Predictors Of Poor Mental Health Research Articles

Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry - the contribution of functional brain imaging.

BackgroundChildhood maltreatment is a potent predictor of poor mental health across the life span. We argue that there is a need to improve the understanding of the mechanisms that confer psychiatric vulnerability following maltreatment, if we are to progress from simply treating those with a manifest disorder, to developing effective preventative approaches that can help offset the likelihood that such disorders will emerge in the first place.MethodsWe review extant functional neuroimaging studies of children and adolescents exposed to early neglect and/or maltreatment, including physical, sexual and emotional abuse across four neurocognitive domains: threat processing, reward processing, emotion regulation and executive control. Findings are discussed in the context of ‘latent vulnerability’, where alterations in neurocognitive function are considered to carry adaptive value in early adverse caregiving environments but confer long‐term risk.ResultsStudies on threat processing indicate heightened as well as depressed neural responsiveness in maltreated samples, particularly in the amygdala, thought to reflect threat hypervigilance and avoidance respectively. Studies on reward processing generally report blunted neural response to anticipation and receipt of rewards, particularly in the striatum, patterns associated with depressive symptomatology. Studies on emotion regulation report increased activation of the anterior cingulate cortex (ACC) during active emotion regulation, possibly reflecting greater effortful processing. Finally, studies of executive control report increased dorsal ACC activity during error monitoring and inhibition.ConclusionsAn emerging body of work indicates that altered neurocognitive functioning following maltreatment: (a) is evident even in the absence of overt psychopathology; (b) is consistent with perturbations seen in individuals presenting with psychiatric disorder; (c) can predict future psychiatric symptomatology. These findings suggest that maltreatment leads to neurocognitive alterations that embed latent vulnerability to psychiatric disorder, establishing a compelling case for identifying those children at most risk and developing mechanistically informed models of preventative intervention. Such interventions should aim to offset the likelihood of any future psychiatric disorder.

Spouses of Stroke Survivors Report Reduced Health-Related Quality of Life Even in Long-Term Follow-Up: Results From Sahlgrenska Academy Study on Ischemic Stroke.

The consequences for the family of stroke survivor are generally studied in a short-term perspective. The aim of this study was to assess long-term aspects of health-related quality of life among spouses of stroke survivors. Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). The health-related quality of life of spouses was assessed by the Short Form-36, and the characteristics of stroke survivors were assessed using the National Institutes of Health Stroke Scale, the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, the Barthel Index, and the modified Rankin Scale. Dyads of 248 stroke survivors aged <70 at stroke onset and 245 dyads of matched controls were included. Spouses of stroke survivors and spouses of controls had a median age of 64 and 65, respectively; proportion of men was 35% and 34%, respectively. The spouses of stroke survivors reported lower scores in all the mental domains (P=0.045; P<0.001), as well as in the domains of general health (P=0.013) and physical role (P=0.006), compared with the spouses of controls. Predictors of poor physical health of the spouses were their own age and the level of global disability of the stroke survivor. Predictors of poor mental health of the spouses were depressive symptoms, cognitive impairment, and global disability among the stroke survivors. The health-related quality of life of spouses of stroke survivors is reduced not only during the first years but also in the long-term perspective.

Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study.

Diversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training. This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress. First year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant. Results increase knowledge about the role of race as a core part of an individual's self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.

Child mental health after parental separation: The impact of resident/non-resident parenting, parent mental health, conflict and socioeconomics

Children of separated parents are consistently shown to have greater likelihood of poor mental health than children of intact families. Explanations to date have focused on the impacts of parental conflict, and the role of resident mothers, neglecting the potential importance of non-resident fathers. Using recent data from the longitudinal study of Australian children, this study: (1) compares the mental health of children from intact families with resident fathers to those from separated families with non-resident fathers; and (2) explores predictors of poor mental health among children from separated families. Children from separated families had poorer mental health than those from intact families, but this difference was explained fully by exposure to parental conflict, socioeconomic status and parent mental health, and to a lesser extent by parenting practices. Among children from separated families, the strongest predictor of child mental health was maternal parenting consistency. Policy implications are discussed.

Health-related quality of life and social support among Chinese patients with coronary heart disease in mainland China

This study aimed to explore and identify the relationship between health-related quality of life (HRQoL) and perceived social support among Chinese patients with coronary heart disease (CHD) in mainland China. A descriptive correlational study was conducted with a convenience sample of 200 Chinese patients with CHD recruited from the cardiac outpatient departments of two university-affiliated hospitals in Xi'an, China. The Chinese Mandarin versions of the Short-form 36-item health survey (CM:SF-36) and the Medical Outcomes Study Social Support Survey (CM:MOS-SSS) were administered to assess HRQoL and perceived social support. The results indicated that Chinese patients with CHD reported a poorer HRQoL and lower social support compared with their Western and Hong Kong counterparts. Multiple regression analyses identified four significant predictors of deteriorated physical health (increasing age, co-morbidity with heart failure or hypertension, and smoking status) and two significant predictors of poor mental health (co-morbidity with heart failure and perceived social support). Health status and social support in Chinese people with CHD should be routinely assessed and, where feasible, addressed through appropriate individually tailored interventions.

Child mental health after parental separation: the impact of resident/non-resident parenting, parent mental health, conflict and socioeconomics.

Children of separated parents tend to have poorer mental health than children of intact families. Explanations to date have tended to focus on resident mothers, neglecting the potential importance of non-resident fathers. Using recent data from the Longitudinal Study of Australian Children, and independent teacher-reports of child mental health, this study 1) compares the mental health of children with resident and non-resident fathers and 2) explores predictors of poor mental health among children with a non-resident father. Children with a non-resident father had poorer mental health than those with a resident father, but this difference was explained fully by exposure to parental conflict, and to a lesser extent by socioeconomic status, parenting, and parent mental health. For children with a non-resident father, the strongest predictors of child mental health were mothers' employment and maternal parenting consistency. Policy implications are discussed.

SF-36v2 norms and its’ discriminative properties among healthy households of tuberculosis patients in Malaysia

The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients. All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health. A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health. The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.

Health status after traumatic injury

This study explored the relationships between health-related quality of life and postacute factors such as patients' perceived access to information and support, perceptions of illness and ability to provide self-care after traumatic injury. Adults (18 years or older) admitted to hospital for ≥ 24 hours for the acute treatment of trauma in two hospitals in Queensland, Australia, were enrolled in a prospective cohort study. Questionnaires completed at hospital discharge and 3 months and 6 months incorporated the following: demographic data; psychological factors (Revised Illness Perception Questionnaire, Information, Autonomy and Support Scale, and Therapeutic Self-Care Scale); and outcome data (medical short form-36). Data on injury and hospital stay were obtained from health care records and the Queensland Trauma Registry. One hundred ninety-four patients with a median Injury Severity Score 9 (interquartile range, 5-14) were enrolled, with 125 (64%) completing questionnaires at 6 months. More than half the cohort reported symptoms of pain, fatigue, stiff joints, sleep difficulties, and loss of strength. All subscale scores on the short form-36 were below Australian norms 6 months after injury. Predictors of poor physical health included older age, lower extremity injury, and increased perceived consequences of their injuries, whereas predictors of poor mental health included younger age, female gender, and lower perceived control over their environment. Patients with minor to moderate injury based on anatomic injury scoring systems have ongoing challenges with recovery including problematic symptoms and low quality of life. Interventions aimed toward assisting recovery should not be limited to trauma patients with major injury. Prognostic study, level III.

Is Torture Reliably Assessed and a Valid Indicator of Poor Mental Health?

Torture is thought to confer worse mental health than other war-related traumatic events. However, reliability of torture assessment and validity of torture constructs as indicators of poor mental health have not been systematically evaluated. Study aims were to assess the psychometric properties of 2 common torture constructs. Refugees were assessed for having experienced torture by 1 subjective and 1 objective criterion. A subset was interviewed about definitions and effects of torture. Reliability and validity of torture constructs were assessed with general linear models. Interview data were analyzed for consistency of themes. Reliability of torture constructs was moderate, which paralleled inconsistencies in interview themes. Both torture criteria had similar dose-dependent relationships to mental health. Multivariate analyses showed that torture was not an independent predictor of poor mental health when controlling for the number of war-related events. Further work is needed to define torture from distinct medical and legal perspectives to improve reliability and validity.

Work Stress, Support, and Mental Health in Construction

Construction professionals are subjected to a plethora of occupational demands that can have a negative effect on their psychological wellbeing. Such demands can have an adverse influence on individual and organizational performance. To investigate the nature of self and social supports and mental health among construction professionals, an exploratory study was undertaken using the Stress and Mental Health Survey. The survey was distributed to construction professionals throughout Australia and 449 responses were received. Analysis revealed that those working for a contracting organization on-site reported higher levels of poor mental health and greater work stress than consultants. Those working on-site also experienced greater levels of self-stress, whereas consultants reported higher levels of self and work support. Work support was a significant predictor of poor mental health for consultants. Good health, however, was predicted by self, situational, and work support, whereas those working for a contractor only self-support predicated good mental health. It is concluded that while supports are essential in the fostering of good mental health, the absence of these supports can have a significant impact on poor mental health.

Needs assessment of family caregivers of cancer survivors: three cohorts comparison

Caregivers' quality of life (QOL) may be maximized when the caregivers' needs in the context of cancer care are met. Therefore, determining what needs are not being satisfied for family caregivers should be the first step in the development of programs designed to enhance caregivers' QOL. The 28-item Needs Assessment of Family Caregivers-Cancer (NAFC-C) scale was developed and validated with caregivers at three different survivorship phases: at 2 months (n=162), 2 years (n=896), and 5 years (n=608) post-diagnosis. The NAFC-C helped to identify caregivers whose needs were less likely to be met, based on their age and ethnicity. Furthermore, the extent to which caregivers' psychosocial needs were not being met was a consistent and strong predictor of poor mental health across all phases of survivorship, beyond the effects of a host of demographic characteristics. Findings suggest that interventions designed to help caregivers manage their own emotional distress as well as the survivors' distress, find meaning in the cancer caregiving experience, and foster supportive familial relationship will benefit caregivers by improving their QOL, not only during the time of diagnosis and treatment but years after.

Prevalence and Predictors of Mental Health Distress Post-Katrina: Findings From the Gulf Coast Child and Family Health Study

Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae.

Sex-role orientation, marital status and mental health in working women.

The objectives of this study were to make a men-women comparison as to the effects of job stress and sex-role orientation on mental health and to determine if marital status modifies effects of job stress and sex-role orientation on mental health in women. Subjects were 644 men and 301 women who were working at two private companies and one national agency. Job contents, sex-role orientation and mental health were measured by the Job Content Questionnaire, the Bem Sex-Role Inventory and the 30-item General Health Questionnaire, respectively. High job demands and femininity in men, masculinity in women predicted poor mental health. The best predictor of poor mental health was consciousness of being a woman in unmarried women, and stress outside the job in married women.

Psychological health in a non-clinical sample of obese women.

The relationship between obesity and psychological health remains unclear. The aims of this study were to evaluate the effect of obesity on the psychological health of a non-clinical sample of obese women, to investigate binge eating in this group, and to examine the predictors of psychological distress. A cross-sectional comparison of women divided into three obesity groups (body mass index (BMI)= 30-34.9, 35-39.9, > or = 40) was used. 179 women with a BMI > 30 (mean age 45 y) returned a questionnaire included in a subscriber-only magazine for women of size 16+. The questionnaire asked for information on demographics, weight history and eating behaviour, and included established self-report measures of body shape assessment, body shape satisfaction, dietary restraint, mental health state and self-esteem. The heaviest women (BMI > 40) did not differ on measures of mental health, but expressed the greatest dissatisfaction with their body weight, shape and appearance, and had the lowest self-esteem. Frequent binge eating was reported by 25% of all women. Self-esteem and peer relationships, but not body weight, were highly significant negative predictors of poor mental health. Poor mental health is not the inevitable consequence even of the most extreme obesity, but is related to both low self-esteem and poor peer relationships. These, and problems with eating control, are features of psychological morbidity that require recognition and therapeutic attention.

Psychological distress among female sex workers.

The prevalence and correlates of psychological distress were examined in a sample of 171 female sex workers in Queensland. It was found that 28 per cent were above the GHQ-28 threshold for mild psychiatric morbidity, a rate that is not appreciably different from that of women in the general community. The sample included only eight street sex workers, all of whom reported significant distress. Logistic regression analyses showed that a history of injecting drug use, an early age at leaving home and wanting to leave the sex industry were independent predictors of poor mental health. Distressed sex workers reported fewer sexual health examinations and less consistent condom use with their clients than those who were not distressed.