Presence Of Psychological Problems Research Articles

The association between social isolation, loneliness and psychological problems in young adults: A study during the acute phase of COVID-19 in Italy.

During the COVID-19 pandemic, governments had to impose social isolation measures to safeguard the citizens' health. However, this could have affected psychological problems. The aim of the present study was to investigate the psychological effects associated with social and emotional isolation during the acute phase of the COVID-19 in Italy. To this purpose, the degree of social isolation and loneliness and the presence of psychological problems (externalising and internalising) were investigated online in a sample of 395 young adults (18-30 years; 57% women). Results confirmed the relevant association between social isolation, loneliness and psychological problems, in both internalising and externalising dimensions. Particularly, loneliness showed the strongest association. Moreover, consistently with surveys conducted during the COVID-19-era, data highlighted that men were more vulnerable to social isolation and loneliness than women. These results underline the need for adequate interpersonal support during moments of isolation to prevent negative effects on psychological problems.

Problematic Smartphone Use and Its Impact on the Psychology of Adolescents in Malaysia

This study aims to determine the prevalence of problematic smartphone use (PSU) among secondary school adolescents and to examine its relationship with psychological problems (depression, anxiety, and stress [Model 1], or the number of psychological problems [Model 2]). This cross-sectional study has utilised a self-administered questionnaire assessing the participants’ sociodemographic and clinical characteristics, pattern and purpose of usage, presence of PSU (via the Malay-version smartphone addiction scale-short version [SAS-SV]), and presence of psychological problems (via the depression-anxiety-stress scale-21 [DASS-21]). Four hundred and fourteen students aged 15–16 from five national secondary schools in Seremban and smartphone users have been recruited via cluster sampling. Students in remedial or special education classes, previously diagnosed with depression, anxiety or stress and absent on the day of data collection were excluded. The prevalence of PSU, probable depression, anxiety and stress were 43.5%, 31.6%, 48.3% and 26.8%, respectively. Most respondents reported mild to moderate severity for each psychological problem. However, three in ten respondents had multiple psychological problems. In both multiple logistic regression models, Malay students had higher daily usage, and the higher monthly costs were significantly associated with PSU when other confounding factors were controlled. A higher number of psychological problems was associated with PSU (adjusted odds ratio: 1.28, 95% confidence interval: 1.06–1.54; p=0.011) but not purpose of usage or individual psychological problem. PSU and psychological problems were prevalent among secondary school adolescents. These findings highlight the complex relationship between PSU and psychological problems that warrant further detailed studies.

The longitudinal association between internet addiction and depressive and anxiety symptoms among Chinese adolescents before and during the COVID-19 pandemic.

The COVID-19 pandemic and related prevention policies, such as home quarantine or online courses, could increase the risks of experiencing internet addiction and mental health problems among Chinese adolescents. There is a lack of longitudinal evidence to show the association between internet addiction symptoms and psychological consequences (e.g., depressive and anxiety symptoms). This study aimed to explore the association between internet addiction and depressive and anxiety symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic. An effective sample of 7,958 Chinese adolescents was recruited for this two-wave longitudinal survey conducted over a six-month interval. All participants completed two-wave surveys before and during the COVID-19 pandemic. A longitudinal cross-lagged path model was used to analyze the associations between internet addiction and depressive and anxiety symptoms after controlling for four covariates (i.e., age, sex, minority, and COVID-19 influence). Higher depressive and anxiety symptoms before COVID-19 significantly predicted severe internet addiction during COVID-19. Results showed a significant bidirectional relationship between internet addiction and depressive symptoms. Furthermore, the prevalence of internet addiction displayed an increasing trend over the two waves. Conversely, a reduced prevalence of anxiety and depressive symptoms was observed over the two waves. This current study provided valuable evidence that psychological problems and internet addiction significantly influenced each other before and during the COVID-19 outbreak. Consequently, the presence of psychological problems before and during the COVID-19 outbreak could indicate internet addiction. Thus, depression- and anxiety-related psychotherapies should be developed to prevent internet addiction among Chinese adolescents.

Psychometric properties of the Persian version of the somatic symptom disorder–B Criteria Scale (SSD-12) in community and clinical samples

ObjectiveIn the DSM-5's diagnostic criteria of somatic symptom disorders (SSD), the presence of psychological problems (i.e., excessive thoughts, feelings, or behaviors) is emphasized more than the absence of the medical causes of patients' bothersome symptoms. In this regard, the Somatic Symptom Disorder–B Criteria Scale (SSD-12) is a screening tool for assessing these psychological features in somatic symptom disorder. This study aimed to validate the Persian version of SSD-12 in the Iranian community (non-clinical) and clinical samples. MethodsData was gathered from 291 individuals in a community sample (aged 18 to 54, M-age = 36.62, SD = 10.56, 79.7% females) and from clinical setting, including 118 patients diagnosed with major depressive disorder (MDD, aged 18 to 60, M-age = 36.52, SD = 11.39, 75.8% females) and 120 patients diagnosed with somatic symptom disorders (aged 18 to 60, M-age = 35.17, SD = 8.77, 73.7% females). To assess the convergent validity of SSD-12 in the clinical samples, participants were asked to complete measures assessing anxiety, depression, somatic symptoms, health anxiety, and emotional regulation. ResultsConfirmatory Factor Analyses (CFAs) showed that the three-factor model of the SSD-12 reached acceptable fit in the community and clinical samples and yielded excellent internal consistency across the samples. Also, test-retest reliability analysis results were good in the community sample. Convergent validity could be shown in the clinical samples. A cut-off score greater than 14 was in the optimal state with a sensitivity of 70.83 and a specificity of 70.07. ConclusionThe current study provides evidence on the factor structure, reliability, and validity of the Persian SSD-12 in the Iranian community and clinical samples. A sum score of 14 can be recommended as the cut-off point. Further studies are needed to assess SSD-12 in different clinical populations and larger samples.

PSYCHOLOGICAL FEATURES OF FOMO, PHUBBING AS MANIFESTATION OF INTERNET ADDICTIONS IN MODERN YOUTH

The article substantiates the problem of the emergence, manifestation and spread of such a modern relevant phenomenon as phubbing and FOMO in the article. It was also revealed the essence of the risks of using information technology, Internet abuse, which leads to social isolation, changes in consciousness, functional changes in the brain, depressive and obsessive disorders, inability to learn, work, think deeply, etc. The state of modern research of Internet addiction, the indicators and the forms, the psychological and physiological symptoms that are characteristic of Internet addiction are analysed.
 Until now, there is no consensus among researchers on the concept and definition of Internet addiction and controversy continues over the proposed diagnostic criteria, whether it is addictive. The highest level for Internet addiction is recorded in adolescents and young people, which may also indicate the presence of psychological problems: unrealized things in the field of communication, problematic relationships in the family, difficulties with learning, from which the younger generation plunges into a more successful virtual life. The results of available researches are generalized, because of which the cognitive-behavioural model of pathological Internet use is offered as two forms of Internet addiction such as specific pathological use of the Internet and multi-purpose excessive use of the Internet. A research analysis made by researchers is presented by proving the relationship between Internet addiction with phubbing and the opportunity syndrome (FOMO). The given data which suggests that FOMO and Phubbing may have the same properties, as they are both related to improper use and dependent behaviour on smartphones. According to the authors, in the development of Phubbing and FOMO play a role in certain psychological characteristics of the individual, the study of which requires further investigation. It also emphasizes the need to solve the problem of Internet addiction by creating recommendations for its prevention and reducing the degree of dependence.

Caregiver burden in older Indian patients with cancer: Experience from a tertiary care center.

e24022 Background: Most of the care for adults with chronic/debilitating illnesses is provided by unpaid family members. There is little information on caregiver burden in older patients with cancer in India. Methods: This was an observational study conducted in the geriatric oncology clinic at the Tata Memorial Centre, a tertiary care oncology center in Mumbai, India. The Fronto Temporal Lobe Disorders (FTLDA) caregiver burden scale was administered to the caregiver who accompanied the patient to the geriatric clinic. The scale has 22 questions, each scored from 0 to 4. The points were added to give the total caregiver burden score. The severity of the caregiver burden was scored based on the standard key: 0-20 little or no burden, 21-40 mild to moderate burden, 41-60 moderate to severe burden, 61-88 severe burden. Descriptive statistics were used for demographic & clinical variables. The factors impacting the caregiver burden were analyzed using multiple linear regression analysis. The caregiver burden score was the dependent variable in this analysis. The independent variables evaluated were patient-related factors (sex, education, primary tumor type), vulnerabilities noted on the geriatric assessment (function & falls, psychological status -depression & anxiety, cognition, nutrition, comorbidity) and caregiver-related, i.e., the relationship of the caregiver with the patient. Results: The caregiver burden scores were obtained from the caregivers of 127 older Indian patients with cancer between June 2020 & January 2021. The median age of patients in this study was 69 years (range, 60-90). There were 96 (75.6%) males; the two commonest malignancies were lung carcinoma (47 patients, 37%) & gastrointestinal cancers (46 patients, 36.2%). The relationship of the caregiver to the patient was child (94, 74%), in-law (12, 9.4%), spouse (7, 5.5%), grandchild (6, 4.7%) and other relative (8, 6.3%). The median caregiver burden score was 12 (IQR, 6-20). The caregiver burden was -little/no in 97 (76.4%), mild-moderate in 25 (19.7%), moderate-severe in 4 (3.1%) & severe in 1 (0.8%) of the caregivers assessed. On multivariate analysis, the factors that significantly impacted the caregiver burden score included the sex of the patient ( P= .0445) & the presence of psychological problems ( P= .0164). In the univariate analysis, the caregiver burden was higher in caregivers of female patients (median score, 16 [IQR 9-25] versus 10 [IQR 5-19], P= .02036). Caregivers of patients with psychological issues also had higher caregiver burden (median score, 19 [IQR 10-28] versus 10 [IQR 5.25-17], P= .00224). Conclusions: The caregiver burden was low in older Indian patients with cancer. Higher caregiver burden was experienced by the caregivers of female patients & patients with psychological disorders. Clinical trial information: CTRI/2020/04/024675.

Is the \u201cBrainwork Intervention\u201d effective in reducing sick leave for non-permanent workers with psychological problems? Results of a controlled clinical trial

BackgroundBoth the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called “Brainwork” was developed. The aim of this study was to assess the effectiveness of the ‘Brainwork Intervention’ in reducing the duration of sick leave compared to usual care over a 12-month follow-up.MethodsIn a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed.ResultsAll 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94–1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%.ConclusionsThe Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol.Trial registrationThe Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013.

Relation between Antenatal Maternal Depression and Anxiety during Pregnancy and Neonatal Outcomes

Background: The presence of psychological problems, including maternal depression and anxiety may harm fetal and neonatal growth. Depression and anxiety in pregnancy increase the liability for adverse fetal and newborn outcomes, including preterm birth. It was accompanied by abnormal infant development that extended to cognitive problems and psychopathology. This study aimed to analyze relation between antenatal maternal depression and anxiety during pregnancy and neonatal outcomes by assessing depression levels among pregnant women, identifying anxiety levels among pregnant women, and investigating the relation between antenatal maternal depression and anxiety during pregnancy and neonatal outcomes. Methods: A cross-sectional descriptive study included 216 pregnant women and their newborns from the Obstetrics and Gynecology ward at Sohag University Hospital and the Maternal and Child Health Center (Dar El–Salam Abed- Allah Health Center) at Sohag City. Tools: 1- A structured self administered questionnaire, anthropometric measurement tool, the Edinburgh Postnatal Depressive Scale (EPDS), the Beck Anxiety Inventory (BAI), and Apgar score sheet, were utilized for collecting the data. Results: Considering depression approximately one quarter of pregnant women had moderate depression symptoms during pregnancy, while three fifth had no depression symptoms and 16.0 of them had severe depression symptoms during pregnancy. As regard less than one fifth of pregnant women had mild level of anxiety, while three quarter of them had a moderate level of anxiety and less than one fifth of them had severe anxiety level during pregnancy. Statistically significant relationships were found between severe depression symptoms scores, anxiety and birth weight, weight-for-GA and length, prematurity less than one fifth, need for resuscitation one quarter, and need for admission to neonatal intensive care near one fifth. Conclusion: Pregnant women who are suffering from severe depression and anxiety symptoms during pregnancy, their babies were more liable to increase the need for neonatal resuscitation, increase the chance of preterm birth, have a low birth weight, and are small for gestational age. Recommendation: Providing pregnant women health educational programs about the effects of depression and anxiety on them and on their neonates, non pharmacological interventions are important treatments for depression or anxiety that focus on promoting a healthy lifestyle with adequate nutrition, exercise and sleep

Impulsivity, risk gambling, and heavy episodic drinking among adolescents: A moderator analysis of psychological health

IntroductionAdolescence is associated with an increased inclination for risk behaviors, like gambling and heavy episodic drinking (HED). While impulsivity is a well-documented risk factor, the purpose of this study is to explore if there are variables modulating this association. The study examined the effects of impulsivity and psychological health on risk gambling and HED, and whether psychological health functions as a moderator, i.e., protective factor. MethodsData was extracted from the Stockholm School Survey, collected in 2014 and 2016 among students in the ninth grade of primary school (15–16 years) and second grade of upper secondary school (17–18 years) in Stockholm (n = 21,886). Impulsivity, psychological problems, risk gambling, HED, and a number of sociodemographic control variables were measured using self-report data. The statistical method was binary logistic regression. ResultsResults showed that risk gambling (3.4%) and HED (22.8%) were prevalent among Swedish pupils. Impulsivity and—to a weaker extent—psychological problems as well as several sociodemographic variables were risk factors for risk gambling and HED. Furthermore, psychological problems negatively moderated the association between impulsivity and HED among girls. ConclusionsThis study supports evidence that impulsivity represents a risk factor for risk behaviors, and—contrary to the a priori hypothesis—indicates that the association between impulsivity and HED in female students might be attenuated by the presence of psychological problems. Prevention measures should particularly address adolescents exhibiting the mentioned risk factors and aim at reducing psychological problems, but not necessarily target the adolescents showing impulsivity and psychological problems simultaneously.

SELF-CARE ACTIVITIES AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN PENAMPANG, SABAH AND ITS ASSOCIATION WITH DEPRESSION, ANXIETY AND STRESS

Performing self-care activities can be challenging but it is important for favourable outcomes of type 2 diabetes mellitus (T2DM). It may be influenced by psychological problems. Therefore, this study examined the level of self-care activities and the presence of psychological problems among patients with T2DM. The association between these activities and the psychological problems was assessed too. This cross-sectional study was conducted at a public health clinic in Sabah. Data was collected between July and September 2017 using a validated self-administered questionnaire which include the depression, anxiety and stress scale-21 (DASS-21) and the summary of diabetes self-care activities (SDSCA) questionnaire. About 91% of 331 participants took diabetes medications in ≥6 days per week. They followed a healthful eating plan, inspected feet and exercised 30 minutes a day in 5.0 (IQR 4.0), 4.0 (IQR 7.0) and 1.0 (IQR 4.0) days per week respectively. Among owners of glucometer, the median (IQR) of monitoring blood glucose was 1.0 (1.0) days per week. The participants with depression, anxiety and stress were 4.5%, 8.8% and 5.7% respectively. Following a healthful eating plan (p<0.001) was found to be significantly associated with anxiety; those with anxiety practised this activity in fewer days than those without anxiety. Generally, self-care activities were poorly practiced by the participants, except for taking diabetes medications. Thus, the patients should be encouraged to improve their self-care activities. Psychological problems were also found to be uncommon. However, anxiety symptoms should not be ignored as it may negatively affect their adherence to healthy diet.

Evolution of psychological condition in caregivers of patients with disorders of consciousness: a longitudinal study.

The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state-VS patients and caregivers of minimally conscious state-MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA). On the other hand, caregivers of MCS patients showed a significant improvement in: BDI II, STAI Y and CNA. These data confirmed that the presence of psychological problems, the quality of life and the psychological wellbeing of caregivers of DOC patients improved over the time.

Adjustment to Type 1 Diabetes Mellitus and its Relation with Anxiety and Depression in Pediatric Patients

Around 26 and 43% of pediatric patients diagnosed with type 1 diabetes mellitus presents psychological problems, being anxiety and depression the more frequent ones. An important factor regarding the wellbeing of these patients is the presence of good adjustment indicators in the process of adapting to this chronic disease.The present study aims to analyze the relationship between the difficulties of adapting to type 1 diabetes mellitus and the presence of clinical symptoms of anxiety and depression in pediatric patients. Our research is an exploratory cross-sectional study in which participated 23 children and adolescents in the age range of 6 to 16 years. All of them were attended in the Pediatric Endocrinology Unit of the General Hospital of Valencia. Our results point out the presence of psychological problems in these patients and a deficient adaptation to the disease. The regression analyses allow observing that the global score in adaptive response to disease predicts the scores in depression (19%), anxiety (16%), useless (17%), irritability (42%) and psycho-physiological symptoms (20%). The present work highlights that an inadequate response to disease in these patients influences their psychological well-being in a negative and significant way.

Prevalence and predictors of psychological problems among principal caregivers of children with cerebral palsy in Galle, Sri Lanka

Background Caregivers of children with disabilities are easy victims of psychological ill-health. Assessment of psychological problems and identification of factors predicting such outcomes are vital in identifying high-risk caregivers, to prevent them from becoming second order patients. Aim To describe the prevalence and predictors of psychological problems among principal caregivers of children with Cerebral Palsy (CP) in the Galle district Methods The study included 375 caregivers of children with CP, attending Teaching Hospital, Karapitiya, Galle. Prevalence of psychological problems of caregivers was assessed using the General Health Questionnaire (GHQ). Level of caregiver burden was assessed using Caregiver Difficulties Scale, developed and validated by the authors. An interviewer administered questionnaire was used to collect data on other study variables. Predictors of psychological problems in caregivers were determined using logistic regression analysis. Results Fifty six percent (95% Confidence Interval = 51.0% 61.0%) of caregivers had GHQ scores above the cut off threshold for psychological disorders. The strongest predictor for presence of psychological problems was high level of caregiver burden {Odds Ratio (OR)=19.99(5.54-72.13),p Conclusions Caregivers of children with CPshow a high prevalence of psychological problems. There are a number of factors predictive of caregiver psychological problems, particularly the level of caregiver burden, which need to be considered when developing long term care plans for children with CP. DOI: http://dx.doi.org/10.4038/jccpsl.v19i1.7621 Journal of the College of Community Physicians of Sri Lanka Vol.19(1) December 2013 8-17

Growth and endocrine disorders in thalassemia: The international network on endocrine complications in thalassemia (I-CET) position statement and guidelines

The current management of thalassemia includes regular transfusion programs and chelation therapy. It is important that physicians be aware that endocrine abnormalities frequently develop mainly in those patients with significant iron overload due to poor compliance to treatment, particularly after the age of 10 years. Since the quality of life of thalassemia patients is a fundamental aim, it is vital to monitor carefully their growth and pubertal development in order to detect abnormalities and to initiate appropriate and early treatment. Abnormalities should be identified and treatment initiated in consultation with a pediatric or an adult endocrinologist and managed accordingly. Appropriate management shall put in consideration many factors such as age, severity of iron overload, presence of chronic liver disease, thrombophilia status, and the presence of psychological problems. All these issues must be discussed by the physician in charge of the patient's care, the endocrinologist and the patient himself. Because any progress in research in the field of early diagnosis and management of growth disorders and endocrine complications in thalassemia should be passed on to and applied adequately to all those suffering from the disease, on the 8 May 2009 in Ferrara, the International Network on Endocrine Complications in Thalassemia (I-CET) was founded in order to transmit the latest information on these disorders to the treating physicians. The I-CET position statement outlined in this document applies to patients with transfusion-dependent thalassemia major to help physicians to anticipate, diagnose, and manage these complications properly.

Anxiety and depression in adolescents with polycystic ovary syndrome and Mayer-Rokitansky-Küster-Hauser syndrome

Purpose. The purpose of this study was to assess self-reported depressive and anxiety symptoms in adolescents with polycystic ovary syndrome (PCOS) and those with the rare Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS), compared with healthy adolescents.Material and methods. The participants were 49 adolescent girls, of whom 27 were patients with confirmed menstrual disorder, 22 with PCOS and 5 with MRKHS; and 22 were healthy eumenorrheic adolescents (control group) matched by age and school grade. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI-Gr) were used to measure depression and anxiety, respectively.Results. The results showed that it was 1.08 times more likely for the PCOS group (p = 0.043) and 1.12 times more likely for the MRKHS group (p = 0.039) to have higher scores than healthy adolescents on the anxiety scale. The MRKHS group was 1.40 times more likely to have a higher number of depressive symptoms (p = 0.040) than the control group.Conclusions. These findings, although based on a small sample, suggest a relationship between PCOS and MRKHS and the presence of psychological problems, such as anxiety and depressive symptoms in adolescents. This study is among the first to examine psychological difficulties in adolescents with such a rare menstrual syndrome as MRKHS.

Impairment of Sexual Life in Patients with Psoriasis

Background: Sexual life can be severely affected in patients with psoriasis. However, this component is not often assessed by clinicians. Objective: To estimate the prevalence of sexual impairment and its degree of association with clinical and personal factors among psoriasis patients. Methods: Sexual life impairment was investigated in all eligible adults hospitalized with psoriasis in a dermatological hospital from February 2000 to February 2002, using answers to specific items from two dermatology-specific questionnaires, and from two psoriasis-specific questionnaires. Clinical severity and psychological problems were also evaluated. The same questionnaires were collected a month after hospital discharge, to estimate changes from baseline. Results: Of 936 patients,from 35.5% (Psoriasis Disability Index) to 71.3% (Impact of Psoriasis on Quality of Life Questionnaire) reported to have experienced sexual problems because of psoriasis. A more severe disease and the presence of psychological problems were also associated with sexual impairment. At 1-month follow-up, a reduction of >75% in clinical severity was associated with a twofold probability of substantial improvement of sexual life. Conclusions: Sexual impairment is very frequent in patients with psoriasis. Single questions on sexual life from quality of life questionnaires provide a simple tool that may be useful in clinical practice to assess sensitive issues, and thus to provide better patient-physician communication.

Psychiatric Epidemiology in Canada and the CCHS Study

The field of psychiatric epidemiology has a long, albeit often neglected, history-one that antedates the beginning of psychoanalysis. Klerman (1) and Weissman (2) have outlined 5 generations of epidemiologic research. The first dates back to 1885, when Jarvis (3) used hospital records and key informants in a Massachusetts town to determine the prevalence of treated and untreated mental disorders. The post-World War II era, which Weissman and Klerman both referred to as the golden age of psychiatric epidemiology, saw the famous Midtown Manhattan Study (4) in the US and the Stirling County Study in Canada (5). These studies and others were marked by large representative samples, high response rates, and the use of measures of overall impairment rather than the unreliable psychiatric diagnoses of the day. The third era saw the introduction of structured clinical interviews, such the Present Status Schedule (6) in the US and the Present State Examination (7) in the UK; the Schedule of Affective Disorders and Schizophrenia (8); the Diagnostic Interview Schedule (9); the Composite International Diagnostic Interview (10); and numerous others. These interviews were accompanied by more objective and reliable criteria for the various diagnostic categories, first manifested in the Research Diagnostic Criteria (11) and leading eventually to the DSM-III and its later modifications. The Epidemiologic Catchment Area study (12), which involved over 18 000 adults in 5 sites and used the Diagnostic Interview Schedule, is perhaps the prime example of this generation of research. The fourth generation melded the previous generation's methodological developments-objective diagnostic criteria and structured interviews-with probability samples that encompassed an entire country, such as the National Comorbidity Study in the US (13) and the Community Health Survey in Canada (14). The fifth generation, which is still relatively young, focuses on children and adolescents. Canada has been a major player in this area and has produced many leaders, including Alec Leighton and Jane Murphy in the Stirling County Study (5); Roger Bland with the Edmonton studies (15); the late Dan Offord, who led the Ontario Child Health Survey and the Ontario Health Supplement (16,17); and the researchers who conducted the Quebec Child Mental Health Survey (18). Each of these studies marks an important stage of development in Canadian psychiatric epidemiology, yet all share a common element: they were conducted in a specific region. Consequently, we have not to date had any national estimates of the prevalence of major psychiatric conditions in this country. The Canadian Community Health Survey (CCHS) Cycle 1.2 remedies this, being a study of the entire country. As will be explained in this issue's articles, it continues a long tradition of community surveys undertaken by Statistics Canada. The CCHS Cycle 1.1 yielded some data regarding the presence of psychological problems; however, its limitations in this regard prompted Cycle 1.2, whose major focus was on factors that predisposed people to or protected them from such problems. At the 2002 meeting of the Canadian Academy of Psychiatric Epidemiology (CAPE), representatives from Statistics Canada outlined the design of CCHS 1.2 and announced a joint Canadian Institutes of Health ResearchStatistics Canada grant competition to analyze the data. The CAPE members decided to collaborate in their submissions rather than compete against each other for a limited number of grants, with very gratifying results in that a significant proportion of the grants were awarded to them. The entire 2004 CAPE meeting, which was held just prior to the annual Canadian Psychiatric Association meeting, was devoted to presentations of the results. The Journal's Editorial Board agreed to devote one issue to those papers. To save space, a single article (see the paper by Gravel and Beland, 19) presents the methods used by all. …

Consultation for and identification of child and adolescent psychological problems in Dutch general practice

Child and adolescent psychological problems are rarely brought to the attention of GPs. Children and adolescents with psychological problems who do visit their GP are seldom identified as such by GPs. To investigate in a general population sample of 2,449 Dutch children and adolescents (4-17 years) GP consultation and GP diagnoses of child psychological problems, and the influence of child and family characteristics upon these variables. The degree to which parent, teacher, and adolescent reports of the presence of child psychological problems are in concordance with GP diagnoses of these problems was determined. Logistic regression analyses were used to examine correlates of GP consultation and psychological diagnoses. Approximately 80% of children and adolescents with psychological problems had visited their GP within the preceding year. GP consultation was most strongly associated with child/adolescent chronic physical disorders. Concordance between GP psychological diagnoses and parent, teacher, and adolescent reports of psychological problems was limited. Children and adolescents with psychological problems according to parent or teacher report, children with school problems, young boys, adolescents with negative health perceptions, and adolescents from single parent families were more likely to be diagnosed with psychological problems by GPs. Improving GPs' interview techniques, introducing standardised screening measures in general practice, increasing GPs' awareness of the possible presence of psychological problems in children consulting for physical problems, and strengthening collaboration between GPs and mental health professionals may increase GP identification of child psychological problems and enhance access to care for those in need.

The Impact of a Clinical Audit on GP Detection of Depression

Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.

Overcoming barriers to nonadherence in asthma treatment.

Inadequate patient adherence to prescribed treatment regimens is a major cause of poor clinical outcomes in the treatment of asthma. Among children with asthma, adherence rates are often below 50%. Multiple treatment-, clinician-, and patient-related barriers prevent the achievement of satisfactory levels of adherence. Treatment-related barriers include prolonged and complex regimens, adverse effects, cost, and delayed onset of action. Clinician-related barriers include difficulty in scheduling, treatment by one different care giver after another, perceived clinician disinterest, and time constraints. Patient-related barriers include mild or severe asthma, poor understanding of the need for treatment, insufficient confidence in the clinician or medication, the presence of psychological problems, and low motivation to change behavior. Although all of these factors must be addressed to maximize adherence, patient motivation may be the most critical. This task falls primarily to clinicians (physicians, nurses, staff), and it requires thorough patient and care giver education, more frequent patient contact, and the development of a patient-clinician partnership dedicated to the effective treatment of asthma.