How common is burnout? Are there protective factors? A study from a tertiary cancer center

Background: Heathcare professionals (HCPs) in the field of oncology face challenging clinical situations, difficult conversations, and death. This can seriously affect their physical and psychological health. Methods: One hundred and eighty doctors and nurses participated in this descriptive study. The primary objective was to determine the proportion of burnout in HCPs in a tertiary care cancer hospital. The secondary objectives included assessment of psychological morbidity, correlation of burnout with demographic factors and years of experience, and resilience and its correlation with burnout. Data were collected using Maslach Burnout Inventory, General Health Questionnaire� (GHQ-28), and a Resilience scale (Dr. Vijaya Lakshmi and Dr. Shruti Narain). Descriptive statistics correlation and regression analysis were used to analyze the data. Results: One hundred and twenty-six (70%) respondents were young adults. Thirty-two (17.78%) respondents had a high Emotional Exhaustion (EE) score. A high Depersonalization score (DP) was seen in 24 (13.33%) and a low sense of Personal Accomplishment (PA) was perceived by 22 (12.22%). More nurses (55, 52.4%) had high resilience scores compared with doctors (21, 28%). Doctors (21, 28%) experienced more psychological morbidity than nurses (15, 14%). Among the domains of GHQ-28, high scores were observed in Somatic, Anxiety/Insomnia, and Social Dysfunction (mean 4.44 � 3.92, 4.61 � 3.85, and 4.54 � 3.16, respectively) and low scores in the severe depression domain (mean 2.48/�29). Conclusion: Fifteen to eighteen percent of HCPs scored high levels of EE, DP, and low PA. Burnout was more common in doctors who had worked in the cancer center for longer. However, the converse was true for nurses. HCPs with high resilience scores had less burnout. Age and resilience protect from burnout.

Predictors associated with the mental health of Japanese male registered nurses: focusing on environments with many female registered nurses and female patients’ refusal to accept nursing services from male registered nurses / Journal of Rural Medicine

Objective: To study the improvement of the mental health of Japanese male registered nurses, we investigated the predictors associated with the Japanese version of the 12-item General Health Questionnaire (GHQ-12). For those predictors, we focused on environments with many female registered nurses and female patients’ refusal to accept nursing services from male registered nurses.Materials and Methods: This study was conducted in 93 hospitals in the Aichi, Gifu, and Mie prefectures of Japan. The analyzed subjects were 1,216 full-time male registered nurses. The average age (standard deviation) was 34.5 (9.2) years. Multiple logistic regression analysis was conducted. A GHQ-12 score of ≤3 indicated good mental health, and a score of ≥4 indicated poor mental health. “Mental health” was a dependent variable. The independent variables were: “Age”, “Male registered nurses as important partners on the job”, “Female registered nurses’ good manners toward male registered nurses”, “Fairness regarding male registered nurses’ promotions”, and “Female patients’ refusal to accept nursing services from male registered nurses”.Results: There were 728 (59.9%) full-time male registered nurses with good mental health and 488 (40.1%) with poor mental health. The mental health of the male registered nurses who had negative feelings regarding, “Male registered nurses as important partners on the job” was significantly worse, and that of those who had negative feelings regarding, “Female registered nurses’ good manners toward male registered nurses” was also significantly worse.Conclusion: Female registered nurses must recognize that their attitudes toward male registered nurses influence the mental health of male registered nurses. Hospital managers should provide male registered nurses who cannot establish appropriate relations with female registered nurses with consultation opportunities. Such organizational action by managers is necessary.

Self-perceived body image, dissatisfaction with body weight and nutritional status of Brazilian adolescents: a nationwide study / Auto-imagem corporal, insatisfação com o peso corporal e estado nutricional deadolescentes brasileiros: um estudo nacional

Abstract Objectives The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents. Methods Students aged 12-17 years participating in the Study of Cardiovascular Risk in Adolescents ("ERICA"), a multicenter, cross-sectional, school-based country-wide study, were included (n = 71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models. Results Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0-46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3. Conclusions Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

Resumo Objetivos A finalidade deste estudo foi avaliar a concordância e os fatores de risco para subestimação e superestimação entre o estado nutricional e a autoimagem corporal e para avaliar a prevalência e os fatores associados à insatisfação com o peso corporal entre adolescentes brasileiros. Métodos Foram incluídos estudantes entre 12 e 17 anos que participavam do Estudo de Riscos Cardiovasculares em Adolescentes ("ERICA"), um estudo multicêntrico, transversal, nacional e de base escolar (n = 71.740). As variáveis analisadas como covariáveis foram sexo, idade, cor da pele, situação socioeconômica e transtornos mentais comuns (triados pelo Questionário de Saúde Geral, QSG-12). A regressão logística multinomial foi usada para explorar a associação entre as covariáveis e as combinações entre a autoimagem corporal e o índice de massa corporal (concordância, subestimação e superestimação). As associações entre a insatisfação com o peso corporal e as variáveis de exposição foram investigadas com os modelos multivariáveis de regressão de Poisson. Resultados Aproximadamente 66% dos estudantes associaram corretamente seu índice de massa corporal com o peso autopercebido (o coeficiente kappa foi 0,38 para meninos e 0,35 para meninas). A concordância foi maior entre jovens e adolescentes de baixa renda. Sexo masculino, adolescentes mais velhos e um escore QSG 12 ≥ 3 foram associados à superestimação do peso. A prevalência de insatisfação com o peso corporal foi 45,0% (IC de 95%: 44,0-46,0), maior entre meninas, adolescentes mais velhos, aqueles abaixo do peso ou com sobrepeso/obesidade, fisicamente inativos e com QSG-12 ≥ 3. Conclusões A maior parte da amostra associou corretamente sua imagem corporal de acordo com o índice de massa corporal. Estudantes com distorção da autoimagem corporal e aqueles insatisfeitos com seu peso foram mais propensos a apresentar rastreamento positivo para transtornos mentais comuns.

Alternative Models Examination and Gender Measurement Invariance of the 12-item General Health Questionnaire among Nigerian Adolescents

OBJECTIVE: The objective of this study was to examine the factor structures of the a priori alternative models of the 12-items General Health Questionnaire (GHQ-12), its psychometric characteristics and gender measurement invariance in a sample of non-clinical Nigerian adolescents (n=1326; M(age)=15.16).METHODS: The sample consisted of 606 (45.7%) males, who completed the GHQ-12 in addition to the Hospital Anxiety and Depression Scale (HADS), the Rosenberg Self-Esteem Scale (RSES) and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). We compared 21 models to identify which has the best fit indices applying confirmatory factor analysis. Gender measurement invariance was examined with nested multiple-group confirmatory factor analysis (MGCFA).RESULTS: The model that best captures psychological distress was a three-factor model that was initially described among the Australian general population (CFI=0.952, SRMR=0.0310, RMSEA=0.042) (90%CI=0.035–0.049). The internal consistencies (ω) of this model and its dimensions were modestly satisfactory. The criterion validity of this model was supported via significant correlations with the other study measures. MGCFA supported the configural, metric and scalar gender invariances of this model.CONCLUSION: A three-factor GHQ-12 model (anhedonia/sleep disturbances; social performance and Loss of confidence) is useful as a psychological distress assessment tool among Nigerian adolescents.

Family Responsibilities And Involuntary Job Absenteeism Among Nurses In Teaching Hospital

@#Dual competing responsibilities between work and family are the challenges faced by most of the healthcare staff. Ineffective handling of these responsibilities may contribute to absenteeism which further disrupt the quality of work and reduce customer satisfaction. The aims of this study were to determine the prevalence of job absenteeism and to identify the association between family responsibilities and job absenteeism among nurses in teaching hospital. This was a cross sectional study targeted to nurses working in medical and surgical field based in a hospital. Questionnaires were distributed using stratified random sampling. Those with working services of less than one year were excluded. The mean age was 35.9 (SD=6.44) years old. Majority were female (94.0%) and Malay (96.0%). The one-year prevalence of absenteeism was 78.0% and majority were due to emergency leaves. Taking care of elderly and no help obtained for taking care of child showed significant associations with job absenteeism which both yielded four times higher odds for being absent. Employees with additional family responsibilities should receive support by the organisation to prevent further job absenteeism among nurses.

Mental Health Status and Its Influencing Factors in the Floating Population in Chengdu / 中国医学科学院学报

To investigate the mental health status of the floating population in Chengdu and explore its influencing factors. A questionnaire-based survey was conducted on non-Chengdu household workers over 16 years old in four directions(east,south,west,and north)of Chengdu from June 2017 to June 2018 to collect their social demographic characteristics and mental health status information through respondent driven sampling method.The 12-item general health questionnaire(GHQ-12) was used to assess the mental health status of the respondents,and a multivariate logistic regression model was used to analyze the influencing factors of mental health. The average score of GHQ-12 was(1.09±1.61)and the detection rate of mental problems was 7.11%.The main mental problems were anxiety and nervousness.Multivariate unconditional logistic regression analysis showed that over 55 years old(=0.425,95%=0.213-0.847),junior middle school education(=0.541,95%=0.356-0.824),length of residence ≥5 years(5-9 years:=0.603,95%=0.394-0.923;≥10 years:=0.534,95%=0.346-0.823),annual income ≥18 000 yuan(18 000-35 999 yuan:=0.524,95%=0.328-0.836;36 000-59 999 yuan:=0.327,95%=0.190-0.565;≥60 000 yuan: =0.356,95%=0.192-0.662),and a good relationship with employers(=0.519,95%=0.363-0.742)were the protective factors for the mental health.Divorce/widowhood(=2.351,95%=1.341-4.124),plan to return hometown after 5 years(=1.805,95%=1.084-3.006)and not yet consideration of leaving Chengdu(=1.844,95%=1.269-2.681)were the risk factors. The mental health of the floating population in Chengdu is generally good.However,floating individuals with poor marital status and/or poor sense of belonging to Chengdu are at higher risk of mental problems.The local government should formulate and improve the policies and measures related to social welfare and public services for the floating population and try to enhance their urban integration and sense of belonging,thus improving their mental health.

Evaluation of factors affecting psychological morbidity in emergency medicine practitioners / 世界急诊医学杂志（英文）

@#BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians'' performance at work. These data can help physicians to practice in the most desired way. The study aimed to evaluate factors affecting psychological morbidity in Iranian emergency medicine practitioners at educational hospitals of Tehran.METHODS: In this cross sectional study 204 participants (emergency medicine residents and specialists) from educational hospitals of Tehran were recruited and their psychological morbidity was assessed by using a 28-question Goldberg General Health Questionnaire (GHQ-28). Somatization, anxiety and sleep disorders, social dysfunction and depression were evaluated among practitioners and compared to demographic and job related variables.RESULTS: Two hundreds and four participants consisting of 146 (71.6％) males and 58 (28.4％) females were evaluated. Of all participants, 55 (27％) were single and 149 (73％) were married. Most of our participants (40.2％) were between 30–35 years old. By using GHQ-28, 129 (63.2％) were recognized as normal and 75 (36.8％) suffered some mental health disorders. There was a signifi cant gender difference between normal practitioners and practitioners with disorder (P=0.02) while marital status had no significant difference (P=0.2). Only 19 (9.3％) declared having some major mental health issue in the previous month.CONCLUSION: Females encountered more mental health disorders than male (P=0.02) and the most common disorder observed was somatization (P=0.006).

A study on prevalence of psychiatric comorbidity in female patients with breast cancer.

Background: The growing awareness of the psychological impact of the diagnosis and treatment of cancer on quality of life has created the need for deeper insights into the adjustment process, its disorders, and effective strategies for the treatment of psychiatric morbidity. Objectives: The study was conducted to find out the prevalence of psychiatric comorbidity among the female breast cancer patients admitted in Surgery or Radiotherapy units of a tertiary care hospital. Material & Methods: The sample was taken from sixty female non pregnant, non lactating breast cancer patients consenting for study admitted in Guru Gobind Singh Medical College, Faridkot aged between 18-60 years. The patients for study were screened by General Health Questionnaire (GHQ 12). After screening the patients who were found to have positive psychological stress, were further interviewed individually and final diagnosis was made on the basis of DSM-IV-TR criteria for mental disorders. Results: The number of patients with psychiatric morbidity was found in 45% of breast cancer patients. The clinical diagnosis as per DSM-IV criteria’s in majority of the patients (59.25%) was Adjustment Disorder. Major Depressive disorder was found in 22.2% patients. Generalised Anxiety Disorder was found in 14.8% patients. Somatoform Disorder was found in 3.7% patients. More number of patients with advanced stage of cancer (21) were found to be having diagnosable psychiatric illness than patients with early stage of cancer (6). Conclusions: The results of the study have implications for clinical training, practice and policy initiatives. Integrating mental health into general health care, effective mass media coverage, networking between mental health-professionals and other health professionals, community-based health services are required.

Quality of Life Assessment in Korean Patients with Pemphigus

BACKGROUND: Measuring the quality of life (QOL) is important in the evaluation of nonclinical aspects of diseases, for the discovery of functional and psychological limitations, and in choosing treatment in the initial phase of the disease. Pemphigus is a potentially fatal autoimmune bullous disease caused by autoantibodies against desmogleins (cadherin family proteins in desmosomes). Thus far, there has been no published study on QOL in Korean patients with pemphigus. OBJECTIVE: To study the impact of pemphigus on the QOL in a large number of Korean patients. METHODS: Sixty-six patients enrolled at the Gangnam Severance Hospital from March 2012 to March 2013 were assessed for QOL by using the Dermatology Life Quality Index (DLQI), and for anxiety and depression by using the General Health Questionnaire (GHQ). Spearman's rank-order correlation, t-test, and ANOVA were used to identify the relations between the DLQI score and other clinical variables. RESULTS: Pemphigus vulgaris and pemphigus foliaceus significantly reduced the QOL of patients. The average DLQI score for all patients was 10.18. The mean DLQI score was 13.45 in patients in the active state and 5.15 in the patients in the remission state. The DLQI score highly correlated with disease severity, titer of anti-desmoglein 1 in enzyme-linked immunosorbent assay, and the corticosteroid dose. However, the QOL was not affected by sex, age, subtype of pemphigus, duration of disease, or comorbidities. Forty-two percent of the patients showed a positive result in the GHQ, reflecting probable minor psychiatric nonpsychotic conditions, and the GHQ score positively correlated to the DLQI score. CONCLUSION: Pemphigus significantly impairs the QOL of patients. The QOL of Korean pemphigus patients significantly correlates with clinical severity. Therefore, considerable attention should be paid to the patients' QOL and psychological states as well as clinical status.

Evaluation of Subjective and Objective Parameters of Stress in First Year Medical Students.

Introduction: Presence of stress among medical students is well known but there are very few studies that objectively prove it. This study aims to assess stresssubjectively and objectively in first year medical students by a) GHQ (General Health Questionnaire) scoring system b) measuring the biochemical parameters: serum cortisol and IgA(Immunoglobulin A). Materials and Methods: 75 students were included in the present study. Estimation of serum cortisol and Immunoglobulin A at the end of first month (time 1) and sixth month (time 2) were done by using autoanalyzers. GHQ scoring and assessment was also made at the end of the first month (time 1) and sixth month (time 2) of the first year. Results: GHQ scoring and serum cortisol for stress had significantly increased at time 2 when compared to time1. IgA levels were significantly decreased at time 2 when compared to time 1. All were found to be statistically significant. Conclusion: The study showed that first year medical course to be stressful by both subjective and objective parameters. It calls for measures to reduce stress in health professional’s education, in a process to improvise it.

Study of psycho-social impairment in patients presenting with age related macular degeneration in a tertiary eye care hospital.

Background: Age Related Macular Degeneration (ARMD) is an eye condition affecting old age people causing severe vision loss. This study was carried out to assess the psycho-social impairment in the ARMD patients and compare it with the normal eye patients. Methods: A Two study groups were made: 1. ARMD patients. 2. Control group patients. Patients of both the groups were made to fill “The validated Gujarati version of: General Health Quality Questionnaire-28 (GHQ 28)”. Self-scoring was done according to 0-1-2-3 lower to higher disability respectively. Results: Prevalence GHQ Mean score of ARMD patients was 34.27 and that of normal eye patients was 24.66. 80.85% of ARMD patients and 26.73% of normal eye patients were psychosocially impaired. Conclusion: ARMD patients are psychosocially more impaired as compared to control group patients (p value <0.001, highly significant).

Stress and its risk factors in medical students: An observational study from a medical college in India.

Objectives: Stress in medical students is well established. It may affect academic performance and lead to anxiety, depression, substance abuse, and burnouts. There is limited data on stress in Indian medical students. We conducted an analytical observational study to assess the magnitude of stress and identify possible "stressors" in medical students of a teaching hospital in Kolkata. Materials And Methods: This questionnaire-based study was conducted in the Institute of Post Graduate Medical Education and Research, Kolkata with consenting undergraduate students of 3 rd , 6 th , and 9 th (final) semesters, during lecture classes in individual semesters on a particular day. The students were not informed about the session beforehand and were assured of confidentiality. The first part of the questionnaire captured personal and interpersonal details which could be sources of stress. The rest comprised three rating scales - the 28-item General Health Questionnaire to identify the existence of stress, the Warwick-Edinburgh mental well-being scale to assess the mental well-being, and the revised version of the Lubben social network scale to assess the social networking. The responses and scores were compared between the three semesters as well as between various subgroups based on baseline characteristics. Results: Data from 215 respondents were analyzed - approximately 75% were male, 45% came from rural background, 25% from low-income families, and 60% from vernacular medium. Totally, 113 (52.56%; 95% confidence interval: 43.35-61.76%) students were found to be stressed, without significant difference in stress incidence between the semesters. About 60% of the female students were stressed in contrast to 50% of the males, but this observed difference was not statistically significant. The mental well-being and social networking of stressed respondents suffered in comparison to their non-stressed counterparts. Conclusions: The stress incidence in medical students in this institution in India is high and is negatively affecting their mental well-being. Further multicentric and longitudinal studies are needed to explore the incidence, causes, and consequences of stress in our setting.

A study on quality of life in patients following myocardial infarction.

Subjective well being has been widely researched in the past few decades and in practical terms it is a term that encompasses the various ways people evaluate their lives including concepts such as life satisfaction, work and health etc. Since, it is well known, that psychological factors including stress, anxiety, poor sleeping habits etc are known to be important causes of life style disorders like myocardial infraction, we started with the hypothesis that subjective well being of post acute MI patients must be poorer compared to normal subjects in the same age group. A comparative study between normal subjects and post acute myocardial infarction patients was undertaken to compare their subjective well being and current mental health status, at Safdarjung Hospital, New Delhi using standardized questionnaires. The results showed significantly higher negative affect like inadequate mental mastery over immediate environment, perceived ill health including disturbed sleep, deficiency in social contacts, and a general ill being about life in the MI group (P<0.05). Regarding the positive emotions, the normal subjects showed a higher general well being positive affect, higher transcedence and higher perception of social support. (P<0.05). The GHQ also yielded significantly better sleeping habits, less anxiety, better perception of health and more satisfaction with life in the normal subjects compared to post acute MI patients. (P<0.05).

Health Related Quality of Life in Common Variable Immunodeficiency

PURPOSE: To quantify the health related quality of life in primary immunodeficiency patients. MATERIALS AND METHODS: We used generic health status and general psychological health questionnaires to determine the range of issues that needed to be considered in examining the burden of common variable immunodeficiency (CVID). RESULTS: The health status of patients with CVID was lower than that observed in normal subjects. Overall, Role-Physical and General Health scales correlated with a poorer clinical status. Surprisingly, the duration of disease did not influence health status. Being female, older, General Health Questionnaire-positive and alexithymic proved to be major risk factors associated with a poor health status. Patients with chronic lung disease and chronic diarrhea had the lowest values on the Medical Outcome Study, Short Form SF-36 (SF-36) scales. Disease severity perception was associated with the General Health Questionnaire and alexithymia status. Limitations in daily activities as a result of lower physical health were the major problems facing common variable immunodeficiency patients. CONCLUSION: Our data underlined the importance of conducting a periodical health related quality of life assessment on patients with primary antibody deficiencies and, moreover, stressed the necessity of providing psychological support to at risk patients.

Feeling Refreshed by Sleep Can Predict Psychological Wellbeing Assessed Using the General Health Questionnaire in Male Workers: A 3-Year Follow-Up Study

Prediction of psychological wellbeing based on several important predictors was conducted for ensuring maintenance of good mental health. A 3-year follow-up study to determine psychological well-being was conducted in 969 Japanese male workers. Age, body mass index, present history of medication and four lifestyle factors were used for the analysis. A logistic regression analysis revealed that the odds ratio (95% confidence interval) for obtaining a score of > or =4 in the General Health Questionnaire-12-item version, among the subjects who felt refreshed by sleep was 0.559 (0.415-0.753). None of the other factors showed any statistically significant association. Feeling refreshed by sleep was identified as a predictor of maintained psychological wellbeing in this 3-year follow-up study.

Estrutura fatorial do Questionário de Saúde Geral (QSG-12) em uma amostra de professores escolares / Factorial structure of General Health Questionnaire (GHQ-12) in a sample of school teachers

O Questionário de Saúde Geral (QSG-12) é um dos instrumentos mais utilizados na avaliação da saúde psicológica.Entretanto, não há consenso sobre sua estrutura fatorial. Este estudo objetiva investigar a estrutura fatorial do QSG-12.Participaram do estudo 517 professores de 57 escolas públicas e particulares, com idade média de 36,52 anos(DP=10,46), sendo 66,3% do sexo feminino. Análises fatoriais exploratórias (n=203) demonstraram a existência de doisfatores oblíquos, denominados Depressão e Autoeficácia. Foram comparados, por meio de análises fatoriaisconfirmatórias (n=304), os índices de ajuste do modelo exploratório e o modelo unidimensional. A solução bidimensionaldemonstrou melhor ajuste (c²/gl=2,43; AGFI=0,90; CFI=0,91; RMSEA=0,068; CAIC=297,98) em comparação àestrutura unifatorial. A consistência interna dos fatores Depressão e Autoeficácia variou de 0,82 a 0,80 e 0,66 a 0,63,respectivamente. São sugeridos estudos que comparem diferentes soluções fatoriais do instrumento em busca de umaestrutura fatorial generalizável do QSG-12.

The General Health Questionnaire (GHQ-12) is one of the most used instruments in psychological health assessment.However, there is no consensus about its factor structure. This study aimed to investigate the factor structure of GHQ-12.The study included 517 teachers from 57 public and private schools, averaging 36.5 years of age (DP=10.34), being66.3% women. Exploratory factor analysis (n=203) demonstrated the existence of two oblique factors, titled Depressionand Self-efficacy. Confirmatory factor analysis (n=314) compared the model fit indexes of the exploratory and singlefactormodels. The two-dimensional solution showed better fit indexes (c²/gl=2.43, AGFI=0.90, CFI=0.91,RMSEA=0.068, CAIC=297.98) compared to the single-factor structure. The internal consistence of the factorsDepression and Self-efficacy ranged from 0.82 to 0.80 and from 0.66 to 0.63, respectively. It is suggested further studiescomparing different factorial solutions of the instrument in the search for a generalizable GHQ-12 factor structure.

False positive rate and false negative rate of the 12-item General Health Questionnaire and related factors / 中国心理卫生杂志

Objective: To evaluate the false positive rate and false negative rate of the Chinese version of the 12-item General Health Questionnaire (GHQ-12) and the related factors in the epidemiological survey of mental ill-nesses in Zhejiang Province. Method: A total of 15000 subjects were randomly selected from the province-wide using multi-stage stratified cluster randomization. Analyses for this paper were made in the quality control sample,10% of the total 15000 subjects (1510 subjects) in which the Chinese version of Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders (SCID) was used as a golden criterion, and a cutoff score of the GHQ-12 was set to ≥ 3 to define GHQ-12 cases. Results: Totally 1449 subjects (96.0%) completed both the GHQ-12 and the SCID. Adjusted for sampling effects, the false positive and negative rates of the GHQ-12 were respective 14.6% and7.8%. Adjusted for other considered correlates and sampling effects, the adjusted odds ratios (AORs) of GHQ-12 false positive with living in less economically developed urban areas (urban type Ⅱ), with self-reportedly poor physical health, with having ever sought help because of mental problems and with being currently married/co-habited were respective 2.23 (95% CI:1.24～4.01), 2.36(1.36～4.10), 1.53 (1.10～2.14) and 0.51 (0.30～0.86) while AORs of GHQ-12 false negative with being aged 35～49 year group and living in less econom-ically developed rural areas (rural type Ⅲ) were respective 2.59 (1.18～5.67) and 2.72 (1.21～6.14). Conclusion:Factors related to the GHQ-12 false positive and negative are different. The cutoff scores of the GHQ-12 should be used based on the characteristics of subjects during identifying or screening mental illnesses.

A multilevel analysis on the association between socioeconomic status and psychiatric disorders / 中华流行病学杂志

Objective To explore the association between psychiatric disorders and socioeconomic status such as education,income,employment and area of community settings in Zhejiang province.Methods Data were from the epidemiological survey of mental illnesses aged 15 and older in 2001(n=14 632).Psychiatric disorders were measured by GHQ-12 with a cut-point 4.Logistic multilevel analysis was the main statistical method being used.Results The overall prevalence of psychiatric disorders was 18.5%(95% confidence intervals,17.9% to 19.1%),higher than the data from Hebei province(u=4.39,P＜0.001).Annual household income and employment were strongly associated with psychiatric disorders especially for those with low income(odds ratio 3.45,95%CI:1.72-6.67)and unemployment(odds ratio 2.03,95%CI:1.73-2.40).Factors as regional effect and education level showed weak or inconsistent association with psychiatric disorders after controlling on other indicators.Conclusion Inverse gradient relation between psychiatric disorders and SES seemed as the main result of low SES individual characteristics and some minor effects at the county level.

The validity of two malay versions of the general health questionnaire (GHQ) in detecting distressed medical students

Objective: To compare the sensitivity, specificity and reliability between the Malay GHQ-30 and the Malay GHQ-12 in detecting distressed medical students. This study determined which version is more sensitive, specific and reliable in detecting distressed medical students. Methods: Three validated instruments, the Malay version GHQ-30, the Malay version GHQ-12 and the Malay version Beck Depression Inventory-II (BDI-II), were administered to a total of 187 medical students. Distress diagnoses were made based on the Malay version BDI-II. ROC curve analysis was applied to determine the sensitivity and specificity of the both GHQs by testing against the BDI-II. Reliability analysis (Cronbach’s alpha) was applied to test internal consistency of the GHQ. The analysis was done using SPSS version 12. Results: 141 (75.4%) medical students participated in this study. The GHQ-30 sensitivity and specificity at cut-off point of 6 was 87.5% and 80.6% respectively with positive predictive value (PPV) of 70% as well as area under ROC curve was 0.93. The GHQ-12 sensitivity and specificity at cut-off point of 4 was 81.3% and 75.3% respectively with PPV of 62.9% as well as area under ROC curve was 0.82 The Cronbach’s alpha value of the GHQ-30 and GHQ-12 was 0.93 and 0.85 respectively. The Kappa value for the GHQ- 12 and GHQ-30 was 0.65 (p < 0.001). Conclusion: This study showed the Malay GHQ-30 had better ability to discriminate between distressed and non-distressed medical students compared to the Malay GHQ-12. The shorter version was found to be as reliable as the long version GHQ-30 in detecting distressed medical students. The optimum threshold score for the GHQ-30 and GHQ-12 to detect distressed medical students were 6 and 4 respectively. The GHQ-12 and GHQ-30 showed a good level of agreement in detecting distressed medical students.

The sensitivity, specificity and reliability of the malay version 12-items general health questionnaire (GHQ-12) in detecting distress medical students

Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-12 among medical student population. This study determined the appropriate GHQ-12 score to detect distressed medical students. Methods: The Malay version of GHQ-12 was derived based on two sources which were the original version GHQ-12 and the validated Malay version 30-items GHQ. The GHQ-12 and the Malay version Beck Depression Inventory-II (BDI-II) were administered to a total of 141 medical students. Distress diagnoses were made based on the Malay version BDI-II. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-12 by testing against the BDI-II. Reliability analysis (Cronbach’s alpha and item total correlation) was applied to test internal consistency of the GHQ-12. The analysis was done using SPSS version 12.Results: The GHQ-12 sensitivity and specificity at cut-off point of 3/4 was 81.3% and 75.3% respectively with positive predictive value (PPV) of 62.9% as well as area under ROC curve more than 0.7. The Cronbach’s alpha value of the GHQ-12 was 0.85.Conclusion: This study showed the Malay version GHQ-12 is a valid and reliable screening tool in detecting distressed medical students. The GHQ-12 score equal to or more than 4 was considered as significant distress.