Psychological Screening Tool Research Articles

The Cosmetic Readiness Questionnaire (CRQ): Validation of a Pre-Operative Psychological Screening Tool for Aesthetic Procedures.

Several psychological risk factors are associated with patient dissatisfaction with aesthetic procedures, such as body dysmorphic disorder (BDD), unmanaged mental health concerns or unrealistic expectations. Identifying these risks via preoperative screening may protect patients from adverse psychological outcomes and provide reputational or legal protection for practitioners. This study aimed to further develop and validate the Cosmetic Readiness Questionnaire (CRQ), a comprehensive psychological screening tool to assess patient suitability for surgical and non-surgical aesthetic procedures. The CRQ was validated across two studies in clinical contexts, examining structural and construct validity in a sample of 8031 individuals who completed the CRQ as part of routine clinical care. In a further sample (n = 574), criterion validity was explored through the relationship between the CRQ and dissatisfaction with past aesthetic treatments. Risk category cut-off scores were developed. Results supported the reliability and validity of a five-factor CRQ which measures Body Dysmorphia, Psychological Distress, Self-Criticism, Unrealistic Expectations and Lack of Openness. High scorers on the CRQ were 78% more likely to report dissatisfaction with a past cosmetic procedure than low scorers. The CRQ is a comprehensive and valid screening measure to identify patients who may require further psychological assessment or additional support prior to aesthetic treatment. Instructions are provided on how to implement the CRQ in clinical practice.

Development of a Pre-Operative Psychological Screening Tool: Piloting the Cosmetic Readiness Questionnaire (Pilot-CRQ).

Patients with psychological risk factors, such as body dysmorphic disorder (BDD), and unmanaged mental health concerns are considered higher risk of dissatisfaction with aesthetic procedures. Identifying these risks before a procedure may decrease the chance of adverse outcomes for patients and practitioners. This study aimed to develop a comprehensive psychological screening tool to assess patient's psychological suitability for surgical and non-surgical aesthetic procedures. Items for the Pilot-Cosmetic Readiness Questionnaire (CRQ) were developed by psychologists (n = 3) and then reviewed by plastic surgeons (n = 2) and non-surgical cosmetic doctors (n = 3). Patient interviews (n = 15) and piloting of the questionnaire (n = 69) provide data to examine the scale's initial psychometric properties. Results supported the reliability and validity of the Pilot-CRQ's subscales of Body Dysmorphia, Psychological Distress, Self-Criticism, Perfectionism, and Lack of Openness. 'Lack of Openness' is a validity scale which examines the degree that respondents may be underreporting symptoms. The CRQ predicted individuals with a BDD diagnosis as rated by a blinded expert clinical psychologist, with high sensitivity and specificity. These results provide support for the Pilot-CRQ in identifying people with BDD and psychological factors related to aesthetic treatment outcomes and provide a strong basis for using the CRQ in clinical contexts and in future research.

Screening for Body Dysmorphic Disorder in Plastic Surgery Patients.

The Australian medical board, the Australian Health Practitioner Regulation Agency (AHPRA) has recently introduced new regulations mandating providers of cosmetic surgery undertake a clinical screen for body dysmorphic disorder (BDD) in all potential cosmetic surgery patients. The assessment must be conducted by the surgeon using a validated psychological screening tool. The aims of this paper are to discuss the key clinical characteristics of BDD before reviewing currently validated screening tools that would meet this new regulatory requirement, and which may be most applicable to a busy plastic surgery practice. A literature search identified 1164 titles, of which 229 titles were retrieved for abstract screening. Six studies were identified that validated BDD screening tools in a setting relevant to cosmetic plastic surgery. Six validated screening were identified: BDD Questionnaire (BDDQ), BDD Questionnaire Dermatology Version (BDDQ-DV), BDD Questionnaire Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), Body Dysmorphia Symptom Scale (BDSS) and the BDD Screening Test (BDD-ST). Our group practice has chosen to adopt the BDDQ-AS to meet the AHPRA regulator requirement for BDD screening based on its robust validation and ease of use in clinical practice, consisting of a seven-item self-report questionnaire that can be reliably completed in 1-2 minutes in most cases. Of the six screening tools for body dysmorphic disorder available for use in clinical practice that have been validated in a cosmetic population setting, we have chosen to use the BDD Questionnaire Aesthetic Surgery (BDDQ-AS). To date all available validated screening tools are based on the DSM-IV, and further work to develop a validated screening tool based on the revised definition of BDD in the DSM-V is recommended, with a particular focus on items relating to repetitive physical or mental behaviours. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Psychological distress and PTSD among clinicians in Roma, Lesotho during the COVID-19 pandemic

Background: Since 2020, the world has been battling the coronavirus disease 2019 (COVID-19) pandemic. The mortality and morbidity at the height of the pandemic sparked generalised fear and uncertainty about the future. Concerns were raised about the psychological impact of the pandemic on workers in healthcare systems globally. This study was conducted to establish the degree of psychological impact of the pandemic on frontline health workers in Lesotho.Methods: The study used a quantitative cross-sectional survey design. The Kessler psychological distress screening tool (K-10) and the post-traumatic stress disorder (PTSD) checklist for civilians (PCL-C) were administered to screen for psychological distress among clinical staff at St. Joseph’s Hospital in Roma and its four Health Centres. Additional open- and closed-ended questions were added for context. Data were analysed using Fisher’s exact tests, Pearson chi-square tests and correlation studies.Results: Of the 101 participants, 42 (41.6%) scored ≥ 24 on the K-10 scale (95% CI: 32.0% – 51.2%) indicating moderate to severe psychological distress and 32 (31.7%) scored ≥ 50 on the PCL-C checklist suggesting severe PTSD (95% CI: 24.5% – 42.9%). High scores on the K-10 were found more among men than women (17 [37.8%] vs. 4 [7.1%]; p ≤ 0.001). Post-traumatic stress disorder was more in the younger age group (p ≤ 0.03), in those reporting anxiety (p = 0.005) and those with more co-morbidities (p ≤ 0.001).Conclusion: This study revealed the grave psychological impact of the COVID-19 pandemic on frontline clinical health workers in Lesotho.Contribution: These data will assist health leaders and policymakers to implement mental health support interventions for health workers in future.

Dentists Role in Psychological Screening and Management of Head-and-neck Cancer Patients Undergoing Radiotherapy - Narrative Review.

Head-and-neck cancer management primarily involves surgery and chemoradiotherapy. Recurrent radiotherapy (RT) sessions are often linked to social, physical, and psychological burdens. Oral physicians are part of the palliative care team and play a pivotal role in decimating the physical side effects associated with disease and its treatment. There is a need to familiarise dentists with the psychological aspect of the treatment. Various libraries were searched from the year 2012 to 2022. A total of nine studies that had head-and-neck RT patients exclusively were included in the study. Anxiety and depression are patients' most prevalent psychological problems during and after the RT regimen. A few most used psychological screening tools were identified. Dental professionals are uneducated about the holistic approach to managing RT patients. The current narrative review details the various psychological screening tools and care measures that can be incorporated into the dental setup to help these patients.

Could olfactory identification be a prognostic factor in detecting cognitive impairment risk in the elderly?

Aging contributes to the deterioration of the olfactory system in humans. Several studies indicate that the olfactory identification test alone may function as a screening test for olfactory dysfunction and they are more feasible to apply in clinical practice. Olfactory identification may be a predictor for cognitive impairment. Multiple studies have considered the use of odor identification as a measure to identify the conversion from normality to mild cognitive impairment or dementia. The objectives were (i) to elucidate the associations between cognitive status and olfactory identification performance in aging; (ii) understand the predictive value of olfactory capacity in identifying subjects with cognitive impairment risk; and (iii) to study how cognitive status and olfactory identification relate with other variables of wellness in aging, such as functional capabilities and clinical measures. For this purpose, a group of 149 participants (77.15 ± 7.29 years; 73 women of 76.7 ± 8 years and 76 men of 77.6 ± 6.52 years) were recruited and were subjected to a sociodemographic questionnaire, a psychological screening tool of general cognitive status, an olfactory identification evaluation, and clinical measures. The participants were divided into groups based on their cutoff scores of previous scientific reports about the Spanish version of Montreal Cognitive Assessment. Our results indicate an age-associated decline in olfactory identification ability and intensity of odor perception. The predictive ability of olfactory identification scores for the risk of mild and severe impairment is around 80%. Olfactory identification decreases with cognitive function. Performance in odor identification is associated with impairment of episodic memory and executive functions. These findings further our current understanding of the association between cognition and olfaction, and support olfactory assessment in screening those at higher risk of dementia.

The detection of mental health conditions by incorporating external knowledge

Mental health conditions have become a growing problem; it increases the likelihood of premature death for patients, and imposes a high economic burden on the world. However, some studies have shown that if patients are detected and treated early, the social impact and economic costs of mental illness can be reduced. With the popularity of social media, people are sharing their feelings on it, which allows data from social media to be used to study mental health conditions. However, past research had been limited to the optimization of the model or using different types of data available on social media, resulting in models that only rely on data to make decisions. Moreover, people judge things not only by the data collected, but also by background knowledge. Therefore, we considered the diagnostic process of doctors and combined the knowledge of psychological screening tools and diagnostic criteria into the model. In addition, we also tested the effect of combining general knowledge. We retrieve the top m most relevant knowledge segments for each user’s post, and then put both into the prediction model. Experimental results show that our method outperforms previous studies, and the F1-score is increased more than 10% in some situations. Moreover, because the knowledge segments are automatically retrieved, our method does not require additional manual labeling, and the knowledge set can be freely adjusted. These show that our method can help detect mental health conditions and can be continuously optimized in practice.

Integration of mental health and quality of life screening tools in an inflammatory bowel disease-specific electronic medical record (Crohn Colitis Care): process and early outcomes.

Psychological problems are prevalent in people with inflammatory bowel diseases but are not routinely addressed. To improve recognition, three psychological screening tools were integrated into clinical management software (Crohn Colitis Care). In the first 6 months, completion rates varied between participating sites, and approximately 23-34% of respondents scored in moderate or higher ranges for psychological distress. Evaluation of the clinical utility of the module to improve patient outcomes is recommended.

Translation and Validation of the Arabic Version of the Athlete Psychological Strain Questionnaire.

The international sports community is becoming more proactive in clinical mental health practice and research. An athlete-specific psychological distress screening tool can identify potential mental health illness. The Athlete Psychological Strain Questionnaire (APSQ) is a simple screening tool for detecting early signs of athlete-specific strain and related mental health concerns. We evaluated the internal consistency and reliability of the translated and culturally adjusted Arabic version of the APSQ (APSQ-Ar) with Arabic-speaking elite athletes. The final translation underwent standard forward and backward translation, an inspection by a team of experts, and then preliminary testing. The APSQ-Ar was cross-culturally validated and then assessed for internal consistency and reliability among (n = 98) Arabic-speaking athletes. There were no problems with the patients' understanding or interpretation of the items on the APSQ-Ar translation. The intraclass correlation value was .93 (95% confidence interval, .89-.95), and the mean difference was 2.4 with a minimal detectable change of 5.12, demonstrating strong test-retest reliability. Moreover, Cronbach alpha showed excellent internal consistency (.76). The APSQ-Ar was demonstrated to be good, reliable, and internally consistent. With APSQ-Ar, sports medicine professionals in Arabic-speaking countries will be able to identify psychological distress and symptoms in athletes and, as a result, provide them with mental health support.

Sistem Deteksi Kecanduan Pornografi Berbasis Chatbot Menggunakan Pornography Addiction Screening Tool (PAST)

The use of the internet not only brings benefits but also harms the ease of access to pornographic content. Pornographic content is not solely available on adult websites but is also spread on social media accessed by many children to adults. As a result, problems arise due to pornography addiction, such as rape, sexual orientation deviation, and sexual crimes against children. Uniquely, pornography addiction is hard to detect objectively compared to drug or alcohol addiction. This study aims to develop a pornography addiction detection system in the form of a chatbot-based mobile application. The choice of chatbot is because this system supports interactive automatic communication patterns and guarantees the privacy of its users. This study adopts a psychological measurement technique Pornography Addiction Screening Tool (PAST), as a benchmark in developing application logic. Meanwhile, chatbot application development uses the waterfall method which has been tested by best practices as a software development method. Tests performed are in a developer environment. The system validation mechanism uses the Black-box testing method to observe the execution of the application when it runs the functionality that was designed beforehand. In addition, the usability measurement level application is adopted from the System Usability Scale (SUS) method. From the test results, it was found that the pornography addiction detection system operates normally and can be used as a supporting medium for handling pornography addiction by psychiatrists.

Evaluating shortlisting methods for admission into the social work degree: personal statement versus psychological test

ABSTRACT Oversubscribed social work (SW) courses and a workforce review in Northern Ireland prompted a review of admissions, to ensure recruitment of applicants with strong core values. Concerns regarding authorship, plagiarism and reliability of personal statements, and calls for values-based recruitment underpinned this research. This study evaluates psychometric properties of an SW specific personal statement (PS) and a values-based psychological screening tool, Social Work Match (SWM). Social Work students (n = 112), who commenced the 3-year undergraduate route (UGR) or the 2-year relevant graduate route (RGR) were invited to participate. Their PS scores and SWM scores permitted investigation of scoring outcomes and psychometric properties. Statistical analysis was conducted using Minitab 17. Forty-nine participants (5 male, 44 female) completed SWM on two occasions (October 2020 and January 2021). Findings provide practical, theoretical, statistical, and qualitative reasons for concluding that the PS has substantial limitations as a measure of suitability. It does not compare well with international test standards for psychometric tests. In contrast, SWM is a valid and reliable measure with good discriminatory power, standardized administration and consistent marking. SWM is a viable alternative to the PS for assessing suitability/shortlisting applicants for social work interviews.

The Posttaumatic Adjustment Scale (PAS) is an effective measure in predicting psychological distress in patients following major trauma

AimsTo determine whether a psychological screening tool - the Posttraumatic Adjustment Scale (PAS), predicts later psychological distress for admissions to a Major Trauma Centre (MTC) and to identify whether there was an unmet need in relation to the psychological support offered. MethodsPatient demographics and details of their injuries were retrieved from the Trauma Audit & Research Network (TARN) database. All patients admitted to Leeds General Infirmary MTC were approached for inclusion in the study over a three-month period. The PAS was administered to all participants at baseline. Following discharge, patients were sent two validated psychological measures via post, the Impact of Events Scale – Revised (IES-R) and the Clinical Outcomes in Routine Evaluation System (CORE-10). Relationships between continuous variables were examined using a Spearman's rank test (SR). The diagnostic accuracy of the different psychological screening systems was examined and compared using Receiver Operator Characteristic (ROC) analysis. ResultsEighty-two patients completed the PAS, 26 of whom had been referred to clinical psychology and 56 who were not. Fifty-seven of these patients (70%) returned follow-up IES-R and CORE-10 data, 20 who had been referred to psychology and 37 who had not. The PAS-P score recorded shortly after admission correlated strongly with the CORE-10 (SR rs 0.54, p<0.0001) and IES-R (SR rs 0.63, p<0.0001) scores recorded at early follow up. A PAS-P of more than 10 predicted the development of PTSD symptoms (IES-R 33 or more) or moderate global psychological distress (CORE-10 15 or more) with 72% sensitivity and 71% specificity. To identify patients who went on to develop psychological symptoms according to either measure (IES-R 33 or more or CORE-10 15 or more), the PAS-P was more sensitive than clinician referral (71% vs 52%, p<0.05) with similar specificity (72% vs 75%, p=0.78). ConclusionsIn an unselected group of trauma inpatients treated in a MTC, the PAS is an effective means of identifying those who are likely to go on to suffer PTSD symptoms or psychological distress. It may useful to use the PAS as a measure to formalise psychology referrals.

Personal statement versus psychological test as admission to the nursing degree: an evaluation

BackgroundA review of admissions to nursing in Northern Ireland was prompted by the growing number of applications and a desire to ensure that the applicants had the right values for a career in nursing. Concerns regarding authorship, plagiarism and reliability of personal statements used to select applicants to interview was the focus of this research. This study evaluates the psychometric properties of a Personal Statement (PS) as a method for admission to a nursing programme and a values-based psychological screening tool, Nurse Match (NM).MethodsA self-selecting, purposive sample (n = 228; 9.7%) was drawn from applicants to Schools of Nursing in the United Kingdom (n = 2350). Participants all of whom had completed a Personal Statement were asked to complete a psychological tool and the scoring outcomes and psychometric properties of both tests were investigated. Statistical analysis was conducted using Minitab 17.ResultsApplicants from 18 schools and five colleges responded. The majority (72.4%) were aged 18–19. Findings provide practical, theoretical, statistical, and qualitative reasons for concluding that the Personal Statement has substantial limitations as a measure of suitability. It does not compare well with international test standards for psychometric tests. In contrast, NM is a valid and reliable measure with good discriminatory power, standardised administration and consistent marking.ConclusionNM is a viable alternative to the PS for shortlisting applicants for nursing interviews.

Cognitive impairment in multiple sclerosis: The role of the general practitioner in cognitive screening and care coordination.

Cognitive impairment is common in multiple sclerosis (MS) and can have animpact on all aspects of daily life. It isalso an early marker of increased MS disease activity and indicates the need to optimise disease-modifying therapies to slow progression and preserve brain functioning. However, it is difficult to detect on clinical interview alone, and patient self-report is unreliable. General practitioners (GP) can have akeyrole in the screening and initial management of cognitive impairment, but they need the right tools to do so. This aim of this article is to describe the best cognitive screening tools to use in MS and some psychological screening tools that can provide useful additional clinical information. The various ways in which information gleaned from applying these tools can guide GPs' care plans related to the effective management and treatment of cognitive impairment during three stages in the trajectory of cognitive change in MS are discussed.

Should psychological distress be listed as a surgical indication for indeterminate pulmonary nodules: protocol for a prospective cohort study in real-world settings

BackgroundPulmonary nodules (PNs) are documented in up to 30% of computed tomography (CT) reports. PNs of indeterminate nature (IPN) have been reported to be associated with increased psychological distress and deterioration of the quality of life. Despite lack of solid evidence, severe anxiety or depression has been proposed to be one of the surgical indications in expert consensus for IPN management. So far, there is no established criterion to guide the decision-making process, or to ensure evidence-based management. This study aims to evaluate whether psychological distress could be a surgical indication for IPN, and to establish an evidence-based distress threshold for necessary surgical intervention.MethodsThis prospective observational study in real-world setting will involve an expected sample size of 1,253 IPN patients from the thoracic clinic of Guangdong Provincial People’s Hospital. Web-based questionnaires powered by Wen Juan Xing (WJX) platform will be delivered to the patients for baseline data collection and psychological screening. Based on our pilot study, a total of 376 IPN patients with abnormal or borderline abnormal psychological states, as assessed by the Hospital Anxiety and Depression Scale (HADS), will be followed for 1 year before proceeding to the final analysis. The planned study period is from Jan 1, 2021, to Sept 30, 2022, and will entail two HADS assessments at baseline and follow-up. Sleep quality and indicators of healthcare-seeking behavior, such as the number of unplanned clinic visits or CT scans per year, will be used as anchors of psychological state. Patients who undergo surgical resection against the follow-up plan will be enrolled into a surgical group (expected n=94), while those who adhere to their plan will be automatically classified as a follow-up group after 1-year follow-up (expected n=282). Statistical measures such as independent-samples t-test and receiver operating characteristics (ROC) analysis will be used to assess the difference in psychological changes between the groups, and to generate an optimal threshold alerting surgical need. A Chi-square test or nonparametric test will be used to compare the baseline characteristics. Contributors to psychological burden and their effect sizes will be evaluated using general linear regression.DiscussionTo date, data on the psychological benefits of surgical resection of IPN remains scanty. Evidence-based procedure of patient selection using appropriate psychological screening tools is crucial in improving the quality of care and preventing overtreatment. This protocol describes the rationale and methodology to address this unmet clinical need using real-world data, aiming to bridge the gap between clinical guidelines and real-world practice.Trial RegistrationClinicalTrials.gov Identifier: NCT04857333. Registered April 23, 2021.

Asthma Control and Psychological Health in Pediatric Severe Asthma

To determine the prevalence of anxiety and depression and impact on asthma control in pediatric patients with severe asthma.Children aged ≥4 years who were referred to the Boston Children’s Hospital Severe Asthma Program by a pediatric pulmonologist, allergist, or intensivist after a life-threatening asthma exacerbation.This was a single-center prospective cohort study from March 2017 to December 2019. Asthma severity for each participant was defined on the basis of the National Heart, Lung, and Blood Institute (NHLBI) asthma medication steps. At each clinical encounter, children completed the Patient Health Questionnaire (PHQ-4) and the Asthma Control Test (ACT) or childhood ACT with parental assistance and had spirometry done to assess lung function, including forced expiratory volume in 1 second (FEV1) to forced vital capacity. The association of the longitudinal psychological assessments and pulmonary function measures were determined by using a linear mixed model (adjusted for sex, age, race, and NHLBI asthma medication step).Data were obtained for 93 clinical encounters from 43 patients. The mean age was 11.7 (+/− 4.2) years; 65% were male (n = 28 of 43); 49% were White (n = 22 of 43). The median NHLBI asthma medication step was 5.5 (interquartile range: 4.5–6.0). A total of 58% (n = 25 of 43) had at least 1 symptom of anxiety and depression, and 19% (n = 8 of 43) had a PHQ-4 score >2, indicating at least mild impairment. Bivariate analyses after adjusting for age, sex, race, and medication step revealed a significant difference in mean ACT scores (7 points lower) for girls with a PHQ-4 score >2 versus that of those with a score ≤2 (95% confidence interval [CI]: −10.88 to −3.12; P = .01); this effect was not seen in mean ACT scores for boys with PHQ-4 scores >2 versus that of those with scores ≤2. Compared with girls, boys with PHQ-4 scores >2 had a mean ACT score that was 4.18 points higher (95% CI: 0.63 to 7.73; P = .03). A PHQ-4 score >2 was significantly associated with percent FEV1 predicted but not with FEV1 to forced vital capacity (95% CI: −33.83 to 1.12; P = .06).Pediatric patients with severe asthma often have comorbid mental health impairment, which is associated with poor asthma-related quality of life. Girls with greater anxiety and depression perceived significantly worse asthma control. No difference in perceived asthma control was seen in boys, regardless of anxiety or depression level.Individuals with poorly controlled asthma can have psychological comorbidities including anxiety and depression, whereas, conversely, these factors can exacerbate asthma and negatively impact asthma control and severity. The perception of asthma control may impact self-care, asthma self-management, and inaccurate perception of symptoms, potentially resulting in higher rates of asthma-related health care use. Just as women often are more likely to report symptoms than men, the girls in this study had the higher level of mental health impairment and more negatively perceived asthma control. Although sex differences were observed in the association between psychological impairment and perceived asthma control, there was no association with objective spirometry results. Study limitations include the small sample size and use of PHQ-4, which is not a standard psychological screening tool. However, with these results, the authors highlight the potential impact of psychological symptoms in our clinical management of patients with asthma.

Cultural adaptation, validity and reliability of the Turkish version of the Örebro Musculoskeletal Pain Questionnaire in acute and subacute neck pain

Background/aims The Örebro Musculoskeletal Pain Questionnaire is categorised as a ‘yellow flag’ pain-associated psychological distress screening tool, which predicts long-term disability. The aim of this study was to assess the validity and reliability of the Turkish translation of the Örebro Musculoskeletal Pain Questionnaire in patients with acute and subacute neck pain. Methods The test–retest reliability and internal consistency were assessed with the intraclass correlation coefficient and Cronbach's α. Construct validity was assessed with a visual analogue scale, the Neck Disability Index and the Fear Avoidance Belief Questionnaire. Results Cronbach's α value was found to be 0.790, test–retest reliability was 0.99. The intraclass correlation coefficient was 0.999 (95% confidence interval: 0.998–0.999; P=0.000). The Örebro Musculoskeletal Pain Questionnaire showed a moderate positive correlation with the Neck Disability Index (r=0.544; P=0.0001), a weak correlation with the Fear Avoidance Belief Questionnaire (r=0.264; P=0.0001) but no correlation with the visual analogue scale. Conclusions The Turkish version of the Örebro Musculoskeletal Pain Questionnaire is a valid, reliable and acceptable screening tool in patients with acute and subacute neck pain.

Screening for psychological distress on Indonesian type 2 diabetes: A validation study.

This study aimed to test the validity and reliability of a four-item patient health questionnaire as a psychological distress screening tool for patients with type 2 diabetes in Indonesia. This cross-cultural adaptation study was applied in five public health-care centres in Indonesia in August-October 2018 using a four-item patient health questionnaire. The content, convergent and factorial validity were assessed, and Cronbach's alpha coefficient was the reliability indicator. A total of 147 participants were involved. Content validity resulted in acceptable outcomes (item and scale content validity indexes were 0.95 and 0.75, respectively). Anxiety and depression were associated with total score and psychological distress status (P < 0.001), supporting the convergent validity outcomes. Principal component analysis using varimax rotation revealed two factors, explaining 76.14% of variance (P < 0.001). Cronbach's alpha coefficients for anxiety, depression and total score were 0.780, 0.500 and 0.713, respectively. The study demonstrated adequate validity and reliability for the Indonesian version of a four-item patient health questionnaire among patients with type 2 diabetes. Therefore, it is applicable as a screening tool for psychological distress in this population.

Submarine medicine: An overview of the unique challenges, medical concerns, and gaps

Submariners face many challenges. For example, they “live where they work” and can be called to duty anytime. They have limited access to open space, natural settings, fresh air, fresh food, sunlight, privacy, exercise, and outside communication. They support a wider range of missions than occur aboard most other Navy vessels. At sea or on shore, submariners work long hours under conditions with little margin for error. They may traverse remote or disputed areas of the ocean far from rescue assets, and must remain vigilant for potential encounters with hostile forces, onboard fires, anomalies in the breathing atmosphere, leaks, undersea collisions, or radiation exposures. If any of these factors cause casualties, the Independent Duty Corpsman (with intermittent advice from shore-based medical personnel), must be ready to provide aid as long as necessary. The challenges of submarine service led to the growth of the unique field of submarine medicine, which has maintained an excellent record of health and safety. This review introduces the field of submarine medicine as practiced in the U.S. Navy, describing its major concerns, giving an overview of the operation of a submarine medical department, and identifying several medical gaps that researchers are working to fill. Submarine medicine already has a stellar record in terms of radiation and atmospheric safety and has made strides in fatigue management. Ongoing work will deliver improved psychological screening and support tools. This report summarizes developments in these and other areas of submarine medicine.

Evidence for the Technical Adequacy of the Risk Assessment and Distress Recovery: Examining Risks While Avoiding Profiling Youth With Mental Health Difficulties

This study examined the psychometric properties of the Risk Assessment and Distress Recovery (RADR) Scale—a new self-report psychological screening tool for high school students that explores risk factors related to mental health characteristics of students who have engaged in school violence. The sample consisted of 1093 high school students from all four regions of the United States. A four-factor model consisting of coping skills, depression, suicidal ideation, and narcissism demonstrated good fit. Results of confirmatory factor analysis and measurement invariance, as well as internal consistency estimates, provide initial evidence for reliability and validity of the RADR. Exploratory analyses between the RADR and characteristics of past school shooters are also presented. Students with disabilities self-reported significantly greater risks for mental health concerns across all four constructs, with small (.15) to large (.80) effect sizes.