Purpose
The aim of this study was to analyse the association between individual mental well-being and social, economic, lifestyle and health factors.
Methods
Cross-sectional study on a representative ...sample of 13,632 participants (> 15y/o) from the Catalan Health Interview Survey 2013–2016 editions. Mental well-being was assessed with the Warwick–Edinburg Mental Well-being Scale (WEMWBS). Linear regressions were fitted to associate well-being and sociodemographic, relational, lifestyle and health variables according to minimally sufficient adjustment sets identified using directed acyclic graphs. Predictors entered the model in blocks of variable types and analysed individually. Direct and total effects were estimated.
Results
Health factors significantly contributed to mental well-being variance. Presence of a mental disorder and self-reported health had the largest effect size (eta
2
= 13.4% and 16.3%). The higher individual impact from a variable came from social support (
β
= − 12.8, SE = 0.48, eta
2
= 6.3%). A noticeable effect gradient (eta
2
= 4.2%) from low to high mental well-being emerged according to economic difficulties (from
β
= 1.59, SE = 0.33 for moderate difficulties to
β
= 6.02 SE = 0.55 for no difficulties). Younger age (
β
= 5.21, SE = 0.26, eta
2
= 3.4%) and being men (
β
= 1.32, SE = 0.15, eta
2
= 0.6%) were associated with better mental well-being. Direct gender effects were negligible.
Conclusions
This study highlights health and social support as the most associated factors with individual mental well-being over socioeconomic factors. Interventions and policies aimed to these factors for health promotion would improve population mental well-being.
To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive EpisodeMDE, Mania/HypomaniaM/H, Panic DisorderPD, Generalized Anxiety ...DisorderGAD) and suicidal thoughts and behaviorsSTB used in the UNIVERSAL project.
Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18-24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales CIDI-SC, the Self-Injurious Thoughts and Behaviors Interview SITBI and the Columbia-Suicide Severity Rating Scale C-SSRS. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview MINI. Measures of diagnostic accuracy and McNemar χ2 test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity.
A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1-55.1% and negative predictive values 90.2-99.0%; likelihood ratios positive were in the range of 2.1-14.6 and likelihood ratios negative 0.1-0.6. All outcomes showed adequate areas under the curve AUCs (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8).
The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.
IntroductionThere is a high prevalence of mental health problems among university students. Better prediction and treatment access for this population is needed. In recent years, short-term dynamic ...factors, which can be assessed using experience sampling methods (ESM), have presented promising results for predicting mental health problems.Methods and analysisUndergraduate students from five public universities in Spain are recruited to participate in two web-based surveys (at baseline and at 12-month follow-up). A subgroup of baseline participants is recruited through quota sampling to participate in a 15-day ESM study. The baseline survey collects information regarding distal risk factors, while the ESM study collects short-term dynamic factors such as affect, company or environment. Risk factors will be identified at an individual and population level using logistic regressions and population attributable risk proportions, respectively. Machine learning techniques will be used to develop predictive models for mental health problems. Dynamic structural equation modelling and multilevel mixed-effects models will be considered to develop a series of explanatory models for the occurrence of mental health problems.Ethics and disseminationThe project complies with national and international regulations, including the Declaration of Helsinki and the Code of Ethics, and has been approved by the IRB Parc de Salut Mar (2020/9198/I) and corresponding IRBs of all participating universities. All respondents are given information regarding access mental health services within their university and region. Individuals with positive responses on suicide items receive a specific alert with indications for consulting with a health professional. Participants are asked to provide informed consent separately for the web-based surveys and for the ESM study. Dissemination of results will include peer-reviewed scientific articles and participation in scientific congresses, reports with recommendations for universities’ mental health policy makers, as well as a well-balanced communication strategy to the general public.Study registrationosf.io/p7csq.
IntroductionSuicide attempts represent an important public health burden. Centralised electronic health record (EHR) systems have high potential to provide suicide attempt surveillance, to inform ...public health action aimed at reducing risk for suicide attempt in the population, and to provide data-driven clinical decision support for suicide risk assessment across healthcare settings. To exploit this potential, we designed the Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study. Using centralised EHR data from the entire public healthcare system of Catalonia, Spain, the CSRC-Epi study aims to estimate reliable suicide attempt incidence rates, identify suicide attempt risk factors and develop validated suicide attempt risk prediction tools.Methods and analysisThe CSRC-Epi study is registry-based study, specifically, a two-stage exposure-enriched nested case–control study of suicide attempts during the period 2014–2019 in Catalonia, Spain. The primary study outcome consists of first and repeat attempts during the observation period. Cases will come from a case register linked to a suicide attempt surveillance programme, which offers in-depth psychiatric evaluations to all Catalan residents who present to clinical care with any suspected risk for suicide. Predictor variables will come from centralised EHR systems representing all relevant healthcare settings. The study’s sampling frame will be constructed using population-representative administrative lists of Catalan residents. Inverse probability weights will restore representativeness of the original population. Analysis will include the calculation of age-standardised and sex-standardised suicide attempt incidence rates. Logistic regression will identify suicide attempt risk factors on the individual level (ie, relative risk) and the population level (ie, population attributable risk proportions). Machine learning techniques will be used to develop suicide attempt risk prediction tools.Ethics and disseminationThis protocol is approved by the Parc de Salut Mar Clinical Research Ethics Committee (2017/7431/I). Dissemination will include peer-reviewed scientific publications, scientific reports for hospital and government authorities, and updated clinical guidelines.Trial registration numberNCT04235127.
Objectives
To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults.
Methods
Systematic review (5 databases ...until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12–26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed.
Results
Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54–2.50), and males for suicide death (HR 2.50, 95% CI 1.8–3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend’s suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied.
Conclusions
More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.
Quality of care initiatives have risen among cancer healthcare providers, and policymakers attempt to systematically measure and improve the quality of cancer care. Cancer is a leading cause of ...morbidity and mortality in Europe. Although cancer survival rates have considerably increased in recent years, its significant impact on the quality of life and healthcare utilization remains. Value-based healthcare (VBHC) proposes that health systems need to be managed in terms of outcomes that matter to patients, connecting health and economic outcomes to determine the value of the healthcare. Benchmarking across healthcare centres might provide support decision-making on what matter most to patients, focusing on lessons learned from best performers, and moving toward a high-value healthcare delivery system. This paper aims to provide a benchmarking of healthcare and economic outcomes across ten hospitals in order to generate better healthcare practices.
The VOICE community is a European hospital cluster addressing the VBHC in breast and lung cancer from theory into practice. The community collects Clinical-Related (CROs), Patient-Related (PROs), Care Process-related (CPRs) and Economic-related (EROs). Two cohorts of patients diagnosed with breast (n=690; 6-hospitals) and lung cancer (n=318; 4-hospitals) in 2019 were recruited with a 6-month follow-up according to ICHOM’s reference guides. For each cohort, a clinical pathway was designed according to clinical practice guidelines; PROs, CROs and CPRs variables were collected according to the ICHOM standard sets; and a standard set of economic variables was designed using a bottom-up approach. Finally, patient archetypes were identified using clustering techniques and clinical expert opinion, and the definition of a set of benchmarking indicators followed a consensus DELPHI methodology. Benchmarking was performed using descriptive analyses and regression models controlling for patient archetypes, clinical and socio-demographic variables. A benchmarking digital solution was provided to clinicians and healthcare managers.
Breast (43) and lung (46) indicators were defined and classified into health outcome (CROs and PROs), CPRs, ERs and case-mix indicators. In breast cancer, significant differences across centres were found in PROs, CPRs and EROs indicators. Quality of life, body image and social and economic function showed significant differences. Time from diagnosis to treatment and the appropriate rate of sentinel node testing showed major differences. The proportion of patients with major outpatient surgery and the use of new chemotherapy molecules were significantly different. In lung cancer, no significant differences were found across centres in PROs indicators but they were in CPRs. Time from diagnosis to treatment or complications of systemic therapies showed high variability. The EROs indicators’ analysis for lung cancer is undergoing.
To the best of our knowledge, this is the first VBHC international coordinated experience across healthcare centres, providing healthcare and economic outcomes to be used with a routine benchmarking intention. This research might be of use for healthcare centres in moving toward VBHC next steps, such as the identification of room to improve their healthcare delivery processes and to modify their healthcare model accordingly. The challenge lies in being able to estimate the VBHC by combining health and economic outcomes using the value equation.
Objectives
Mental disorders and suicidal thoughts and behaviors (STB) are common and burdensome among college students. Although available evidence suggests that only a small proportion of the ...students with these conditions receive treatment, broad‐based data on patterns of treatment are lacking. The aim of this study is to examine the receipt of mental health treatment among college students cross‐nationally.
Methods
Web‐based self‐report surveys were obtained from 13,984 first year students from 19 colleges in eight countries across the world as part of the World Health Organization's World Mental Health–International College Student Initiative. The survey assessed lifetime and 12‐month common mental disorders/STB and treatment of these conditions.
Results
Lifetime and 12‐month treatment rates were very low, with estimates of 25.3–36.3% for mental disorders and 29.5–36.1% for STB. Treatment was positively associated with STB severity. However, even among severe cases, lifetime and 12‐month treatment rates were never higher than 60.0% and 45.1%, respectively.
Conclusions
High unmet need for treatment of mental disorders and STB exists among college students. In order to resolve the problem of high unmet need, a reallocation of resources may focus on innovative, low‐threshold, inexpensive, and scalable interventions.
•Mental disorders among first-year Spanish university students are common.•35.7% of students screened positive for 12-month mental disorder.•Depression and generalized anxiety disorder are the most ...frequent disorders.•29.2% of students with mental disorders report severe role impairment.•12.6% of students with mental disorder receive mental health treatment.
The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited.
To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use.
First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM–IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed.
Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8).
The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations.
One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment.
Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic ...among healthcare professionals in Spain.
All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 – September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- PHQ-8≥10, Generalized Anxiety Disorder-GAD- GAD-7≥10, Panic attacks, Posttraumatic Stress Disorder –PTSD- PCL-5≥7; and Substance Use Disorder –SUD-CAGE-AID≥2. Severe disability assessed by the Sheehan Disability Scale was used to identify probable “disabling” current mental disorders.
9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring “all of the time” for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).
One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.
Los profesionales sanitarios son vulnerables al impacto negativo en salud mental de la pandemia COVID-19. Evaluamos la prevalencia de trastornos mentales y factores asociados durante la primera oleada de la pandemia en sanitarios españoles.
Se invitó a todos los trabajadores de 18 instituciones sanitarias españolas (6 CCAA) a encuestas en línea evaluando características individuales, estado de infección y exposición a COVID-19 y salud mental (5 Mayo – 7 Septiembre, 2020). Reportamos: probables trastornos mentales actuales (Trastorno depresivo mayor TDD PHQ-8≥10, Trastorno de ansiedad generalizada TAG GAD-7≥10, Ataques de pánico, Trastorno de estrés postraumático TEP PCL-5≥7; y Trastorno por uso de sustancias TUS CAGE-AID≥2. La interferencia funcional grave (Escala de Discapacidad de Sheehan) identificó los probables trastornos “discapacitantes”.
Participaron 9.138 sanitarios. Prevalencia de cribado positivo: 28,1% TDD; 22,5% TAG, 24,0% Pánico; 22,2% PTE; y 6,2% TUS. En general, el 45,7% presentó algún trastorno mental actual y el 14,5% algún trastorno discapacitante. Los sanitarios con trastornos mentales previos tuvieron el doble de prevalencia que aquellos sin patología mental previa. Ajustando por todas las variables, el trastorno mental incapacitante se asoció positivamente con: trastornos previos (TUS: OR=5.74; 95%CI 2.53-13.03; Ánimo: OR=3.23; 95%CI:2.27-4.60; Ansiedad: OR=3,03; IC 95%: 2,53-3,62); edad 18-29 años (OR=1,36; IC 95%: 1,02-1,82); atender “siempre” a pacientes COVID-19 (OR=5,19; IC 95%: 3,61-7,46), género femenino (OR=1,58; IC 95%: 1,27-1,96) y haber estado en cuarentena o aislado (OR=1,60; IC 95%: 1,31-1,95).
Uno de cada 7 sanitarios españoles presentaron un probable trastorno mental discapacitante durante la primera oleada de COVID-19. Aquéllos con trastornos mentales alguna vez antes de la pandemia, los que están expuestos con frecuencia a pacientes con COVID-19, los infectados o en cuarentena / aislados, las mujeres y las enfermeras auxiliares deben considerarse grupos que necesitan seguimiento y apoyo de su salud mental.
Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in ...university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain.
MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables.
Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, “high” self-perceived support, and “high” self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. “Middle” self-perceived support, sleeping ≥8 h per day, and “high” self-perceived mental health reduced the odds of low MWB.
The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014–15 academic year using self-reported online surveys.
The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students.
•This study explored factors associated with high and low mental well-being (MWB).•A representative sample of first-year university students in Spain (N = 2082) was analysed.•The short version of the Warwick-Edinburgh Mental Well-Being Scale was used.•Gender, country of birth and place raised were the main sociodemographic factors associated with MWB.•Relational, adversity and stress factors, lifestyle and (self-perceived) mental health were also assocaited with MWB.
PDF
