Predictors Of Mental Health Problems Research Articles

Mental health problems among young doctors: an updated review of prospective studies.

Previous studies have shown the medical community to exhibit a relatively high level of certain mental health problems, particularly depression, which may lead to drug abuse and suicide. We reviewed prospective studies published over the past 20 years to investigate the prevalence and predictors of mental health problems in doctors during their first postgraduate years. We selected clinically relevant mental health problems as the outcome measure. We found nine cohort studies that met our selection criteria. Each of them had limitations, notably low response rate at follow-up, small sample size, and/or short observation period. Most studies showed that symptoms of mental health problems, particularly of depression, were highest during the first postgraduate year. They found that individual factors, such as family background, personality traits (neuroticism and self-criticism), and coping by wishful thinking, as well as contextual factors including perceived medical-school stress, perceived overwork, emotional pressure, working in an intensive-care setting, and stress outside of work, were often predictive of mental health problems. The studies revealed somewhat discrepant findings with respect to gender. The implications of these findings are discussed.

Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study.

Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful. To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school. A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year. A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression. Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.

Predictors of delayed social maturation and mental health disorders in young adults chronically ill since childhood

To ascertain the influence of juvenile-onset chronic physical diseases and associating factors of social environment on delayed social maturation and mental health disorders in young adults, we analysed a group of 407 (184 female, 223 male) subjects with these conditions and compared the results with those of 123 (63 female, 60 male) healthy controls studied at the age of 19 ?25 years. The social maturation index was formed on the basis of a demographic interview, which also reviewed the state of social development and the family situation during childhood. Mental health disorders were assessed with a Present State Examination (PSE) interview analysed with the CATEGO program. With regard to social maturation at least half of the patients and controls were doing well, whereas for 29% (CI95, 25%?33%) of the patients and 17% (CI95, 10%? 24%) of the controls the index showed delayed maturation. Subjects with poor social maturation were found most often among the disabled patients but also among the patients without severe diseases. The prevalence of PSE-CATEGO-identified psychiatric syndromes was equal in the patients and the controls (22% versus 20%). However, the patients with severe or disabling diseases had more severe psychiatric syndromes. The prevalences of depressive syndromes were also equal, but the depression of the patients was more often a profound affective disorder. Male sex, poor scholastic and vocational success, and social problems in the family during childhood were significantly associated with poor social maturation. On the other hand, the most significant predictors of mental health problems in young adults were female sex, family distress during childhood, and a severe disease. Juvenile-onset physical disease was considered to delay social maturation in some subjects and to deepen or modulate the clinical picture of mental health disorders. It is concluded that juvenile-onset physical diseases combined with family-related factors affect in different ways the social growth and psychiatric well-being. The results suggest that the subjects with chronic diseases during childhood should be thoroughly assessed by a child psychiatrist to evaluate the orientation of psychological development and the impact of the child's disease on the family and to ensure balanced psychological and social growth.

The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study.

Previous studies have shown that physicians have an increased risk of mental health problems such as depression, suicide and substance abuse. To study the prevalence of mental health problems during the first postgraduate year, and to investigate whether work-related factors in hospital are linked to these, when we control for gender, previous mental health problems, personality traits, stress in medical school and other possible predictors. Nationwide and prospective postal questionnaire survey. University of Oslo. Medical students who answered questionnaires in their graduating semester, and 1 year later when they were junior house officers (n=371). Mental health problems (needing treatment) during internship were reported by 11%, with no gender difference. Adjusted predictors of mental health problems were: previous mental health problems, (odds ratio (OR)=5.1, 95% confidence interval (CI) 1.7 to 15.8); being married/cohabitant (OR=0.2, CI 0.1 to 0.7); the personality trait 'vulnerability' (OR=1.5, CI 1.1 to 2.0); negative life events during internship (OR=2.1, CI 1.2 to 3.5), and job stress as house officer (OR=1.05, CI 1.01 to 1.10). The job stress factor of emotional pressure/demands from patients was most important. Perceived study stress and lack of skills at the end of medical school were univariately related to mental health problems in internship, but not when other variables were adjusted. Gender, weekly working hours and lack of sleep were not linked to having problems. Job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled for. More support during internship is needed.

Mothers' Mental Illness and Child Behavior Problems: Cause-Effect Association or Observation Bias?

A number of studies have consistently found that a mother's mental health (particularly her level of depression) is a strong predictor of mental health problems experienced by her child(ren). However, the validity of this finding is in doubt because the majority of these studies have relied on maternal reports as indicators of children's behavior. This prospective, longitudinal study examines data on the mental health of the mother from prior to the birth of her child to when the child reaches 14 years of age. Child behavior is measured at 14 years of age using reports from mother and child. Mother and child responses are compared to provide an indication of the possible magnitude of maternal observation bias in the reporting of child behavior problems. Anxious and/or depressed mothers tend to report more cases of child behavior problems than do their mentally healthy counterparts or children themselves. Differences between mothers and youths in reporting behavior problems appear to be related to the mothers' mental health. Current maternal mental health impairment appears to have a substantial effect on the reporting of child behavior problems by the mother, thereby raising questions about the validity of reports of child behavior by persons who are currently emotionally distressed.

Measuring Neighborhood and School Environments Perceptual and Aggregate Approaches

This paper describes scales measuring perceptions of neighborhood and school quality. The scales are short and easy to administer, and easily understood by respondents. The measure of neighborhood quality (the NegNeb) has high reliability (alpha = .81), correlates with census data, shows sensitivity to change in neighborhood quality, and discriminates among urban neighborhoods. The measure of school quality (the NegEd) correlates to an index of aggregate school problems. Theories posit that the impact of environment on mental health is determined by perception of that environment. A regression model controlling for family and other characteristics showed that perception of neighborhood (as measured by the NegNeb) contributed unique variance to adolescent mental health. Perception of school did not. However, a second regression model showed that perception of school environment contributed unique variance to peer misbehavior, which was the largest predictor of mental health problems in the first equation. In each regression model aggregate measures of neighborhood and school quality contributed less to the model than did perceived measures. Because adolescents' perceptions of their neighborhood and school environments are clearly linked to their mental health and peer environment, researchers interested in effects of neighborhood and school environment should use subjects' perceptions to conceptualize and measure these realities.

Bereavement and grief in adults with learning disabilities

This paper reports on the follow-up of a cohort of parentally bereaved adults with learning disabilities. To investigate whether significant psychopathology, present up to 2.1 years after the death, had resolved five years later. Of an original sample of 50 adults with learning disabilities, 41 were reassessed. The Aberrant Behaviour Checklist and the Psychopathology Instrument for Mentally Retarded Adults were re-administered to carers. At follow-up, there was a small increase in the measures of aberrant behaviour. Measures of psychopathology showed improvement, and in particular there was a reduction in anxiety. The response to bereavement by adults with learning disabilities is similar in type, though not in expression, to that of the general population. Learning disability is a significant predictor of mental health problems following bereavement. Participants adapted more easily when basic emotional needs had been constructively met by carers.

HEALTH PROBLEMS OF LOW-INCOME FEMALE CAREGIVERS OF ADULTS WITH HIV/AIDS

The purpose of this study was (a) to determine the mental and physical health status of low-income urban women who were providing informal home care to adults with HIV/AIDS, (b) to discover the best predictors of physical and mental health problems in the caregivers, and (c) to make recommendations for nursing interventions to assist these caregivers. The study was based on a conceptualization of female caregivers as a population vulnerable to increased morbidity. Personal interviews were conducted with caregivers ( n = 36) of adults with HIV/AIDS who were attending HIV clinics in public hospitals. Caregivers had significant physical and mental health problems and experienced loneliness, loss, anger, isolation, and stigma. Caregiver distress over care receiver memory and behavior problems, anxiety, and lack of knowledge about AIDS were the best predictors of mental health problems. Caregiver depression, anger, and the number of care receiver illness symptoms were the best predictors of physical health problems.

Sex, Marital Status, and Mental Health: A Reappraisal

Previous research (cf. Gove) has suggested that the higher rates of mental illness among females may be due to the greater stress associated with the marital role for women in our society. Using data (N = 3674) gathered as part of a major epidemiologic study in the southeastern United States, the authors examine the relationships between Health Opinion Survey scores (a widely used psychiatric assessment instrument), marital status, marital history, length of marital status, and several sociodemographic variables. As anticipated, higher scores for females across race and in most marital statuses were found. But when data were analyzed via multiple regression which controlled for sociodemographic and marital status factors, it was found that low socioeconomic status (SES) was the strongest predictor of high scores. Being female was also significant. The only significant marital status variable in the equation was being separated. Persons who had been married more than once also had significantly elevated scores. Marital status, length of present status, and history of previous marital statuses were not powerful predictors of mental health problems: most of the explained variance was subsumed by sociodemographic variables. The authors conclude that the disproportionately high rates of mental illness among females cannot be accounted for by marital status and its incumbent stresses and suggest that other explanations need to be explored. The relationship between sex roles, marital status, and mental illness has received recently an increasing amount of attention in the social science and psychiatric literature (Brodsky: Clancy and Gove; Cooperstock; Gittleman-Klein and Klein: Gove; Gove and Tudor; Overall; Pokorny and Overall; Redick; Rosen et al.)1 Findings from these and other studies indicate that females in our society have higher rates of mental illness than males and/or that they more often seek treatment for problems related to psychiatric distress. The reasons for these differential rates have not been definitively established although a number of hypotheses have been offered. For example, Phillips and Segal have argued that the higher rates for females are due to methodological factors associated with response biases, e. g., naysaying and social desirability, a position refuted by Clancy and Gove. Gurin et al. have suggested the higher rates for females result from their finding marriage less satisfying than males. Others have contended that role strain, particularly as engendered by the changing status of females in industrial societies, produces ambiguous *This research was made possible by MH Grant No. 24740-01.