Self-Reporting Questionnaire-20 Items Research Articles

The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi

IntroductionAdverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi—an HIV endemic resource-limited setting. MethodsThis is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. ResultsThe mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms—even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LimitationsData on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. ConclusionsACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.

The Effects of Climate Change on the Mental Health of Smallholder Crop Farmers in Embu and Meru Counties of Kenya

The weather patterns and climatic conditions have been changing over the last decades. Environmental psychosocial stresses associated with the effects of climate change are known to cause mental health issues such as depression and other mood disorders, anxiety, trauma, psychosis, substance abuse, ecological grief, relational problems, and psychological distress. The purpose of this study was to investigate the effects of climate change on the mental health of smallholder crop farmers in Embu and Meru Counties of Kenya. A sample of 400 smallholder farmers was determined using Yamane’s formula then participants selected using quota sampling. Data collection utilized the Self-Reporting Questionnaire 20-item (SRQ-20) to assess the mental health of the smallholder crop farmers and a researcher formulated questionnaire to assess the effects of climate change as well as the coping mechanisms utilized by the farmers to cope with the effects of climate change and mental illnesses. The results indicate that prevalence of mental health issues among smallholder crop farmers in Embu and Meru is at 35.2%. Correlational analysis shows that the mental health of smallholder farmers in Embu and Meru has been affected by climate changes. This study recommends that the government, agricultural agencies, and other private partnerships should help smallholder crop farmers with creative and innovative ways of dealing with climate change. Owing to the prevalence of mental illness among smallholder crop farmers, the study recommends that farmers proactively seek mental health services to help them in managing mental illnesses. Farmers should engage in seminars that train them on effective coping mechanisms to deal with climate change on one hand and mental illness on the other. Government and private entities, that are able to, could facilitate access to free or subsidized mental healthcare to smallholder crop farmers since most of these farmers cannot afford mental healthcare.

Association of Maternal Common Mental Disorder and Young Children Acute Malnutrition among Mekelle Public Health Facilities, Northern Ethiopia, 2019 - a Case-control Study

Background: The World Health Organization has claimed that morbidity and disability of the global population due to child malnutrition has internationally become the chief cause of disability. However, in our country, its association with a young child’s nutritional outcomes is rarely studied. Objectives: To assess the effect of maternal common mental disorder and substance abuse on young child acute malnutrition. Methods: An institution's based case-control study was conducted among 192 women; 64 cases and 128 control in Mekelle public health facilities. Two hospitals and three health centers were included in this study. Self-Reporting Questionnaire 20-Item (SRQ-20) was used to assess the presence of maternal common mental disorder. Bivariate and multivariable logistic regression analysis was performed. The strength of association was measured through odds ratio at their 95% CI. The statistical significance was set at p<0.05. Results: The result of this study revealed that young children who have a mother with a common mental disorder are 6.1 times [AOR= 6.11, 95%CI (1.18, 31.71)] more likely to develop acute malnutrition than children who have mothers with no common mental disorder. Mothers of acutely malnourished children should be evaluated early for the detection of maternal common mental disorder for appropriate referral and support. Conclusion: Maternal common mental disorder was an independent determinant of young children’s acute malnutrition. Mothers of acutely malnourished children should be evaluated early for the detection of maternal common mental disorder for appropriate referral and support.

Impact of social violence and childhood adversities on pregnancy outcomes: a longitudinal study in Tunisia.

BackgroundAccumulating research suggests that exposure to intra-familial adversities are significant risk factors for adverse pregnancy outcomes. However, the relationship between social violence (peer violence, witnessing community violence and exposure to collective violence) and pregnancy outcomes has not been extensively investigated. Our study aims to examine the association between social Adverse Childhood Experiences (ACEs) and pregnancy outcomes and to explore the role of depression during pregnancy as a mediator of this association.MethodsWe performed a prospective follow-up study of pregnant women in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from September 2015 to August 2016. Enrolled women were followed during the second trimester, third trimester of pregnancy and during the postnatal period. Exposure to violence was assessed retrospectively using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. The Self Reporting Questionnaire 20-Item (SRQ-20) was used as a screening tool for depression during pregnancy.ResultsWe recruited and followed a total of 593 women during the study period. Witnessing community violence was the most frequently reported social ACE among pregnant women (237; 40%), followed by peer violence (233; 39.3%). After adjustment for high risk pregnancies, environmental tobacco smoke, and intra-familial ACEs, the risk of premature birth was significantly associated with exposure to collective violence (P < 0.001) and witnessing community violence (P < 0.05). The risk of low birth weight was significantly associated with witnessing community violence (P < 0.001). In the mediation analysis, depression mediated significant proportions of the relationship between the cumulative number of ACEs and pregnancy outcomes.ConclusionsSocial ACEs may have a long-term effect on maternal reproductive health, as manifested by offspring that were of reduced birth weight and shorter gestational age. A public health framework based on the collaboration between pediatric, psychiatric obstetrical health professionals, education professionals and policy makers could be applied to ensure primary prevention of childhood adversities and pay attention to expected mothers with history of exposure to such adversities.

Associations of antenatal maternal psychological distress with infant birth and development outcomes: Results from a South African birth cohort

BackgroundAntenatal maternal psychological distress is common in low and middle-income countries (LMIC), but there is a dearth of research on its effect on birth and developmental outcomes in these settings, particularly in Sub-Saharan Africa. This study set out to identify risk factors for antenatal maternal psychological distress and determine whether antenatal maternal psychological distress was associated with infant birth and developmental outcomes, using data from the Drakenstein Child Health Study (DCHS), a birth cohort study in South Africa. MethodsPregnant women were enrolled in the DCHS from primary care antenatal clinics. Antenatal maternal psychological distress was measured using the Self-Reporting Questionnaire 20-item (SRQ-20). A range of psychosocial measures, including maternal childhood trauma, depression, and posttraumatic stress disorder (PTSD) were administered. Birth outcomes, including premature birth, weight-for-age z-score and head circumference-for-age z-score, were measured using revised Fenton growth charts. The Bayley III Scales of Infant and Toddler Development was administered at 6 months of age to assess infant development outcomes, including cognitive, language, and motor domains in a subset of n=231. Associations of maternal antenatal psychological distress with psychosocial measures, and with infant birth and developmental outcomes were examined using linear regression models. Results961 women were included in this analysis, with 197 (21%) reporting scores indicating the presence of psychological distress. Antenatal psychological distress was associated with maternal childhood trauma, antenatal depression, and PTSD, and inversely associated with partner support. No association was observed between antenatal maternal psychological distress and preterm birth or early developmental outcomes, but antenatal maternal psychological distress was associated with a smaller head circumference at birth (coefficient=−0.30, 95% CI: −0.49; −0.10). ConclusionAntenatal maternal psychological distress is common in LMIC settings and was found to be associated with key psychosocial measures during pregnancy, as well as with adverse birth outcomes, in our study population. These associations highlight the potential value of screening for antenatal maternal psychological distress as well as of developing targeted interventions.

Validation of the WHO self-reporting questionnaire-20 (SRQ-20) item in primary health care settings in Eritrea

BackgroundIn Eritrea, highly centralized mental health care services and lack of trained psychiatric personnel at primary health care units remain a challenge to the mental health care system. These problems can be minimized by introducing screening programs with a simple screening tool for mental disorders in the primary health care settings. Thus, this study aimed to assess the validity of the WHO self-reporting questionnaire 20 (SRQ-20) in Tigrigna version for use in Eritrean primary health care setting.MethodsThe SRQ-20 was translated into a local language (Tigrinya) in a process of forward and backward translation. SRQ-20 data were collected in a primary health care setting on 266 respondents. Internal reliability was tested using Cronbach’s alpha. Factorial validity was done using principal component analysis with varimax rotation to investigate whether SRQ-20 items properly measure the underlying dimensions of mental illness. Criterion validity was analyzed by looking at the relationship between the SRQ-20 and Brief Psychiatric Rating Scale using Pearson’s correlation coefficient. Sensitivity, specificity and the predictive values of the screening instrument were used to assess how well the results of SRQ-20 correspond with the criterion instrument.ResultsThe SRQ-20 had good internal reliability (α = 0.78). Factor analysis yielded two factors, explaining 31.2% of the total variance. The instrument performed well in detecting common mental disorders, with an area under the curve (AUC) of 0.879 (SE = 0.23, 95% CI 0.83–0.92) to the overall sample and with optimal cut-off score at 5/6 with sensitivity 78.6% and specificity 81.5%. Cut-off scores were different for women (5/6) and men (4/5). For male participants, the AUC statistic was 0.877 (SE = 0.04, 95% CI 0.79–0.96) and 0.871 (SE = 0.02 95% CI 0.81–0.92) for female participants.ConclusionThe Tigrinya version of the SRQ-20 can be used for screening probable common mental disorders in Eritrean primary health care setting, but cut-off scores need to be adjusted for men and women separately.

Symptom Endorsement and Sociodemographic Correlates of Postnatal Distress in Three Low Income Countries

Background. Maternal mental illness has been implicated in adverse child development outcomes. Factors such as context and culture may influence experiences of maternal distress and explain differences in outcomes across settings. Methods. We analyzed baseline data from 5,647 mothers in Ethiopia, India (Andhra Pradesh), and Vietnam participating in an ongoing cohort study (Young Lives) to compare symptom endorsement and sociodemographic correlates of distress. Maternal distress was assessed using the Self-Reporting Questionnaire-20 Items (cutoff: ≥8). Logistic regressions were stratified by sample to identify correlates of distress. Results. Symptom endorsement was similar among distressed women, particularly with regard to feeling unhappy (76%, 80%, and 79%). Notable differences were observed in three items assessing Depressive Thoughts, which were most highly endorsed in Ethiopia (49%–56%). Having a child experiencing a life-threatening event was correlated with distress in all three samples. A variety of correlates were unique to only one sample. Conclusions. There were multiple similarities but also notable differences across sites in the expression and correlates of maternal distress. Feeling unhappy appears to be a hallmark feature of distress. Correlates highlight the relationship between distress and indicators of poverty, child wellbeing, and economic shocks. Differences demonstrate the value of further exploration of cross-cultural differences.

Validation of the Self Reporting Questionnaire 20-Item (SRQ-20) for Use in a Low- and Middle-Income Country Emergency Centre Setting.

Common mental disorders are highly prevalent in emergency centre (EC) patients, yet few brief screening tools have been validated for low- and middle-income country (LMIC) ECs. This study explored the psychometric properties of the SRQ-20 screening tool in South African ECs using the Mini Neuropsychiatric Interview (MINI) as the gold standard comparison tool. Patients (n=200) from two ECs in Cape Town, South Africa were interviewed using the SRQ-20 and the MINI. Internal consistency, screening properties and factorial validity were examined. The SRQ-20 was effective in identifying participants with major depression, anxiety disorders or suicidality and displayed good internal consistency. The optimal cutoff scores were 4/5 and 6/7 for men and women respectively. The factor structure differed by gender. The SRQ-20 is a useful tool for EC settings in South Africa and holds promise for task-shifted approaches to decreasing the LMIC burden of mental disorders.

Trafficking experiences and psychological dysfunction among female trafficking survivors returning to Vietnam

<h2>Abstract</h2><h3>Background</h3> Studies have shown high levels of depression and post-traumatic stress disorder in female trafficking survivors and that mental disorders might be associated with factors such as pretrafficking childhood abuse, trafficking trauma, and unmet needs at post-trafficking. No study has provided comparisons of trafficking experiences and subsequent psychological dysfunction between individuals trafficked for different types of exploitation. <h3>Methods</h3> A cross-sectional convenience sample of trafficked women and girls returning to and receiving assistance through a post-trafficking project in Vietnam's northern border region were recruited for the study. Participants who provided informed consent were interviewed about demographic characteristics, trafficking experiences including trafficking trauma, and self-reported health. Psychological dysfunction was assessed by a score on the self-reporting questionnaire-20 items. Univariate and bivariate statistics were done to examine distributions of trafficking experience and psychological dysfunction between women trafficked into sex work, marriage, and domestic servitude. Multivariate regression analyses were done to determine predictive factors of psychological status in this sample of returning trafficking survivors. <h3>Findings</h3> 80 of 92 participants who agreed to participate in the study had complete data for the dependent variable; of whom 23 reported being trafficked into sex work, 15 into marriages, 12 into domestic servitude, and 30 in other/missing category. In the sample, age at trafficking averaged at 21·0 years (SD 5·5, range 14–45), duration of trafficking averaged at 7·9 months (SD 12·2, range 0–58), and most (n=57) were rescued by the police. Participants reported an average of 5·5 trauma items (of 18, SD 3·9, range 0–14). Individuals in domestic servitude reported the most amount of trauma (mean 8·4, SD 2·7, range 4–12), followed by those in sex work (mean 6·1, SD 3·9, range 0–14), and then those in marriages (mean 4·8, SD 2·7, range 0–10). The sample averaged a self-reporting questionnaire-20 score of 7·2 (SD 3·8, range 0–20). Regression analysis showed that individuals trafficked into marriages and domestic servitude reported significantly more psychological dysfunction than those trafficked into sex work, when adjusted for age, marital status, trafficking duration, and trafficking trauma (marriage: b=3·02, SE 1·17, p=0·012; domestic servitude: b=2·47, SE 1·21, p=0·045). <h3>Interpretation</h3> Trafficking trauma and post-trafficking psychological dysfunction might be different between women trafficked into sex work, marriages, or domestic servitude. Provision of services for trafficking survivors should assess the types and severity of trauma and mental health status while remaining cognisant of the specific type of exploitation. Further evidence is needed to determine if these patterns are present in other samples of trafficking survivors. <h3>Funding</h3> None.

Common Mental Disorders Among Civil Aviation Pilots

The purpose of this study was to estimate the prevalence of suspected cases of common mental disorders (CMD) on Brazilian civil aviation pilots and to investigate associations between CMD, demographics, and labor variables. A quantitative cross-sectional study was conducted on 807 working pilots between October 2009 and October 2010 using a self-administered questionnaire to obtain sociodemographic data and information about workload. CMD prevalence was estimated with the Self-Reporting Questionnaire-20 items (SRQ-20). Multiple logistic regression was used in statistical data analyses. The overall prevalence of CMD was 6.7% with the cutoff point of 8 used in this study, i.e., scores greater than or equal to 8 in SRQ-20 define positive cases. Using alternative cutoffs, the prevalence was 9.2% (cut off point 7) or 12% (cutoff point 6). Among the individuals who did not exercise, 10.2% presented suspected CMD. Among those with a heavy workload, 23.7% presented scores indicating suspected CMD. Only variables relating to workload and the practice of physical activity were significantly correlated with the estimate of CMD after multivariate analysis. Regular physical exercise afforded a possible protective effect against suspected cases of CMD, while there was a higher prevalence of suspected cases among subjects with heavy workloads. The inclusion of the topic of mental health among the targets and priorities of civil aviation in Brazil is imperative. Addressing issues such as the regular practice of physical activity and workload can contribute to achieving a better balance between flight safety and productivity.

Psychometric Properties of the Chinese Version of the Self-Reporting Questionnaire 20 (SRQ-20) in Community Settings

Community mental health services in China are in need of a brief, valid instrument to identify mental disorders. Many studies support the Self-Reporting Questionnaire 20 (SRQ-20) as a cost-effective instrument with which to measure community mental health, but there have been no previous studies conducted with the Chinese version of SRQ-20. In this paper, the psychometric properties of the Chinese version of SRQ-20 in community settings were investigated. SRQ-20 was used to evaluate 959 participants from 10 communities of Hangzhou City and 60 participants from two community primary care centres for the presence of mental disorders. Discriminative, concurrent, and construct validity as well as internal consistency and screening properties of SRQ-20 were evaluated. Cronbach's alpha for SRQ-20 was 0.90 for primary care and 0.91 for the community. Item-total correlation coefficients ranged from 0.40 to 0.73 in primary care, and from 0.51 to 0.69 in the community. The test-retest correlation coefficient was 0.93 in primary care and 0.94 in the community. Varimax-rotated principal component analysis of the SRQ-20 items yielded three factors: depressive symptoms, anxiety symptoms and somatic symptoms. The area under the ROC curve was 0.83 (SE =0.04, 95% CI 0.75-0.90) for the community and primary care samples. The optimal cut-off point for SRQ-20 was 6/7 yielding sensitivity of 93% and specificity of 62%. SRQ-20 appears to be a reliable and valid measure of mental disorders in the community in China.

Transtornos mentais em comunidade atendida pelo Programa Saúde da Família

The first objective of this study was to estimate the prevalence of mood, anxiety, and somatoform disorders (MASD) using the screening tool Self-Reporting Questionnaire-20 Items (SRQ-20) in a community assisted by the Family Health Program (FHP) in Santa Cruz do Sul, Rio Grande do Sul, Brazil. The second goal was to verify associations between demographic variables and MASD. We invited all residents>14 years of age to participate. The total sample consisted of 1,122 subjects. MASD prevalence was 38% (95%CI: 35.12-40.88). Female gender, low schooling, and unemployment were independently associated with MASD. The high prevalence of MASD observed in this study confirms the relevance of these disorders for public health planning, and could also help explain the high suicide rate in Santa Cruz do Sul in the last decade (4.66 times the national rate). Finally, the study highlights the importance of including mental health in the FHP priority agenda in Brazil.

Factors associated with postpartum physical and mental morbidity among women with known HIV status in Lusaka, Zambia

The objective of our study was to investigate factors associated with postpartum physical and mental morbidity among women in Lusaka, Zambia with particular reference to known HIV status. Our study was part of the Breastfeeding and Postpartum Health (BFPH) longitudinal cohort study conducted between June 2001 and July 2003. Women were recruited at 34 weeks gestation and followed up to 16 weeks postpartum. Data on maternal health were collected at 3, 7, 10, and 14 days and at 3, 4, 5, 6, 9, 12, and 16 weeks postpartum. Maternal mental health data were collected from April 2002 onwards at recruitment and at seven days and six weeks postpartum. Data on physical morbidity were collected for 429 women (218 HIV-negative, 211 HIV-positive) and data on mental morbidity were collected for 272 women (134 HIV-negative, 138 HIV-positive). Multivariate logistic regression was used to examine factors associated with postpartum physical or mental morbidity. Postpartum physical morbidity was associated with HIV status, parity ≥5 and age < 20 years. Neither antenatal nor postpartum mental morbidity, as indicated by a self-reporting questionnaire 20-item (SRQ-20) score ≥7, were associated with HIV status or with postpartum physical morbidity in this population. Larger comparative studies are required to corroborate or contest these findings.

Detection of depression in women of child-bearing age in non-western cultures: A comparison of the Edinburgh Postnatal Depression Scale and the Self-Reporting Questionnaire-20 in Mongolia

Background This study assesses, for the first time, the validity and internal reliability of the Edinburgh Post Natal Depression Scale (EPDS) and the WHO Self-Reporting Questionnaire 20-item version (SRQ-20) in detecting depression in Mongolian women of reproductive age. Methods 100 women age recruited from two psychiatric units specialising in depression ( n = 55) and three community-based child immunisation clinics ( n = 45) in Ulaanbataar, Mongolia, were formally psychiatrically assessed by a clinician and by administering the revised Clinical Interview Schedule (CIS-R). Each woman also completed the EPDS and SRQ-20. Results Ninety four women provided complete data and identical optimal cut-off points for both the EPDS (11.5) and SRQ-20 (8.5) were determined against both the psychiatrist's and CIS-R based diagnosis using standard validation parameters. On all parameters the SRQ-20 performed better than the EPDS. The sensitivity of the SRQ-20 in detecting depression was 93% and the specificity 97% against the psychiatrist's diagnosis. Internal reliability was satisfactory. Limitations The use of a mixed clinical and community sample for validation, and a single psychiatrist may limit the generalisability of these results. Conclusions The SRQ-20 performed well and better than the EPDS in detecting depression in this group of Mongolian women.