Self-assessed Mental Health Research Articles

A longitudinal analysis of mental and general health status of informal carers in Australia

BackgroundThe study investigated the self-assessed mental and general health status of informal carers in Australia. It evaluated the influence of carer’s health behaviours, namely physical activity, smoking and drinking status, along with their social connectedness and workforce engagement on their health status.MethodsThe study used a retrospective longitudinal design using data from the Household Income and Labour Dynamics of Australia survey, waves 5–15 (2005–2015). It included individuals aged 15 years and older from Australian households surveyed over a period of 11 years. The sample consisted of 23,251 individuals. The outcome measures included: mental health, general health and physical functioning domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. Using fixed effects regression and following individuals over time, the analysis took care of the issue of individuals self-selecting themselves as carers due to some predisposing factors such as age, poor health, socioeconomic status and sedentary behaviour.ResultsThere were statistically significant carer-noncarer status differences in mental (Beta = − 0.587, p = 0.003) and general health (Beta = − 0.670, p = 0.001) outcomes. Aging had a modifying impact on carers’ mental and general health outcomes. Older carers coped better with their caregiving responsibilities than younger ones. Moreover, while physical activities had a positive influence on both mental and general health for non-carers, with more activities generating better health outcomes, it only had a modifying impact on carers’ mental health. Furthermore, the study found that moderate levels of social drinking had beneficial modifying impact on carers’ mental and general health.ConclusionThis study added value to the literature on informal carers’ mental and general health in Australia by identifying some of the protective and risk factors. The study found the modifying effects of carers’ age, health behaviours such as physical activity, smoking and drinking status on their health. Finally, the study identified an apparent beneficial link between moderate levels of social drinking and carer health that needs to be further explored with more targeted future research.

Declines in mental health associated with air pollution and temperature variability in China

Mental disorders have been associated with various aspects of anthropogenic change to the environment, but the relative effects of different drivers are uncertain. Here we estimate associations between multiple environmental factors (air quality, residential greenness, mean temperature, and temperature variability) and self-assessed mental health scores for over 20,000 Chinese residents. Mental health scores were surveyed in 2010 and 2014, allowing us to link changes in mental health to the changes in environmental variables. Increases in air pollution and temperature variability are associated with higher probabilities of declined mental health. Mental health is statistically unrelated to mean temperature in this study, and the effect of greenness on mental health depends on model settings, suggesting a need for further study. Our findings suggest that the environmental policies to reduce emissions of air pollution or greenhouse gases can improve mental health of the public in China.

Aircraft noise and self-assessed mental health around a regional urban airport: a population based record linkage study

BackgroundLimited evidence suggests that residential exposure to aircraft noise negatively influences population mental health around large airports, but it is not known whether the same is true for smaller airports. We investigated whether residential exposure to aircraft noise near a regional urban airport was associated with risk of chronic self-assessed mental ill health.MethodsThis is a cross-sectional study of 198,532 people aged 18 years and over living in Belfast, United Kingdom, enumerated at the 2011 Census. Residential exposure to aircraft noise (LAeq,16h) was assessed by linking Census records with modelled noise contours surrounding George Best Belfast City Airport (c.42,000 annual aircraft movements). Associations between noise and mental ill health were estimated using multiple logistic regression adjusting for demographic characteristics, socio-economic status and comorbidity.ResultsPrevalence of self-assessed mental ill health was greater in high noise (≥57 dB) compared to low noise (< 54 dB) areas (12.4% vs. 9.7%). We found no association between aircraft noise and risk of mental ill health after adjustment for socio-economic status (high vs. low noise odds ratio: 1.03 CI: 0.93, 1.14).DiscussionAssociations between aircraft noise and mental health have been reported near large airports at similar average noise levels to those observed here. Our findings indicate that the noise environment around this smaller airport (with fewer flights and no night flights) has little influence on population mental health.

Unge og selvskade: Resultater fra en dansk national repræsentativ undersøgelse i 2008

In a nationwide school survey in 2008 conducted by use of multi-media computer assisted self-interviewing, prevalence rates of suicidal attempts and non-suicidal self-injury were assessed among 1,991 boys and 1,942 girls in 9th grade and correlated to comprehensiveinformation on the adolescents’ family, social contacts, exposure to physical violence, sexual abuse and to other adverse experiences and their self-assessed mental health. One in five girls and one in ten boys reported fantasies about self-harm, suicidal intention or non-suicidal self-injury during the past week. Among boys, self-harm was correlated to adverse experiences: sexual abuse, intra-family violence and lack of confidence to parents. Depression was correlated to girls’ self-harm and suicidal intention. Prevention of self-harm should build on the development of programs that address the psychosocial, family and related factors that apparently contribute to the risk of selfharm.

The Relationship between Perceived Underemployment and Wellbeing: Evidence from Mid-Size Canadian Cities

This study examines the association between underemployment and quality of life, with a focus the explanatory power of community and leisure factors. Using survey data collected by the Canadian Index of Wellbeing in four mid-size communities (N = 5561), a subsample of participants was selected who indicated that they worked for pay (n = 2845). About one-fifth of workers were underemployed, based on a perceived mismatch between their job and their education and training. Guided by a modified perspective of the Leisure Constraints Model that includes intrapersonal, interpersonal, and structural level constraints and/or facilitators to participation, data were analyzed using two linear regression models examining overall wellbeing and self-assessed mental health. After controlling for socio-demographic characteristics in each model, mediators were introduced and then further probed to determine significant pathways in the relationships. In both cases, the direct effect of underemployment was negative. Wellbeing among underemployed workers was partially mediated by two structural, and one interpersonal factors: time for self, perceived access to recreation and cultural opportunities, and sense of community. Mental health was fully mediated by time for self and sense of community. In a test of contrast between significant pathways, there were no differences in either model, suggesting that each of the significant leisure moderators contributed equally to the relationship between underemployment and quality of life. Community and leisure factors have been relatively unexamined to date, but results show that they should be considered for inclusion in future research on personal outcomes of underemployment.

Recovery After Same-Day Surgery in Patients Receiving General Anesthesia: A Cohort Study Using the Quality of Recovery-40 Questionnaire

The contemporary rise in the number of elective procedures performed in same-day surgery (SDS) requires that health care professionals increase their knowledge of patient satisfaction and recovery, including patient-assessed quality of life. This study investigates the quality of recovery (QoR) of anesthetized SDS patients. Data from SDS patients were collected from hospital records at T1 (the morning before operation), T2 (day 1 postsurgery), and T3 (day 4 postsurgery). The QoR-40 and three questions that addressed tiredness, hoarseness, and thirst were used to measure health status at T2 and T3. QoR-40 mean score at T2 was 175 (SD=17.5; n = 328) and T3 was 181 (SD=16.6; n = 340). QoR improved significantly from T2 to T3 as did tiredness, hoarseness, and thirst. Patients who underwent throat, nose, or ear surgery had the lowest mean score at T3, whereas gynecology patients had the highest mean score at the same time point. Stepwise multiple linear regression analysis found the main predictor of QoR to be tiredness at T2, needing assistance with daily activities, preoperative education, not being discharged home, length of anesthesia, self-assessed mental health at T1, and hoarseness at T2 (R2 = 0.469). SDS patients needing assistance with daily activities, self-assessed in compromised mental health, who have undergone a lengthy anesthesia, and have not been discharged home need information, education, and special follow-up care.

Juvenile Probation Officer Self-Assessed Mental Health Competency as a Predictor of Case Management Practices.

Justice-involved youth endorse high rates of mental health problems. Juvenile probation is the most common disposition in the justice system and juvenile probation officers (JPOs) are crucial for connecting justice-involved youth with appropriate care. We examined the role of mental health competency on the use of self-report case management strategy types (deterrence, restorative justice, and treatment) by JPOs and whether jurisdiction-level differences were relevant. Results suggest that mental health competency predicted use of restorative justice and treatment strategies and all three strategy types varied at the county level. The role of mental health competency in use of treatment strategies is relevant to connecting justice-involved youth to mental health care. Furthermore, a substantial amount of the variance predicting the use of all three strategies was accounted for at the county level.

The contribution of paid vacation time to wellbeing among employed Canadians

ABSTRACT Vacations provide an opportunity to relax, recover from the demands of work, and spend time with family and friends. Recently, however, concerns have been expressed regarding the low uptake of paid vacation time among Canadian workers and its potential impact on their quality of life. Guided by the conservation of resources theory, we examined the extent to which Canadian employees use their paid vacation allotment and how the amount of paid vacation time is related to feelings of wellbeing. A subsample of 3,451 people who worked full-time at a paid job or business was drawn from Statistics Canada’s 2010 General Social Survey. More than one-third of Canadian employees reported taking less than the minimum amount of federally mandated paid vacation time (10 days) during the previous year. This included 19.3% who reported taking no paid vacation days at all. Factors significantly associated with uptake of vacation days were age, socio-economic status, having younger children in the household, flexible work schedules and occupational sector. Fewer than half of agriculture, accommodation and food services, and construction sector employees took the minimum amount of paid vacation days. Linear regression analysis with mediation indicated that taking more paid vacation days was positively associated with both overall health and life satisfaction. The relationship for each factor was partially mediated by feelings of time pressure, satisfaction with work–life balance, and self-assessed mental health. Findings suggest the need to examine sector-specific workplace cultures and management practices in order to encourage employees to take their full vacation allotment.

Effect of a Faith-Based Education Program on Self-Assessed Physical, Mental and Spiritual (Religious) Health Parameters.

The aim of the study was to determine the effect of attending a faith-based education program (FBEP) on self-assessed physical, mental and spiritual health parameters. The study was designed as a prospective, observational, cohort study of individuals attending a 5-day FBEP. Out of 2650 sequential online registrants, those previously unexposed to the FBEP received automated invitations to complete 5 sequential Self-Assessment Questionnaire's (SAQ's) containing: (1) Duke University Religion Index (DUREL); (2) Negative Religious Coping (N-RCOPE); (3) Perceived Stress Scale (PSS); (4) Center for Epidemiology and Statistics-Depression Scale (CES-D); (5) Brief Illness Perception Questionnaire (BIPQ); and the (6) State Trait Anxiety Inventory (STAI). Pre-attendance SAQ (S1) was repeated immediately post-FBEP (S2), at 30days (S3), 90days (S4) and after 1year (S5). Of 655 invited, 274 (42%) succeeded, 242 (37%) failed and 139 (21%) declined to complete S1. Of the 274, 37 (14%) were excluded at on-site interview; 26 (9%) never attended the FBEP (i.e., controls: 5♂; 21♀; 27-76years); and 211 (77%) participated (i.e., cases: 105♂; 106♀; 18-84years) and were analyzed over time: 211 (S1); 192 (S2); 99 (S3); 52 (S4); 51 (S5). IRB approval was via the Human Research Ethics Committee of Stellenbosch University. DUREL showed significant, sustained changes in Intrinsic Religiosity. N-RCOPE showed significant, lasting improvement. In others, median values dropped significantly immediately after the FBEP (S1:S2) for STAI-State p<0.0001; PSS p<0.0001; BIPQ p<0.0001; and CES-D p<0.0001; and at 1month (S1:S3) for STAI-Trait p<0.001; all changes were sustained (S3 through S5). This FBEP produced statistically and clinically significant changes; these lasted in those followed up >1year.

Mental Health Self-Assessment in Patients With Moderate to Severe Psoriasis: An Observational, Multicenter Study of 1164 Patients in Spain (The VACAP Study)

BackgroundPoor self-assessed mental health appears to be related to the severity of psoriasis. ObjectiveTo evaluate the impact of psoriasis severity on mood and anxiety disorders. MethodsA prospective, observational, multicenter study was conducted by 123 dermatologists in Spain. Patients (n=164; mean [SD] age, 45.11 [13.92] years; 60.8% males) with moderate to severe psoriasis were evaluated at baseline and 4 months later. Psoriasis severity was measured using the Psoriasis Area and Severity Index (PASI), with a score range of 0 (mild) to 72 (severe); body surface area involvement (BSA); and physician global assessment (PGA) scores, with a range of 1 (mild) to 7 (severe). Mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with a total possible score of 0–42 (higher scores representing worse mental health). Mean first and second visit scores were compared. ResultsMean (SD) scores improved between the first and second visit as follows: 13.24 (9.50) to 5.07 (6.03) for PASI, 12.52 (7.92) to 10.78 (7.32) for overall HADS, 7.83 (4.55) to 6.85 (4.21) for the HADS anxiety subscale, and 4.72 (4.12) to 3.95 (3.76) for the HADS depression subscale (P<.001 in all cases). Multivariate analyses showed that the main factors related to anxiety were psoriasis severity, sex, and completion of graduate studies. The independent variables included in the model for depression were psoriasis severity, sex, and psoriasis located on the head. ConclusionsReductions in disease severity improve self-assessed mood and anxiety disorders in patients with moderate to severe psoriasis.

Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence.

BackgroundMental health problems are common in the work force and influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).MethodsEmployed women and men (n=6140), aged 19–64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health and work situation (response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.ResultsThe likelihood of RTW (≥105 days) was higher among those with persistent mental illness OR= 2.97 (95% CI, 2.10-4.20) and those with low mental well-being OR= 2.89 (95% CI, 2.31-3.62) after adjusting for gender, age, SES, hours worked and sick leave 2007. An analysis of employees who were off sick when they answered the questionnaire, the likelihood of RTW (≥105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (≥105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.ConclusionSelf-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.

Mental Health Self-Assessment in Patients With Moderate to Severe Psoriasis: An Observational, Multicenter Study of 1164 Patients in Spain (The VACAP Study)

BackgroundPoor self-assessed mental health appears to be related to the severity of psoriasis. ObjectiveTo evaluate the impact of psoriasis severity on mood and anxiety disorders. MethodsA prospective, observational, multicenter study was conducted by 123 dermatologists in Spain. Patients (n=164; mean [SD] age, 45.11 [13.92] years; 60.8% males) with moderate to severe psoriasis were evaluated at baseline and 4 months later. Psoriasis severity was measured using the Psoriasis Area and Severity Index (PASI), with a score range of 0 (mild) to 72 (severe); body surface area involvement (BSA); and physician global assessment (PGA) scores, with a range of 1 (mild) to 7 (severe). Mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with a total possible score of 0–42 (higher scores representing worse mental health). Mean first and second visit scores were compared. ResultsMean (SD) scores improved between the first and second visit as follows: 13.24 (9.50) to 5.07 (6.03) for PASI, 12.52 (7.92) to 10.78 (7.32) for overall HADS, 7.83 (4.55) to 6.85 (4.21) for the HADS anxiety subscale, and 4.72 (4.12) to 3.95 (3.76) for the HADS depression subscale (P<.001 in all cases). Multivariate analyses showed that the main factors related to anxiety were psoriasis severity, sex, and completion of graduate studies. The independent variables included in the model for depression were psoriasis severity, sex, and psoriasis located on the head. ConclusionsReductions in disease severity improve self-assessed mood and anxiety disorders in patients with moderate to severe psoriasis.

Demographic, Clinical, and Lifestyle Correlates of Subjective Memory Complaints in the Australian Population

To provide estimates of the prevalence and correlates of subjective memory complaints in older individuals by using population-based Australian data. 2007 National Survey of Mental Health and Well-Being. Australia. 1,905 community-dwelling participants aged 65-85 years. Subjective memory complaints were assessed by using two questions reflecting: (1) poorer memory compared with others of the same age ("worse memory"); and (2) a decline in memory performance over the previous 5 years ("declining memory"). Twelve-month and lifetime diagnoses were derived from structured diagnostic interviews. Other correlates investigated included chronic physical conditions, lifestyle factors, and service use. Analyses adjusted for scores on the Mini-Mental State Examination. Subjective memory complaints were reported by one-third (33.5%) of respondents. Those who reported either complaint were more likely to report psychological distress, poor functioning, service use, and negative self-assessed mental and physical health. "Declining memory" over the past 5 years was also related to an increase in the rates of psychiatric disorders. After adjusting for other variables of interest, associations were established between subjective memory complaints and psychological distress, poor functioning, negative self-assessed mental health, and alcohol use disorders. Except for the association between "declining memory" and anxiety and depression, these associations remained significant afterexcluding those with scores<27 on the Mini-Mental State Examination. Subjective memory complaints were associated with several negative clinical characteristics that should be considered when interpreting these complaints. Subjective memory complaints may be valid indicators of psychopathology and the need for clinical assessment.

Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

BackgroundHeart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery.MethodsA randomised clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study.DiscussionThe study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015).Trial registrationClinicalTrials.gov (http://NCT01558765).

The DRUID study: racism and self-assessed health status in an indigenous population.

BackgroundThere is now considerable evidence from around the world that racism is associated with both mental and physical ill-health. However, little is known about the mediating factors between racism and ill-health. This paper investigates relationships between racism and self-assessed mental and physical health among Indigenous Australians as well as potential mediators of these relationships.MethodsA total of 164 adults in the Darwin Region Urban Indigenous Diabetes (DRUID) study completed a validated instrument assessing interpersonal racism and a separate item on discrimination-related stress. Self-assessed health status was measured using the SF-12. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as mediators and moderators of the relationship between racism/discrimination and self-assessed health status.ResultsAfter adjusting for socio-demographic factors, interpersonal racism was significantly associated with the SF-12 mental (but not the physical) health component. Stress, lack of control and feeling powerless as a reaction to racism emerged as significant mediators of the relationship between racism and general mental health. Similar findings emerged for discrimination-related stress.ConclusionsRacism/discrimination is significantly associated with poor general mental health among this indigenous population. The mediating factors between racism and mental health identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. In particular, the importance of reducing racism-related stress, enhancing general levels of mastery, and minimising negative social connections in order to ameliorate the negative consequences of racism.

Mental distress, alcohol use and help-seeking among medical and business students: a cross-sectional comparative study

BackgroundStress and distress among medical students are thoroughly studied and presumed to be particularly high, but comparative studies including other student groups are rare.MethodsA web-based survey was distributed to 500 medical students and 500 business students. We compared levels of study stress (HESI), burnout (OLBI), alcohol habits (AUDIT) and depression (MDI), and analysed their relationship with self-assessed mental health problems by logistic regression, with respect to gender.ResultsMedical students' response rate was 81.6% and that of business students 69.4%. Business students scored higher on several study stress factors and on disengagement. Depression (OR 0.61, CI95 0.37;0.98) and harmful alcohol use (OR 0.55, CI95 0.37; 0.75) were both less common among medical students. However, harmful alcohol use was highly prevalent among male students in both groups (medical students 28.0%, business students 35.4%), and among female business students (25.0%). Mental health problems in need of treatment were equally common in both groups; 22.1% and 19.3%, respectively, and was associated with female sex (OR 2.01, CI95 1.32;3.04), exhaustion (OR 2.56, CI95 1.60;4.10), lower commitment to studies (OR 1.95, CI95 1.09;3.51) and financial concerns (OR 1.81 CI95 1.18;2.80)ConclusionsMedical students may not be more stressed than other high achieving student populations. The more cohesive structure of medical school and a higher awareness of a healthy lifestyle may be beneficial factors.

The general practitioner's role in providing mental health services to Australians, 1997 and 2007: findings from the national surveys of mental health and wellbeing

To compare the findings of the 1997 and 2007 Australian national surveys of mental health and wellbeing (NSMHWBs) with respect to the role of general practitioners in providing mental health services. There were 10,641 participants Australia-wide in the 1997 survey and 8841 in the 2007 survey. Data were gathered through face-to-face interviews using a written questionnaire. Rates of use of GPs and other health care providers for treatment of mental health problems; levels of met and unmet need for mental health services reported by those accessing GP services. Between 1997 and 2007, the proportion of people accessing any mental health care service within the previous 12 months increased significantly, from 12.4% to 21.4% (P < 0.01), although the proportion accessing GP care for mental health problems did not increase. In both surveys, nearly 60% of individuals with self-assessed mental health problems sought no professional help for their problems, although about 80% of these non-users had seen GPs about other matters. The proportions of participants who reported receiving sufficient information, medication and/or therapy for their mental health problem increased significantly over the 10-year period. However, unmet need for information also increased. In both surveys, over 90% of participants aged 60 years or over with self-assessed mental health problems reported obtaining no help for their mental health problem despite seeing a GP for other reasons. Despite a significant rise in the use of mental health services, the role of GPs in providing such services has not increased.

Anxiety is contagious—symptoms of anxiety in the terminally ill child affect long‐term psychological well‐being in bereaved parents

We studied the relation between unrelieved symptoms in terminally ill children and the psychological well-being in the bereaved parents 4-9 years after their loss. We contacted parents in Sweden who had lost a child to a malignancy 1992-1997. The parents were asked to assess symptoms affecting their child's well-being during his or her last month of life, and their own current psychological well-being. Altogether 449/561 (80%) eligible parents supplied information on 19 specific symptoms that may occur in children with a malignancy and how each of these symptoms had affected their child's well-being during his or her last month of life (not applicable, none, low, moderate, or severe). These results were linked to questions concerning the parents' self-assessed mental health. Parents of children who were affected by disturbed sleep also had increased risk to develop these symptoms; RR 2.0 [1.4-2.9] for depression, 1.8 [1.3-2.5] for anxiety, 1.5 [1.2-1.8] for decreased psychological well-being, and 1.5 [1.3-1.9] for decreased quality of life. Bereaved parents whose children were affected by anxiety or disturbed sleep due to anxiety or pain had an increased risk of long-term psychological morbidity. Reducing psychological complications in seriously ill children may also improve the psychological well-being in bereaved parents.

Reliability, Validity, and Health Issues Arising From Questionnaires Used to Measure Psychosocial and Organizational Work Factors (POWFs) Among Hospital Nurses: A Critical Review

This systematic review assesses the validity of epidemiological questionnaires used to measure psychosocial and organizational work factors (POWFs) in nurses. Of the 632 articles published between 1980 and July 2008 identified in this review, 108 provide some data concerning analysis of the intrinsic characteristics of such instruments (content validity or conceptual basis, reliability, validation of internal construction) and their external validity with respect to health aspects (concurrent validity and predictive validity). Psychometric properties of generalist questionnaires validated among blue collar or white collar workers were also assessed in the nurse population. The Job Content Questionnaire (JCQ), because of its longevity and reputation, was the generalist questionnaire most used among this population. Although its structure often raises questions in the nurse population, its dimensions (mainly the control one) have been shown to be predictive of some health outcomes measured with "objective" indicators concerning absenteeism, injuries, and musculoskeletal disorders. Effort Reward Imbalance (ERI), which has a structure more stable among the nurse population, has shown concurrent validity in terms of intent to leave the nursing profession. No questionnaire specifically designed for nurses can claim to satisfy all of the recommendations in terms of internal validity. Nevertheless, the Practice Environment Scale-Nursing Work Index (PES-NWI) seems to be one of the most promising instruments because of its appropriateness (content validity), its structure, which has a rather good fit (construct validity), its ability to discriminate magnet hospitals like other NWI derivates (discriminant validity), and it has also been associated in cross-sectional studies with health outcomes, especially nurses' self-assessed mental health but also with patients' health outcomes objectively assessed (concurrent validity). However, elements for predictive validity are still lacking with NWI derivates. The Discussion provides recommendations for measuring POWFs, encompassing the use of external validated measurements.

Continuity of Health Insurance Coverage and Perceived Health at Age 40

While a lack of health insurance or interrupted coverage has been shown to lead to poorer health status among preretirement populations, this phenomenon has not been examined among a large population of younger, working-age adults. We analyzed a nationally representative data set of persons born between 1957 and 1961, the National Longitudinal Survey of Youth-1979, to examine the links between insurance continuity and self-assessed physical and mental health at age 40. Among respondents turning 40 in 1998 or 2000, 59.8% had been continuously insured during the decade before they reached age 40. In unadjusted analysis, persons who were continuously covered had the highest scores for both physical and mental health. After controlling for respondent characteristics, insurance coverage was not significantly associated with perceived physical or mental health.