Deborah A. Goebert

Depressive Symptoms in Medical Students and Residents: A Multischool Study

Background This multisite, anonymous study assessed depressive symptoms and suicidal ideation in medical trainees (medical students and residents). Method In 2003–2004, the authors surveyed medical trainees at six sites. Surveys included content from the Center for Epidemiologic Studies–Depression scale (CES-D) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) (measures for depression), as well as demographic content. Rates of reported major and minor depression and of suicidal ideation were calculated. Responses were compared by level of training, gender, and ethnicity. Results More than 2,000 medical students and residents responded, for an overall response rate of 89%. Based on categorical levels from the CES-D, 12% had probable major depression and 9.2% had probable mild/moderate depression. There were significant differences in depression by trainee level, with a higher rate among medical students; and gender, with higher rates among women (&khgr;2 = 10.42, df = 2, and P = .005 and &khgr;2 = 22.1, df = 2, and P < .001, respectively). Nearly 6% reported suicidal ideation, with differences by trainee level, with a higher rate among medical students; and ethnicity, with the highest rate among black/African American respondents and the lowest among Caucasian respondents (&khgr;2 = 5.19, df = 1, and P = .023 and &khgr;2 = 10.42, df = 3, and P = .015, respectively). Conclusions Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees.

The Impact of Cyberbullying on Substance Use and Mental Health in a Multiethnic Sample

The objective of this study was to examine the relationship between cyberbullying and mental health problems among a multiethnic sample of high school students in Hawai`i. A University-Community partnership was established to direct the research. Using a mixed-methods approach, we explored violence among Asian and Pacific Islander youth. In the first phase, focus groups were conducted to identify areas of youth concern and develop survey questions. Responses from 677 high school students on interpersonal youth violence and risk and protective factors were utilized in this study. More than 1 in 2 youth (56.1%) had been victims of cyberbullying in the last year. Filipino and Samoan youth were more likely to report feeling badly about themselves as a result of cyberbullying. While cyberbullying and mental health problems varied by sex and ethnicity, we found that cyberbullying is widespread with serious potential consequences among Asian and Pacific Islander youth. A multifaceted approach is needed to reduce and prevent cyberbullying. School, family and community programs that strengthen positive relationships and promote safe use of technology provide promise for reducing cyberbullying.

Acculturation factors and substance use among Asian American youth.

In this study of 329 Cambodian, Chinese, Laotian/Mien, and Vietnamese youth in Oakland, California, acculturation factors of individualism-collectivism and acculturative dissonance were examined as risk and protective factors for substance use. Results of structural equation modeling and bootstrapping revealed that peer substance use was a robust mediator between individualism and youth’s self-reported substance use, particularly among Vietnamese and males. Peer substance use also significantly mediated the relation between collectivism and substance use for females. As such, there appears to be ethnic and gender group variations in the saliency of cultural/acculturation factors with respect to substance use. Implications for substance use prevention programs for ethnic and immigrant youth are discussed.

A program for reducing depressive symptoms and suicidal ideation in medical students.

Purpose Although depressive symptoms and suicidal ideation are common in medical students, few programs address this serious problem. The authors developed, and then tested the effectiveness of, an intervention meant to reduce reported depressive symptoms and suicidal ideation. Method To reduce the alarming reported rates of depression and suicidal ideation among medical students, the University of Hawaii John A. Burns School of Medicine implemented the following interventions: increased individual counseling for students, faculty education, and a specialized curriculum including lectures and a student handbook. Although counseling had always been available, a new emphasis was placed on facilitating an anonymous process and providing several options, including volunteer psychiatrists not involved in student education. In 2002 and 2003, the authors measured depressive symptoms and suicidal ideation in third-year medical students using, respectively, the Center for Epidemiologic Studies Depression Scale and a question about suicidal ideation from the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire. Results Before the intervention, 26 medical students (59.1%) had reported depressive symptoms, and 13 (30.2%) reported suicidal ideation. After the intervention, 14 medical students (24.1%) reported depressive symptoms (&khgr;2 = 12.84, df = 2, P < .01), and 1 (3%) reported suicidal ideation (&khgr;2 = 13.05, df = 1, P < .001). Conclusions Programs that provide specific mental health support for medical students may significantly decrease the reported rates of depressive symptoms and suicidal ideation.

Changes in PTSD symptomatology and mental health during pregnancy and postpartum.

Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman’s experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians’ office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.

Mental Health During Pregnancy: A Study Comparing Asian, Caucasian and Native Hawaiian Women

Objective: This study examines perinatal mental health issues, ethnic differences, and comorbidity among pregnant women in Hawaii. Methods: Eighty-four participants were recruited from women, ages 18–35, seeking prenatal care on Oahu. They were interviewed at their initial prenatal visit about substance use, depression, and anxiety. Results: Sixty-one percent of women screened positive for at least one mental health issue. Thirteen percent of all pregnant women reported drinking during pregnancy with 5% reporting problem drinking, 15% reported smoking cigarettes on a regular basis, 5% of pregnant women had probable depression, and 13% of pregnant women had probable anxiety. Significant ethnic differences were found in cigarette smoking, with the highest rate among Native Hawaiian women (35%). Native Hawaiian women were also more likely to binge drink. Conclusion: Given the high rates of potential mental health issues in our sample, our findings highlight the importance of screening and treatment for mental health issues early in pregnancy in Hawaii.

Moving Toward Comprehensiveness and Sustainability in a Social Ecological Approach to Youth Violence Prevention: Lessons from the Asian/Pacific Islander Youth Violence Prevention Center

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O`ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O`ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Alcohol Use and Violence Among Adolescents in a Multiethnic Setting

Abstract This study compares the prevalence of drinking behaviors and violence (fighting, weapon carrying, being threatened and feeling unsafe) among Hawaiian, other Asian American and Pacific Islander (AAPI), and Caucasian students, using data collected from the Youth Risk Behavior Survey in Hawaii in 1997 and 1999 (N = 2,146). Native Hawaiians and Caucasians were more likely than other AAPIs to have had a drink and to binge drink. Drinking behavior was a predictor for all violence behaviors, increasing its likelihood as much as ten-fold. Violent behaviors differed by ethnicity. The findings highlight the need to develop culturally sensitive strategies for violence prevention and to explore risk factors among AAPI subgroups.

Methamphetamine in Emergency Psychiatry

ObjectivesThe purpose of this study is to determine the prevalence of methamphetamine-related diagnoses seen in the psychiatric emergency department (ED) of a large urban hospital, which serves an area with a known methamphetamine epidemic. This study also examines the characteristics and ED interventions of psychiatric patients with and without methamphetamine-related diagnoses. MethodsThe records of 904 patients admitted to the psychiatric ED of the largest urban hospital in Hawaii between March and May 2002 were reviewed. Diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders IV. Patients were classified as having a methamphetamine-related diagnosis if they were diagnosed with methamphetamine intoxication, dependency, abuse, withdrawal, methamphetamine-induced mood disorder or psychotic disorder. ResultsOne hundred sixty-six patients (18%) were diagnosed with a methamphetamine-related diagnosis. Patients with methamphetamine-related diagnoses were more likely to be male (70% vs. 57%), non-Caucasian (75% vs. 57%), and presented with suicidality (47% vs. 32%) and agitation (48% vs. 30%) more often than non-methamphetamine-related diagnosis patients. Poly-drug use (14% vs. 3%) and dual diagnosis (37% vs. 17%) were more common among patients with methamphetamine-related diagnoses. Patients with methamphetamine-related diagnoses were treated with sedating medications more frequently (37% vs. 25%), stayed longer in the ED (median 225 vs. 193 min), and were more likely to be admitted to the hospital (53% vs. 40%) than non-methamphetamine-related diagnoses patients. ConclusionsPsychiatric ED patients with methamphetamine-related diagnoses present more acutely and use more hospital resources.