A Qualitative Exploration of General Practitioners' Treatment Decision-Making for Depressive Symptoms.

BACKGROUND: General practitioners (GPs) provide the most antidepressant prescriptions and psychologist referrals in Australia, yet little is known about how they decide between treatments for depressive symptoms. AIMS: This study examined the decision cues that GPs use when deciding how to treat depressive symptoms and the meaning they attribute to these associations. METHODS: Structured interviews were conducted with 16 Australian GPs in a "think-aloud" verbal protocol analysis format. The transcripts were analyzed using content coding and thematic analysis, informed by the dual processes model of decision making. RESULTS: Participants associated prescribing antidepressants with severe depressive symptoms, and psychologist referrals were the preferred initial treatment provided patients were willing to engage. Four main themes emerged from the thematic analysis: 1) psychologist as default, 2) the risk is just too high, 3) medication as supplement, and 4) drivers of antidepressants. Contrary to previous findings, participants identified a strong heuristic association between depressive symptoms and psychologist referral. Antidepressant prescription was associated with severe symptoms, higher risk, and a cluster of cues that lead them away from psychologist referral. CONCLUSIONS: Participants demonstrated an oversensitivity to depressive symptom severity, associating psychologist referrals with subclinical depressive symptoms, and starting antidepressants for suicidal ideation and significant functional decline. HIGHLIGHTS: Psychologist referrals were the default preference for GPs when treating depressive symptoms, whereas antidepressants were reserved for patients with elevated risk from severe depressive symptoms and suicidal ideation.Participants' conceptualization of depression severity was oversensitive compared with treatment guidelines.Contrary to treatment guidelines, GPs in this study demonstrated their discomfort for referring patients with suicidal ideation to a psychologist without initiating antidepressants.GPs should consider whether patients within their mild to moderate assessment range can be treated exclusively with more cost-effective means than psychological therapy such as e-mental health programs, guided self-help, and lifestyle changes alone.

Dysfunctional sleep beliefs and behaviours: Psychological factors in sleep-related headaches.

Sleep problems are amongst the most common triggers of migraine and non-migraine primary headache. Despite a majority of sleep problems being psychological in nature, there is a paucity of quantitative research on the psychological factors involved in sleep-related headaches. This is the first study to examine the link between maladaptive sleep beliefs and headaches. 542 participants completed an online battery measuring headache, sleep, and psychological distress. Avoidance of sleep-related headache triggers was associated with more headaches, as mediated by increased sensitivity to the triggers. Sleep quality, sleep beliefs, and sleep behaviours all significantly (p < .001) correlated with headache frequency and disability, with effect sizes ranging from small (rs = 0.16) to medium (rs = 0.37). Mediation models testing the effect of sleep beliefs on headaches via sleep quality (covaried by sleep behaviours) accounted for 13% and 14% of variance in migraine and non-migraine headaches, respectively (p < .001). Avoidance of sleep-related headache triggers was shown to be associated with greater headache frequency (via increased trigger sensitivity). It is posited that maladaptive sleep beliefs and behaviours may increase headache activity by causing poor sleep quality, leading to dysregulation in brain regions shared between sleep and headaches.

N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial.

OBJECTIVE: Preliminary evidence has suggested that adjunctive N-acetylcysteine (NAC), an antioxidant precursor to glutathione, may reduce symptoms of obsessive-compulsive disorder (OCD). We conducted a 20-week, multi-site, randomized controlled trial to investigate the safety and efficacy of the adjunctive use of NAC in OCD. METHODS: The study was a phase III, 20-week, double-blind, randomized controlled trial across multiple sites in Australia investigating 2 g to 4 g per day of NAC (titrated according to response) in 98 participants with DSM-5 diagnosed OCD. Data were analysed using linear mixed effects models for the 89 participants who attended at least one follow-up visit. RESULTS: A modified intention-to-treat analysis of the primary outcome found no evidence that NAC reduced symptoms of OCD measured on the Yale-Brown Obsessive-Compulsive Scale, relative to placebo (mean difference at week 20 = 0.53, 95% compatibility interval = -2.18, 3.23; p = 0.70; favouring placebo). There was also no evidence that NAC, compared to placebo, improved outcomes on the secondary measures including anxiety, depression, quality of life, functioning, or clinician/participant impression. NAC was well-tolerated with only mild gastrointestinal adverse events associated with the treatment. CONCLUSION: We found no evidence supporting the efficacy of the adjunctive use of NAC in OCD.

Treatment of refractory obsessive-compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach. OBJECTIVE: To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5' phosphate, and selenium. METHODS: A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale (YBOCS), administered every 4 weeks. RESULTS: An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of -7.13 (95% confidence interval = -9.24, -5.01), with a mean reduction of -1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered "responders" (YBOCS ≥35% reduction and "very much" or "much improved" on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD. CONCLUSIONS: While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.

A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder.

Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ2 (11) = 39.8, p = 3.8 × 10-5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant's individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.

Decision-making in single and multiple-screen CCTV surveillance.

One task of CCTV operation is to decide whether footage shown in videos depicts criminal behaviour, or allows a viewer to predict its occurrence. An increasing prevalence of cameras in the world, means an increase in screens in the control room. This presents a signal-to-noise challenge where the signal (criminal activity) may become more difficult to detect amongst the noise. We used signal detection approaches to understand which factors were associated with decision-making in a CCTV task. When detecting aggressive incidents, higher conscientiousness was associated with making better decisions, with a higher criterion for responding (meaning fewer false-positive responses). However, conscientious individuals tended to be less confident (in multiplex displays), and were slower in responding - which reflects that these individuals require more evidence to make these decisions. Higher trait cognitive anxiety was again associated with making earlier responses, while extraversion was also associated with earlier responding in multiplexed displays. Taken in combination, our results suggest that there is a fine balance between making correct decisions, and making early decisions - and that these need to be considered together in the CCTV task.

Fear and Anxiety Pathways Associated with Root Canal Treatments Amongst a Population of East Asian Origin.

Objective: This study aimed to identify and compare the pathways of endodontic fear and anxiety amongst East Asian origin patients attending Griffith University's Dental Clinics, Gold Coast, Australia. Methods: East Asian patients who attended the Griffith University dental clinics were included in this study. The "My Endodontic Fear" survey was used. The pathways involved in self-perception of dental fear and anxiety were assessed through 5 different questions. Chi-square test was for statistical analysis and the level of significance was set at P<0.05. Results: One hundred and forty six participants (n=146) (ages 18-62 years) of East Asian descent met the criteria to participate. 58.2% were females, and 41.8% males. The ethnicities were split into Chinese origin and non-Chinese origin (Korean, Phillipino, Japanese, Vietnamese). Results indicate multiple pathways affect the origin of fear, regardless of ethnicity. The Cognitive Conditioning pathway was the primary pathway selected by the Chinese and non-Chinese sub groups (51.4%, 43.6%) followed by the Informative (38.3%, 38.5%), then Vicarious (27.1%, 33.3%) and Parental (18.7%, 33.3%) pathways respectively.The Verbal Threat pathway was the least selected pathway for both groups, however the non- Chinese group selected this pathway significantly more often than the Chinese group (P<0.001). Conclusion: This study demonstrates that the Cognitive Conditioning pathway was the primary fear and anxiety pathway utilized by both East Asian sub-groups. Understanding how patients develop fear and anxiety can help treating dentists discuss triggering factors for patients and alleviate undue anxiety prior to treatment.

Psychological Sleep Interventions for Migraine and Tension-Type Headache: A Systematic Review and Meta-Analysis.

Disordered sleep, poor sleep quality, and insufficient or excessive sleep duration are known triggers of primary and secondary headaches. Given this, it is plausible that improving sleep will subsequently reduce headache activity. We report a systematic review of the literature, examining studies utilising psychological sleep interventions for the treatment of migraine and tension-type headache. PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Central were searched, using terms pertaining to psychological sleep interventions and headaches. Meta-analysis was performed for two outcome measures; headache frequency, and headache intensity. 103 studies were retrieved, of which 55 were duplicates. After completing reviews, three studies were retained. An additional eligible study was published after the initial search, and was found via monthly update searches, resulting in a total of four included studies. The effects of psychological sleep interventions (and in one study, combined with drug therapy) significantly reduced headache frequency and headache intensity. Three studies improved various sleep outcomes such as duration, efficiency, and excessive sleepiness. Psychological sleep interventions improve headache frequency and sleep, however there is conflicting evidence for the effect on headache intensity between studies. Limitations include the small number of studies conducted to date. Despite this, the notable improvements in headaches and sleep achieved after psychological sleep interventions indicates further research on this promising topic is warranted.

Influence of culture change on the perception of fear and anxiety pathways in Endodontics: A pilot proof of concept study.

This study assessed the influence of cultural changes (known as acculturation) on pathways of fear and anxiety in Endodontics. A purposive sampling technique identified patients of Saudi Arabian descent living in Australia and Saudi Arabia. Only patients with root canal fillings (or treatment planned for endodontic treatment) were included. Patients with intellectual disabilities, surgical root therapy, and aged under 20 were excluded. Consenting patients attending the dental clinics of University of Griffith University, Australia and University of Dammam, Saudi Arabia completed the "My Endodontic Fear Questionnaire." Three hundred and twenty-four patients (21-75 years) were included, 90% of participants reported more than one pathway. Australian Saudi Arabians mainly utilised vicarious pathway (94.9%), whilst Saudi Arabians utilised the verbal threat (93.5%) and parental pathway (78.3%). This study highlights the possible role of acculturation on the perception of fear and anxiety in Endodontics; however, further research with other ethnic groups is essential to enhance our understanding.

Factors influencing health practitioners' cognitive processing and decision-making style.

Successful interventions, healthcare planning, and patient-centered care require explanation, justification, and collaboration through interprofessional clinical decision-making (CDM). Understanding health practitioners' decision-making styles and influencing factors can enhance CDM capabilities. Health professionals and students (N = 229) completed an online survey on their decision-making styles, interprofessional education, interprofessional practice, discipline education, clinical experience, processing styles, personality, interpersonal motivational factors, and age. To assess the influence of task structure, participants answered CDM questions on a high- and a low-structured case study. Age demonstrated an effect on the level of clinical experience, while clinical experience also mediated the effect of age on rational processing styles. While personality results were mixed, consistent with previous findings, conscientiousness predicted rational processing style. Effects of interpersonal motivation on personality were also mixed, insofar as results indicated an association between conscientiousness and both experiential and rational processing styles. Interpersonal motivation also predicted rational processing styles. The complexity of CDM and factors influencing healthcare practitioners' processing and decision-making styles was highlighted. To optimize CDM processes by addressing errors and biases, CDM, and practice complexity, healthcare practitioner education should include theory-driven CDM orientation frameworks.

Anticipatory processing in social anxiety: Investigation using attentional control theory.

BACKGROUND AND OBJECTIVES: Cognitive models of social anxiety disorder (SAD) emphasize anticipatory processing as a prominent maintaining factor occurring before social-evaluative events. While anticipatory processing is a maladaptive process, the cognitive mechanisms that underlie ineffective control of attention are still unclear. The present study tested predictions derived from attentional control theory in a sample of undergraduate students high and low on social anxiety symptoms. METHODS: Participants were randomly assigned to either engage in anticipatory processing prior to a threat of a speech task or a control condition with no social evaluative threat. After completing a series of questionnaires, participants performed pro-saccades and antisaccades in response to peripherally presented facial expressions presented in either single-task or mixed-task blocks. RESULTS: Correct antisaccade latencies were longer than correct pro-saccade latencies in-line with attentional control theory. High socially anxious individuals who anticipated did not exhibit impairment on the inhibition and shifting functions compared to high socially anxious individuals who did not anticipate or low socially anxious individuals in either the anticipatory or control condition. Low socially anxious individuals who anticipated exhibited shorter antisaccade latencies and a switch benefit compared to low socially anxious individuals in the control condition. LIMITATIONS: The study used an analogue sample; however findings from analogue samples are generally consistent with clinical samples. CONCLUSIONS: The findings suggest that social threat induced anticipatory processing facilitates executive functioning for low socially anxious individuals when anticipating a social-evaluative situation.

Cognitive continuum theory in interprofessional healthcare: A critical analysis.

Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.

Comorbidity in Emetophobia (Specific Phobia of Vomiting).

BACKGROUND: Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self-report instruments. METHOD: Sixty-four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. RESULTS: Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder were found in participants compared with general population norms. CONCLUSIONS: Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self-report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting. Individuals with emetophobia show high comorbidity with other anxiety and mood disorders. The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive-compulsive disorder. Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia.

Effective behavioural strategies for reducing disgust in contamination-related OCD: A review.

Disgust is an understudied but important emotion in various psychological disorders. Over the last decade, increasing evidence suggests that disgust is also present in various subtypes of obsessive-compulsive disorder (OCD), especially in contamination-related OCD (C-OCD). The treatment of choice for C-OCD is exposure with response prevention, originally designed to reduce fear-associated emotions thought to be acquired through Pavlovian conditioning (PC). However, disgust has been proposed to be acquired through evaluative conditioning (EC) and according to the referential model of this form of learning, there are functional differences between PC and EC that need to be considered in the treatment of disgust-related responses. Alternative strategies suggested by EC-based models include counterconditioning (contingent presentation of the CS with a US of opposite valence) and US revaluation (contingent presentation of the US with US of opposite valence). Drawing on the referential model, this paper reviews evidence for the effectiveness of each strategy to identify the most theoretically sound and empirically valid intervention to reduce disgust in C-OCD.

Ethnicity and Pathways of Fear in Endodontics.

INTRODUCTION: Cultural competencies in multicultural societies with different ethnic perceptions pose a challenge during the management and treatment of patients with dental fear and anxiety. This study aimed to identify the most common and relevant pathways of fear and anxiety related to root canal treatment in different ethnic groups. METHODS: All participants visiting the Griffith University Dental Clinics, Gold Coast, Australia, were invited to participate if they had undergone primary root canal treatment or were scheduled to undergo the same. Patients with mental disabilities, those with no history of root canal treatment, those who only had surgical root canal treatment, and those below 20 years old were excluded. All participants completed the "My Endodontic Fear questionnaire." RESULTS: Eight hundred seventy-nine patients (20-90 years old) who had root canal treatment or were scheduled to have one consented to participate in this study. White (54.5%) and Arab/African respondents (30.9%) were more likely (P < .001) to use the conditioning pathway compared with East Asian (10.5%) or Aboriginal/Pacific Islander groups (3.9%). Age was a significant factor for all ethnicities (P < .05); 40-year-old and 65+-year-old groups showed less fear compared with the 20- to 39-year old groups. Female sex was significantly related to the use of the informative (P < .001) and parental (P = .002) pathways. CONCLUSIONS: The present study showed that different pathways appear to be adopted by different ethnic groups, indicating the importance of customizing strategies in a multicultural society to manage fear and anxiety related to root canal treatment.

Exposure treatment in multiple contexts attenuates return of fear via renewal in high spider fearful individuals.

BACKGROUND AND OBJECTIVES: Research has demonstrated that after exposure treatment, re-exposure to a previously feared stimulus outside of the treatment context can result in renewal of fear. The current study investigated whether conducting exposure treatment in multiple real-life contexts can attenuate renewal of fear. METHODS: Forty-six moderate to high spider fearful individuals were randomly allocated to groups that received exposure treatment in either one context or three contexts. Follow-up testing was conducted one week and four weeks after exposure in the treatment context or a novel context. RESULTS: Renewal of fear was found for the single extinction context group when exposed to the feared object in a novel context with self-report of fear, heart rate, and behavioural avoidance. However, renewal of fear was attenuated for the multiple extinction context group. LIMITATIONS: The sample included moderate to high spider fearful participants rather than clients with spider phobia, potentially limiting the generalisability of the findings to clinical populations. CONCLUSIONS: Using multiple extinction contexts in combination with other methods of attenuating renewal (e.g., context similarity) may provide a means to reduce the risk of renewal of fear.

Evoking and reducing mental contamination in female perpetrators of an imagined non-consensual kiss.

BACKGROUND AND OBJECTIVES: Mental contamination refers to feelings of internal dirtiness that can arise without physical contact with a contaminant. Previous research has demonstrated that contamination-related feelings and subsequent washing behaviours can be evoked by engaging in an imaginal task involving a non-consensual kiss. We sought to test the efficacy of neutralisation behaviours such as washing on experimentally induced mental contamination. METHODS: The current study used a female undergraduate sample (N = 80) to act as the perpetrator of an imagined non-consensual kiss of a 14-year old boy, to examine whether mental contamination would be evoked, and whether neutralisation would be effective. RESULTS: Mental contamination was successfully evoked in using the imaginal task. None of the neutralisation strategies (physical washing, mental washing, atonement) was more effective than a control group in reducing mental contamination. Groups using physical washing completed the experiment with higher levels of negative emotions than the control group, suggesting specific deleterious impact of this neutralisation behaviour. LIMITATIONS: The use of a non-clinical sample, as well as a uniform mental contamination method (rather than one specifically tailored to each participant) are limitations of the current study. CONCLUSIONS: Mental contamination is not reduced by a range of neutralisation strategies, and physical washing may have further negative effects such as increased negative emotion.

Pathways of fear and anxiety in dentistry: A review.

The aim of this article was to analyze the theories underpinning dental fear, anxiety and phobias. To be included, articles must have been published between the years of 1949 and 2013 concerning fears and phobias within dentistry and/or psychiatry. Of 200 articles originally under review, 140 were included and reviewed by the authors.Five specific pathways relating to dental fear and anxiety were identified; Cognitive Conditioning, Informative, Visual Vicarious, Verbal Threat, and Parental. Eight currently accepted management techniques across all dental disciplines for dental fear and anxiety were identified. Further research is required to identify clinical diagnosis and treatment for fears originating from different pathways.

Fear of evaluation in social anxiety: mediation of attentional bias to human faces.

Social anxiety disorder (SAD) is a debilitating psychological disorder characterised by excessive fears of one or more social or performance situations, where there is potential for evaluation by others. A recently expanded cognitive-behavioural model of SAD emphasizes that both the fear of negative evaluation (FNE) and the fear of positive evaluation (FPE) contribute to enduring symptoms of SAD. Research also suggests that socially anxious individuals may show biases toward threat relevant stimuli, such as angry faces. The current study utilised a modified version of the pictorial dot-probe task in order to examine whether FNE and FPE mediate the relationship between social anxiety and an attentional bias. A group of 38 participants with moderate to high levels of self-reported social anxiety were tested in groups of two to four people and were advised that they would be required to deliver an impromptu speech. All participants then completed an assessment of attentional bias using angry-neutral, happy-neutral, and angry-happy face pairs. Conditions were satisfied for only one mediation model, indicating that the relationship between social anxiety and attentional avoidance of angry faces was mediated by FPE. These findings have important clinical implications for types of treatment concerning cognitive symptoms of SAD, along with advancing models of social anxiety. Limitations and ideas for future research from the current study were also discussed.

Obsessive-compulsive symptoms in a normative Chinese sample of youth: prevalence, symptom dimensions, and factor structure of the Leyton Obsessional Inventory--Child Version.

BACKGROUND: Chinese adolescents face life stresses from multiple sources, with higher levels of stress predictive of adolescent mental health outcomes, including in the area of obsessive-compulsive disorders (OCD). Valid assessment of OCD among this age group is therefore a critical need in China. This study aims to standardise the Chinese version of the Leyton short version scale for adolescents of secondary schools in order to assess this condition. METHODS: Stratified randomly selected adolescents were selected from four high schools located in Beijing, China. The Chinese version of the Leyton scale was administered to 3221 secondary school students aged between 12 and 18 years. A high response rate was achieved, with 3185 adolescents responding to the survey (98.5 percent). Exploratory factor analysis (EFA) extracted four factors from the scale: compulsive thoughts, concerns of cleanliness, lucky number, repetitiveness and repeated checking. The four-factor structures were confirmed using Confirmatory Factor Analysis (CFA). RESULTS: Overall the four-factor structure had a good model fit and high levels of reliability for each individual dimension and reasonable content validity. Invariance analyses in unconstrained, factor loading, and error variance models demonstrated that the Leyton scale is invariant in relation to the presence or absence OCD, age and gender. Discriminant validity analysis demonstrated that the four-factor structure scale also had excellent ability to differentiate between OCD and non-OCD students, male and female students, and age groups. LIMITATIONS: The dataset was a non-clinical sample of high school students, rather than a sample of individuals with OCD. Future research may examine symptom structure in clinical populations to assess whether this structure fits into both clinical and community population. CONCLUSIONS: The structure derived from the Leyton short version scale in a non-clinical secondary school sample of adolescents, suggests that a four-factor solution can be utilised as a screening tool to assess adolescents׳ psychopathological symptoms in the area of OCD in mainland Chinese non-clinical secondary school students.