GHQ Caseness Research Articles

Occupational Grade, Mental Distress, and the Use of Psychotherapy.

Previous studies have shown that manual workers use less psychotherapy than non-manual workers. However, little is known about the match between the use and the need of psychotherapy in different occupational grades. Our study investigates how the prevalence of mental distress corresponds to psychotherapy use rate in different occupational grades by gender. The data were collected from the Rise of Mental Vulnerability Study (use of psychotherapy) and the FinHealth 2017 Study (prevalence of mental distress). Adjusting for age, we calculated General Health Questionnaire (GHQ-12) caseness (a measure for mental distress), a 3-year psychotherapy use rate, and the ratio between GHQ caseness and the psychotherapy use rate in 3 occupational grades (upper non-manual employees, lower non-manual employees, and manual workers) for men and women separately. In men, for 1 person having used psychotherapy there were 10 persons experiencing mental distress in upper non-manual workers, 14 in lower non-manual workers, and 31 in manual workers. In women, for 1 person having used psychotherapy, there were 6 persons experiencing mental distress in upper non-manual workers, 9 in lower non-manual workers, and 18 in manual workers. At the population level, manual employees use considerably less long-term psychotherapy than upper non-manual workers although their level of mental distress is high. This indicates a mismatch between symptoms and therapy, which was higher for men in all occupational grades.

Occupational class, gender, mental distress and use of psychotherapy

Abstract Introduction Previous studies have shown the effects of occupational class and gender on mental distress and use of psychotherapy. However, less is known about the mental distress-based use of psychotherapy in different occupational classes. Objectives The aim of our study is to show how the prevalence of mental distress and the use of long-term psychotherapy correlates in different occupational classes by gender. Methods Data were drawn from the Rise of Mental Vulnerability Study (psychotherapy) and FinHealth 2017 Study (mental distress). Adjusting for age, we calculated GHQ caseness, psychotherapy use rate, and the ratio between GHQ caseness and psychotherapy use rate in three occupational classes (upper non-manual employees, lower non-manual employees, and manual workers) separately for men and women. Age-adjustment was performed through regression analysis by using model generated predicted values of GHQ caseness and psychotherapy use rate at the average sample age of 40. Results In the group of upper non-manual men there were 10 persons with severe mental distress for every single person having used psychotherapy. For lower non-manual men and manual male workers the numbers were 14 and 31, respectively. In the group of upper non-manual women there were six persons with severe mental distress for every person having used psychotherapy. For lower non-manual women and manual female workers these numbers were nine and 18, respectively. Conclusions We found differences in the mental distress-based use of state-subsidized long-term psychotherapy between occupational classes. For upper non-manual workers, the use of therapy best meets their mental distress. The opposite is true for manual workers. We also found differences between men and women, but these findings should be confirmed with larger datasets.

Sociodemographic and Clinical Variables of Depression among Patients with Epilepsy in a Neuropsychiatric Hospital in Nigeria.

Background Depression is a major contributor to the global burden of disease. Its occurrence in patients living with epilepsy is not just common but also a serious comorbidity. Patients tend to suffer if the depressive disorder is undetected and thus untreated. The aim of this study is to estimate the prevalence of depressive disorder in patients with epilepsy. Also, the sociodemographic and clinical factors that are associated with the development of depression in people living with epilepsy were examined. Materials and Method. This was a descriptive cross-sectional study of participants living with epilepsy and receiving care at the Federal Neuropsychiatric Hospital, Sokoto, Nigeria. Participants were recruited consecutively as they come for follow-up care. A sociodemographic/clinical questionnaire and General Health Questionnaire version 28 (GHQ-28) were first administered to participants followed by the Composite International Diagnostic Interview (CIDI). The descriptive statistics were generated and analyzed. Logistic regression was also done to determine the predictors of depression in the study participants. All test of probability was set at p < 0.05. Results A total of 400 participants with epilepsy were examined with GHQ-28 and CIDI. Out of the GHQ-28 examined individuals, 71 people (17.8%) met criteria for caseness while 35 participants (8.8%) were depressed when assessed with CIDI. The predictors of depressive illness in participants living with epilepsy were GHQ caseness (p < 0.05. p < 0.05. p < 0.05. Conclusion Depression is common in people with epilepsy. Physicians should actively assess individuals with epilepsy for symptoms of depression. Special attention should be paid to patients with a family history of epilepsy and those from minority ethnic groups.

Correlates of Psychosis Among Patients with Seizure Disorders in a Neuropsychiatric Hospital in Nigeria

Psychosis may complicate epilepsy. The aim of this study was to estimate the prevalence of Psychosis among patients with epilepsy and to examine its socio-demographic and clinical correlates. This study was a descriptive cross-sectional study that involved the use of General Health Questionnaire, version 28(GHQ-28) and the Composite International Diagnostic Interview (CIDI), which were used to investigate each of the 400 consecutive participants. The diagnosis of epilepsy was based on the International Classification of Diseases (ICD-10) diagnostic criteria and all participants with Psychosis were diagnosed using CIDI. A proforma Questionnaire was used to assess the socio-demographic and clinical variables among the participants. Logistic regression was done to determine the predictors of psychosis. Thirty-two participants (8%) were diagnosed as having psychosis. Unemployment and GHQ caseness were predictors of Psychosis among the participants (p=0.038, p=<0.001 respectively). The study showed the existence of Psychosis among patients with seizure disorder. This is an important association with seizure disorders which has implications on the course of the disorder. The assessment of these patients for this co-morbidity and identification of the factors that leads to unemployment among people with seizure disorder will enhance treatment outcome.

Correlates of Anxiety Disorder among Patients with Seizure Disorders in a Neuropsychiatric Hospital in Nigeria

Background: Anxiety may complicate epilepsy as is often the case out of the various psychiatric comorbidities patients can suffer from when they are suffering from epilepsy. The aim of this study was to estimate the prevalence of anxiety among patients that had epilepsy and also to examine the associated socio-demographic and clinical factors that are associated with and eventually predictive of this psychiatric comorbidity. Materials and Method: This study was a descriptive cross-sectional study that involved the use of General Health Questionnaire, version 28 (GHQ-28) and the Composite International Diagnostic Interview (CIDI), which were used independently to investigate each of the 400 consecutive participants in this study over a period of 24 weeks. The diagnosis of epilepsy was based on the International Classification of Diseases (ICD10) diagnostic criteria and all participants with anxiety were diagnosed using CIDI. A proforma Questionnaire was used to assess the socio-demographic and some clinical variables among patients. Logistic regression was done to determine the predictors of anxiety in the study participants. Results: When screened with GHQ-28, 71 people (17.8%) met criteria for caseness. When all the participants were examined using CIDI, 12 (3%) were diagnosed with generalized anxiety disorder. The variables found to be the predictors of anxiety were family history of psychiatric disorders (p = 0.045), fear of having seizure (p = 0.036) and GHQ caseness (p = 0.002). Conclusion: The study showed the existence of anxiety disorders among patients with seizure disorder. This is an important association with seizure disorders which is often overlooked. It will be beneficial to these patients if this co-morbidity is actively looked out for. Patients suffering from seizure disorder that have a family history of mental illness should be considered for an assessment of anxiety disorder. Psychological intervention for anticipatory fear of seizure should be employed by mental health professionals.

Cannabis use among Navy personnel in Sri Lanka: a cross sectional study.

BackgroundPrevalence of cannabis use among military populations vary. There is evidence that drug use is associated with combat exposure and PTSD. The objective of the study was to assess the prevalence of cannabis use among Sri Lanka Navy (SLN) personnel and to identify any relationship with cannabis use and combat exposure.MethodsThis cross sectional study was carried out among representative samples of SLN Special Forces (Special Boat Squadron) and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Personnel who had served continuously in combat areas during the 1 year period prior to end of combat operations were included in the study. Cannabis use was defined as smoking cannabis at least once during the past 12 months.ResultsThe sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of cannabis use was 5.22 % (95 % CI 3.53–6.9). There was no significant difference in prevalence of cannabis use among Special Forces personnel compared to regular forces. Cannabis use was significantly higher in the age group 18–24 years [OR 4.42 (95 % CI 2.18–8.97)], personnel who were never married [OR 2.02 (95 % CI 0.99–4.12)], or had an educational level less than GCE O’Level [OR 4.02 (95 % CI 1.17–13.78)]. There was significant association between cannabis use and hazardous alcohol use [adjusted OR 5.47 (95 % CI 2.65–11.28)], PTSD [adjusted OR 4.20 (95 % CI 1.08–16.38)], GHQ caseness [adjusted OR 2.83 (95 % CI 1.18–6.79)] and multiple somatic complaints [adjusted OR 3.61 (95 % CI 1.5–8.7)]. Cannabis use was not associated with smoking. Risk of cannabis use was less in those who had seen dead or wounded [adjusted OR 0.42 (95 % CI 0.20–0.85)]. Experiencing hostility from civilians was the only combat exposure that significantly increased the risk of cannabis use [adjusted OR 4.06 (95 % CI 1.06–15.56)].ConclusionsAmong Sri Lanka Navy personnel exposed to combat cannabis use was significantly associated with hazardous alcohol use but not smoking. PTSD and other adverse mental health outcomes were associated with an increased risk of cannabis use. Exposure to combat was not associated with increased risk of cannabis use.

The Mental Health of British Adults with Intellectual Impairments Living in General Households.

People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health. The present authors undertook secondary analysis of confidentialized unit records collected in Wave 3 of Understanding Society. British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR=1.77, 95% CI (1.25-2.52), P<0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [GHQ Caseness adjusted OR=1.06, 95% CI (0.73-1.52), n.s]. Our analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalized or vulnerable groups.

Adolescent loneliness and psychiatric morbidity in Northern Ireland

Previous research has identified an association between loneliness and psychiatric morbidity, but many of the studies have been based on small convenience samples and have not always used standardized measures. This study aimed to assess the association between standardized measures of loneliness and psychiatric morbidity using data from a large sample of adolescents from Northern Ireland (Young Life and Times Survey, 2011). A total of 1,434 participants completed the survey. The prevalence of loneliness and psychiatric morbidity was 15.6% and 28.4% respectively. A multivariate binary logistic regression was used to identify the significant correlates of psychiatric morbidity. Demographic and loneliness variables were entered as covariates and female gender and perceptions of familial poverty were significantly associated with GHQ caseness. Loneliness increased the likelihood of GHQ caseness by more than five times. Adolescent loneliness is significantly associated with psychiatric morbidity for Northern Irish adolescents. School-based screening and interventions to reduce loneliness may reduce the prevalence of loneliness.

Multiple physical symptoms in a military population: a cross-sectional study

BackgroundMedically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms.MethodsThis is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version.ResultsPrevalence of multiple physical symptoms was 10.4% (95% CI 8.11–12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, ‘thought I might be killed’ , ‘coming under small arms fire’ , and ‘coming under mortar, missile and artillery fire’ remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health.ConclusionsPrevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment.

A study to assess the emotional disorders with special reference to stress of medical students of Agartala government medical college and Govinda ballabh pant hospital

Background:Stress is very common psychological phenomena where medical students faced in day to day activities. Epidemiological studies have asserted that about 70-80% of the diseases may be related to stress. Research related to this stress especially among medical students is essential, considering their learning, role and responsibilities as a future physician and health intervention programs.Objectives:To estimate the prevalence of stress and identify stressors among medical students.Materials and Methods:A Cross-sectional study was carried out among undergraduate medical students and self administered GHQ-12 and stressor questionnaire were used to collect information regarding stress. Binary logistic regression analysis was performed to calculate odds ratio (OR).Results:Prevalence of stress was 94.52% and more common among females. 33.56% students felt constantly under strain and 25.34% had loss of sleep over worry. Majority of the students of all semesters had stress (P > 0.05) and stressors viz. ‘competition for marks’ (P = 0.005), ‘frequent examination’ (P = 0.001), ‘difficulty in finding time for recreation’ (P = 0.014) and ‘being away from home’ (P = 0.027) were predominantly experienced by the 1st year medical students. Multiple logistic regression analysis revealed the causal effect of main parameter on the GHQ caseness and students who found difficulties in following teaching language among the caseness had 81.59% higher chance of developing stress (OR = 8.159, CI = 1.228-54.213).Conclusion:The stress experience was more common due to academics and seen among all year of medical students. Strategy development for eliminating stressors is necessary for promoting healthy life.

Mental health of deployed UK troops in Afghanistan – operational mental health needs evaluation – OMHNE-A 2010

ObjectivesThe Mental Health of UK armed forces, is of growing political and societal interest. Studies have explored the mental health of troops, before and after operational deployment, but this is...

The Mind Continues to Matter: Psychologic and Physical Recovery 5 Years After Musculoskeletal Trauma

Posttraumatic psychopathology may complicate recovery from musculoskeletal injury. This article details the 5-year follow-up of a cohort study examining the relationship between posttraumatic psychopathology and recovery after musculoskeletal trauma. A prospective cohort study of patients with musculoskeletal injuries (Grampian Trauma Outcomes Study) assessed 5 years after their injury. Orthopaedic trauma unit, Level I equivalent. One hundred four of the initial group of 200 patients with musculoskeletal injuries. Trauma care and prospective evaluation of physical and psychologic recovery. Development of psychopathology (measured by the General Health Questionnaire [GHQ]) and functional outcome (measured by Short Form-36 [SF-36] and Musculoskeletal Function Assessment [MFA]). Follow-up at 5 years was 104 patients (52%). GHQ caseness was predictive of physical dysfunction (SF-36, MFA), which had not returned to baseline levels by 5 years. Although injury severity was strongly predictive of psychological disturbance (GHQ caseness) at 5 years, linear regression analysis demonstrated that GHQ score was an important predictor of outcome, whereas Injury Severity Score contributed very little. Psychologic disturbance after musculoskeletal trauma is related to adverse functional outcome. This is not influenced by preinjury state, but constitutes a sustained posttraumatic effect that is only weakly related to severity of injury.

Aircraft Noise Exposure and Its Effects on Quality of Life and Cognitive Function Among Thai Residents

PP-29-185 Background/Aims: Noise exposure is considered an essential part of daily living for human. However, excessive and prolonged exposure to noise could lead to several adverse health effects. To assess the association between aircraft noise exposure and health effects, we conducted a follow-up study around 2 international airports in Bangkok. Methods: Data were collected 2 times to compare noise exposure and health effects before and after Don Muang International Airport closure and the opening of Suvarnabhumi International Airport. Study subjects consisted of 332 residents and 284 fourth grade primary school students from the Suvarnabhumi and Don Muang areas. Noise was recorded by an integrating sound level meter which was calibrated and set to record noise every 2 seconds for a period of 24 hours. World Health Organization's quality of life (QOL) and General Health (GHQ-28 Thai version) questionnaires were used to evaluate QOL and subjective health while short- and long-term memories of the children were assessed. Results: Results showed that Leq,day ranged from 41.0–51.0 and 53–74.1 dB(A) prior to and after Suvarnabhumi Airport opening. Meanwhile, Leq,day ranged from 63.9–74.7 and 54.2–66.4 dB(A) prior to and after Don Muang Airport closure. Residents living around Don Muang Airport had lower QOL scores than those around Suvarnabhumi Airport without statistical significance. At 1-year follow-up, the prevalence of GHQ caseness around Suvarnabhumi Airport was 39.42% (95% CI: 33.21–45.63) which was statistically higher than that of Don Muang area; 17.61% (95% CI: 11.93–23.30). Short-term memory scores of students studying around Suvarnabhumi Airport increased significantly but long-term memory scores remained unchanged. However, long-term memory scores of children in Don Muang area increased significantly after airport closure. Conclusion: This study suggested that aircraft noise could affect well-being of residents and cognitive function of children living around airport and long-term health surveillance should be initiated.

The psychosocial impact of human papillomavirus testing in primary cervical screening— a study within a randomized trial

The purpose of the study was to assess the psychosocial impact of human papillomavirus (HPV) testing as an adjunct to cytology in routine primary cervical screening. A controlled study of the psychosocial impact of HPV testing within a randomized trial of HPV testing to assess its efficacy in cervical screening was carried out. The trial provides a randomized setting of revealed HPV results versus concealed results permitting valid comparisons for assessing true psychosocial impact. The setting comprised a large number of general practices in primary care. Women aged 20–64 years who underwent routine cervical screening participated in the study. The intervention was a revealed high-risk HPV test result in addition to cervical cytology. The main outcome was measured using General Health Questionnaire (GHQ-28), Spielberger State–Trait Anxiety Inventory, and Sexual Rating Scale (SRS). Among women with either mildly abnormal or normal cytology, receiving an HPV(+ ve) result did not impact significantly on GHQ caseness and mean scores or on Spielberger State and Trait scores when compared with women in whom the HPV(+ ve) test result was concealed. Among women with normal cytology, receiving an HPV(+ ve) result was associated with a reduction in the Sexual Rating Scale compared with similar women whose HPV(+ ve) result was concealed. HPV testing does not add significant psychologic distress when combined with cytology in routine primary cervical screening.

Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health - sexually transmitted infections, psychosexual concerns and psychological distress - but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.

Psychological distress in mothers and fathers of preschool children: a 5‐year follow‐up study after birth

Maternal and paternal psychological distress influence children's development and health beyond the perinatal period. The aim of our study was to describe psychological health during a 5-year period in parents of preschool children. Secondarily, we wanted to explore differences between mothers and fathers and identify predictors for increased psychological distress in parents. Prospective cohort study. A county in Southern Norway 1998-2004. One hundred and twenty-three mothers and 112 fathers were candidates for the follow-up study. Parental psychological responses were assessed using the General Health Questionnaire (GHQ-28), State Anxiety Inventory-X1 and Impact of Event Scale at 0-4 days, 6 weeks, 6 months and 5 years after delivery of a healthy child. Parental psychological distress defined by GHQ-28 Likert sum score at 5-year follow-up. Clinically important psychological distress (GHQ case score > or = 6) was reported by more mothers (29%) than by fathers (11%) (P = 0.004). In multivariate analysis, psychological distress (GHQ-28 Likert sum score) after 5 years was predicted by initial psychological distress, being single and low educational level in mothers, and unemployment and low quality of relationship with partner in fathers. Fathers reported significantly lower frequency of clinically important psychological distress and more stable scores than mothers throughout the period. The results indicate that selected psychometric screening may be warranted for parents with known psychosocial risk factors.

The psychosocial impact of human papillomavirus testing in primary cervical screeninga study within a randomized trial

The purpose of the study was to assess the psychosocial impact of human papillomavirus (HPV) testing as an adjunct to cytology in routine primary cervical screening. A controlled study of the psychosocial impact of HPV testing within a randomized trial of HPV testing to assess its efficacy in cervical screening was carried out. The trial provides a randomized setting of revealed HPV results versus concealed results permitting valid comparisons for assessing true psychosocial impact. The setting comprised a large number of general practices in primary care. Women aged 20-64 years who underwent routine cervical screening participated in the study. The intervention was a revealed high-risk HPV test result in addition to cervical cytology. The main outcome was measured using General Health Questionnaire (GHQ-28), Spielberger State-Trait Anxiety Inventory, and Sexual Rating Scale (SRS). Among women with either mildly abnormal or normal cytology, receiving an HPV(+ve) result did not impact significantly on GHQ caseness and mean scores or on Spielberger State and Trait scores when compared with women in whom the HPV(+ve) test result was concealed. Among women with normal cytology, receiving an HPV(+ve) result was associated with a reduction in the Sexual Rating Scale compared with similar women whose HPV(+ve) result was concealed. HPV testing does not add significant psychologic distress when combined with cytology in routine primary cervical screening.

First-Time Fathers’ Study: Psychological Distress in Expectant Fathers During Pregnancy

High levels of distress have previously been reported among expectant fathers, with the level of distress for new fathers falling after the birth and during the first year of their infants' lives. The aim of the present study was to report on the associations with the fathers' initial high levels of distress. The men completed a series of questionnaires on various aspects of their psychological functioning at a baseline assessment when their partners were in the late first trimester of their pregnancy. The General Health Questionnaire-28 (GHQ-28) was the key measure of psychological distress for the present study. Men scoring >5 on the GHQ were considered to be cases of distress. The cases and non-cases were contrasted on the baseline psychosocial measures. A total of 312 men completed the questionnaires, of whom 18.6% were designated as cases. GHQ caseness was associated with high levels of symptoms on other measures of psychological distress, higher levels of alcohol consumption, poorer quality of their current intimate relationship, poorer social support, a lower quality of life, high levels of neuroticism and the use of immature ego defences. Multiple regression analysis identified the key variables associated with psychological distress to be high levels of neuroticism, dissatisfaction with social support and an excess number of additional life events. Psychological distress among expectant fathers is associated with a range of psychological variables, particularly poor marital relationship and poor social networks. This is consistent with a general vulnerability model for psychological distress. Fathers who had insufficient information about pregnancy and childbirth were also at risk of being distressed, suggesting that more attention needs to be paid to providing information to men about their partner's pregnancy, childbirth and issues relating to caring for a newborn infant.

The impact of changes in clinical severity on psychiatric morbidity in patients with psoriasis: a follow-up study

Psoriasis has a strong impact on quality of life and is correlated to psychopathological states. It is important to investigate the effect of clinical changes on psychological status. To analyse the extent of clinical change and its effect on the presence of psychiatric morbidity in a group of patients with psoriasis. All eligible adults hospitalized with psoriasis in a dermatological hospital (February 2000-February 2002) were given the self-administered Psoriasis Area and Severity Index (SAPASI) to assess clinical severity, the 12-item General Health Questionnaire (GHQ-12) to detect patients with psychological problems (defined as 'cases') and the Skindex-29 to evaluate symptoms. The same questionnaires were completed by the patients a month after hospital discharge. In our population of 414 patients, the incidence of GHQ cases becoming noncases was correlated with the SAPASI percentage improvement, ranging from 17.6% in patients with SAPASI worsened or unchanged at follow-up, to 68.2% in patients with clearance of psoriasis. Also, the proportion of patients who became GHQ noncases was much higher in patients with improvement of >/= 50% in symptoms, compared with patients with no improvement or worsening (70% vs. 32%, respectively). In a multivariate model the possible determinants of the passage from GHQ case to noncase were: SAPASI improvement, symptom improvement, no localization on the face, and gender (i.e. women were less likely to improve psychologically). The improvement in clinical severity and symptoms was associated with a decreased frequency of psychiatric disturbance. However, dermatologists should be aware that even in the presence of vast clinical improvement patients may still substantially suffer psychologically.

Quality of life issues in caregivers of youngsters with thalassemia

To assess the contribution of psychiatric problems, concerns regarding the illness to Quality of Life (QOL) in caregivers. Forty four caregivers were screened for psychiatric problems using the General Health Questionnaire 12 item version (GHQ-12) and their concerns and QOL were assessed using the Concerns Checklist and the EQ5D respectively. Clinical psychiatric interview was conducted for those qualifying for GHQ caseness and a psychiatric diagnosis was ascribed. These were correlated with the Childhood Psychopathology Measurement Schedule/ GHQ- 12 scores (as appropriate) and the EQ5D score of the youngster. Fifty seven percent of the caregivers had psychiatric problems, with depressive disorders in 19/44 (45%) QOL was affected in 50% (Pain/ discomfort (n =19, 45%), Mobility (n = 7, 17%), Depression and Usual activities dimensions (n= 6, 14% each). The greatest concerns were regarding the future (91%), illness (80%) and finances (73%). Caregiver support through psychological interventions or medication would alleviate psychiatric problems and concerns and contribute towards a better QOL.