heterosexual contact.     

Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors

Background  

The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services.     

Lifestyle factors as risk factors for fatigue and psychological distress in the working population: prospective results from the Maastricht Cohort Study

We examined potentially modifiable lifestyle factors as possible risk factors for the onset of fatigue and psychological distress after 1-year follow-up among 8833 employees who participated in the prospective Maastricht Cohort Study of "Fatigue at Work." Results showed, even after adjustment for demographics, presence of disease, other lifestyle factors, psychosocial work characteristics, and psychological distress, that overweight (body mass index, 25 to 29.9) and being physically inactive during leisure time were strongly related to onset of fatigue in men, whereas underweight (body mass index, < 18.5) in women increased the risk for future fatigue. In addition, the study suggests some differential effects of lifestyle factors in the onset of psychological distress. Certainly, these modifiable factors can be targeted in interventions, either on an individual or group level, to prevent or at least reduce the risk of developing fatigue and psychological distress in the working population.     

普通外科手术切口感染的影响因素与防治

目的 探讨普通外科手术后切口感染的影响因素及防治措施.方法 回顾性分析2009年1月-2012年12月医院普通外科手术患者切口感染的影响因素及治疗与预防措施.结果 2915例普通手术患者术后发生切口感染203例,感染率6.96％,其中高龄、急症手术、Ⅱ、Ⅲ类手术切口、合并基础疾病患者更易发生切口感染.结论 年龄、手术种类、切口类型、合并基础疾病是普通外科手术切口感染的影响因素,临床工作中需针对性采取防范措施减少切口感染发生.     

军事应激条件下官兵心理健康状况及其影响因素

目的了解军事应激条件下执行特殊任务官兵的心理健康状况,为有针对性地开展心理卫生工作提供依据。方法以执行某基地军事演习任务的部队为研究样本,采用自行编制的军事应激条件下心理健康状况量表,对465名执行某基地军事演习任务的官兵进行现场测试。结果 (1)军事应激条件下心理健康状况量表各因子之间有相关性。(2)在军事应激条件下心理健康状况量表多数因子上,不同兵种、职别、学历、文化程度、年龄、性别、婚姻状况得分差异有显著性,心理健康状况有所不同,其中炮兵、干部、高学历军人、18岁以下义务兵、已婚军人、男性军人心理健康状况较差(P0.05,P0.01)。结论军事应激条件下执行军事演习任务的不同兵种、不同职别、不同文化程度、不同年龄、不同性别、不同婚姻状况官兵之间的心理健康有明显差异,应分别对其进行心理健康教育与心理干预工作。     

Fatigue in the Danish general population. Influence of sociodemographic factors and disease

OBJECTIVE: To measure the levels of fatigue in the general population, and to examine how disease and sociodemographic factors influence fatigue. DESIGN: Cross sectional questionnaire study in the Danish general population. SUBJECTS: A random, age stratified sample of 1608 people aged 20-77 with an equal gender distribution (response rate 67%). MAIN OUTCOME MEASURES: Five fatigue scales from the questionnaire Multidimensional Fatigue Inventory: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation and Mental Fatigue. RESULTS: Fatigue scores were skewed towards absence of fatigue. The General Fatigue and Physical Fatigue scales showed the highest fatigue levels while the Reduced Motivation scale showed lowest levels. Gender differences in fatigue scores were small, but the variability among women was higher-that is, more women had high scores. A multiple linear regression analysis showed that respondents of low social status and respondents with a depression had high fatigue scores on all scales, independent of other factors. Chronic somatic disease had an independent direct effect on Mental Fatigue, but for the rest of the scales, the effect of somatic disease depended on age, gender and/or whether the person was living alone. For example, General and Physical Fatigue decreased with age among healthy people, whereas scores on these scales increased with age among those with a somatic disease. CONCLUSIONS: Physical and mental diseases play essential parts for the level of fatigue and as modulators of the associations between sociodemographic factors and fatigue. These interactions should be taken into account in future research on fatigue and sociodemographic factors and when data from clinical studies are compared with normative data from the general population.