Psychological Symptom Scores Research Articles

Physical and Psychological Symptoms and Risk of Virologic Rebound Among Patients With Virologic Suppression on Antiretroviral Therapy

We examined the association of self-reported physical and psychological symptoms with subsequent virologic rebound among patients with viral suppression on combination antiretroviral therapy (cART). We included 188 HIV patients from a routine London clinic, who completed a questionnaire on heath/treatment issues in 2005, and were on cART, with viral load (VL) < 50 c/mL. Symptom measures were based on the Memorial Symptom Assessment Scale Short Form, and additional questions: (1) physical symptom score; (2) psychological symptom score; (3) global symptom score; (4) total number of symptoms; (5) anxiety/depression; and (6) suicidal thoughts. Associations with time to (1) VL > 200 c/mL and (2) VL > 50 c/mL were assessed, considering each symptom measure separately. Of 188 patients, 22 experienced VL > 200 c/mL and 46 experienced VL > 50 c/mL (median follow-up: 2.2 years). Risk of VL > 200 c/mL was increased 4- to 5-fold for the highest versus lowest tertiles for the symptom scores (measures 1-3) and total number of symptoms (measure 4), and almost 4-fold for anxiety/depression (measure 5). Associations remained after adjustment for demographic and treatment-related factors (P = 0.006 to P = 0.050, measures 1-5), and were little attenuated after additional adjustment for subject-reported nonadherence (P = 0.011 to P = 0.072). There was a weaker, nonsignificant association with suicidal thoughts (measure 6). For risk of VL > 50 c/mL, all symptom measures were positively associated with rebound risk (P = 0.019 to P = 0.053, measures 1-6, adjusted for demographic and treatment-related factors; P = 0.022 to P = 0.084 after additional adjustment for nonadherence). Among patients on successful cART, physical and psychological symptoms were strongly predictive of viral rebound. Simple symptom inquiry may be valuable in the clinical setting to identify patients at risk of treatment failure, and provide opportunity for intervention.

Prevalence of childhood sexual abuse among 2508 college students in 6 provinces of China

To assess the prevalence of childhood sexual abuse (CSA) in college students and to explore the association of CSA with youth mental health problem. A retrospective survey was conducted among 2508 students (females 1360, males 1148) in Nov. 2003 to Mar. 2004. The students were from 6 colleges/universities in Beijing, Hebei, Shanxi, Jiangsu, Shaanxi and Anhui provinces of China. Of the 2508 students, 24.8% of females and 17.6% of males reported one or more types of nonphysical contact CSA (females 20.0% vs. males 14.6%) or/and physical contact CSA (females 14.1% vs. males 7.8%) before the age of 16 years. Risk of any CSA was not associated with the existence of siblings (one-child vs. two-or more child families), rural/non-rural residence during childhood, or parental education. Compared with their peers who had no CSA, the students with CSA showed significantly higher mean scores of psychological symptoms of somatization, obsessiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. The problem of CSA was not uncommon and there was a significant correlation between CSA experience and students mental health problems. More attention should be paid on CSA prevention and provision of health services for the victims.

The Prevalence and Incremental Validity of Identity Problem Symptoms in a High School Sample

This paper examines the expression, prevalence, and incremental validity of identity problem symptoms in adolescence. A sample of high school students (N = 140) aged 15-18 completed measures of identity problem symptoms, identity status, and psychological symptom severity. Findings suggested that 14.3% would meet DSM IV criteria for identity problem. Identity problem symptoms predicted psychological symptom scores beyond identity status, and identity status accounted for substantially less variance in psychological symptom severity when controlling for identity problem symptoms. Additional research on the relationship between identity problems and psychological adjustment is needed and greater attention to the role of identity issues in clinical practice is warranted.

Functional bowel disorders in primary care: Factors associated with health-related quality of life and doctor consultation

Background The role of psychological factors in irritable bowel syndrome (IBS) remains unclear, particularly in a primary care setting, where relatively little research on this common and costly condition has been carried out. The aim of this study was to investigate the relative contribution of physical and psychological factors to health-related quality of life and health-care utilization in patients with functional bowel disease (IBS-like symptoms) in primary care. We also wished to establish the relevance of formal diagnostic criteria to IBS in the primary care setting. Methods This study used a cross-sectional design. Four hundred twenty patients with functional bowel disorders in primary care completed a series of measures, including bowel symptom status and severity, severity of psychological distress, personality, and quality of life. The number of visits to a general practitioner (GP) in the previous 12 months was recorded. Results The following variables were independently and highly significantly associated with health-related quality of life in patients with functional bowel disorders in primary care: total psychological symptom score, diarrhea severity, abdominal pain for >12 weeks, and abdominal distension. A similar pattern emerged between patients who met meet Rome II criteria for IBS and patients who did not meet Rome II criteria for IBS. Relatively few variables (either physical or psychological) had a major impact on the number of GP consultations, with the exception of frequency of bowel movements. Conclusion This study confirms that psychological factors are significantly associated with health-related quality of life in patients with IBS in primary care. Physical symptom severity is also important. Relatively few symptom measures, either physical or psychological, have a major impact on doctor consultation rates in primary care.

Effect of androgens combined with hormone therapy on quality of life in post-menopausal women with sexual dysfunction

Aim. To evaluate with validated instruments changes in quality of life and sexuality in women receiving hormonal replacement therapy (AHT).Design. Randomised, double-blind, double-dummy study with two parallel treatment arms.Patients and methods. Forty-seven healthy post-menopausal women, aged 45–64 years, were evaluated using the Female Sexual Function Index (FSFI) and the menopause-specific quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised progesterone or placebo. After 3 months follow-up, FSFI and MENQOL questionnaires were administered for a second time.Results. Quality of life was unchanged in the placebo group whereas AHT significantly improved scores of vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was not modified in the placebo group while in AHT group the FSFI score improved significantly. In addition, at the end of the study, 68.7% of subjects of the AHT group did not fit did not fit the criteria for sexual dysfunction as per the FSFI (p < 0.0001).Conclusions. Adding methyl-testosterone to hormone therapy improves quality of life and sexuality in post-menopausal women with sexual dysfunction.

健康中年男性におけるテストステロンとADAMおよびAMS質問紙の妥当性に関する検討

To evaluate the usefulness of the ADAM questionnaire and aging males' symptoms' (AMS) rating scale for Japanese middle-aged men, we analyzed the results of these tests. We also examined the range of serum testosterone levels of these individuals. Answers to these tests were obtained from 187 healthy Japanese men (from 46 to 64 years old) who visited for medical check-up. Serum total (TT) and free (FT) testosterone were also examined, and calculated free (cFT) and bioavalable (cBT) testosterone levels were obtained. According to the ADAM questionnaire, 140 (77.8%) men were judged to be PADAM. Mean AMS total, psychological, somatovegetative, and sexual symptom scores were 29.4, 7.5, 12.9, and 9.0, respectively. Although 32 (17.5%) men had more than moderate symptoms on AMS total score, 119 (65.0%) men complained of more than moderate sexual symptoms. In contrast, the testosterone levels of these people were not always low. Mean values of TT, FT, cFT, and cBT were 5.50 ng/ml, 14.7 pg/ml, 116.1 pg/ml, and 292.3 ng/dl, respectively. None of these testosterone levels was significantly correlated with age or AMS score. Only sexual symptom score among AMS subscales was significantly correlated with age. The borderlines for the ADAM questionnaire and AMS rating scale appear too stringent for healthy Japanese middle-aged men. The sexual activity of Japanese middle-aged men appears less than that of Westerners. Criteria of these tests in Japanese middle-aged men, especially sexual function, should be changed.

Risk factors for common mental disorders in women

The determinants of common mental disorders in women have not been described in longitudinal studies from a low-income country. Population-based cohort study of 2494 women aged 18 to 50 years, in India. The Revised Clinical Interview Schedule was used for the detection of common mental disorders. There were 39 incident cases of common mental disorder in 2166 participants eligible for analysis (12-month rate 1.8%, 95% CI 1.3-2.4%). The following baseline factors were independently associated with the risk for common mental disorder: poverty (low income and having difficulty making ends meet); being married as compared with being single; use of tobacco; experiencing abnormal vaginal discharge; reporting a chronic physical illness; and having higher psychological symptom scores at baseline. Programmes to reduce the burden of common mental disorder in women should target poorer women, women with chronic physical illness and who have gynaecological symptoms, and women who use tobacco.

Psychological distress and perceived discrimination: a study of women from India

The association between health and immigration has been widely discussed, but there continue to be inconsistencies in the findings. Coping strategies, perceptions of discrimination among them, may be a source of the inconsistencies. The present study explores the relationship between psychological distress and perceived discrimination among immigrant women from India living in Canada. Findings show that female Indian immigrants who were hesitant to deal forthrightly with personally directed discrimination exhibited higher blood pressure and psychological symptom scores, especially anger. An implied benefit of a more open coping style is considered.

Differences among out-of-treatment drug injectors who use stimulants only, opiates only or both: implications for treatment entry

The goal of this study was to compare drug and alcohol use, psychological symptoms and substance abuse treatment entry among 583 street-recruited, out-of-treatment injection drug users (IDUs) who used stimulants only, opiates only or both stimulant and opiate. Data analyzed from structured interviews indicated that stimulant-only users had the most severe alcohol problems and the highest psychological symptom scores for hostility, paranoia and psychoticism. In the 2 months following their interview only 3% of the stimulant-only users entered substance abuse treatment, as compared to nearly half of the participants in the other two groups. Even after controlling for variables that differed among the groups by logistic regression analysis, stimulant only users were still 24–25 times less likely than opiate only or both stimulant and opiate users to enter treatment. Researchers and clinicians are challenged to better understand and address the unique needs of stimulant users, including potential psychological problems and alcohol abuse, in order to attract them to treatment and serve them through a comprehensive treatment approach.

Psychological impact of news of genetic risk for Huntington disease

A one-year longitudinal study was conducted investigating the psychological effects of the news of genetic testing for the Huntington disease (HD) gene. Participants were assessed at baseline (before obtaining news of test results) and at three, six, and 12 months after test results on stress-specific symptom measures. Among carriers of the HD gene, a considerable number (55%) showed evidence of neurological impairment at baseline, indicative of HD. Also noteworthy, these individuals had significantly higher psychological symptom scores at baseline than carriers without neurological impairment or noncarriers. Despite this, these individuals were no more aware of their carrier status at baseline than carriers without HD symptoms or noncarriers. Furthermore, the psychological symptom levels of HD carriers with neurological impairment remained elevated across the follow-up assessments. Results for noncarriers and carriers without HD neurological symptoms were consistent with the findings of previous studies indicating that news of genetic testing for the HD gene had limited detrimental impact. The clinical implications of the results are discussed.

Measurement of quality of life in alcohol-dependent subjects by a cancer symptoms checklist

There are few studies of Quality of Life measures (QoL) in alcohol-misusing patients. The present study addresses this deficiency. The sample consisted of 60 (39 men, 21 women) alcohol dependent subjects defined by DSM-IV criteria (American Psychiatric Association, 1994). At baseline (4–5 days after admission and detoxification) sociodemographic data were collected, and three questionnaires were administered: the Rotterdam Symptoms Checklist (RSCL), the Severity of Alcohol Dependence Questionnaire (SADQ), and Alcohol Problems Questionnaire (APQ). QoL scores for dependent alcoholics both for physical and psychological measures were significantly worse (higher) than those reported for a variety of cancer patients. Psychological symptom scores were higher than physical symptoms at baseline. Correlations of RSCL scores to both SADQ and APQ were greater for RSCL physical compared to psychological symptom scores. The subjects were followed up at 12 weeks when the RSCL was re-administered and relapse status ascertained. Fifty-eight (97%) subjects were successfully contacted at 12 weeks of whom 36 (62%) had relapsed. After a repeated measures ANOVA psychological and physical symptom subscores were statistically significantly improved as a result of not relapsing to heavy drinking. There was no significant change in scores in the relapse group when baseline and week 12 scores were compared. The RSCL measure is a useful QoL assessment tool in alcohol-dependent subjects.

THE STABILITY OF SYMPTOM MEASURES: IMPLICATIONS FOR STRESS RESEARCH

Forty-nine female undergraduates completed life events and stress ratings on a daily basis over a 4-week period. They also completed a checklist of physical and psychological symptoms at the end of each week. Data from this study as well as others reported in the literature showed that physical and psychological symptom scores are highly stable over time. Although life events and stress ratings predicted future symptoms, the correlations diminished after initial symptom levels were controlled. The correlation between stress measured at time 1 and symptoms measured at time 2 is largely a function of their concurrent correlation at time 1 as well as the stability of the symptom measure. Hence, the value of computing lagged correlations between stress and symptoms has to be reexamined. Possible reasons for the stability of symptom measures are discussed.

Level of education, age of bearing children and mental health of women

The present study examined the longitudinal relationship between women's mental health and both their level of education and age at which they had their first child. The women were divided into four groups depending on whether or not they had further education after leaving school and whether or not they had a baby before the age of 21. Longitudinal data collected over a 19-year period from this group of women suggested that psychological morbidity was relatively stable across this time span. Women who left school without proceeding to further education and those who became mothers before the age of 21 had higher psychological symptom scores than the other groups throughout this period. These two factors were associated with poorer mental health in an additive fashion. The women were also more likely to have separated from the father of their child and continued to be economically disadvantaged into mid-life.

Ratio of proportions and the use of the delta method for confidence intervals in logistic regression

To present an application of logistic regression modelling to estimate ratios of proportions, such as prevalence ratio or relative risk, and the Delta Method to estimate confidence intervals. The Delta Method was used because it is appropriate for the estimation of variance of non-linear functions of random variables. The method is based on Taylor's series expansion and provides a good approximation of variance estimates. A computer program, utilizing the matrix module of SAS, was developed to compute the variance estimates. A practical demonstration is presented with data from a cross-sectional study carried out on a sample of 611 women, to test the hypothesis that the lack of housework sharing is associated with high scores of psychological symptoms as measured by a validated questionnaire. Crude and adjusted prevalence ratio estimated by logistic regression were similar to those estimated by tabular analysis. Also, ranges of the confidence intervals of the prevalence ratio according to the Delta Method were nearly equal to those obtained by the Mantel-Haenszel approach. The results give support to the use of the Delta Method for the estimation of confidence intervals for ratios of proportions. The method should be seen as an alternative for situations in which the need to control a large number of potential confounders limits the use of stratified analysis.

Inhibition of ovulation with oral progestins — effectiveness in premenstrual syndrome

Forty-eight women with premenstrual problems were recruited for therapy with either medroxyprogesterone (MPA) or norethisterone (NET), both compared with placebo, in a double-blind cross-over study. Thirty-five (73%) completed the study. At an oral dose of 15 mg daily for 21 days each cycle, both MPA and NET suppressed ovulation, although reduction of urinary total oestrogen excretion was significantly greater with NET. Breakthrough bleeding occurred in 74% of the cycles treated with MPA but only in 22% of those with NET. Symptoms were monitored daily by visual analogue scales. Both progestins significantly reduced breast discomfort, compared with placebo. While MPA significantly improved individual psychological symptom scores by the second active treatment cycle and pooled psychological symptom scores in both active cycles, NET was no more effective than the placebo. Similar numbers from both groups withdrew because of adverse effects. Among the women treated with MPA, the response to active and placebo therapy was related to the pretreatment psychological symptom profile. The results suggest that the beneficial effect of therapy with MPA in women with premenstrual problems was a consequence of disruption of menstrual cyclicity rather than a result of ovulation suppression.