GHQ-12 Cases Research Articles

Caregiving and mental health needs in the significant others of women receiving inpatient and home treatment for acute severe postpartum mental illness

To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24–69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family.

Supporting wellbeing through peer-befriending (SUPERB) for people with aphasia: A feasibility randomised controlled trial

Objective: To determine the feasibility and acceptability of peer-befriending, for people with aphasia. Design: Single-blind, parallel-group feasibility randomised controlled trial comparing usual care to usual care + peer-befriending. Participants and setting: People with aphasia post-stroke and low levels of distress, recruited from 5 NHS Hospitals and linked community services; their significant others; and 10 befrienders recruited from community. Intervention: Six 1-hour peer-befriending visits over three months. Main measures: Feasibility parameters included proportion eligible of those screened; proportion consented; missing data; consent and attrition rates. Acceptability was explored through qualitative interviews. Outcomes for participants and significant others were measured at baseline, 4- and 10-months; for peer-befrienders before training and after one/two cycles of befriending. Results: Of 738 patients identified, 75 were eligible of 89 fully screened (84%), 62 consented (83% of eligible) and 56 randomised. Attrition was 16%. Adherence was high (93% attended ⩾2 sessions, 81% all six). The difference at 10 months on the GHQ-12 was 1.23 points on average lower/better in the intervention arm (95% CI 0.17, −2.63). There was an 88% decrease in the odds of GHQ-12 caseness (95% CI 0.01, 1.01). Fourty-eight significant others and 10 peer-befrienders took part. Procedures and outcome measures were acceptable. Serious adverse events were few (n = 10, none for significant others and peer-befrienders) and unrelated. Conclusions: SUPERB peer-befriending for people with aphasia post-stroke experiencing low levels of distress was feasible. There was preliminary evidence of benefit in terms of depression. Peer-befriending is a suitable intervention to explore further in a definitive trial. Clinical trial registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT02947776 Subject terms: Translational research, mental health, rehabilitation, quality and outcomes, stroke

Correlates of psychiatric morbidity among Pakistani medical students: A cross-sectional survey

Background and Aim: Cultural variations among medical students is one of the factors causing stress and psychological morbidity. This study was carried out to determine presence of psychological morbidity and its association with different sociodemographic characteristics among medical students at a public sector college. Methods: This cross-sectional study was carried out in Gujranwala Medical College, Gujranwala. Eighty-six students out of one hundred selected students by simple random sampling completed the self-administered proforma. It contained socio demographic profile, 12- item General Health Questionnaire (GHQ-12) and standardized sources of academic stress. Psychological morbidity or stress was labelled if student scored GHQ score ≥ 21. Results: Twenty-three students (26.7%) were GHQ-12 cases (i.e., scored ≥21) i.e. suffering from severe stress. Among these students, majority were female (73.91%), in their clinical years (73.91%) and living in hostel (56.52%). Academic concerns and psychosocial factors like feeling of being lonely, mood swings and being worried about expectations of parents were major stressors among all the students. Hostelers were worried about the quality of food in mess and feeling of homesickness. Conclusions: It is noteworthy, that in our study population, academic demands were additional sources of psychological morbidity besides other personal and psychosocial issues. It is the need of the hour to intervene at the psychological, social and academic level to improve the quality of life for medical students. This will help in avoiding many psychological problems in the future.

Screening for psychiatric morbidity in the population - a comparison of the GHQ-12 and self-reported medication use.

IntroductionUptake of psychotropic medication has been previously used as a proxy for assessing the prevalence of population mental health morbidity. However, it is not known how this compares with estimates derived from population screening tools.ObjectiveTo compare estimates of psychiatric morbidity derived by a validated screening instrument of psychiatric morbidity and a self-reported medication uptake measure.MethodsThis study used data from two recent population-wide health surveys in Northern Ireland, a country (UK) with free health services and no prescription charges. The psychiatric morbidity of 7,489 respondents was assessed using the GHQ-12 and self-reported use of medication for stress, anxiety and depression (sDAS medication).ResultsOverall, 19% of respondents were defined as ‘cases’ and 14.3% were taking sDAS medication. Generally, the two methods identified the same population distributions of characteristics that were associated with psychiatric morbidity though nearly as many non-cases as cases received sDAS medication (46.4% vs. 53.6%). A greater proportion of women and older people were identified as cases according to sDAS medication use, while no such variation was observed between socio-economic status and method of assessment.ConclusionsThis study indicates that these two methods of assessing population psychiatric morbidity provide similar estimates, despite potentially identifying different individuals as cases. It is important to note that different health care systems might be linked to variations in obstacles when accessing and using health care services.HighlightsThere was a reasonable correspondence between the different methods of assessment.A greater proportion of women and older people were identified as cases through the self-reported use of medication.An almost equal amount of GHQ-12 cases and non-cases reported being in receipt of medication.

Uncertainty and Ambiguity and Their Association with Psychological Distress in Medical Students

The practice of medicine is inherently uncertain. We sought to measure the level of psychological distress among medical students and to ascertain if an intolerance of uncertainty and ambiguity were associated with distress. The authors conducted a cross-sectional study with a population consisting of 4th year undergraduate medical students at an Irish university. Psychological distress was measured with the GHQ-12 scale. The "tolerance of ambiguity" scale and the "Intolerance of Uncertainty Scale (IUS)-12" were used to measure the respective variables. One hundred students (class size of 123) participated in this study giving a response rate of 81 %. A total of 27 % of the students met the criteria for psychological distress. Student psychological distress, as measured by GHQ-12 caseness, was associated with a higher intolerance of uncertainty (mean 31.70 (6.18)) compared with those who were not distressed (mean IUS score 26.66 (6.58)) (t (98) = -5.52, p < 0.001). A relative lack of tolerance for uncertainty may prove to be an important predictor of psychological distress in undergraduates. There is an argument for designing appropriate interventions so that learners can come to recognize and embrace uncertainty rather than its remaining unacknowledged and potentially contributing to psychological morbidity.

Efficacy of Biofeedback and Cognitive-behavioural Therapy in Psoriatic PatientsA Single-blind, Randomized and Controlled Study with Added Narrow-band Ultraviolet B Therapy.

Increasing data suggests that there is a connection between stress and the appearance of psoriasis symptoms. We therefore performed a clinical trial enrolling 40 participants who were randomly allocated to either an 8-week cognitive-behavioural therapy (CBT) (treatment group) plus narrow-band UVB phototherapy or to an 8-week course of only narrow-band UVB phototherapy (control group). We evaluated the clinical severity of psoriasis (PASI), General Health Questionnaire (GHQ)-12, Skindex-29 and State-Trait Anxiety Inventory (STAI) at baseline and by the end of the study. Sixty-five percent of patients in the treatment group achieved PASI75 compared with 15% of standard UVB patients (p = 0.007). GHQ-12 cases were reduced from 45% to 10% in the treatment group and from 30% to 20% in the control group (p = 0.05). The Skindex-29 emotional domain showed a significant improvement in the CBT/biofeedback group compared with control patients (-2.8 points, p = 0.04). This study shows that an adjunctive 8-week intervention with CBT combined with biofeedback increases the beneficial effect of UVB therapy in the overall management of psoriasis, reduces the clinical severity of psoriasis, improving quality of life and decreases the number of minor psychiatric disorders.

The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University

This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies. This is a preliminary 2-stage cross-sectional report, which is part of a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslach's burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearson's correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk. 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored ≥ 3). Students who had morbidity were 9 times at risk of being stressed consequent upon 'competing with their peers' and 4 times at risk due to 'inadequate learning materials'. Morbidity was significantly more likely to engender use of 'religion', 4 times less likely to engender use of 'positive reframing' with a trend in the use of 'self blame' as coping strategies. Aside from psychosocial/personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize 'religion' and 'positive reframing' to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.

The transition to living alone and psychological distress in later life

Background: living alone in later life has been linked to psychological distress but less is known about the role of the transition into living alone and the role of social and material resources.Methods: a total of 21,535 person-years of data from 4,587 participants of the British Household Panel Survey aged 65+ are analysed. Participants provide a maximum 6 years' data (t0−t5), with trajectories of living arrangements classified as: consistently partnered/ with children/alone; transition from partnered to alone/with children to alone. General Health Questionnaire (GHQ)-12 caseness (score >3) is investigated using multi-level logistic regression, controlling for sex, age, activities of daily living, social and material resources.Results: after a transition from partnered at t0 to alone at t1, the odds for GHQ-12 caseness increased substantially, but by t3 returned to baseline levels. The odds for caseness at t0 were highest for those changing from living with a child at t0 to living alone at t1 but declined following the transition to living alone. None of the covariates explained these associations. Living consistently alone did confer increased odds for caseness.Conclusions: living alone in later life is not in itself a strong risk factor for psychological distress. The effects of transitions to living alone are dependent on the preceding living arrangement and are independent of social and material resources. This advocates a longitudinal approach, allowing identification of respondents' location along trajectories of living arrangements.

The effect of mental ill health on absence from work in different occupational classifications: analysis of routine data in the British Household Panel Survey.

To investigate relationship of mental ill health to absence from work in different occupational classifications. Examined sickness absence, mental health (GHQ-12), physical health, job characteristics, and personal characteristics in 18 waves of the British Household Panel Survey. Overall sickness absence rate was 1.68%. Increased absence was associated with age greater than 45 years, female gender, lower occupational classification, and public-sector employers. Decreased absence was associated with part-time working. Scoring 4 or more on the General Health Questionnaire 12-item version (GHQ-12 caseness) was strongly associated with sickness absence. Public-sector employers had highest rates of sickness absence. GHQ-12 caseness had largest impact on absence in the public and nonprofit sectors, whereas physical health problems impacted more in the private sector. GHQ-12 caseness is strongly associated with increased absence in all classifications of occupations. Differences between sectors require further investigation.

Subjective social status and health in young people

Health inequalities according to objective socioeconomic position (SEP), have been well-documented. Yet, in young people the associations are negligible. Recently, research on the association of subjective social status (SSS), and adult health has begun to accumulate. Studies on young people are rare and describe societies with large income inequalities. Here, we investigated the association between SSS and health, while controlling for own and familial SEP. The study population consisted of 15-year-olds (N = 2369) who have grown up in a context of low social inequalities. Data were derived from surveys carried out in 2004 in 29 secondary schools in Helsinki. The SSS was measured with an indicator specific to and validated for adolescents (a societal ladder). Outcome measures were self-rated health, health complaints, presence of limiting longstanding illness (LLI) and GHQ-12 caseness (indicating psychiatric morbidity). The SSS associated strongly with all health measures. Adjusting for objective socioeconomic measures attenuated the associations; although they all remained statistically significant apart from LLI among girls. The subjective assessment contributes to health inequalities in young people largely independent of objective SEP. Subjective ratings most probably capture aspects of social hierarchy that are more subtle and less well represented than in conventional measures.

Predicting which people with psychosocial distress are at risk of becoming dependent on state benefits: analysis of routinely available data

Objectives To examine whether there was significant variation in levels of claiming incapacity benefit across general practices. To establish whether it is possible to identify people with mental health problems...

Quality of life and psychological problems in patients undergoing neurological rehabilitation

Aim:To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities.Materials and Methods:Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63±11.87).Outcome Measure:WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score.Results:The duration of illness was three to 30 months (10.63±7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score ≥15) and seven having severe problem and psychological distress (score≥20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores≥11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83±8.02), (50.76±9.79), (48.53±18.46) and (49.13±10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation (P<.05) with functional abilities.Conclusion:Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant.

Job Strain and Psychologic Distress: Influence on Sickness Absence Among Finnish Employees

Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases. Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption. Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men). Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.

Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S

Elevated rates of psychological morbidity and symptomatology have been widely reported in 1991 Gulf War veterans. The present study used brief self-report instruments to compare the psychological health of Australian Gulf War veterans with that of a randomly sampled military comparison group. The 12-item Short Form Health Survey (SF-12), 12-item General Health Questionnaire (GHQ-12), Posttraumatic Stress Disorder Checklist--Specific (PCL-S) and Military Service Experience (MSE) questionnaire were administered to 1424 male Australian Gulf War veterans and 1548 male Australian Defence Force members who were operational at the time of the Gulf War conflict, but were not deployed there. The Gulf War veterans exhibited poorer psychological health, as measured by the above three instruments, than the comparison group members. For Gulf War veterans, the number of stressful experiences, as measured by the MSE questionnaire, was correlated with scores on the three instruments. SF-12 mental health component summary scores and PCL-S caseness, but not GHQ-12 caseness, differed significantly between Gulf War veterans and comparison group members who had been on at least one active deployment. More than a decade after the 1991 Gulf War, Australian Gulf War veterans are exhibiting higher levels of current (past month) psychological ill-health, as measured using the GHQ-12 and PCL-S, as well as lower mental health status, as measured by the SF-12, than the comparison group. Although not a replacement for formal psychiatric diagnosis, instruments such as those above may aid in the assessment of veterans' psychological health.

Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs.

Patients with mental disorder presenting with medically unexplained symptoms (somatized mental disorder) are difficult to treat and consume a lot of health care. The aim of the study was to examine the cost-effectiveness of a training package for somatized mental disorder delivered by GPs. The study design was a prospective, before- and after-training study of different cohorts of patients attending eight GPs, acting as their own controls. Cost-effectiveness analysis was estimated using changes in case level on a self-rated psychiatric symptom questionnaire (GHQ-12) and direct health costs between the index consultation and 3 months later. There were 103 and 112 patients with somatized mental disorder in the before and after training cohorts, respectively. After training, costs of referrals outside the primary care team decreased significantly by 23%, with little overall change in primary care costs. Total direct health care costs, including training, were reduced by 15%. After training, an extra 17 patients were successfully treated (no longer GHQ-12 cases) at 3 months. The marginal cost-effectiveness per extra successfully treated patient was pound sterling 325 and the cost per successfully treated case was 69% of the cost of the GP's usual treatment. Training GPs with the reattribution training package appears to be extremely cost-effective.

Long-term treatment with antidepressants in primary care

A postal survey of 222 patients receiving long-term antidepressants in a training general practice showed that the majority were GHQ-12 cases and 62% of respondents reported moderate or severe depressive symptoms on the BDI-13. Although these patients received significantly higher doses than those reporting few or no symptoms, only 40% were prescribed at least a therapeutic antidepressant dose. All patients reporting mild, moderate or severe depressive symptoms consulted their general practitioner significantly more frequently than those without symptoms and the content of these consultations suggested that the general practitioners were aware of these patients' psychological morbidity. Monitoring and appropriate management of patients receiving long-term antidepressants could lead to reduction in morbidity and consultation rate.

Psychometric properties of the Eating Disorders Inventory (EDI-1) in a nonclinical Chinese population in Hong Kong.

To evaluate the psychometric properties of the Chinese Eating Disorders Inventory (EDI-1) in a nonclinical population in Hong Kong.1,172 (females 606, males 566) Chinese undergraduates completed the Chinese EDI-1; 105 of them also completed the 12-item General Health Questionnaire (GHQ-12).In female subjects, the Chinese EDI-1 and its subscales met conventional standards of internal consistency, item-total, item-subscale, and subscale correlations, and exhibited an excellent degree of factorial integrity. The subscales discriminated among male, female, high Drive for Thinness, high Body Dissatisfaction, constitutionally slim, and Canadian female subjects. Female GHQ-12 cases and noncases were only distinguished by the Interpersonal Distrust, Interoceptive Awareness, and Ineffectiveness subscales. 3.3% of female subjects could be characterized as being pathologically weight preoccupied.This study provides preliminary evidence that the Chinese EDI-1 is an economical, reliable, and potentially useful self-report instrument for investigating the psychological and behavioral dimensions of eating disorders in Hong Kong. But further work is needed to evaluate its transcultural validity in clinical and less modernized Chinese populations.