Feelings of guilt and loss of control dominate in stress and depression inventories from women with recurrent pregnancy loss.

PURPOSE: Which feelings on the major depression inventory (MDI) and the perceived stress scale (PSS) are predominant among women with recurrent pregnancy loss (RPL)? MATERIALS AND METHODS: Prospective cohort study of women with RPL referred to the tertiary RPL Unit at Copenhagen University Hospital, Rigshospitalet, Denmark, from 2010-2013. All women answered the MDI and PSS at time of referral. RESULTS: In total, 298 women completed the MDI and the PSS, of which 162 had primary RPL and 136 secondary RPL. The most common feelings were low in energy (42%), loss of interest (35%), sadness (35%), and guilt (29%). Twenty-six (8.6%) women fulfilled the criteria for moderate to severe depression. Of the remaining 272 women, nine felt that life was not worth living. Among all women feeling angered of things outside their control (35%) and unable to control important things (27%) were predominant. Women with primary RPL compared to secondary RPL more often felt less self-confident and that life wasn't worth living (p = 0.007 and p = 0.002). CONCLUSIONS: Feelings of guilt and loss of control were predominant in women with RPL. Women with primary RPL could represent a particularly sensitive group. Addressing these specific feelings could help treating the psychological aspects of RPL.

Stress and depression among women and men who have experienced recurrent pregnancy loss: focusing on both sexes.

RESEARCH QUESTION: Are women and men suffering from recurrent pregnancy loss (RPL) more affected by psychological stress and depression than the general population? DESIGN: Cross-sectional study investigating the prevalence of stress and depression in women and men with RPL seen in the Danish national RPL Unit. Data were collected between 2015-2018. All newly referred couples were asked to complete the Major Depression Index (MDI) and Cohen's Perceived Stress Scale (PSS). The scores of both sexes were compared with scores from relevant cohorts of men and women from the general population. RESULTS: In total, 412 women with RPL (82% response rate) and 281 male partners (60% response rate) were included. Depression: 5/281 (1.8%) of men with RPL had moderate/severe depression vs. 5/253 (2.0%) of men in the comparison group (relative risk (RR) 0.90; 95% CI 0.26-3.07, p=0.99). Among women with RPL, 34/412 (8.3%) had a moderate/severe depression vs. 2.2% in the comparison group (RR 3.74; 95% CI 2.40-5.83, p<0.001). High stress levels were found in 30/281 men with RPL (10.7%) vs. 15.8% in the comparison group (co-habiting men) (RR 0.67; 95% CI 0.48-0.94, p=0.017). High stress level was found among 110/384 (28.6%) of RPL-women vs. 420/1813 (23.2%) of comparison women (RR 1.24; 95% CI 1.03-1.48, p=0.026). Both MDI and PSS scores, respectively, for a woman and a man in an RPL couple were significantly correlated. CONCLUSION: Male partners in RPL couples did not have increased prevalence of stress and depression compared with other men but we confirmed our previous finding of significantly increased frequencies among women with RPL.

Danish translation and validation of Kessler's 10-item psychological distress scale - K10.

BACKGROUND: Psychological distress is a trans-diagnostic feature of mental suffering closely associated with mental disorders. Kessler's 10-item Psychological Distress Scale (K10), a scale with sound psychometric properties, is widely used in epidemiological studies. AIM: To translate and investigate whether K10 is a reliable and valid rating scale for the measurement of psychological distress in a Danish population. METHODS: The translation was carried out according to official WHO translation guidelines. A sample of 100 subjects was included, 54 patients from the regional Mental Health Service (MHS) and 46 subjects with no psychiatric history. All participants were assessed with a psychiatric diagnostic interview (MINI) and handed out K10. Concurrent validity was assessed by WHO Well-being Index (WHO-5). Correlation matrix analysis was conducted for the full sample and receiver operating characteristic (ROC) curves for discriminating mental health service affiliation. RESULTS: Mean K10 scores differed, with decreasing levels, between inpatients and outpatient in MHS and the subjects with no psychiatric history. Factor analysis confirmed a unidimensional structure, and Cronbach's alpha and Omega showed excellent internal reliability. AUC for the K10 ROC curves showed excellent sensitivity (0.947 [0.900-0.995]), accurately differentiating mental health from non-mental health patients. CONCLUSION: The Danish K10 has the same strong internal reliability as the original English version, and scores differ between psychiatric patients in outpatient and emergency ward settings. CLINICAL IMPLICATIONS: The Danish K10 translation is authorized and freely available for download at https://www.hcp.med.harvard.edu/ncs/k6_scales.php . The utility as an instrument for clinical screening in a mental healthcare setting is supported.

A clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R) in general population studies (Denmark, Norway, and Italy).

BACKGROUND: Although the Symptom Checklist (SCL-90-R) is one of the most widely used self-reported scales covering several psychopathological states, the scalability of the SCL-90-R has been found to be very problematic. AIMS: We have performed a clinimetric analysis of the SCL-90-R, taking both its factor structure and scalability (i.e. total scale score a sufficient statistic) into account. METHODS: The applicability of the SCL-90-R has been found acceptable in general population studies from Denmark, Norway and Italy. These studies were examined with principal component analysis (PCA) to identify the factor structure. The scalability of the traditional SCL-90-R subscales (i.e. somatization, hostility, and interpersonal sensitivity) as well as the affective subscales (i.e. depression and anxiety and ADHD), were tested by Mokken's item response theory model. RESULTS: Across the three general population studies the traditional scaled SCL-90-R factor including 83 items was identified by PCA. The Mokken analysis accepted the scalability of both the general factor and the clinical SCL-90-R subscales under examination. CONCLUSION: The traditional, scaled, general 83 item SCL-90-R scale is a valid measure of general psychopathology. The SCL-90-R subscales of somatization, hostility, and interpersonal sensitivity as well as the affective subscales of depression, anxiety, and ADHD were all accepted by the Mokken test for scalability, i.e. their total scores are sufficient statistics.

Cross-cultural adaptation and validation of the Danish consensus version of the 10-item Perceived Stress Scale.

OBJECTIVES: The aims of the present study were to (i) cross-culturally adapt a Danish consensus version of the 10-item Perceived Stress Scale (PSS-10) and (ii) evaluate its psychometric properties in terms of agreement, reliability, validity, responsiveness, and interpretability among patients with work-related stress complaints. METHODS: A consensus-building process was performed involving the authors of the three previous Danish translations and the consensus version was back-translated into English and pilot-tested. Psychometric properties of the final version were examined in a sample of 64 patients with work-related stress complaints. RESULTS: The face validity, reliability, and internal consistency of the Danish consensus version of the PSS-10 were satisfactory, and convergent construct validity was confirmed. Receiver operating characteristic (ROC) curves of the change scores showed that the ability of the PSS-10 to correctly classify patients as improved or unchanged according to the patients' own judgment was acceptable. The estimates of minimal clinically important change were 11 points and 28% for absolute and relative change scores, respectively. CONCLUSION: The Danish consensus version of the PSS-10 appears to be feasible for use in clinical research settings and has good psychometric properties in terms of agreement, reliability, validity, responsiveness, and interpretability.

Comparison of mental distress in patients with low back pain and a population-based control group measured by Symptoms Check List--A case-referent study.

PURPOSE: Mental distress is common in persons experiencing low back pain and who are sick-listed or at risk of being sick-listed. It is, however, not known how mental distress measured by the Symptoms Check List-90 differs between patients with low back pain and the general population. The objective of this study was to compare mental symptoms and distress as measured by the Symptoms Check List-90 in sick-listed or at risk of being sick-listed patients with low back pain with a population-based control group. METHODS: Mental distress was compared in a group of patients with low back pain (n=770) and a randomly selected population-based reference group (n=909). Established Danish cut-off values for mental distress were used to evaluate the mental distress status in the low back pain and control group and logistic regression was used to calculate odds ratios for the Global Severity Index and the symptom scales of the Symptoms Check List-90 while controlling for baseline demographic differences between the groups. RESULTS: Group mean scores showed that all symptom scales and the Global Severity Index for both sexes were statistically elevated in the low back pain group, except for interpersonal sensitivity in women. When the scores were dichotomized to cases and non-cases of mental distress, a significantly higher prevalence of cases was observed in the low back pain group compared to the reference group on all symptom check list scales, except for paranoid ideation for both sexes and interpersonal sensitivity for women. The biggest between-group difference was observed for the somatization symptom scale. CONCLUSIONS: Low back pain patients who are sick-listed or at risk of being sick-listed, are more mentally distressed compared to a randomly selected sample of the general Danish population. Self-reported symptoms of somatization, anxiety, phobic anxiety, obsessive-compulsive, depression and hostility are all more common among patients with low back pain compared to the general population.

[The prevalence of depression in Denmark]. / Forekomsten af depression i Danmark.

The prevalence of depression in the Danish general population is 3-4%. The gender difference in the prevalence seems to be less pronounced the more severe the depressive state is manifested. Particularly among men depression is undertreated, partly reflected by the gender difference in help-seeking behaviour. Risk factors for depression include traumatic life events in social life or other stressors, social status as well as over-consumption of alcohol. Information, detection and treatment of depression are of great importance.

[Street prostitution and drug addiction]. / Gadeprostitution og stofmisbrug.

INTRODUCTION: Street-based prostitution accounts for 10% of the prostitution activity in Denmark, mainly involving female drug addicts. We studied a group of women with a common history of substance abuse and their comparative psychosocial characteristics, correlated with whether they had previously been a prostitute or not. Their psychic symptoms were evaluated and compared with those of controls. MATERIALS AND METHODS: 27 females receiving maintenance treatment for substance abuse completed a questionnaire dealing with their social background, substance abuse profile, and history of sexual abuse and prostitution, as well as their current health status, including SCL-90. The scores were compared to those of a control group of an age- and gender-matched Danish standard population. RESULTS: Neglect in childhood and adulthood corresponded to international findings. 14 of the women had previous sex-trading experience, and early use of heroin and cocaine was a predictor for starting a career in prostitution. The SCL-90 scores for the dimensions of somatization and depression were significantly higher for drug-abusing women in general than in the control group. The scores of drug-abusing former prostitutes were similarly significantly higher on most of the dimensions except the hostility dimension when compared to those of drug-abusing women who had never been involved in prostitution. Rape and domestic violence were characteristic phenomena among drug-abusing prostitutes (p < or = 0.05). DISCUSSION: Victimization during childhood and adulthood constitutes a serious risk for generating social vulnerability through drug addiction and prostitution. Various psychosocial stress factors among street-based prostitutes indicate the need for broader psychiatric approaches in Danish drug addiction maintenance programmes.

Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale.

The health status questionnaire Short-Form 36 (SF-36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well-being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well-being items are also included in the WHO-Five well-being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO-Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self-reported health over the past year has been tested. The results of the study on 9,542 respondents showed that, although the WHO-Five and the mental health subscale were found to be unidimensional, the WHO-Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO-Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not. In conclusion, the WHO-Five, which measures psychological well-being, reflects aspects other than just the absence of depressive symptoms.