Self-reported mental distress in the United States: a Bayesian analysis of the spatial structure over the COVID-19 pandemic across age groups

Background The COVID-19 had an outstanding impact on well-being and mental health, which might have elicited geographical variations over time. This study examines the eventual impact of COVID-19 on self-reported mental distress in the mainland USA. Aims There were two main aims. First, to evaluate the pre-pandemic (2019) and post-pandemic (2021) mental distress spatial distribution. Second, to contrast spatial data across three age groups, young (18-44 years), middle-aged (45-65 years), and old (older than 65 years). Method We considered a the Bayesian modified Besag–York–Molli`e (BYM2) model, which is a Bayesian hierarchical model. Mental distress was the response variable function of age group, year and spatially structured and unstructured effects. Results The main findings indicate a positive spatial dependence between states of general mental distress before and after the COVID-19 and across age groups with substantial unstructured component. Moreover, younger individuals reported higher levels of mental distress and suffered the major worsening due to the pandemic. Conclusions COVID-19 had a detrimental impact on mental health across the population, with consistent evidence of positive spatial dependence across states. Notably, young adults emerged as particularly vulnerable, exhibiting concerning levels of mental distress problems and being more sensitive to the effects of the pandemic.

BackgroundMental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients’ self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses.MethodsA questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16–65 years in six GP offices in Oslo, Norway during 21 months in 2014–2016.ResultsWe found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis.ConclusionsWe found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue.Trial registrationTrial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.

BackgroundAssociations between shift work (SW) schedules, mental distress and job satisfaction have never been completely described.AimsTo examine gender-specific associations of SW with mental distress and job satisfaction in nurses in Hebron District, Palestine, in 2012.MethodsDetailed information on work schedules (day versus shift), socio-demographic status, mental distress (General Health Questionnaire, GHQ-30) and job satisfaction (Generic Job Satisfaction Scale) in nurses employed in Hebron District, Palestine, was obtained through a questionnaire survey. Associations of SW and outcomes were examined by linear regression analysis.ResultsOf 372 nurses eligible for the study, 309 and 338 completed surveys regarding mental distress and job satisfaction, respectively. The sample comprised 62% women and 38% men. After adjusting for covariates, women working shifts reported significantly higher levels of mean mental distress [β coefficient 3.6; 95% confidence interval (CI) 0.3–7.0] compared with women working regular day shifts. Men working shifts reported significantly lower levels of job satisfaction (–3.3; 95% CI –6.2 to –0.5) than men working regular day shifts. Women reported higher levels of mental distress than men, but this was unrelated to work schedule.ConclusionsIn this study, nurses working shifts reported higher levels of mental distress and lower levels of job satisfaction, although these associations were weaker when adjusted for potential covariates. There was no evidence of a gender differential in the association between SW and mental distress and job satisfaction.

ObjectivesTo understand the mental health distress, demographics and service utilization patterns among South Asian and non-South Asian youth accessing integrated youth services (IYS) in British Columbia (BC), Canada.MethodsThis study used data from youth accessing services at the BC-IYS (Foundry) between April 2018 and October 2023. Descriptive statistics summarized demographic and service utilization data, with categorical variables compared using chi-squared tests and continuous variables using t-tests. A linear regression model examined the relationship between ethnicity (South Asian vs. non-South Asian) and mental health distress measured by Kessler Distress Scale (K10), stratified by gender [cisgender and transgender and non-conforming (TGNC)].ResultsThe study included 30,016 youth, among whom 5.5% (n = 1,652) were South Asian. South Asian youth had higher distress levels (Average K10 score: 32.1 vs. 31.3, P < 0.001) and lower mental health service utilization within the past year (57.1% vs. 48.4%) compared to non-south Asian youth. They were also more likely to use virtual services (30.2% vs. 19.4%). For gender, 94.5% of South Asian youth identified as cisgender and 5.1% as TGNC, compared to 14% TGNC in non-South Asians (P < 0.001). Regression analyses showed a significant association between ethnicity and mental health distress. This was amplified within the TGNC strata for South Asian participants compared to non-South Asian youth (B = 2.00, 95% CI, 0.35 to 3.66, P = 0.018). Younger age was associated with higher levels of mental health distress among South Asian youth in both gender strata: cisgender (B = -0.07, 95% CI, -0.10 to -0.03, P < 0.001) and TGNC (B = -0.14, 95% CI, -0.21 to -0.06, P < 0.001).ConclusionThis study reveals that South Asian youth accessing services from the BC-IYS experience higher levels of mental distress compared to non-South Asian youth. The findings highlight the need for culturally sensitive mental health services, education and policies to improve outcomes for South Asian youth in BC.Plain Language Summary TitleUnderstanding the Needs of South Asian Youth Accessing Integrated Youth Services in British Columbia, Canada.

To study the association between mental distress and the use of alternative medicine (AM) among cancer patients. A longitudinal questionnaire-based study was carried out at the Department of Oncology, University Hospital of Tromsø, Norway, during the period 1990-1991. The level of mental distress in 158 patients aged less than 75 years was assessed 4 months after first admission to the cancer ward. The patients answered five questions about mental distress selected from the General Health Questionnaire (GHQ). The questions were scored continuously according to the Likert scoring procedure. The level of mental distress was also ranked from 1 (little or no mental distress) to 3 (high mental distress). A total of 53 of the 158 patients reported use of AM at inclusion of the study or during the 4 months of follow-up. Among patients with low mental distress, 21% were users of AM, 36% of patients with medium distress and 48% in patients with high level of mental distress (p-value for linear trend = 0.02). Adjusted for all known relevant variables, patients with medium level of mental distress had 1.9 times higher prevalence of use of AM than patients with low level of mental distress, patients with high mental distress had a 2.9 times higher prevalence (p = 0.15 and 0.07, respectively). Analyzed as a continuous variable (Likert score between 5 and 20), mental distress was associated with use of AM (p = 0.007). These findings suggest that seeking alternative treatment is more common among mentally distressed cancer patients.

The COVID-19 pandemic has brought unprecedented disruptions to people’s everyday life and induced wide-ranging impacts on people’s physical health, mental health and well-being. This research investigated the relationship between risk perception, mental health distress, and flourishing during the peak period of the COVID-19 pandemic in China. Three hundred and ninety Chinese completed measures on risk perception, mental health distress, positive and negative affect, flourishing, and demographic information. The results revealed that 27.2% of participants experienced some level of mental health distress, but they also experienced a relatively high level of flourishing. Higher level of risk perception and negative affect were risk factors, whereas positive affect was a protective factor, of mental illness and flourishing. Experiences of positive and negative affect mediated the relationship between risk perception and level of mental health distress and flourishing, respectively. Although the COVID-19 pandemic led to a higher level of mental distress among the general public in China, most people were also resilient during the pandemic. The results have implications for improving mental health and enhancing resiliency during public health crises such as the COVID-19 pandemic.

BackgroundMental distress measured by the HSCL-10 is used as an indicator of psychiatric disorders in population studies, where a higher level of mental distress has been shown to be related to demographic factors such as living conditions and level of education. The first aim of the study was to explore whether mental distress could be a valuable concept in substance use treatment. The second aim of the study was to explore to what degree mental distress among substance users at admission to treatment could be explained by the same demographic factors as in population studies, or whether treatment differences or differences in substance use would be better predictors of mental distress in this population.MethodsPatients (N = 185) who received inpatient substance use treatment in five different settings in Northern Norway participated in the study. HSCL-10 was used as a measure for mental distress at admission to treatment. The self-report measures AUDIT, DUDIT and DUDIT-E were used for measuring substance use and readiness for treatment. The patients' clinicians reported demographic and treatment factors. A three-block hierarchical multiple regression analysis was conducted to determine potential predictors of mental distress. Block 1 included demographic variables, Block 2 included treatment variables, and Block 3 substance use variables.ResultsPatients generally reported a high level of mental distress at admission to treatment, and 83% reported mental distress higher than the established cut-off level. Being female, having previously received psychiatric treatment, having a higher score on DUDIT and AUDIT, and using a larger number of substances all predicted a higher level of mental distress. The model explained 32% of the variance in mental distress.ConclusionsMental distress measured by the HSCL-10 can be a valuable concept in substance use treatment. The HSCL-10 can be useful in screening for patients who are in need of further assessment for psychiatric disorders. Female gender, previous psychiatric treatment, and higher use of substances all predicted a higher level of mental distress. The study underlines the importance of assessing the mental health of patients in substance use treatment.

Diverging mental health after Brexit: Evidence from a longitudinal survey

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were ‘not out’, those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.

Changes in mental health, pain, and drug misuse since the mid-1990s: Is there a link?

BackgroundHazardous alcohol use is known to be comorbid with insomnia problems. The present study examined the prevalence of insomnia and if the odds of insomnia differed between women and men with a hazardous alcohol use.MethodsCross-sectional data from the seventh survey of the Norwegian population-based Tromsø Study 2015–2016 (participation 65%). The sample included 19 185 women and men 40–96 years. Hazardous alcohol use was defined by the Alcohol Use Disorder Identification Test (AUDIT) and insomnia by the Bergen Insomnia Scale. Covariates included socio-demographics, shift work, somatic conditions and mental distress defined by Hopkins Symptom Check List-10 (HSCL-10). Mental distress was also included as a moderator.ResultsInsomnia was more prevalent among participants with a hazardous alcohol use (24.1%) than without (18.9%), and participants who had hazardous alcohol use had higher odds of insomnia (odds ratio = 1.49, 95% CI = 1.20, 1.85). The association turned non-significant after adjustment for mental distress. Adding mental distress as a moderator variable revealed a higher odds of insomnia among hazardous alcohol users having no or low-to-medium levels of mental distress, but not among participants with high levels of mental distress.ConclusionInsomnia was more prevalent among women and men reporting hazardous alcohol use. When mental distress was treated as a moderator, hazardous alcohol use did not yield higher odds for insomnia among those with high levels of mental distress. This suggests that mental distress may play an important role in the association between hazardous alcohol use and insomnia. And that the impact of alcohol on insomnia may differ depending on the severity of mental distress.

BackgroundSubstance users being admitted to inpatient treatment experience a high level of mental distress. In this study we explored changes in mental distress during treatment.MethodsMental distress, as measured by the HSCL-10, was registered at admission and at discharge among 164 substance users in inpatient treatment in Northern Norway. Predictors of reduction in mental distress were examined utilizing hierarchical regression analysis.ResultsWe found a significant reduction in mental distress in the sample, but the number of patients scoring above cut-off on the HSCL-10 at discharge was still much higher than in the general population. A more severe use of substances as measured by the AUDIT and the DUDIT, and being female, predicted a higher level of mental distress at admission to treatment as well as greater reduction in mental distress during treatment. Holding no education beyond 10 year compulsory school only predicted a reduction in mental distress.ConclusionsThe toxic and withdrawal effects of substances, level of education as well as gender, contributed to the differences in change in mental distress during treatment. Regression to the mean may in part explain some of the findings.

Mental distress is a common health problem facing university students worldwide. It manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue. University students are a high-risk group for mental distress than the general population. This study aimed to assess knowledge, the prevalence of mental distress, and its associated factors among undergraduate students. A cross-sectional study was conducted among undergraduate students at the University of Dodoma in Tanzania. Data were collected using pre-tested and self-administered questionnaires. Bivariate and multivariable logistic regression models were used to identify factors associated with mental distress. A total of 224 undergraduate students gave a complete response, of which the majority were aware of the common symptoms of mental distress. Self-reported mental distress experience was reported among 116/224 (51.8%) students. Multivariable logistic analysis showed that only alcohol consumption (aPR = 1.61, 95% CI 1.22–2.11, p = 0.001) was independently associated with mental distress among students. The findings of this study revealed that undergraduate students had adequate knowledge of the symptoms of mental distress. Our results show that the prevalence of self-reported mental distress was moderately high among undergraduate students. Furthermore, the study indicates a significant association between alcohol consumption and self-reported mental distress among these students. These results suggest that interventions aimed at reducing alcohol consumption may be beneficial in mitigating mental health issues among undergraduate students in Tanzania.

Examining women veterans' self-reported mental health is critical to understanding their unique mental and physical health needs. This study describes self-reported mental distress over a 17-year period among cross-sectional nationally representative samples of women in the USA using data from the Behavioral Risk Factor Surveillance System (BRFSS) core national surveys from 2003 to 2019. Nationally representative prevalence estimates of self-reported mental distress were compared between women veterans and their (1) men veteran and (2) women civilian counterparts. In each year examined, women veterans report significantly more days of recent mental distress and significantly higher prevalence of frequent mental distress than their men veteran counterparts. In several years, women veterans also report greater levels of recent and frequent mental distress than women civilians. These findings highlight the long-standing high prevalence of self-reported poor mental health among women veterans and suggest that specific efforts to address mental health among women veterans as a unique population may be warranted.

Welfare recipients were often considered the least deserving of COVID-related support. Despite the recent attention paid to the impact of COVID-19 pandemic on mental health, few studies have explored the mental distress experienced by welfare recipients. This cross-sectional study on female Comprehensive Social Security Allowance recipients in Hong Kong aimed to explore their level of mental distress and its association with a range of risk factors specific to welfare recipients. Hence, 316 valid cases from a local community center responded to our online survey. We found that 52.3%, 23.4%, and 78% of the participants showed moderate to extremely severe depression, anxiety, and stress symptoms, respectively. A higher level of mental distress was associated with having a psychiatric diagnosis, poorer social, and greater concerns over disciplining children, the living environment, daily expenses and being infected by COVID-19. Unexpectedly, being married, having a permanent residence, and having a job were not significant protective factors for this group. The models explained 45.5%, 44.6%, and 52.5% of the overall variance in the level of depression, anxiety, and stress (p < 0.01), respectively. Our findings have important implications for supporting female welfare recipients during a public health crisis and may help frontline staff and professionals provide prompt assistance to this group in need.