Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study.

BACKGROUND: The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety. OBJECTIVES: This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries. METHOD: A total sample of 9230 adults, 71.3 % female, Mage = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups. RESULTS: The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country. CONCLUSIONS: The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population. LIMITATIONS: The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Predicting transitions between longitudinal classes of post-traumatic stress disorder, adjustment disorder and well-being during the COVID-19 pandemic: protocol of a latent transition model in a general Dutch sample.

BACKGROUND: A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of post-traumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, AD and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups. METHODS AND ANALYSIS: We will conduct a three-wave longitudinal online survey study of n≥2000 adults from the general Dutch population. The first measurement occasion takes place 6 months after the start of the pandemic, followed by two follow-up measurements with 6 months of intervals. Latent transition analysis will be used for data analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in 11 countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media appearance among (psychotrauma) professionals and the general public.

Corrigendum: The UK National Homicide Therapeutic Service: A Retrospective Naturalistic Study Among 929 Bereaved Individuals.

[This corrects the article DOI: 10.3389/fpsyt.2020.00878.].

Psychopathology in a treatment-seeking sample of homicidally bereaved individuals: Latent class analysis.

BACKGROUND: Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables. METHODS: We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis. RESULTS: Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05). LIMITATIONS: The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample. CONCLUSIONS: Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.

The UK National Homicide Therapeutic Service: A Retrospective Naturalistic Study Among 929 Bereaved Individuals.

Homicidal bereavement puts survivors at risk of developing a broad range of lasting and severe mental health problems. Previous research has often relied on relatively small and homogenous samples. Still, little is known about what factors influence the expression of symptoms following homicidal bereavement. Preventive and curative treatments often do not consider the complex coherence between the emotional, judicial, financial, and societal challenges that likely arise following a homicide. Despite the severity of its consequences on mental health, no gold standard for the preventative and curative treatment of mental health issues in homicide survivors exists. We aimed to introduce a time-limited, traumatic grief-focused outreaching model of care designed specifically for homicide survivors, and to examine its potential effectiveness. Furthermore, we aimed to investigate what factors influence the severity of mental health problems and response to treatment. In the current study, self-reported data on five different outcome measures, namely, symptoms of posttraumatic stress, prolonged grief, depression, anxiety, and functional impairment were available from 929 homicidally bereaved treatment receiving adults. We used Latent Growth Modeling to analyze our repeated measures data and to classify individuals into distinct groups based on individual response patterns. Results showed that the current model of care is likely to be effective in reducing mental health complaints following homicidal bereavement. Having a history of mental illness, being younger of age and female, and having lost either a child or spouse consistently predicted greater symptom severity and functional impairment at baseline. For change in symptom severity and functional impairment during treatment, having a history of mental illness was the only consistent predictor across all outcomes. This study was limited by its reliance on self-reported data and cross-sectional design without a control group. Future prospective, longitudinal research across different cultures is needed in order to replicate the current findings and enhance generalizability. That notwithstanding, findings provide a first step toward evaluating a novel service-delivery approach for homicide survivors and provide further insight in the development of mental health complaints following bereavement by homicide.