Tom Sørensen

Concordance between symptom screening and diagnostic procedure : the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I

Abstract The definition of case is a core issue in psychiatric epidemiology. Psychiatric symptom screening scales have been extensively used in population studies for many decades. Structured diagnostic interviews have become available during recent years to give exact diagnoses through carefully undertaken procedures. The aim of this article was to assess how well the Hopkins Symptom Checklist-25 (HSCL-25) predicted cases by the Composite International Diagnostic Interview (CIDI), and find the optimal cut-offs on the HSCL-25 for each diagnosis and gender. Characteristics of concordant and discordant cases were explored. In a Norwegian two-stage survey mental health problems were measured by the HSCL-25 and the CIDI. Only 46% of the present CIDI diagnoses were predicted by the HSCL-25. Comorbidity between CIDI diagnoses was found more than four times as often in the concordant cases (cases agreed upon by both instruments) than in the discordant CIDI cases. Concordant cases had more depression and panic/generalized anxiety disorders. Neither the anxiety nor the depression subscales improved the prediction of anxiety or depression. The receiver operating characteristic (ROC) curves confirmed that the HSCL-25 gave best information about depression. Except for phobia it predicted best for men. Optimal HSCL-25 cut-off was 1.67 for men and 1.75 for women. Of the discordant HSCL-25 cases, one -third reported no symptoms in the CIDI, one-third reported symptoms in the CIDI anxiety module, and the rest had symptoms spread across the modules. With the exception of depression, the HSCL-25 was insufficient to select individuals for further investigation of diagnosis. The two instruments to a large extent identified different cases. Either the HSCL-25 is a very imperfect indicator of the chosen CIDI diagnoses, or the dimensions of mental illness measured by each of the instruments are different and clearly only partly overlapping.

Prevalence, incidence and age at onset of psychiatric disorders in Norway

Abstract  Background: Increased demands for psychiatric services and increased rates of sickness absence for depression have raised the question of the occurrence of psychiatric disorders in Norway, and whether there is in fact a rising incidence rate. Methods: Between 1989–1991, 2015 and 617 persons participated in a two-phase population study. Phase I comprised screening by the Hopkins Symptom Check List 25 items (HSCL-25), and phase II a diagnostic interview by the Composite International Diagnostic Interview (CIDI), including report of date (year) of the first occurrence of any symptoms, and any consequent diagnosis: Results: A symptom score of 1.75 or more was found in 19.8% of the women and 9.3% of the men by the HSCL-25. Depression, anxiety or somatoform disorder by CIDI was found in 21.5% of the women and 11.5% of the men. The incidence rate increased significantly from 3.3 to 12.8 per 1000 person years from 1930 to 1991. The incidence rate in the year before the interview was 42.6 per 1000 person years. Age of onset became lower. More women became ill, but the illness seemed to last longer in men. A major problem in comparing results between studies is the different concepts and operationalisations of psychiatric illness, and the varying time periods given for estimates. Conclusion: The findings provide evidence of psychiatric illness being a rising and major health problem, but the role of recall bias must be further investigated.

The meaning and significance of caseness : the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview II

Abstract In previous analyses of data from the present general population study we found that screening of anxiety and depression symptoms by the Hopkins Symptom Checklist-25 (HSCL-25) and diagnostic classification by the Composite International Diagnostic Interview (CIDI) identified the same amount of cases, but agreed in only half of them. In this paper we compared and validated the screening cases with the classificatory cases by the use of medication, loss of functioning and help seeking (illness indicators). We thought that the CIDI cases would have more illness indicators, because they reflected diagnoses, “true illness”, in contrast to the HSCL-25, which was a more unspecific measure of distress. The HSCL-25 and the illness indicators data were collected in a stage I random individual population sample above 18 years during 1989–1991 (N = 1879, response rate 74%), the CIDI data were collected in a selected stage II, (N = 606, response rate 77%). The stage II data were weighted to represent the population sample. Screening cases by the HSCL-25 had significantly more illness indicators than diagnostic cases by the CIDI. Cases agreed upon with both instruments had the most illness indicators, cases agreed upon only by the CIDI had the least. Diagnoses give information about help eventually needed, the HSCL-25 distress measure expresses more the urgency with which it is needed. The choice between the HSCL-25 and the CIDI would depend on the aim and the resources of the study. If evaluation of needs is involved, using an instrument picking up both classification and distress would be the best choice. Given our positive experience with interviewing with the CIDI, a CIDI improved to be more sensitive to how much distress a certain diagnosis exerts on the individual would be a good choice.

Changes in body mass index by age, gender, and socio-economic status among a cohort of Norwegian men and women (1990–2001)

BackgroundConsistent with global trends, the prevalence of obesity is increasing among Norwegian adults. This study aimed to investigate individual trends in BMI (kg/m2) by age, gender, and socio-economic status over an 11-year period.MethodsA cohort of 1169 adults (n = 581 men; n = 588 women) self-reported BMI during a general health interview twice administered in two regions in Norway.ResultsAverage BMI increased significantly from 23.7 (SD = 3.4) to 25.4 (SD = 3.8), with equivalent increases for both genders. Proportion of obesity (BMI ≥ 30) increased from 4% to 11% for women and 5% to 13% for men. Of those already classified as overweight or obese in 1990, 68% had gained additional weight 10 years later, by an average increase of 2.6 BMI units. The greatest amount of weight gain occurred for the youngest adults (aged 20–29 years). Age-adjusted general linear models revealed that in 1990, women with a lower level of education had a significantly greater BMI than more educated women. In both 1990 and 2001, rural men with the highest level of household income had a greater BMI than rural men earning less income. Weight gain occurred across all education and income brackets, with no differential associations between SES strata and changes in BMI for either gender or region.ConclusionResults demonstrated significant yet gender-equivalent increases in BMI over an 11-year period within this cohort of Norwegian adults. Whereas socio-economic status exerted minimal influence on changes in BMI over time, young adulthood appeared to be a critical time period at which accelerated weight gain occurred.

Is women's mental health more susceptible than men's to the influence of surrounding stress?

Abstract.Background:Most epidemiological population studies have demonstrated that women suffer more anxiety and depression than men. A higher level of stress, greater vulnerability to stress, and a non-additive effect of private/domestic and occupational obligations on women have been suggested as an explanation.Objective:The objective of this study was to examine if women’s mental health is more susceptible than men’s to the influence of surrounding stress.Material and method:A cross-sectional, random sample of the population resulted in 651 men and 626 women, all of whom were employed, participating in the study. Participants were interviewed using face-to-face standardized questionnaires.Results:Younger women experienced more stressful relationship events, illness events and network events than men of the same age. Relationship events were more important for men as they grew older, and interacted with other stress to increase anxiety and depression symptoms. Stressful illness events were more strongly related to anxiety/depression symptoms in women over 40 than in men of the same age, and interacted with work stress to increase symptom scores.Conclusion:Stress was more strongly related to symptoms in women, suggesting that they may have a greater susceptibility to surrounding stress, and to somatic illness stress. This might contribute to the sex difference in psychiatric illness.

Diabetes mellitus and psychological well-being. Results of the Nord-Trøndelag health survey

The present study relies on questionnaire data from a diabetes and hypertension screening carried out on the entire adult population of a medium-sized Norwegian county (total number of participants = 74,977). Self-reported diabetic patients were compared with non-diabetics, and with patients with self-reported angina pectoris, previous cardiac infarction, and stroke. The psychological well-being of the known diabetic patients was found to be significantly poorer than that of those without diabetes, but better than that of those with angina and stroke. HbAl level was found to be significantly related to well-being, the low levels of HbAl (below 7.5%) scoring low on well-being and the high levels (above 15%) scoring high. Because of its special design, the present study allowed comparisons between diabetic patients undergoing treatment and newly detected patients who had not yet been treated. Treatment-related interpretations therefore could be rejected.

Job demands, job control, and mental health in an 11-year follow-up study: Normal and reversed relationships

Abstract Despite numerous studies of the demand-control model, there is a need for more longitudinal studies to test not only the normal, but also the reversed and reciprocal relationships between work characteristics and mental health. There is also a need for more studies of the multiplicative interaction between demands and control with respect to mental health, which is different from the simple additive effect of the two variables. This is a longitudinal study with an exceptionally long period of follow-up (11 years), with the focus on normal as well as reciprocal and reversed causality between work characteristics and mental health, as measured by reliable instruments close to the original definitions of Karasek. The study was based on a sample of 439 Norwegian employees of different occupations who had stayed in the same profession during the follow-up period. The results were in agreement with the hypothesis that low job control, and in particular low control in combination with high demands (“high strain jobs”), has a negative effect on mental health. There was a significant multiplicative interaction between demands and control, indicating a “buffering” effect of job control. Job demands alone were not significantly associated with mental health. The reversed relationship hypothesis was supported for job demands, but not for job control.

Do quitters have anything to lose? Changes in body mass index for daily, never, and former smokers over an 11-year period (1990-2001).

Aims: The purpose of the present study was to examine whether body mass index (BMI) trajectories differed between daily smokers, never smokers, and former daily smokers among a population-based sample over an 11-year period. Methods: A cohort of 1,166 adults (n = 579 men; n = 587 women) self-reported BMI during a general health interview twice administered in two regions in Norway. Of the participants, 37.5% were never smokers, 31.6% current smokers, and 31% were former smokers. Results: Those who had quit smoking within the past five years had the highest age-adjusted BMI increase, gaining 3 kg and 5 kg more weight on average than current smokers (women and men, respectively). No significant differences in weight gain over the 11-year period existed between never smokers and former smokers who had quit ≥ five years ago. Conclusions: Our finding that former daily smokers (≥ five years since quitting) demonstrated equivalent BMI increases to never smokers (1990—2001) is in line with evidence suggesting that the average body weight of quitters tends to stabilize over time to levels of never smokers. As post-cessation weight gain often represents a barrier to successful quitting, improved knowledge about the temporal and variable effects of smoking cessation on long-term weight outcome may strengthen motivational enhancement and relapse prevention efforts.

To measure quality of life: Relevance and use in the psychiatric domain

The expression “quality of life” has a strong positive connotation. The definition will be influenced by values and points of reference. Not at least in the psychiatric domain we need a precise and not to wide-ranging definition. If we are to investigate the relation between living conditions or different psychiatric diagnoses, and peoples subjective experience, we have to separate these sets of phenomena. Quality of life is related to individual feelings. It is subjective and includes a global assessment. It is seen as both a cognitive evaluation and some degree of positive and negative feelings. It correlates with depression but can be separated from it. Personality factors will influence quality of life, but it reacts to life changes and cannot be seen as synonymous with any particular trait. Quality of life measurements have shown that long-term psychiatric patients have lower well-being than others. They can also help us to weigh between different treatment programmes, and between patients and their...

Social Networks for Mental Health Clients: Resources and Solution

Abstract Several studies have illustrated the importance of social support and social networks for persons with mental health problems. Social networks may mean a reduced need for professional services, but also help to facilitate access to professional help. The interplay between social networks and professional services is complicated and invites further investigation. Compare aspects of clients’ experiences with social networks to experiences with professional services and learn about the relationship between network resources and help from the public health service system. Quantitative analyses of a sample of 850 informants. Supportive networks exist for a majority of the informants and can also be a substitute for public/professional services in many respects. Regarding help to recover, social networks may offer qualities equal to those of professional services. Furthermore, there is a positive relationship between trust in a social network and trust in public professional services. Trust in a social network also increases the probability of achieving positive experiences with professional services. Our findings imply that more network qualities should be included in professional services, and also that professionals should assist vulnerable groups in building networks.