Psychological distress among university female students and their need for mental health services.

Psychological distress among university students, especially young women, is of increasing concern. This study focuses on the prevalence of psychological distress among female university students and their need for mental health services. The analysis is based on two cross-sectional surveys, an internet survey among women students attending the University of Iceland in the spring of 2007, and a postal survey of Icelandic female adults conducted in the Fall of 2006. Psychological distress was measured with the Symptom Checklist-90 Depression and Anxiety subscales. The prevalence of above-threshold depression and anxiety among the university women students was 22.5% and 21.2% respectively. Results showed that the mean depression score was significantly lower among the students than among women of the same age in the general population. However, little less than one-third of students with elevated distress levels received any professional help. Only 1.4% of the distressed students received mental help care from nurses. The high proportion of distressed female students not receiving professional help is a challenge to the primary health-care system and the nursing profession. This also raises questions about the adequacy of the current system of health-care delivery and the potential advantages of on-campus health services, in closer proximity to the students.

Sociodemographic differences in patterns of sedentary and physically active behavior in older children and adolescents.

UNLABELLED: Numerous studies have found that involvement in moderate-intensity and strenuous activity has positive effects on health. This study considered the prevalence of different aspects of physical activity and sedentary behavior in 11-16-y-olds based on a representative national survey of 3270 Icelandic primary schoolchildren (91% response rate). All-day sedentary behavior was extremely rare (< 1%), and the vast majority (91%) were physically active (> or = 3 times per week) during school or leisure time, thanks largely to school physical education. Only 39% were physically active (> or = 3 times per week) during leisure time, and only 29% engaged in regular (> or = 3 times per week) leisure time strenuous exercise. Girls were more sedentary, less leisure time physically active, and less involved in leisure time strenuous exercise. Sedentary behavior increased and physically active behavior decreased with age, especially after early adolescence. However, there were no age differences in strenuous leisure time exercise. Upper-class students were less sedentary and more physically active during leisure time than working-class students. Finally, rural students were more sedentary during leisure time, and less physically active than students from urban areas. An interaction was found between age and residence when predicting leisure time physical activity, indicating that the inverse age-activity relationship in urban areas is partly reversed in rural areas. CONCLUSION: Compulsory school physical education frequently failed to translate into voluntary physical involvement. Sociodemographic differences in physical activity were greater during leisure time, than during school and leisure time combined.

[In search for explanatory factors in the relationship between educational level and mortality.].

OBJECTIVE: The connection between socioeconomic status and mortality is well known in Western countries. Educational level has frequently been used as a socioeconomic indicator. In a recent Icelandic prospective study, an inverse relationship between educational level and mortality was shown. The objective of the present study is to consider possible explanatory factors. MATERIAL AND METHODS: This study was a part of the Reykjavík Study. A stratified sample of 400 people was taken from one of six study groups. The sample was equally divided between the sexes and four educational levels. Mean age of the sample was 72.7 years. Participants completed a questionnaire concerning knowledge of risk factors for coronary heart disease, expected response to symptoms of cardiac infarction, social network and use of health care. Response rate was 78.5%. The relationship between answers and educational level was assessed with logistic regression. RESULTS: People with higher education were more likely to be in personal contact with nurses and doctors and receive advice concerning health and treatment from them. Participants were generally satisfied with the Icelandic health care system and seemed generally to have good access to it. A relationship with educational level was not shown. A larger proportion of those with lower education had regular communication with their general practician. CONCLUSIONS: Our results suggest that certain health care services are integrated into the social network of those with higher education. This may lower their morbidity and mortality. Other hypotheses concerning possible explanatory factors for differences in health were not supported.

Direct and indirect effects of chronic physical conditions on depression: a preliminary investigation.

The study focuses on the relationship between chronic physical illness and depression in the general population. Based on a representative survey of 825 adult residents in the urban Reykjavik area of Iceland, the results suggest that chronic physical conditions affect depression directly, as well as indirectly by aggravating domestic, occupational, and economic strains, and by undermining personal resources (self-esteem and mastery). These relationships persisted when sociodemographic background and previous mental health status were controlled. A nonsignificant direct relationship between chronic physical conditions and social support suggests that chronic illness does not affect support independent of domestic and economic strains. Significant direct relationships between chronic physical illness and personal resources suggest that the experience of inescapable loss lowers self-esteem and the sense of mastery. The implications and limitations of the study are discussed.

Factors related to physical activity: a study of adolescents.

Although the consequences of physical activity have been carefully documented, less is known about its correlates, particularly among children and youth. Based on a representative national survey of 1131 Icelandic adolescents, the study examined various physical, psychological, social and demographic factors related to physical activity. Male sex, significant others' involvement in physical activity (father, friend and older brother), sociability, perceived importance of sport and of health improvement and satisfaction with mandatory gym classes in school, were all related to more involvement, whereas hours of paid work and TV-viewing were related to less. Furthermore, the data suggested that the influence of friend's participation in physical activity depends on his or her emotional significance. Influential others appeared to affect males and females in the same way. The meaning of the results and their implications for future research are discussed.

Factors associated with suicide ideation in adults.

The study considers numerous factors potentially related to suicide ideation in adults, including life stress, stress perceptions, social support, personality, alcohol use, chronic conditions, distress symptoms and sociodemographic background. Using data from a health survey of 825 adult residents in the urban Reykjavik area of Iceland, the study finds that financial hardship, legal stress, family difficulties, stress perceptions and low material support are significantly related to thoughts of committing suicide. Multiple chronic conditions, frequent alcohol use and various forms of distress (e.g. depression, anxiety, hopelessness, pain) are also related to suicide ideation. Furthermore, low self-esteem and external locus of control (low sense of mastery) are both associated with suicidal thoughts. No significant relationships were found between sociodemographic background and suicide ideation. The meaning of the results, and their implications for continued theoretical and clinical work in this area, are discussed. Suicide research has primarily focused on completed suicides (e.g. Durkheim [1897] 1951; Fisher et al. 1993; Henry and Short 1954; Lester 1974; Pritchard 1996) or suicide attempts (e.g. Diekstra 1982; Maris 1981; Slap et al. 1989; Smith and Crawford 1986; Stack and Wasserman 1995). Relatively few studies have focused on thoughts of own death or suicide, or suicide planning. Nevertheless, there is a growing understanding that ideation and planning are important steps in a process of suicide, characterised by a stepwise hierarchy of actions with an underlying gradient of severity (Beck 1986; Bonner and Rich 1987; Diekstra 1993; Smith and Crawford 1986). Ideation precedes planning, which may result in an attempt leading to death. If nonfatal, the attempt may increase the likelihood of subsequent ideation, planning and attempt (see paths a-e in Fig. 1). It should therefore be of theoretical as well as clinical value to consider the risk factors associated with suicide ideation and planning.

Life stress, social support and clinical depression: a reanalysis of the literature.

In recent years, theorists and researchers have disagreed about the relationship between social support and mental health. Some believe that support is a direct provoking agent (i.e. lack of support constitutes strain), whereas others maintain that support is a vulnerability factor moderating the effect of life stress. Focusing on clinical depression, the article reviews the arguments and evidence supporting a strain hypothesis of social support versus a vulnerability hypothesis. Reanalyzing cross-classified data from 12 community studies of clinical depression, the study shows that the choice of model depends on the specification of functional form of the stress-clinical depression relationship. The linear probability specification suggests a vulnerability hypothesis, whereas the logit and probit specifications support a strain hypothesis. However, theoretical and statistical arguments tend to favor a logit or probit specification, and an additional analysis of data from Brown and Harris [Social Origins of Depression: A Study of Psychiatric Disorder in Women. The Free Press, New York, 1978] supports these arguments. Thus, the study concludes that the strain hypothesis of social support is more consistent with the available data.

Factors related to cigarette smoking and alcohol use among adolescents.

Based on a national survey of Icelandic adolescents, this study examined the various predictors of cigarette smoking and alcohol use. It was found that the use of tobacco and alcohol was related to a number of different factors: sex, residence, hours of paid work, physical activities, social network, educational performance and beliefs, and psychological distress. Further, smoking and drinking had most predictors in common. It was concluded that existing theoretical perspectives on juvenile deviance do not provide an adequate account of adolescent smoking and drinking. The need to integrate existing theories into a wider explanatory framework is discussed.

Sport participation and perceived health status: a study of adolescents.

Although it is a well-accepted notion that sport participation enhances health, the precise nature of the relationship has been unclear. Based on a national survey of Icelandic adolescents, this study evaluates the direct and indirect effects of sport participation on perceived health status. It is shown that sport participation has a substantial direct effect on perceived health, controlling for other health related behaviours, psychological distress and disease status. Sport participation also affects perceived health indirectly through distress and smoking, but does not seem to operate through alcohol consumption. The meaning of these results and their implications for future research are discussed.