Mental health and sociodemographic characteristics among Icelanders, data from a cross-sectional study in Iceland.

BACKGROUND: Mental health challenges are on the rise worldwide. In Iceland, little is known about the sociodemographic factors associated with poor mental health. This study aimed to investigate symptoms of depression, anxiety, stress, and psychiatric medication for mental disorders in a nationally representative sample in Iceland and to explore its associations with sociodemographic factors. METHODS: This Icelandic cross-sectional study 'Health and Wellbeing of Icelanders' was conducted in 2017 and included 9,887 randomly chosen adults. Participants' depression, anxiety, and stress levels were measured with the Depression Anxiety and Stress scale-21(DASS-21) and the association with sociodemographic factors and prescribed psychiatric medication was assessed in a multinominal logistic regression analysis. RESULTS: The youngest age group (18 to 29 years old) had the poorest mental health. Males had a higher risk of medium and high depression scores than females, RRR 1.23 (95% CI 1.06-1.44) and RRR 1.71 (95% CI 1.25-2.33) when adjusted for sociodemographic factors (age, sex, education, marital status, financial status, living area, employment) and use of psychiatric medication. Participants with the most considerable financial difficulties had the highest risk of high scores on depression RRR 11.19 (95% CI 5.8-21.57), anxiety RRR 12.35 (95% CI 5.62-27.14) and stress RRR 11.55 (95% CI 4.75-28.04) when compared to those that do not. CONCLUSIONS: The youngest participants and those with the most extensive financial difficulties had the highest depression, anxiety, and stress scores. Males scored higher than females on depression. There was a trend towards worse mental health with lower sociodemographic status. Higher education, living with someone, and financial security were associated with better mental health. These results implicate the importance of government actions to counteract social inequalities in the Icelandic nation.

Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project.

PURPOSE: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population.

OBJECTIVE: To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity. DESIGN: Population-based cross-sectional study. SETTING: Iceland. PARTICIPANTS: A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19. MAIN OUTCOME MEASURES: Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities. RESULTS: Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44). CONCLUSIONS: Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

Measuring Resilience Across Participating Regions in the UPRIGHT EU Horizon 2020 Project: Factor Structure and Psychometric Properties of the Resilience Scale for Adolescents.

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents (READ) have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the READ in four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers (UPRIGHT) project. Participants included adolescents aged 10-15 years from Spain (n = 391, females = 51%), Iceland (n = 379, females = 55%), Italy (n = 460, females = 55%), and Poland (n = 316, females = 51%). The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported (except for the social competence subscale). The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided.

UPRIGHT, a resilience-based intervention to promote mental well-being in schools: study rationale and methodology for a European randomized controlled trial.

BACKGROUND: Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention. METHODS: UPRIGHT project is a research and innovation project funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods. DISCUSSION: We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376 . Registered 15 May 2019.

Measuring mental well-being in Denmark: Validation of the original and short version of the Warwick-Edinburgh mental well-being scale (WEMWBS and SWEMWBS) and cross-cultural comparison across four European settings.

This study examined the psychometric properties of the Danish WEMWBS and its short version (SWEMWBS) in a Danish population sample, and compared scores in Denmark with scores representative of three other European settings. A total of 3,508 Danish men and women aged 16-95 filled out an electronic survey. Face validity was examined by cognitive interviews. Content validity was assessed by examining response distributions and construct validity by confirmatory factor analysis, measurement invariance, and relations to other or similar measures. Overall mental well-being scores were calculated, as well as stratified by sex and age. Support was found for the single-factor hypothesis, yielding good model fits for both versions of the scale. Both scales have high internal consistency. Correlations with mental health measures were largely in line with expectations. The highest mental well-being scores were reported for Catalonia, followed by Denmark, Iceland, and England. The (S)WEMWBS appear to be appropriate instruments to measure mental well-being in the Danish population. The present findings encourage the use of the scales, particularly SWEMWBS, in epidemiological, intervention and evaluation studies in research and practice. Cross-cultural comparisons like the one reported here may be essential to inform international mental health policy.

Facing unemployment: study protocol for the implementation and evaluation of a community-based intervention for psychological well-being promotion.

BACKGROUND: Economic crises and unemployment have profound impact on mental health and well-being. Main goal of the Healthy Employment (HE) project is to enhance intersectoral actions promoting mental health among unemployed, namely through the implementation and effectiveness-evaluation of short-term and sustainable group interventions. METHODS: The project follows a RE-AIM-based (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework for assessing a cognitive-behavioural and psychoeducational intervention that has been developed for promoting mental health among unemployed people. It is a short-term group intervention (five sessions, four hours each, 20 unemployed persons per group) focused on mental health literacy, interpersonal communication and of emotional regulation. Implementation of the intervention will be carried out by clinical psychologists, following a standardized procedure manual. Effectiveness will be assessed through a randomized field study with two arms (intervention and control). Participants are unemployed people (18-65 years old, both genders, having at least nine years of formal education) registered at public employment centres from different geographical regions for less than 12 months (including first-job seekers). Allocation to arms of the study will follow a random match-to-case process, considering gender, age groups and educational level. Three moments of evaluation will occur: before intervention (baseline), immediately after its ending and three months later. Main outcomes are mental health literacy, mental health related personal and perceived stigma, psychological well-being, satisfaction with life and resilience. Intention-to-treat and per-protocol analyses will be conducted. Cohen's d coefficient and odds ratio will be used for assessing the size of the intervention effect, when significant. DISCUSSION: Scientific and clinical knowledge will be applied to promote/protect psychological well-being of unemployed people. While the first phases of the project are funded by the European Economic Area Grants, long-term assessments of the intervention require a larger timeframe. Further funding and institutional support will be sought for this purpose. Already established intersectoral collaborations are key-assets to reach long-term sustainability of this project. TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry; Prospectively registered number: ACTRN12616001432404 ; date of registration: 13 October 2016.

A psychometric evaluation of the Icelandic version of the WHO-5.

The psychometric properties of the Icelandic version of the World Health Organization five wellbeing index (WHO-5) were evaluated using two samples, a randomly selected sample (N = 3,896) from the Icelandic National Registry and a convenience sample of primary care patients (N = 126). The factor structure of the scale was tested with confirmatory factor analysis (CFA). The correlation between the WHO-5 and other measures of depression and anxiety were calculated to assess the scale's convergent and divergent validity. The discriminant validity of the WHO-5 was explored with a receiver operating analysis compared to the Mini International Neuropsychiatric Interview. The CFA indicated that the factor structure of the WHO-5 was one-dimensional and factorial invariant between groups. The internal reliability of the WHO-5 was adequate and the convergent, divergent and discriminant validity of the WHO-5 was supported. It is concluded that the psychometric properties of the Icelandic version of the WHO-5 are satisfactory.