Training general practitioners to recognise and respond to psychological distress and suicidal ideation in young people.

OBJECTIVE: To determine the effectiveness of a training program for general practitioners in recognising and responding to psychological distress and suicidal ideation in young people. DESIGN AND SETTING: The study, conducted in general practice surgeries in Tasmania, Victoria and Western Australia in 1996 and 1997, used a pre-/posttest design to audit consecutive young patients presenting in the six weeks before and the six weeks after the GPs' participation in the training program. PARTICIPANTS: Consisted of 23 GPs who attended a youth suicide prevention workshop and 423 patients aged 15-24 years who presented to the GPs' surgeries (203 pre-workshop and 220 post-workshop). INTERVENTION: GPs attended a one-day training workshop designed to enhance their ability to recognise, assess and manage young patients at risk of suicide. MAIN OUTCOME MEASURES: Scores on three patient self-report inventories (General Health Questionnaire-12 [GHQ-12], Center for Epidemiological Studies Depression Scale [CES-D] and Depressive Symptom Inventory--Suicidality Subscale [DSI-SS]); a GP-completed form for each patient summarising presenting complaint(s), psychological assessment and proposed management plan. RESULTS: After training, GPs demonstrated increased recognition rates of psychologically distressed patients scoring above the cut-offs of the GHQ-12 (48% increase; odds ratio [OR], 1.748; 95% CI, 0.904-03.381) and CES-D (39.5% increase; OR, 2.067; 95% CI, 1.031-4.143); enquiry about suicidal ideation increased by 32.5% (OR, 1.483; 95% CI, 0.929-2.366); and identification of suicidal patients (determined by DSI-SS score) increased by 130% (OR, 3.949; 95% CI, 1.577-9.888). Training did not lead to any significant change in GPs' patient management strategies. CONCLUSIONS: A one-day training course can significantly enhance GP detection rates of psychological distress and suicidal ideation in young patients, but higher recognition rates do not necessarily lead to changes in patient management.

The relationship between chief complaints, psychological distress, and suicidal ideation in 15-24-year-old patients presenting to general practitioners.

OBJECTIVES: To determine the prevalence of psychological distress and suicidal ideation among patients aged 15-24 years presenting to general practitioners, and the relationship between these variables and patients' chief complaints. DESIGN AND SETTING: Questionnaire survey of young people presenting to Australian general practitioners between 1996 and 1998. PARTICIPANTS: 247 general practitioners who volunteered to participate in a nationwide project aimed at teaching general practitioners to identify and treat suicidal youth; 3242 consecutive 15-24-year-old patients presenting to participating general practitioners during a specified six-week period. MAIN OUTCOME MEASURES: Patients completed three self-administered questionnaires: the General Health Questionnaire-12, the Center for Epidemiological Studies Depression Scale, and the Depressive Symptom Inventory-Suicidality Subscale. Patients' chief complaints were obtained from summary sheets completed by their general practitioners. RESULTS: While only 12% of patients presented with psychological complaints, about 50% percent had clinically significant levels of psychological distress and 22% had clinically significant levels of suicidal ideation. CONCLUSIONS: Despite presenting with primarily medical complaints, almost half of young people presenting to primary care physicians had high levels of psychological distress and almost a quarter had high levels of suicidal ideation.

Fetal growth and subsequent mental health problems in children aged 4 to 13 years.

To test the hypothesis that children with suboptimal fetal growth have significantly poorer mental health outcomes than those with optimal growth, a population random sample survey of children aged 4 to 16 years in Western Australia in 1993 was conducted. The Child Behavior Checklist (Achenbach 1991a) and the Teacher Report Form (Achenbach 1991b) were used to define mental health morbidity. Survey data for 1775 children aged 4 to 13 years were available for linkage with original birth information. The percentage of expected birthweight (PEBW) was used as the measure of fetal growth. Children below the 2nd centile of PEBW who had achieved only 57% to 72% of their expected birthweight given their gestation at delivery were at significant risk of a mental health morbidity (OR 2.9, 95% CI 1.18, 7.12). In addition, they were more likely to be rated as academically impaired (OR 6.0, 95% CI 2.25, 16.06) and to have poor general health (OR 5.1, 95% CI 1.69, 15.52).

Intentions to use alcohol among fifth and sixth graders: the roles of social and stress/coping motives.

This study of children in grades five and six assessed the relationship between social and stress/coping motives and students' intentions to drink in junior high school. Whereas the two motives were not seen as separate by fifth graders, they were differentiated by sixth graders, for whom they were associated--social motives more strongly than stress/coping motives--with intentions to use alcohol. Implications for the design and timing of prevention programs are considered.

Vietnamese parental perceptions of child and adolescent mental illness.

OBJECTIVES: To determine the symptoms and behaviors in children which are considered psychopathological by Vietnamese parents, to identify professionals and agencies in the community whom Vietnamese parents would consult if their child had a mental illness, and to determine Vietnamese parents' awareness of existing community mental health services. METHOD: Structured interviews were conducted with a randomized community sample of 283 Vietnamese parents in Perth, Australia. Parents were asked to identify the symptoms and behaviors they considered psychopathological in children, where they would turn for help with a mentally ill child, their knowledge of community mental health services for children, and their understanding of the causes of child psychiatric disorders. RESULTS: Vietnamese parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological. They preferentially endorsed Western-style treatment approaches but had little awareness of existing community mental health services for children. A biological/chemical imbalance, traumatic experiences, and a metaphysical/spiritual imbalance were identified as the most likely causes of child mental illness. CONCLUSIONS: Despite a different cultural tradition, Vietnamese parents appear open to services provided by Western-trained mental health professionals. Their very limited awareness of child and adolescent mental health services in the community, however, may severely limit their utilization of such services.

Psychological and social characteristics and precipitants of vomiting in children with cyclic vomiting syndrome.

A psychological etiology or predisposition for cyclic vomiting syndrome (CVS) has long been suspected. Much of the psychiatric literature to date has blamed patients or their families for the problem or focused on psychoanalytic interpretation to account for the syndrome. Thirty-two patients with CVS were compared with 64 age- and sex-matched controls. The patients had a higher incidence of psychological symptoms and migraine. On the Achenbach Child Behavior Checklist patients had higher internalizing, somatic complaints, and anxiety/depression scores. CVS is a migraine variant, with attacks usually precipitated by stress and intercurrent infections. The psychological characteristics of patients with CVS probably contribute to their vulnerability.

Problems and competencies reported by parents of Vietnamese children in Hanoi.

OBJECTIVE: To determine the distribution of behavioral and emotional problems and competencies among a sample of Vietnamese children aged 4 through 18 years living in Hanoi. METHOD: A representative community sample of 1,526 children and adolescents was selected from 2 precincts in Hanoi. Problems and competencies were assessed with the Child Behavior Checklist (CBCL). RESULTS: Vietnamese children had lower mean raw scores than U.S. norms on the CBCL's Total, Externalizing, Internalizing, and Competence scales. Boys were reported to have more externalizing problems and girls more internalizing problems. Girls' levels of internalizing problems increased significantly with age. CONCLUSION: The lower levels of problems and competencies reported in Vietnamese children may represent differences in the prevalence of psychiatric disorders, in parental perceptions of what constitutes deviant behavior, or in parental comfort with reporting psychopathological behaviors. Further research is needed to clarify the relationship between the reported behavioral and emotional problems of Vietnamese children and the presence of psychiatric disorders. From a clinical perspective, the study's results suggest that levels of problems and competencies may vary significantly between different ethnic and cultural groups. Specific clinical cutoffs used to identify children requiring further psychiatric assessment need to be established separately for different ethnic groups.

Sex knowledge and sexual attitudes among medical and nursing students.

OBJECTIVES: The aim of this study was to assess the relationship between background and sociodemographic variables, attitudes toward controversial aspects of human sexuality and sex knowledge among medical and nursing students. METHOD: The study design was a questionnaire-based survey of medical and nursing students in Western Australia. Participants were first- through fifth-year medical students at the University of Western Australia and first- through third-year undergraduate nursing students at Edith Cowan University. Outcome measures were students' attitudes toward controversial aspects of human sexuality expressed on a five-point Likert scale and a modified version of the Kinsey Institute/Roper Organization National Sex Knowledge Test. RESULTS: A significant relationship was found between certain background and sociodemographic variables, sexual attitudes and sex knowledge. The background variable most strongly related to both attitudes and knowledge was frequency of attendance at religious services of any religious denomination during the past month, with those attending three or more times more likely to express negative attitudes and have lower sex knowledge scores. Lower sex knowledge was related to negative attitudes toward gay/lesbian/bisexual behaviour, masturbation, premarital sex and contraception. Other important background and sociodemographic variables related to negative attitudes were: never having experienced sexual intercourse; right-wing political orientation; lower family income; gender and ethnicity. CONCLUSIONS: Negative attitudes toward controversial aspects of human sexuality and lower sex knowledge scores among medical and nursing students can be predicted on the basis of background and sociodemographic variables. Education aimed at increasing sex knowledge and modifying negative attitudes may increase students' ability to function more effectively as sexual history takers and sex counsellors.

Lack of prognostic significance of SPECT abnormalities in non-demented elderly subjects with memory loss.

OBJECTIVE: To determine if hypoperfusion abnormalities on single photon emission computed tomography (SPECT) are associated with poorer cognitive function at baseline or increased risk of decline in cognitive function and progression to dementia in memory-impaired but non-demented elderly subjects meeting the criteria for aging associated cognitive decline (AACD). DESIGN: Cross sectional study of 36 AACD subjects comparing hexamethyl propylene-amine oxime (HMPAO) SPECT results rated by visual inspection with base line cognitive functioning. Prospective study of these AACD subjects with clinical and neuropsychological follow-up over 35 months. SETTING: The memory clinic and nuclear medicine unit of a university teaching hospital. SUBJECTS: Thirty-six subjects meeting the criteria for AACD recruited from patients seen on a physician referral basis. MAIN OUTCOME MEASURES: 1) Baseline cognitive function as measured by the Mini Mental State Examination (MMSE), Boston naming, Logical Memory I subtest of the WAIS-R, and verbal fluency, correlated with SPECT status. 2) Decline in cognitive function as measured by clinical exam and the MMSE, with progression to dementia on follow-up being correlated with SPECT status at baseline. RESULTS: 18 of the 36 subjects progressed to dementia (probable Alzheimer's Disease) over follow-up. No correlation was found between the presence or absence of SPECT abnormality and MMSE or other cognitive measures. There was no correlation between the presence or absence of SPECT abnormality at initial examination, and cognitive decline according to the MMSE, or with the occurrence of clinical dementia on follow-up. CONCLUSIONS: We conclude that SPECT abnormalities assessed by visual inspection do not correlate with severity of impairment in AACD individuals, and are not useful in predicting progression to dementia in AACD subjects.

Emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents.

OBJECTIVE: The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported. METHOD: Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire. RESULTS: On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants. CONCLUSIONS: In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalizing problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.

Psychological distress and suicidal ideation among 15-24-year-olds presenting to general practice: a pilot study.

OBJECTIVES: The study sought to determine: (i) the prevalence rates of psychological distress and suicidal ideation among 15-24-year-old patients presenting to general practice; and (ii) the relationship between patients' presenting complaints and their levels of psychological distress and suicidal ideation. METHOD: This was a pilot study designed to sample patients aged 15-24 years presenting consecutively to general practitioners during a 4-week period. The study was set among five general practices in the western suburbs of Perth, Western Australia. Participants included five general practitioners and 69 patients aged 15-24 years. Main outcome measures were the General Health Questionnaire (GHQ-12), the Centre for Epidemiological Studies Depression Scale (CES-D) and the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). RESULTS: One-third of patients scored above the cut-off of the GHQ-12, 31.9% above the cut-off of the CES-D and 20.3% above the cut-off of the DSI-SS. The majority of patients (87.5%) presented with medical complaints. Of these, 26.8%, 23.2% and 21.4% scored above the cut-offs of the GHQ-12, CES-D and DSI-SS, respectively. Patients presenting with psychological complaints (12.5%) were significantly more likely to score above the cut-off of the CES-D. CONCLUSIONS: In this pilot study, patients aged 15-24 presenting to five general practices had relatively high levels of psychological distress and suicidal ideation. Of most concern were those presenting with medical complaints and who also had high levels of unreported psychological distress.

Replication and extension of a risk profile for Amerasian youth.

The relationship between number of risk factors and symptoms of anxiety and depression was examined in a cohort of Vietnamese Amerasians, replicating a study done with a previous cohort. One hundred forty seven subjects awaiting U.S. placement completed the Hopkins Symptom Checklist, the Vietnamese Depression Scale, and a questionnaire which included items found to be risk factors for psychological distress among Amerasians. Number of risk factors was linearly related to symptoms of both depression and anxiety. Results are consistent with previous findings of the relationship between risk factors and symptoms of psychological distress. The profile may be helpful in anticipating which refugees may be at risk for future psychological distress, and thus be useful in preventively allocating scarce treatment resources.

A prospective study of psychological distress related to refugee camp experience.

OBJECTIVE: Previous reports have suggested a direct relationship between refugee camp experience and levels of psychological distress among refugees. Specifically, it has been postulated that refugee camps with harsh conditions and low levels of social support foster high levels of psychological distress. The present study was designed to assess the relationship between camp conditions and social support within a refugee camp and refugees' levels of psychological distress. Unlike previous reports, which were based on retrospective data, the present study evaluated psychological distress among a group of Vietnamese refugees both prior to departure from Vietnam and during their refugee camp experience. METHOD: A group of 101 Vietnamese Amerasians was assessed at a transit centre in Vietnam and subsequently at a refugee camp in the Philippines. Assessment instruments were the Hopkins Symptom Checklist-25 and a Camp Comparison Questionnaire. RESULTS: There were significant decreases in symptom levels of anxiety and depression between the transit centre in Vietnam and the refugee camp in the Philippines. However, these changes were not related to changes in refugee camp conditions or social support within the camp. CONCLUSIONS: Contrary to previous reports, levels of psychological distress among this group of Vietnamese refugees were not related to either refugee camp conditions or levels of social support within the camp.

Comparative levels of psychological distress in a pre-migratory refugee population.

OBJECTIVE: This study compares levels of psychological distress in a pre-migratory sample of Vietnamese Amerasians with those in a like-aged, non-migratory sample of Vietnamese living in Ho Chi Minh City, Vietnam. METHOD: Subjects were assessed using two measures developed and validated for Vietnamese clinical populations in the United States: the Hopkins Symptom Checklist-25 and the Vietnamese Depression Scale. RESULTS: Amerasians had significantly higher symptom levels on the depression scale of the Hopkins Symptom Checklist-25, but not on the other measures utilised. CONCLUSIONS: Amerasians' higher levels of depressive symptoms are probably a result of their traumatic lives in Vietnam, but may also reflect acute situational factors or selection bias.

Is there a role for child psychiatry in Vietnam?

OBJECTIVES: (i) To describe the need for child psychiatric services in Vietnam; (ii) to review child psychiatry's present role within the Vietnamese health care system; (iii) to identify cultural, economic and manpower obstacles to the development of child mental health services; and (iv) to recommend a course for the future development of child psychiatry in Vietnam. METHOD: The existing literature relevant to the Vietnamese health and mental health care systems, traditional practices and beliefs regarding health and mental health, and the current status of psychiatry and child psychiatry in Vietnam was reviewed. In addition, discussions regarding these topics, and the future of child psychiatry in Vietnam, were held with leading Vietnamese health and mental health professionals. RESULTS: The current role of child psychiatry in Vietnam is limited by the health care system's focus on infectious diseases and malnutrition, and by cultural, economic and manpower factors. Treatment is reserved for the most severely afflicted, especially patients with epilepsy and mental retardation. Specialised care is available in only a few urban centres. In rural areas treatment is provided by allied health personnel, paraprofessionals and community organisations. CONCLUSIONS: While the present role of child psychiatry in Vietnam is limited, it can still make important contributions. These include: research defining the need for child and adolescent mental health services, identifying priority child psychiatric disorders and assessing the effectiveness of priority disease treatment; and training to enhance the skills of primary health care providers in the treatment of priority disorders.

Do fifth graders' attitudes and intentions toward alcohol use predict seventh-grade use?

OBJECTIVE: To examine the relationship among children's perceptions of peer and parental attitudes toward alcohol use, fifth graders' attitudes toward alcohol use and intentions to use alcohol in junior high school, and alcohol use of these same children as seventh graders. METHODS: Subjects completed questionnaires as fifth graders that assessed their perception of parents' and peers' attitudes toward alcohol use, children's attitudes toward alcohol use, and intentions to use alcohol in junior high school. They completed a survey in the seventh grade that assessed alcohol use. RESULTS: Path analyses indicated that perceived peer and parental attitudes were directly related to children's fifth-grade attitudes toward alcohol use. Attitudes, in tum, were related to fifth-grade intentions, which were related to seventh-grade alcohol use. Peer and parental attitudes, and children's attitudes as fifth graders, were not directly related to later alcohol use. CONCLUSIONS: Peer and parental attitudes toward alcohol use among fifth graders exert an indirect, rather than direct, influence on later alcohol use. Similarly, attitudes of fifth graders influence later alcohol use through their influence on intentions to use alcohol. Prevention programs should be targeted toward younger children prior to initiation of alcohol use and should address both peer and parental influences on attitudes and intentions to use alcohol.

Chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetics.

Seven diabetic patients developed a progressive, moderately severe, motor rather than sensory neuropathy predominantly affecting the legs. This met clinical and electrophysiological criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). Nerve biopsies showed a variety of abnormalities, none of which clearly distinguished between diabetic polyneuropathy and CIDP. The patients were treated with combinations of corticosteroids, azathioprine, plasmapheresis and intravenous immune globulin; all improved substantially. We believe that CIDP may masquerade as unusually severe and progressive diabetic distal symmetric polyneuropathy. It is important to recognize CIDP in diabetics because, unlike diabetic polyneuropathy, CIDP is treatable.

The prevalence of psychiatric disorders among Vietnamese Amerasians: a pilot study.

A pilot study of the prevalence rate of DSM-III psychiatric disorders among Vietnamese Amerasians prior to migration from Vietnam found current prevalence of such disorders to be lower than previously reported among Vietnamese refugees in the United States and Australia. Methodological and cultural factors contributing to the lower than expected prevalence rate are discussed, and implications for clinical assessments and future research are noted.

A comparative study of Vietnamese Amerasians, their non-Amerasian siblings, and unrelated, like-aged Vietnamese immigrants.

OBJECTIVE: The authors compared the personal histories, levels of psychological distress, and adaptation to American life of Vietnamese Amerasians (N=140), their non-Amerasian siblings (N=71), and a group of unrelated, like-aged Vietnamese immigrants (N=118). METHOD: Subjects completed two self-administered symptom checklists and provided demographic and personal history data. RESULTS: Vietnamese Amerasians differed significantly from the other two groups on measures of alcohol use, number of hospitalizations, years of education, childhood trauma, perceived effects of trauma, and score on the Vietnamese Depression Scale. The Amerasians did not, however, differ on measures of social support or in their success at adapting to life in the United States. CONCLUSIONS: Despite multiple disadvantages, Vietnamese Amerasians appear to be adapting to life in the United States as well as other like-aged Vietnamese immigrants.

Premigratory expectations and postmigratory mental health symptoms in Vietnamese Amerasians.

OBJECTIVE: To determine the relationship between premigratory expectations for one's future life in the United States and postmigratory symptoms of anxiety and depression in a group of Vietnamese Amerasians. METHOD: A cohort of 161 Vietnamese Amerasian migrants was assessed prior to departure from Vietnam using the Hopkins Symptom Checklist-25 (HSCL-25), the Vietnamese Depression Scale, and an Expectations Questionnaire. After migration to the United States, subjects were reassessed using the HSCL-25 and the Vietnamese Depression Scale. RESULTS: Premigratory expectations for support from the Vietnamese community in the United States were associated with significantly higher scores on the HSCL-25 Depression scale. Of subjects reassessed in the United States, 20% scored in the clinical range for depression. CONCLUSIONS: Like-ethnic community support is critically important in preventing depressive symptoms among Vietnamese Amerasian migrants. Clinicians working with Amerasians should target those with unrealistically high expectations for preventive intervention and should approach Vietnamese community leaders to mobilize support for recently arrived Amerasians.