Mental Health Inventory Score Research Articles

COVID-19 and long-term impact on symptoms and Health-Related Quality of Life in Costa Rica: the RESPIRA cohort study

BackgroundEvidence continues to accumulate regarding the potential long-term health consequences of COVID-19 in the population. To distinguish between COVID-19-related symptoms and health limitations from those caused by other conditions, it is essential to compare cases with community controls using prospective data ensuring case-control status. The RESPIRA study addresses this need by investigating the lasting impact of COVID-19 on Health-related Quality of Life (HRQoL) and symptomatology in a population-based cohort in Costa Rica, thereby providing a robust framework for controlling HRQoL and symptoms.MethodsThe study comprised 641 PCR-confirmed, unvaccinated cases of COVID-19 and 947 matched population-based controls. Infection was confirmed using antibody tests on enrollment serum samples and symptoms were monitored monthly for 6 months post-enrolment. Administered at the 6-month visit (occurring between 6- and 2-months post-diagnosis for cases and 6 months after enrollment for controls), HRQoL and Self-Perceived Health Change were assessed using the SF-36, while brain fog, using three items from the Mental Health Inventory (MHI). Regression models were utilized to analyze SF-36, MHI scores, and Self-Perceived Health Change, adjusted for case/control status, severity (mild case, moderate case, hospitalized) and additional independent variables. Sensitivity analyses confirmed the robustness of the findings.ResultsCases showed significantly higher prevalences of joint pain, chest tightness, and skin manifestations, that stabilized at higher frequencies from the fourth month post-diagnosis onwards (2.0%, 1.2%, and 0.8% respectively) compared to controls (0.9%, 0.4%, 0.2% respectively). Cases also exhibited significantly lower HRQoL than controls across all dimensions in the fully adjusted model, with a 12.4 percentage-point difference [95%CI: 9.4-14.6], in self-reported health compared to one year prior. Cases reported 8.0% [95%CI: 4.2, 11.5] more physical limitations, 7.3% [95%CI: 3.5, 10.5] increased lack of vitality, and 6.0% [95%CI: 2.4, 9.0] more brain fog compared to controls with similar characteristics. Undiagnosed cases detected with antibody tests among controls had HRQoL comparable to antibody negative controls. Differences were more pronounced in individuals with moderate or severe disease and among women.ConclusionsPCR-confirmed unvaccinated cases experienced prolonged HRQoL reductions 6 months to 2 years after diagnosis, this was particularly the case in severe cases and among women. Mildly symptomatic cases showed no significant long-term sequelae.

Pilot Randomized Controlled Trial of Multi-Disciplinary Community-Based Biofeedback Vs Health Promotion Programs on Mental Health And Drug Use Among People Experiencing Homelessness

Background: PEH are most vulnerable to COVID-19 due to high levels of chronic disease and social isolation. However, in Skid Row Los Angeles, there are limited resources for mental health and drug treatment services. Biofeedback (BF) has been found to decrease depression and substance use among drug users; however, no studies have assessed the impact of BF on PEH during the COVID-19 pandemic.
 Aim: Our multi-disciplinary team designed and pilot tested an 8-week Heart Rate Variability-Biofeedback (HRV-BF) intervention, utilizing a nurse-led, Community Health Worker model of care with 50 people experiencing homelessness (PEH) as compared with a Health Promotion (HP) program. Our goal was to establish feasibility of the program, and to assess effects HRV-BF on measures of HRV, mental health and drug use as compared to HP.
 Methods: Utilizing Community Based Participatory Research (CBPR) principles, a community advisory board was established to refine the HRV-BF intervention and assess acceptability and feasibility. We enrolled 40 PEH and randomized into HRV-BF vs HP program and assessed a) impact on anxiety and depression; b) HRV and cortisol indices; and c) drug and alcohol use among all participants.
 Results: In total, 40 PEH were enrolled with 36 completing the intervention; 17 HRV-BF and 19 HP. Majority were male (80%) and were equally Black (37.5%) or Hispanic (35%). The mean age of PEH was 49 (SD 16.7), median age 53. The HRV measure RMSSD (root mean square of successive differences between normal heart beats, a time-based variable reflecting vagally mediated HRV), assessed during the resting 5-minute period, showed significant increases in 71% of participants (75% among HRV-BF and 68% among HP), using paired t-tests with natural log transformed variables, p=0.004, and by non-parametric tests, p= 0.006 (p values one-sided). Across the sample, PHQ-9 (depressive symptoms) showed marginally significant improvement (p= 0.09). Anxiety and Mental Health Inventory scores showed improvement, though not significant. Between-group analysis showed the HRV-BF group had better GAD-7 and MHI scores at 8 weeks (post-intervention), though not statistically significant. Chronic disease was found to be high in both groups (67% among HRV-BF and 82% among HP). No significant differences were found in terms of substance use.
 Conclusions: As the first known study to date examining the role of a biofeedback self-regulation training on biomarkers of stress/mental health measures among PEH, our study shows feasibility and acceptability among the study population and positive initial results for both arms of the study. We plan to extend the follow-up period beyond the intervention period of 8 weeks to establish the sustainability of the intervention.
 Funding: Susan Samueli Integrative Health Institute Pilot Studies Award

Psychiatric Symptoms and Fatigue in COVID-19 Survivors.

Psychiatric symptoms and fatigue are common after the coronavirus disease 2019 (COVID-19) illness. The cause of these symptoms is direct neuronal injury and indirect injury with immune-mediated inflammation. In addition, social factors also affect mental health. We aim to compare psychiatric symptoms and fatigue between COVID-19 survivors and healthy controls. We prospectively evaluated 100 COVID-19 survivors for anxiety, depression, positive affect, andbehavior control using the Mental Health Inventory (MHI). Fatigue is assessed using the Modified Fatigue Impact Scale (MFIS) score. We compared them with 100 healthy controls. There was a significant statistical difference between the MHI score and individual components of MHI. Overall, MHI scores in cases and controls were 79.41 and 93.31, respectively, with a P value of less than 0.0001. Computed scores for anxiety, depression, behavior control, and positive affect of COVID-19 survivors showed statistically significant differences as compared to healthy controls.There was a weak association between hospital stay duration and poor MHI scores. Fatigue was significantly worse in COVID-19 survivors, with a mean score of 6.93 in cases and 5.35 in controls, with a P value of 0.0001. This was a cross-sectional study evaluating psychiatric symptom scores, but not establishing the diagnosis. It is suggested that appropriate treatment and counseling for these symptoms should be done. Psychiatric symptoms and fatigue were significantly more common in COVID-19 patients after recovery from acute illness. It is a major contributing cause of morbidity other than organic complications of COVID-19 and requiresattention in management.

Trends in mental health inequalities for people with disability, Australia 2003 to 2020.

Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities. We use annual data (2003-2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened. This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations.

Association of serum homocysteine, folate, and vitamin B12 and mood following the Swank and Wahls elimination dietary interventions in relapsing-remitting multiple sclerosis: Secondary analysis of the WAVES trial.

Depression and anxiety are common psychiatric comorbidities among people with multiple sclerosis (MS). Emerging data suggest abnormal serum homocysteine, vitamin B12, and folate levels in people with MS, which are related to a range of neurological disorders, including mood and mental illnesses. Evidence suggests that dietary interventions could affect mood disorders via several pathways. This study aimed to evaluate the impact of the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls) diets, along with a supplement regimen, on mood as assessed by Hospital Anxiety and Depression Scale (HADS), and Mental Health Inventory (MHI). The secondary objective was to identify changes in serum levels of homocysteine, folate, and vitamin B12 and the association and mediation effects between their changes and HADS and MHI scores and their subscales among people with relapsing-remitting MS (RRMS). In a previously conducted randomized parallel-arm trial, participants with RRMS (n=77) were randomly allocated to either the Swank or Wahls diets at baseline and followed for 24 weeks. Blood was drawn at four study visits spaced 12 weeks apart: (1) run-in, (2) baseline, (3) 12 weeks, and (4) 24 weeks. Serum vitamin B12, folate, and homocysteine were analyzed. HADS and MHI questionnaires were also completed by participants at the four study visits to assess symptoms of depression and anxiety, behavioral control and positive affect respectively. Significant improvement in severity of depression (HADS-D) and anxiety (HADS-A) symptoms, MHI total, and MHI subscores were seen at 12 and 24 weeks in each diet group. Further, a significant within-group reduction in serum homocysteine and a significant increase in serum vitamin B12 level were observed in both groups at 12 and 24 weeks compared to corresponding baseline values (p≤0.05 for all). All participants exceeded the analytical maximum threshold for folate of 20nmol/L at 12 and 24 weeks. Changes in serum levels of homocysteine and vitamin B12 were not associated with and did not mediate changes in HADS depression, anxiety, MHI total and four subscales scores (p>0.05). Participants on both Swank and Wahls dietary interventions, including folate and vitamin B12 supplements, showed significant improvement in mood. However, the favorable effects of both diets on mood were not associated with or mediated by the effect of the diets on serum levels of homocysteine, folate, and vitamin B12 (p>0.05).

Depression and Subsequent Risk for Incident Rheumatoid Arthritis Among Women.

To investigate the association of depression with subsequent risk of rheumatoid arthritis (RA) by serologic phenotype. We performed a cohort study using pooled data from the Nurses' Health Study (NHS; 1992-2014) and the NHSII (1993-2015). Depression was defined according to the following composite definition: diagnosis by clinician, regular antidepressant use, or a 5-question Mental Health Inventory score of <60 using time-updated questionnaires during follow-up. Incident RA cases met research criteria by medical record review. Information on covariates, including smoking, diet, and body mass index, was obtained using questionnaires. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for RA risk (overall and by serologic phenotype) according to depression status and adjusted for potential confounders. All analyses included a time separation between assessments of depression and the window for RA risk of at least 4 years to lower the possibility that depressive symptoms due to early RA prior to diagnosis explained any associations. Among 195,358 women, we identified 858 cases of incident RA (65% seropositive) over 3,087,556 person-years (median 17.9 years per participant). Compared to women without depression, those with depression had multivariable HRs as follows: 1.28 (95% CI 1.10-1.48) for all RA; 1.12 (95% CI 0.93-1.35) for seropositive RA; and 1.63 (95% CI 1.27-2.09) for seronegative RA. When analyzing components of the composite depression exposure variable, regular antidepressant use was not associated with subsequent seropositive RA (HR 1.21 [95% CI 0.97-1.49]) and was associated with seronegative RA (HR 1.75 [95% CI 1.32-2.32]). Indicators of depression, specifically antidepressant use, were associated with subsequent increased risk for seronegative RA, and this finding was not explained by measured lifestyle factors prior to clinical presentation.

Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?

As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient-caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer. One hundred patients, aged ≥65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI). Patient-caregiver assessments were compared using the Wilcoxon signed rank test and paired t test. Association between caregiver burden and differences between patient-caregiver assessments was examined using generalized linear regression. Median patient age was 70 (range 65-91) and 70% had advanced disease. Sixty percent of patients reported requiring help with instrumental activities of daily living (IADLs); most had good social support (median Medical Outcomes Study [MOS]-Social Support Survey score 92) and mental health (median Mental Health Inventory score 85).Caregivers were a median age of 66 (range 28-85), 73% female, 68% spousal caregivers, and 79% lived with the patient. Caregivers rated patients as having poorer physical function (more IADLs dependency [p = .008], lower Karnofsky Performance Status [p = .02], lower MOS-Physical Function [p < .0001]), poorer mental health (p = .0002), and having more social support (p = .03) than patients themselves. Three-quarters of caregivers experienced some caregiver burden (mean CSI score 3.1). Only differences in patient-caregiver assessment of the patient's need for help with IADLs were associated with increased caregiver burden (p = .03). Patient-caregiver assessments of patient function, mental health, and social support differ. However, only differences in assessment of IADLs dependency were associated with increased caregiver burden. As patients age, there is a higher incidence of frailty and cognitive impairments. As a result, caregivers play an increasingly vital role in providing information about patient health to healthcare providers, which is used to help healthcare providers tailor treatments and optimize patient health. These findings highlight that caregiver reporting in older adults with cancer may not replace patient reporting in those older adults who are otherwise able to self-report. Furthermore, clinicians should check for caregiver burden in caregivers who report providing more help with instrumental activities of daily living than patients themselves report and provide appropriate support as needed.

Time Spent Commuting to Work and Mental Health: Evidence From 13 Waves of an Australian Cohort Study

Time-related stressors, such as long working hours, are recognized as being detrimental to health. We considered whether time spent commuting to work was a risk factor for poor mental health. Data from the Household, Income Labour Dynamics in Australia Survey were used to conduct fixed-effects longitudinal regression analyses. The outcome variable was the Mental Health Inventory, and the main exposure represented hours per week traveling to and from a place of paid employment. Effect modifiers included sex, low job control, high demands, and low job security. Compared with when a person commuted for ≤2 hours per week, there was a small decline (coefficient=-0.33, 95% CI: -0.62, -0.04; P=0.025) in the Mental Health Inventory score when they commuted for over 6 hours per week. Compared with persons with high job control, persons working in jobs with low job control experienced significantly greater declines in the Mental Health Inventory score when commuting 4 to 6 hours per week and when commuting over 6 hours per week. We found no influence from the other hypothesized effect modifiers. These results suggest the importance of considering commuting time as an additional work-related time stressor.

Improving mental health through the regeneration of deprived neighbourhoods: a prospective controlled quasi-experimental study

BackgroundPolicy makers often target deprived neighbourhoods for regeneration with the expectation that population health will improve, since housing and neighbourhoods of low quality, as well as the social and economic determinants of poor health, are concentrated in the most deprived areas. Our aim was to examine the effects of Communities First, a Welsh Assembly Government community-led programme of neighbourhood regeneration targeted at the 100 most deprived electoral wards in Wales on mental health. MethodsInformation on Communities First regeneration activities in 35 intervention lower super output areas (LSOAs) (n=4197) and 75 control LSOAs (6695) were linked to data from the eCATALyST study, a prospective cohort study, in 2001 (before regeneration) and 2008 (after regeneration) within the Secure Anonymised Information Linkage (SAIL) databank. Communities First was delivered through multiagency partnership boards in all 22 local authorities. Boards worked with residents to identify and secure funding for regeneration activities. The primary outcome was the change in Mental Health Inventory (MHI) score (a population-based measure of anxiety and depressive symptoms) between 2001 and 2008 recorded in eCATALyST. We examined the changes in mental health in intervention LSOAs compared with control LSOAs using propensity score matching (1:1 ratio) to balance the level of socioeconomic disadvantage across groups. Sensitivity analysis examined the impact of length of residence in an intervention area and six types of regeneration activity. Findings1500 regeneration projects were funded from 2001 to 2008. Before regeneration, mental health was worse in the intervention than in the control group (mean MHI score 66·6, SD 22·3 vs 71·0, SD 20·8). After propensity score matching, regeneration was associated with an improvement in the mental health of intervention compared with control group residents (β=1·54, 95% CI 0·50–2·59), suggesting that inequalities in mental health narrowed. We found evidence of a dose–response association between length of residence and improvements in mental health (ptrend=0·05). We could not attribute improvements to any one type of regeneration activity. InterpretationTargeted regeneration directed by the residents of deprived urban communities can help reduce inequalities in mental health. FundingThis study was funded by a grant from the National Institute for Social Care and Health Research (RFS-12-05) and undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (MR/KO232331/1) and the Farr Institute of Health Informatics Research.

Effects of a peer-assisted tai-chi-qigong programme on social isolation and psychological wellbeing in Chinese hidden elders: a pilot randomised controlled trial

BackgroundThe term hidden elder is used in Chinese society to describe older adults who are socially isolated and refuse social participation. Substantial evidence has indicated the important role of social isolation in increasing psychiatric morbidity and mortality risks in later life. Innovative service is promptly needed to address the social and psychological health needs of hidden elders. We aimed to test the feasibility and the preliminary effectiveness of a peer-assisted tai-chi-qigong programme in strengthening social networks and enhancing psychosocial wellbeing of Chinese hidden elders. MethodsThis randomised controlled trial recruited 46 people aged 60 years or older who did not engage in any social activities, through the social network of two community centres in Hong Kong. Participants were randomised to receive either peer-assisted tai-chi-qigong (n=24) or usual care (n=22) with computer-generated random codes. In the 3-month tai-chi-qigong programme, participants practiced two 60-min sessions each week, during which they were paired up with socially active older adults. Both groups received usual care, which included regular home visits by social workers. The primary outcome was social network using the Lubben social network scale-6 (LSNS-6). Secondary outcomes were De Jong Gieveld loneliness scale score, SF-12 quality of life score, and mental health inventory score. Data were collected at baseline and 3 months thereafter. We used a generalised estimating equations model for intention-to-treat analysis. Ethics approval was obtained from the Joint Clinical Research Ethics Committee of the Chinese University of Hong Kong and New Territory East Cluster. Written informed consent was obtained from every eligible person. Trial registration number CUHK_CCRB00489. FindingsThe improvement in the primary outcome, LSNS-6, did not differ significantly between the groups (regression coefficient of group by time interaction B=0·76, 95% CI −1·39 to 2·92, p=0·487; Cohen's d effect size 0·304). Participants who received the peer-assisted tai-chi-qigong programme generally showed better improvement in outcomes than the control group. With support from peer elders, the compliance rate of elders participating in tai-chi-qigong was 71% (ranged from 66–100%). InterpretationThis pilot study showed that peer-assisted tai-chi-qigong is a feasible social intervention for hidden elders. A full-scale trial is needed to assess the possible benefits for social and physical health. FundingThis study was funded by the School Seeding Fund, the Nethersole School of Nursing, the Chinese University of Hong Kong.

Screening for overall mental health status using mental health inventory amongst medical students of a government medical college in North Karnataka, India

Background: In developing countries like India, seeking mental health care is still a taboo, and a lot of stigma is attached to consulting a psychiatric specialist or a counselor. This problem magnifies when budding doctors have a mental health issue. Objective of the study was to assess the overall mental health status of undergraduate medical students studying in a Government Medical College of North Karnataka by using the mental health inventory (MHI) questionnaire. Methods: A cross-sectional study was carried out during the period of July to September 2016 amongst 210 undergraduate medical students at Government Medical College, Koppal, Karnataka by administer a standard 18 items MHI questionnaire. The raw MHI scores (0-6) and computed MHI scores (0-100) were calculated for overall and four subscales (i.e. anxiety, depression, behavioural control, and positive affect) were also calculated. Results: Out of total 210 study participants, 119 (56.67%) were male and 91 (43.33%) female students. The overall computed MHI scores (0-100) total score ranges from 58-74, mean score 63.5, median 64.43 and a standard deviation of 4.01. However, computed MHI (0-100) scores for subgroups like anxiety ranged from 8 to 60, mean score 47.36, depression ranged from 8 to 84, mean score 50.29, behavior control ranged from 30 to 85, mean score 67.76, and positive affect ranged from 25 to 100, mean score 42.7. Conclusions: Poor mental health and presence of some emotional health problems among medical students is substantially high. Early screening, diagnosis, care and support should be made available to all the medical students.

Risk of depression in women with psoriasis: a cohort study.

Psoriasis is a common, chronic and inflammatory disease of the skin, which has been associated with depression in cross-sectional studies with limited adjustment for confounders. In this prospective cohort study, we investigated the risk of incident depression among individuals with psoriasis and psoriatic arthritis (PsA). We included 50 750 US female nurses from the Nurses' Health Study who were free of depression at baseline in 2000. Those participants who had ever self-reported clinician-diagnosed depression or regular use of antidepressants, or had a Mental Health Inventory score of ≤ 52 were excluded. In 2008, we retrospectively asked participants if they had ever received a physician's diagnosis of psoriasis or PsA. We defined depression as self-report of clinician-diagnosed depression or regular use of antidepressant medication. Time-dependent Cox proportional hazard models were used to estimate age and multivariate-adjusted relative risks (RRs) of clinical depression. After adjusting for covariates including body mass index, physical activity, smoking and the presence of major chronic conditions, the multivariate-adjusted RRs of clinical depression were 1·29 [95% confidence interval (CI) 1·10-1·52] for women with psoriasis and 1·52 (95% CI 1·06-2·19) for women with psoriasis and concomitant PsA, compared with women without psoriasis. We found an increased risk of depression in US women with psoriasis compared with those without psoriasis. This risk was higher in those who reported concomitant PsA. Future studies are needed to confirm these findings in other populations and to identify pathophysiological mechanisms linking psoriasis to depression.

Symptom Burden and Comorbidities Impact the Consistency of Responses on Patient-Reported Functional Outcomes

ObjectiveTo assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs). DesignTwo data sources were used. The first, a cross-sectional database of patients with breast cancer who completed functional PROs and were administered the FIM, was used to examine whether average pain intensity (as measured with an 11-point numeric rating scale [NRS]) and Rand Mental Health inventory scores differed among those rating their functional independence as different than clinicians. The second, a longitudinal database of 311 adults with late-stage lung cancer who completed the Activity Measure for Post Acute Care Computer Adaptive Test (AM PAC CAT) with differences between their expected and actual responses as reflected in their AM PAC CAT SEs. SettingTwo tertiary medical centers. ParticipantsData source #1, 163 women with stage IV breast cancer; data source #2, 311 adults with late-stage lung cancer. InterventionsNot applicable. Main Outcome MeasuresData source #1, FIM, pain NRS, Older Americans Resource Study activities of daily living subscale, Physical Function-10, Mental Health Inventory-17. Data source #2, AM PAC CAT and NRS symptom ratings. ResultsPain intensity was significantly higher when clinicians and patients disagreed regarding a patient's independence in the ability to transfer (NRS pain severity, 3.78 vs 2.40; P=.014), groom (3.71 vs 2.36, P=.009), bathe (3.76 vs 2.40, P=.016), and dress (3.09 vs 2.44, P=.034). The magnitude of AM PAC CAT SEs was significantly associated with the severity of participants' pain, dyspnea, and fatigue, as well as the presence of musculoskeletal disorders and coronary artery disease. Neither mood nor emotional distress was associated with clinician-patient agreement or AM PAC CAT SE. ConclusionsPain intensity is associated with disagreement between patients and clinicians about the patient's level of functioning. Moreover, physical symptoms (pain, dyspnea, fatigue) as well as specific medical comorbidities (musculoskeletal disorders, coronary artery disease), but not mood, are associated with inconsistency in patients' assessment of their functional abilities.

Community‐based epidemiological study of psychosocial effects of acne in Japanese adolescents

In this community-based cross-sectional study, 1443 Japanese adolescents aged 13-19 years participated from two schools in Kagawa Prefecture. Students completed a self-administered questionnaire to assess the prevalence of acne, knowledge about acne, self-management of acne and emotional well-being. A five-item version of the Mental Health Inventory (MHI) subscale of the Short Form 36 was used to assess psychological health and depression status. Among respondents, 859 (59.5%) said they had acne (51.6% of the boys and 64.8% of the girls). A majority (56.8%) of those who said they had acne also reported a family history of acne. Of the 555 female respondents with acne, 39.1% reported experiencing acne flares in temporal proximity to menstruation. Less than half (38.8%) of respondents with acne had sought or were seeking treatment. The three most common factors believed to trigger or exacerbate acne were stress, lack of sleep and sweat. The mean MHI score of 847 students with acne was significantly lower than 475 students without acne. The mean MHI score of female students with acne was significantly lower than male students with acne. Students with acne were also significantly more depressed than those without acne and female students were significantly more depressed than male students. Acne is a common problem for Japanese teenagers and causes personal and social difficulties. Our results suggest the necessity of educational programs in school or public to ensure that adolescents are aware of acne and to encourage young people to improve their mental health through better acne treatment.

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

Purpose People with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders. Methods Eight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise ( n = 7) or usual care (control) ( n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM. Results The exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score ( p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score ( r = 0.8, p = 0.009) as was reduction in depressive symptoms ( r = −0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise ( r = −0.93, p = 0.02). Conclusions A 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.

Depressive Symptoms Increase the Incidence of Nocturia: Tampere Aging Male Urologic Study (TAMUS)

We assessed the effects of depressive symptoms on the incidence of nocturia in men. The target population comprised all men who were 50, 60 or 70 years old and residing in the Tampere area in 1994. A self-administered questionnaire was mailed to 3,143 randomly selected men in 1994 and a second round was mailed to the 2,837 who were alive and eligible in 1999. The followup sample consisted of 1,580 men with information on nocturia available at baseline and followup. The incidence of mild to severe nocturia was 75 cases per 1,000 person-years (95% CI 66-85) and that of moderate or severe nocturia was 9 (95% CI 7-11). Men with depressive symptoms at study entry were at 2.8 times higher risk (95% CI 1.5-5.2) for moderate or severe nocturia than those without depressive symptoms. A dose response relation was found between the severity of depressive symptoms at baseline and the incidence of moderate or severe nocturia. Each unit increment in the short form of the Mental Health Inventory score on a scale of 5 to 30 increased the incidence rate ratio of moderate or severe nocturia by 10% (95% CI 4-16). Only untreated depressive symptoms increased the incidence of moderate or severe nocturia (adjusted RR 3.3, 95% CI 1.7-6.2) but not medically treated symptoms. Nocturia at study entry had no significant effect on depressive symptoms during followup. Our findings show a unidirectional effect of depressive symptoms on the incidence of moderate or severe nocturia. Untreated depressive symptoms may cause nocturia.

Telemedicine as a means of delivering cognitive-behavioural therapy to rural and remote mental health clients

We explored the feasibility and acceptability of delivering cognitive-behavioural therapy (CBT) via videoconference to clients with depression and/or anxiety living in rural north Queensland. The study involved 15 mental health clients and their five case managers. First, each case manager was instructed in the use of telemedicine for clinical consultation, and given training in CBT. This was done via videoconference. Then the clients were introduced to telemedicine. Following six to eight intensive weekly sessions of CBT, there was improvement in certain clinical outcome measures (i.e. the Mental Health Inventory and the Health of the Nation Outcome Scale). There was a significant improvement (P<0.05 using a t-test) in the client Mental Health Inventory scores before (mean = 109) and after treatment (mean = 148). However, in the absence of a control condition, it was not possible to conclude that the treatment had a specific effect on the disorders studied. Both clients and case managers found telemedicine consultations acceptable. Clients' ratings ranged from 3 to 4.5, while case mangers' ratings ranged from 3 to 5 ('average' to 'much better than average').

Pregnancy outcomes after prenatal diagnosis of aneuploidy

Objective: To determine the benefits of antenatal diagnoses of fetal aneuploidy in women who continued their pregnancies. Methods: A questionnaire was mailed to 51 mothers of children with aneuploidy. Women whose fetuses were diagnosed prenatally comprised the study group and those whose infants were diagnosed at birth were controls. Outcomes measured included an assessment of pregnancy management, neonatal outcome, subjective measures of depression and anxiety, and evaluation of women’s emotional and physical experience of the pregnancy. For outcomes measured by nonparametric survey questions, 20 women were needed in each arm to achieve a power of 80% to detect a 2-point difference on a 6-point scale; for our neonatal outcomes, 100 women were needed in each arm to achieve 80% power to detect a difference in length of stay (less than 1 week versus greater than 1 week) or need for surgery. Results: Thirty-eight women (75%) responded. Most (86%) had children with trisomy 21. Seventeen women (45%) received their child’s diagnosis at birth; 21 (55%) had prenatal diagnoses. Demographic measures were similar except that women with prenatal diagnoses attended religious services more frequently (1–3 times per month versus once to several times per year, P = .04). Women with prenatal diagnosis had better perceptions of their physical experience of pregnancy (median score of 10 versus 6 on a 10-point visual analog scale, P = .005) and their emotional experience of the birth (median score of 7.5 versus 2, P = .001). Mental Health Inventory scores were similar between groups. Neonates without prenatal diagnoses were more likely to be transferred to tertiary centers after birth (70% versus 24%, P = .004); lengths of hospital stays and need for surgery were similar. Seventy-one percent (95% confidence interval [CI] 48, 89%) of women with prenatal diagnoses said they would have done nothing differently in the pregnancy compared with 29% (95% CI 10, 56%) of women with diagnoses at birth. Conclusion: Early knowledge of fetal aneuploidy is beneficial to women who continue their pregnancies. These results might be useful when counseling women who do not intend to terminate abnormal pregnancies, but are considering prenatal diagnosis.

Recovery following acute exacerbations of multiple sclerosis: from impairment to quality of life.

To observe the pattern of recovery after treatment with intravenous Methylprednisolone (i.v. MP) for a relapse of multiple sclerosis (MS), and to determine the best time to plan further interventions such as rehabilitation, we assessed consecutive outpatients (n = 24) treated with i.v. MP for a relapse over a period of 12 weeks. Outcomes measures used were the Expanded Disability Status Scale (EDSS), the Incapacity Status Scale (ISS), the MOS Short Form-36 (SF-36), the Mental Health Inventory (MHI), and the MS-Related Symptom Checklist (MSSCL). There was statistically significant early improvement of EDSS and ISS scores, which was sustained until week 12, and significant improvement of MHI and MSSCL scores between 4 and 12 weeks. Although trends for improvement of scores reflecting the same pattern of recovery were observed with the SF-36 physical and mental composites, these changes did not reach statistical significance. Our results suggest that improvement of impairments and disability after treatment with i.v. MP for a relapse of MS occurs early, while improvement of subjective health status is delayed. Even after maximum improvement is reached, patients are left with multiple symptoms and functional limitations, and may benefit from additional rehabilitative interventions.