Mari A. Toda

Temporal variation of validity of self-rating questionnaires : repeated use of the General Health Questionnaire and Zung's Self-rating Depression Scale Among women during antenatal and postnatal periods

The 30‐item General Health Questionnaire (GHQ) and Zungs Self‐Rating Depression Scale (SDS) were distributed to 120 pregnant women 4 times – in early and late pregnancy and 5 days and 1 month after the child was born. The validity of the questionnaires was assessed against the subjects’ Research Diagnostic Criteria (RDC) diagnoses. Both the GHQ and SDS sufficiently identified cases of minor mental disorder and depressive disorders respectively in early pregnancy; they lost their validity on the subsequent two occasions, but gained it again 1 month after the birth; the optimal cut‐off points varied accordingly. This study suggests that the optimal cut‐off point for a questionnaire should be validated against an externally determined clinical diagnosis whenever the instrument is used repeatedly on the same population.

Premenstrual mood changes and maternal mental health in pregnancy and the postpartum period

To investigate the relationship between premenstrual mood changes and maternal mental health in the perinatal period, a prospective questionnaire survey of 1,329 women was carried out. Women with a premenstrual mood changes (irritability) before pregnancy showed significantly higher Zungs Self-rating Depression Scale (SDS) scores than those without it, throughout pregnancy and the postpartum period (6 time points: early, middle, and late pregnancy, 5 days, 1 month, and 6 months after childbirth). In addition, women with premenstrual irritability had greater anxiety about pregnancy and delivery, were more reluctant to accept mother roles, and felt their babies (fetuses or neonates) were more vulnerable. These findings suggest that premenstrual mood change is correlated with unstable mental health throughout the perinatal period.

Psychiatric disorders among Japanese children.

OBJECTIVE To generate current data on the prevalence of psychiatric disorders among Japanese children, using DSM-III-R criteria. METHOD As part of an ongoing longitudinal study in a Japanese community sample, 114 mother-child dyads were interviewed when the children were approximately 8 years old. DSM-III-R disorders of the children were diagnosed through the administration of a structured diagnostic instrument, the parent and child versions of the Child Assessment Schedule, to both the children and their mothers. RESULTS The prevalence rate for any diagnosis was 49.1%, which is similar to that of U.S. children and adolescents. CONCLUSION The Child Assessment Schedule is an appropriate scale for assessing the psychopathology of Japanese children, which is as prevalent as in a U.S. sample.

Social support and pregnancy:II. Its relationship with depressive symptoms among Japanese women

Abstract In a questionnaire survey among 1329 first‐trimester pregnant women, both the husband support measures and unwanted pregnancy (‘stressor’ agent in pregnancy) showed significant effects on an elevated score of the cognitive disturbance subscale of the Zungs self‐rating depression scale (SDS), while only unwanted pregnancies showed an effect on an elevated score of the dysphoric mood subscale of the SDS. However, no interaction was observed between the husband support measures and unwanted pregnancy, therefore the effect of the husbands social support on the cognitive disturbance score was not that of a buffer, but rather a main effector. Finally, multiple regression analyses showed that the dysphoric mood score was preceded by unwanted pregnancy, premenstrual irritability, public self‐consciousness, and maternal overprotection; while the cognitive disturbance score was preceded by unwanted pregnancy, husband reduced ‘given’ and ‘giving’ support, maternal reduced care and overprotection, paternal reduced care, low annual income, low private self‐consciousness, and smoking. These findings suggest that the husbands support for a pregnant woman is effective only in reducing cognitive symptoms, and that different symptomatic constellations have different sets of psychosocial correlates.

Single and repeated elective abortions in Japan: a psychosocial study

Despite its social, legal and medical importance, termination of pregnancy (TOP) (induced abortion) has rarely been the focus of psychosocial research. Of a total of 1329 women who consecutively attended the antenatal clinic of a general hospital in Japan, 635 were expecting their first baby. Of these 635 women, 103 (16.2%) had experienced TOP once previously (first aborters), while 47 (7.4%) had experienced TOP two or more times (repeated aborters). Discriminant function analysis was performed using psychosocial variables found to be significantly associated with either first abortion or repeated abortion in bivariate analyses. This revealed that both first and repeated aborters could be predicted by smoking habits and an unwanted current pregnancy while the repeated aborters appear to differ from first aborters in having a longer pre-marital dating period, non-arranged marriages, smoking habits, early maternal loss experience or a low level of maternal care during childhood. These findings suggest that both the frequency of abortion and its repetition have psychosocial origins.

Validity of the repeated GHQ among pregnant women: a study in a japanese general hospital

Objective: The authors examined the variability of the validity of the General Health Questionnaire (GHQ) on two different occasions. Method: The subjects were 120 pregnant women attending an antenatal clinic of a general hospital in Japan. The GHQ was distributed twice—in the first and third trimesters. They were then interviewed by a psychiatrist blind to the GHQ scores using the standard and the “change” version of the Schedule for Affective Disorders and Schizophrenia (SADS). Results: Of the 120 women, 108 and ninety-eight completed the GHQ and were successfully interviewed in the first and third trimesters, respectively. Seventeen percent (18/108) and 13 percent (13/98) women were given RDC diagnoses in the first and third trimesters, respectively: They were designated as cases. Despite a satisfactory discriminatory power of the GHQ on the first occasion [1], the validity measures of the GHQ on the second occasion were generally poor. Thus, the sensitivity was 39 percent and specificity 82 percent for the cut-off point of 7/8. Conclusions: The GHQ should be validated separately when distributed repeatedly to the same subjects.

Comparison of Different Scoring Systems for the Japanese Version of the General Health Questionnaire

The General Health Questionnaire (GHQ) is a self-rating questionnaire to identify current non-organic non-psychotic morbidity. Each item of the GHQ has four response codes; the left-side one represents the most healthy while the right-side one the most ill. The ability of four scoring systems of the GHQ items to discriminate psychiatric cases from non-cases, 0-0-0-1 (codes 1-3 = 0, code 4 = 1), 0-0-1-1 (codes 1 and 2 = 0, codes 3 and 4 = 1, the original GHQ scoring) and 0-1-1-1 (code 1 = 0, codes 2-4 = 1), were compared against the greatest increase in the rate of cases between neighbouring codes and by using discriminant function analysis with the three scoring systems as predictors among 108 antenatal clinic attenders. The data revealed that the original GHQ scoring was the most valid in its ability to identify psychiatric cases.

Childhood adversities and depression: II. Parental loss, rearing, and symptom profile of antenatal depression

Summary Among a total of 1,329 pregnant women, neither early loss experience by death or by separation before the age of 16 was related to any of the three depressive symptom constellations derived from Zungs Self-rating Depression Scale – Dysphoric Mood, Cognitive Disturbance, and Poor Concentration. Paternal and maternal low care and overprotection scores of the Parental Bonding Instrument, a measure of perceived rearing, had main effects on the Cognitive Disturbance and Poor Concentration scores, with significant interaction of the two predictors; Dysphoric Mood was also linked to maternal overprotection. These findings suggest that perceived parenting is a predictor of two specific symptom constellations of antenatal depression.

Social support and pregnancy:I. Factorial structure and psychosocial correlates of perceived social support

Abstract In a questionnaire survey among 1329 first‐trimester pregnant women, social support providers were divided by factor analysis into husband, ‘premarital network’ (parents and friends) and ‘postmarital network’ (children and mother‐in‐law), while social support contents were divided into ‘given’ (emotional, informational and instrumental support) and ‘giving’ (nurturing opportunity and general confiding). The husband was most frequently nominated by the woman as the support provider in both of these categories. Multiple regression analyses revealed that a husbands poor ‘given’ support was predicted by the presence of premenstrual irritability, a lower level of the womans own education, her smoking habits and past experience of pregnancy termination, while a husbands poor ‘giving’ support was predicted by current older age, smoking habits and past experience of delivery.

Childhood adversities and depression: I. Effects of early parental loss on the rearing behaviour of the remaining parent

Summary Although early parental loss and perceived rearing have both been the target of intensive research, they have rarely been linked. This study examined the effects of parental loss on the perceived parenting of the remaining caregiver. The effect of early (before age 16) experience of the fathers or mothers death or separation from them for 12 months or longer on the rearing behaviour of the remaining parent was studied retrospectively among 1,329 pregnant women. Women who had experienced either death of or separation from the father reported having received less care from the mother. However, experiences of loss of the mother did not show significant effects on the perceived rearing behaviour of the father. The number of siblings was correlated with reduced paternal and maternal care and with reduced maternal overprotection. Our hypothesis that early parental loss experience would have a negative influence on parental rearing behaviour was proved only for the effects of the paternal loss. Search for other determinants may be warranted.