Most of the data on psychological outcome and the mental health treatment available following natural disasters originate from the indigenous population of the region destroyed. Examining tourists returning from the area affected by the 2004 tsunami presents an opportunity of studying the impact of natural disasters on psychological outcome and mental health treatment in their countries of origin. The aim of the present study was to extend the current knowledge on psychiatric morbidity and potential positive outcomes, as well as subsequent mental health treatment following a natural disaster, based on the results from a sample of home-coming Swiss tourists.
Tourists who had been potentially affected by the 2004 tsunami were assessed using the Post-traumatic Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Post-traumatic Growth Inventory. Outcome variables were related to the degree of tsunami exposure. In addition, mental health treatment before and after the tsunami was assessed.
Of the 342 respondents, 55 (16.8%) fulfilled the criteria of post-traumatic stress disorder (PTSD). Evidence of anxiety or depressive disorder was found in 17.8% and 8.0%, respectively. The tsunami victims who had been directly affected showed significantly more symptoms of anxiety, depression and PTSD, as well as post-traumatic personal growth, than tourists who were indirectly affected or unaffected. A total of 12.3% of untreated respondents fulfilled the criteria for PTSD and 38% of respondents who had received psychiatric treatment were still fulfilling PTSD criteria 2(1/2) years after the tsunami.
A marked percentage of respondents reported symptoms of PTSD but they remained untreated or were treated insufficiently. We recommend that tourists returning from regions affected by natural disasters be informed about PTSD and that careful screening be given to those found to be at risk of PTSD. An open-door policy of mental health services is particularly needed for tourists returning home who have been affected by large-scale disasters.
To assess the acceptability and face validity of a psychological assessment instrument, the Patient Health Questionnaire 9 (PHQ-9), as a depression screening tool for use with Aboriginal and Torres Strait Islander patients.
Four focus groups were held in an urban, Aboriginal community-controlled health service. Participants' attitudes to screening for depression and the specific components of PHQ-9 were explored.
Process-oriented and PHQ-9-specific themes were raised. They included the role of family in the screening process, the need for a trusting relationship between the tool administrator and patient, the risk of confounding by social disadvantage or physical co-morbidities, the absence of a question assessing the presence of anger as a symptom of depression, and the importance of culturally appropriate language within the tool.
Modification of the screening process and wording of the PHQ-9 in response to these concerns should render it acceptable for use with Aboriginal and Torres Strait Islander patients in this setting.
These results may apply to the use of other psychological screening tools in the Aboriginal and Torres Strait Islander population. This is particularly relevant given the policy emphasis on screening in Indigenous health.
Acceptance and Commitment Therapy preceded by an experimental Attention Bias Modification procedure in recurrent depression: study protocol for a randomized controlled trial.
This project studies the effect of group-based Acceptance and Commitment Therapy (ACT) following Attention Bias Modification (ABM) on residual symptoms in recurrent depression. ACT is a cognitive-behavioral intervention combining acceptance and mindfulness processes with commitment and behavior-change processes. ACT enjoys modest empirical support in treating depression and has also shown promising results in secondary prevention of depression. The experimental cognitive bias modification (ABM) procedure has been shown to reduce surrogate markers of depression vulnerability in patients in remission from depression. The aim of the current project is to investigate if the effect of group-based ACT on reducing residual depressive symptoms can be enhanced by preceding it with ABM. Also, assessment of the relationship between conceptually relevant therapeutic processes and outcome will be investigated.
An invitation to participate in this project was extended to 120 individuals within a larger sample who had just completed a separate randomized, multisite, clinical trial (referred to hereafter as Phase 1) in which they received either ABM (n = 60) or a control condition without bias modification (n = 60). This larger Phase-1 sample consisted of 220 persons with a history of at least two episodes of major depression who were currently in remission or not fulfilling the criteria of major depression. After its inclusion, Phase-1 participants from the Sørlandet site (n = 120) were also recruited for this study in which they received an 8-week group-based ACT intervention. Measures will be taken immediately after Phase 1, 1 month, 2 months, 6 months, and 1 year after the conclusion of Phase 1.
This study sequentially combines acceptable, nondrug interventions from neuropsychology and cognitive-behavioral psychology in treating residual symptoms in depression. The results will provide information about the effectiveness of treatment and on mechanisms and processes of change that may be valuable in understanding and further developing ABM and ACT, combined and alone.
ClinicalTrials.gov, Identifier: NCT02648165 . Registered on 6 January 2016.
BACKGROUND: As staff members prioritize medical resources for patients, it is imperative to find out whether their assessments of patients' health status agree with patients' assessments. The degree to which physicians and nurses can identify the distress, anxiety, and depression experienced by adolescents recently diagnosed with cancer was examined here. PROCEDURE: Adolescents undergoing chemotherapy (13-19 years, n = 53), physicians (n = 48), and nurses (n = 53) completed a structured telephone interview, 4-8 weeks after diagnosis or relapse, investigating disease and treatment-related distress, anxiety, and depression. RESULTS: The accuracy of staff ratings of physical distress could be considered acceptable. However, problems of a psychosocial nature, which were frequently overestimated, were difficult for staff to identify. Staff underestimated the distress caused by mucositis and worry about missing school more than they overestimated distress. These aspects were some of the most prevalent and overall worst according to the adolescents. Both physicians and nurses overestimated levels of anxiety and depression. Nurses tended to show higher sensitivity than physicians for distress related to psychosocial aspects of distress, while physicians tended to show higher accuracy than nurses for physical distress. CONCLUSIONS: Staff was reasonably accurate at identifying physical distress in adolescents recently diagnosed with cancer whereas psychosocial problems were generally poorly identified. Thus, the use of staff ratings as a "test" to guide specific support seems problematic. Considering that the accuracy of staff ratings outside a research study is probably lower, identification of and action taken on adolescent problems in relation to cancer diagnosis and treatment need to rely on direct communication.
Short screening instruments have been suggested to improve the detection of psychological symptoms. We examined the accuracy of the Danish version of the 'Distress Thermometer'.
Between October 2008 and October 2009, 426 women with newly diagnosed primary breast cancer who were operated at the Breast Surgery Clinic of the Rigshospitalet, Copenhagen, were eligible for this study. Of these, 357 participated (84%) and 333 completed a questionnaire. The distress thermometer was evaluated against the 'hospital anxiety and depression scale' (HADS). We also examined the women's wish for referral for psychological support.
A cut-off score of 6 vs 7 (low: =6, high: =7) on the distress thermometer was optimal for confirming distress, with a sensitivity of 42%, a specificity of 93%, a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 73%. A cut-off score of 2 vs 3 was optimal for screening, with a sensitivity of 99%, a specificity of 36%, a PPV of 47% and a NPV of 99%. Of those who were distressed using the cut-off score of 2 vs 3 on the distress thermometer, 17% (n = 41) wished to be referred for psychological support and 57% (n = 140) potentially wanted a later referral.
The distress thermometer performed satisfactorily relative to the HADS in detecting distress in our study. A screening procedure in which application of the distress thermometer is a first step could be useful for identifying persons in need of support.
The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured.
Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study.
ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter.
Thirty three (77%) participants reported exposure to torture. The tortured did not differ significantly from the nontortured on measures of ADL ability (two-sample t-tests: Motor, p= 0.36; Process, p= 0.82). ADL performance impairment was observed in the overall study sample. Twelve had motor and 15 process ability measures below age norms and 2 below both AMPS motor and process cut-offs for effortless and efficient ADL performance. There were statistically significant - weak to moderate - correlations between self-reported psychological distress, VAS average pain, pain distribution and the AMPS measures.
The study results supported significant ADL ability impairment in tortured as well as non-tortured newly arrived asylum seekers. Implementation of performance-based evaluation of ADL ability as part of the initial medical screening of this particular population should be considered.
Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study - the Northern Swedish Cohort study.
There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today's standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.
All pupils in the last year of compulsory school in Luleå in 1981 (n?=?1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of 43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up: depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.
As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.
Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.
Department of Mental Health and Substance Abuse Services, Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. taina.huurre@thl.fi
To examine which socioeconomic, family, personal and lifestyle risk factors in adolescence were the strongest independent predictors of excessive alcohol use in adulthood.
In a prospective longitudinal study, all 16-year-olds of one Finnish city completed questionnaires at school, and were followed up by postal questionnaires at 32 years of age [n = 1,471, (females n = 805, males n = 666); response rate 70.3%). The alcohol use disorders identification test (AUDIT) was used to assess alcohol use in adulthood. AUDIT scores of 8 or more for females and 10 or more for males were classified as excessive alcohol use. Adolescent risk factors examined were parental social class, school performance, depressive symptoms, self-esteem, impulsiveness, parental divorce, relationships with parents, parental trust, health behaviour, leisure-time spent with friends, dating, and problems with the law.
All the socioeconomic, family, personal, and lifestyle variables in adolescence, except parental social class in both genders and self-esteem among females, showed significant univariate associations with excessive alcohol use at age 32 years. Multivariate logistic regression analysis showed that among adolescent males, parental divorce, moderate and high level of depressive symptoms, leisure-time spent daily among friends and moderate and drunkenness-orientated drinking were the strongest predictors of excessive alcohol use in adulthood. Among females, the strongest adolescent predictors of excessive alcohol use in adulthood were drunkenness-orientated drinking and frequent smoking.
Early interventions for adolescent substance use and a set of specific psychosocial risk factors should be tailored and evaluated as methods for identifying those at high risk of and preventing excessive alcohol use in adulthood.
This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n=196) were compared with adolescents with a non-visible cleft (n=93), and with a comparison group (n=1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns.
There are considerable inconsistencies in the literature concerning the relationship between age and depression. Recently, however, two independent studies in the U.S. have shown that the distribution is U-shaped with the lowest reported levels of depression at ages 45-49. Three reasons for past inconsistencies are identified and addressed using the 1994 National Population Health Survey by Statistics Canada. Using both a distress scale and a diagnostic measure, a substantially different relationship was found. The prevalence of distress decreased steadily with age until about 65, with only a slight increase afterwards for both males and females. After the introduction of several sociodemographic covariates, however, this relationship was clearly negative. These findings are discussed in terms of future research questions.
