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Is there a survey regarding the meaning of distress in the definition of mental disorder?

Is there a survey regarding the meaning of distress in the definition of mental disorder?


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Although without a doubt discussed in professional circles for a long time before, the definition of mental disorder has been recently brought to the limelight by Trump narcissism debate:

“Everyone has a personality,” [Allen] Frances says. “It's not wrong to have a personality; it's not mentally ill to have a personality. It's only a disorder when it causes extreme distress, suffering, and impairment.” [… ]

Gartner - who has a PhD and treats patients in a private practice - wholeheartedly disagrees with Frances's position. “The thing about people with personality disorders… they don't have distress related to their disorder; they cause distress in other people,” he says. “They're in complete denial about the nature of their illness or even having an illness.”

I'm not going to ask here what is your take on the controversy because that would be primarily opinion based. What I want to know is whether any surveys have been conducted of psychiatrists or psychologists on this issue, i.e. on where to draw the line with respect to harm/distress. Asking them this will not violate any ethics rules, I think. (I know where the DSM letter stands; for others' convenience here are links to DSM-IV's and DSM-5's version.)


When it comes to any surveys on how mental health is assessed, you can't go far wrong with looking at the DSM-5

In 2010, the APA launched a unique Web site to facilitate public and professional input into DSM-5. All draft diagnostic criteria and proposed changes in organization were posted on www.dsm5.org for a 2-month comment period. Feedback totaled more than 8,000 submissions, which were systematically reviewed by each of the 13 work groups, whose members, where appropriate, integrated questions and comments into discussions of draft revisions and plans for field trial testing. After revisions to the initial draft criteria and proposed chapter organization, a second posting occurred in 2011. Work groups considered feedback from both Web postings and the results of the DSM-5 Field Trials when drafting proposed final criteria, which were posted on the Web site for a third and final time in 2012. These three iterations of external review produced more than 13,000 individually signed comments on the Web site that were received and reviewed by the work groups, plus thousands of organized petition signers for and against some proposed revisions, all of which allowed the task force to actively address concerns of DSM users, as well as patients and advocacy groups, and ensure that clinical utility remained a high priority. (Source: Page 8 of DSM-5)

My copy of DSM-5 has the following definition for Mental Disorder:

Notice that it said:

Mental disorders are usually associated with significant distress or disability

So therefore, Allen Frances was only slightly incorrect with what he said as there can be social or occupational disabilities without distress, but then based on the findings of Miller at al (2007), John Gartner was also wrong. An example is that Narcisistic Personality Disorder has "weak but significant" relation with intrapersonal distress (Miller, et al. 2007). However, in defense of John Gartner is the fact that;

the strongest impairment associated with NPD is the distress or “pain and suffering” experienced not by the narcissist but by his or her significant others.

References

Miller, J. D., Campbell, W. K., & Pilkonis, P. A. (2007). Narcissistic personality disorder: Relations with distress and functional impairment. Comprehensive psychiatry, 48(2), 170-177.
DOI: 10.1016/j.comppsych.2006.10.003 PMCID: PMC1857317
Free PDF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857317/pdf/nihms18536.pdf


Gender Dysphoria: DSM-5 Reflects Shift In Perspective On Gender Identity

Editor's Note: With the release of the latest edition of the mental health manual, the Diagnostic and Statistical Manual of Mental Disorders (the DSM), LiveScience takes a close look at some of the disorders it defines. This series asks the fundamental question: What is normal, and what is not?

The latest edition of the mental health manual used by psychiatrists to diagnose disorders reveals a change in thinking on gender identity. The perspective change is similar to a decision made in 1973, when the American Psychiatric Association eliminated homosexuality from its disorders' list.

In the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released on May 22, the now-defunct diagnosis of gender identity disorder (GID) receives a new name, gender dysphoria, which reflects a new emphasis.

Both GID and gender dysphoria describe a condition in which someone is intensely uncomfortable with their biological gender and strongly identifies with, and wants to be, the opposite gender. Some of these people may live as their desired gender, and may even seek gender reassignment surgery that can allow them to trade, for example, a penis for a clitoris and a scrotum for a vagina. [5 Surprising Facts About Gay Conversion Therapy]

In the old DSM-IV, GID focused on the "identity" issue -- namely, the incongruity between someone's birth gender and the gender with which he or she identifies. While this incongruity is still crucial to gender dysphoria, the drafters of the new DSM-5 wanted to emphasize the importance of distress about the incongruity for a diagnosis. (The DSM-5 uses the term gender rather than sex to allow for those born with both male and female genitalia to have the condition.)

This shift reflects recognition that the disagreement between birth gender and identity may not necessarily be pathological if it does not cause the individual distress, said Robin Rosenberg, a clinical psychologist and co-author of the psychology textbook "Abnormal Psychology" (Worth Publishers, 2009). For instance, many transgender people -- those who identify with a gender different than the one they were assigned at birth -- are not distressed by their cross-gender identification and should not be diagnosed with gender dysphoria, Rosenberg said.

Transgender people and their allies have pointed out that distress in gender dysphoria is not an inherent part of being transgender. This sets it apart from many other disorders in the DSM, because if someone is depressed, for example, he or she is, almost by definition, distressed as part of depression. In contrast, the distress that accompanies gender dysphoria arises as a result of a culture that stigmatizes people who do not conform to gender norms, Rosenberg said.

In this regard, the change resembles the elimination of homosexuality from the manual 40 years ago.

"The concept underlying eliminating homosexuality from the DSM was recognizing that you can be homosexual and psychological healthy or be homosexual and psychologically screwed up. Being homosexual didn't have to be the issue," Rosenberg said.

The DSM-5 also separates the diagnosis of gender dysphoria for children from that of adolescents and adults. The characteristics of gender dysphoria vary with age, and many children with gender dysphoria outgrow it as they age, the manual notes.


Assessing Sleep Problems of Older Adults

Psychological Measures

Psychological distress or dysfunction may well be the appropriate focus of treatment to improve sleep. Clinicians or researchers interested in the psychological correlates of sleep disorder may use measures of global psychological functioning, such as the Brief Symptom Inventory ( Derogatis, 1993 ). Measures of a specific psychological disorder, such as anxiety or depression, can be used such as the Beck Depression Inventory ( Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 ), or the State Trait Anxiety Inventory ( Spielberger, Gorsuch, & Lushene, 1970 ). Finally, health care providers may choose to assess cognitive functioning, with a brief questionnaire, such as the Short Portable Mental Status questionnaire (Pfieffer, 1975). Such measures are used to gain a snapshot of a patient's psychological status and to determine if a more comprehensive psychological evaluation is warranted. Unless severe cognitive deficit, psychopathology or personality disorder is suspected, lengthy and costly measures such as neuropsychological assessment batteries or comprehensive personality assessments are typically not warranted.


RELATIONSHIP OF THE CLINICAL SIGNIFICANCE CRITERION TO DSM-IV’S DEFINITION OF MENTAL DISORDER

The first sentence of the paragraph in DSM-IV explaining the clinical significance criterion states that “the definition of mental disorder in the introduction to DSM-IV requires that there be clinically significant impairment or distress.” Thus, the clinical significance criterion is claimed merely to incorporate part of the definition of mental disorder into the diagnostic criteria sets. However, this is not the case. The relevant sentence from the DSM-IV definition of mental disorder is, “In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. (DSM-IV, p. xxi emphasis added)

A careful reading of this long sentence indicates that the DSM definition recognizes, first, that there are harms other than distress and impairment that might be associated with having a mental disorder and, second, that disorder may be diagnosed in situations where a condition has not yet caused harm in the form of distress or impairment but is likely to do so in the future. Analogously, in physical medicine, a tumor may be asymptomatic but still be considered a disorder because with time it is likely to cause symptoms.

A second and more fundamental divergence between DSM’s definition of mental disorder and the clinical significance criterion is the different way in which disability (impairment) is conceptualized. In the definition of mental disorder, disability refers to impairment of any important areas of functioning, which could include either role functioning or biological functions (such as sleep, attention, or sexual arousal), whereas the clinical significance criterion, as noted above, seems to exclusively refer to social, occupational, or other role functioning. The clinical significance criterion thus imposes an impairment requirement that is much narrower than that required by the mental disorder definition. As we discuss below, this change leads to a problem of potential false negatives.

Most important, the heart of DSM’s definition is not addressed by the clinical significance criterion: “Whatever its original cause, it [the syndrome or pattern] must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual” (DSM-IV, pp. xxi–xxii). As we will show, the failure of the clinical significance criterion to address the key concept of underlying dysfunction leads to its failure to eliminate false positives from several important categories of disorders.


Suing For Emotional Distress

It is often very difficult to recover damages for injuries that resulted in emotional distress. Unlike a broken bone or other physical injury, it is often hard to definitively prove your injuries. Thus, it is important to understand the different types of emotional distress claims that you may make before attempting to file a lawsuit based on emotional distress.

Emotional distress, also known as “ mental anguish ,” is a non-physical and mainly psychological injury that may be asserted in civil lawsuits. In short, the law recognizes emotional distress as a state of mental suffering that occurs because of an experience caused by the negligence or intentional acts of another, usually of a physical nature.

Bystanders or individuals who personally experienced the emotional trauma, along with their relatives, may be able to assert a civil lawsuit alleging emotional distress. Emotional distress may be exhibited by feelings of humiliation/shame, insomnia, depression, self-destructive thoughts, anxiety, stress, or another emotional response resulting from a traumatic event.

It is important to note that in most cases, you may only be able to sue for emotional damages if the incident in question resulted in physical harm. However, as of June 2019, some courts have recognized a right to award monetary damages for emotional distress claims without a showing of actual physical harm in cases of sexual harassment or defamation .

In these cases expert witness testimony from a therapist or psychiatrist may be used to prove a plaintiff’s case of emotional distress, as well as evaluate the range of monetary damages associated with the injury.

Contents

Is it Hard to Sue for Emotional Distress?

As noted above, emotional distress cases are tricky, due to the nature of having to prove an injury that you cannot physically see (like chronic anxiety versus a broken leg) Therefore, cases in which emotional distress damages are claimed must be backed by solid documentation that will prove to the court that you have suffered actual damages.

In some cases this may mean a therapist, doctor, or psychologist diagnosing you with depression, post traumatic stress disorder (“PTSD”), or other mental health condition. This means that the use of expert witness is often necessary to help prove to a court that you both suffered an actual injury and the amount of damages that resulted from that injury. Because of the use of expert witnesses, suing for emotional distress is often very expensive.

However, if you have a valid claim for severe emotional distress, a personal injury attorney may take your case on a contingency fee basis, which will save you from having to pay high case fees yourself.

In addition to the numerous amount of evidence you must have to prove damages, you must also be able to prove the other elements of an emotional distress claim. This means you must prove that the incident that caused the emotional distress was due to the intentional or reckless acts of a person who acted with extreme or outrageous conduct, and it resulted in your suffering of severe emotional distress.

Outrageous conduct means more than mere insults, threats, annoyances, or petty oppressions. For example, someone shouting at you that they hope you die would not result in a valid claim of emotional distress, but someone falsely informing you that your child or a close family member had been killed may.

What is the Zone of Danger?

Most jurisdictions require that a person making a claim for emotional distress be within the “zone of danger.” In legal terms, the zone of danger is the area within which one is in actual physical peril from the negligent conduct of another person. This means that often in order to recover for emotional distress, you must either be directly injured yourself or you were also in danger of physical injury.

For example, if you were in a car wreck with your family due to the negligent driving of a drunk person , you may be able to recover for the emotional distress you suffered from both your physical injuries and injuries to your family.

Another example is where a drunk driver drives onto a sidewalk and hits a child walking with their family. In that case, the family members, who were also in danger of being physically injured by the driver, may recover for the emotional distress that they suffered.

When Can I Bring My Emotional Distress Claim?

Importantly, emotional distress claims have a time limit in which they must be brought, known as a “ statute of limitations .” Thus, it is important that you consult with an attorney immediately in order to make sure that your claims are brought within the time limit specified by your local jurisdiction. A typical statute of limitations period for most claims of negligent or intentional infliction of emotional distress is two years from the date of injury.

What Type of Emotional Distress Claims are Available?

As noted above, there are two main types of emotional distress claims. The different types of claims available for emotional distress include:

  • Negligent Infliction of Emotional Distress: This claim for emotional distress occurs when a defendant’s actions are accidental or unintentional. However, there must still be a causal connection between the defendant’s action and the emotional distress the plaintiff suffers. For instance, cases where a person witnessed the death or injury to their family member from a drunk driver may qualify for negligent infliction of emotional distress and
  • Intentional Infliction of Emotional Distress: This claim for emotional distress occurs when a defendant’s actions are intentional or reckless. For example, an employer having you fired and escorting you out in handcuffs may be humiliating, that treatment would likely not rise to a level of intentional infliction of emotional distress.
    • However, a case where you have been diagnosed with post traumatic stress disorder due to having been repeatedly subject to bullying and workplace harassment, and your employer knew but took not action, may be likely to succeed.

    Do I Need a Lawyer to Sue for Emotional Distress?

    As can be seen, proving an emotional distress claim is often a difficult matter, especially where you do not also have a physical injury. Further, emotional distress cases are often very expensive to bring, due to the nature of having to hire expert witnesses, such as a therapist, doctor, or psychologist to prove the extent of your injuries and the amount of money needed to allow for a proper recovery.

    Additionally, state laws will vary as to what will be required to properly prove a claim for emotional distress. For all of these reasons, consulting with a well qualified and knowledgeable personal injury attorney may be in your best interests.

    An experienced personal injury attorney will help evaluate your case, build evidence to prove your injuries, hire expert witnesses, represent you in court, and even may take you case on a contingency fee basis to help you with the hire case fees associated with cases involving claims for emotional distress.


    Monitoring Children&rsquos Mental Health

    Public health surveillance &ndash which is the collection and monitoring of information about health among the public over time &ndash is a first step to better understand childhood mental disorders and promote children&rsquos mental health. Ongoing and systematic monitoring of mental health and mental disorders will help

    • increase understanding of the mental health needs of children
    • inform research on factors that increase risk and promote prevention
    • find out which programs are effective at preventing mental disorders and promoting children&rsquos mental health and
    • monitor if treatment and prevention efforts are effective.

    CDC issues first comprehensive report on children&rsquos mental health in the United States

    A report from the Centers for Disease Control and Prevention (CDC), Mental Health Surveillance Among Children &mdashUnited States, 2005&ndash2011, describes federal efforts on monitoring mental disorders, and presents estimates of the number of children with specific mental disorders. The report was developed in collaboration with key federal partners, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute of Mental Health (NIMH), and Health Resources and Services Administration (HRSA). It is an important step towards better understanding these disorders and the impact they have on children.

    This is the first report to describe the number of U.S. children aged 3&ndash17 years who have specific mental disorders, compiling information from different data sources covering the period 2005&ndash2011. It provides information on childhood mental disorders where there is recent or ongoing monitoring. These include ADHD, disruptive behavioral disorders such as oppositional defiant disorder and conduct disorder, autism spectrum disorders, mood and anxiety disorders including depression, substance use disorders, and Tourette syndrome. The report also includes information on a few indicators of mental health, specifically, mentally unhealthy days and suicide.


    Definitions

    To effectively match patient needs with treatment interventions, health care professionals must be able to distinguish the periodic difficulties that characterize normal adjustment from more-serious mental disorders. To assist in this evaluation, health care professionals need to understand the distinctions among a variety of related concepts, as defined below.

    Normal adjustment: Adjustment or psychosocial adaptation to cancer has been defined as an ongoing process in which the individual patient tries to manage emotional distress, solve specific cancer-related problems, and gain mastery of or control over cancer-related life events.[1-3] Adjustment to cancer is not a unitary, single event but rather a series of ongoing coping responses to the multiple tasks associated with living with cancer. (Refer to the Normal Adjustment section of this summary for more information.)

    Psychosocial distress: Distress in cancer has been defined as “a multifactorial unpleasant experience of a psychological (i.e., cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, its physical symptoms, and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis.”[4,5] (Refer to the Psychosocial Distress section of this summary for more information.)

    Adjustment disorders: The adjustment disorders, a diagnostic category of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5),[6] are characterized by the presence of clinically significant emotional or behavioral symptoms that result in marked distress or significant impairment in social, occupational, or other important areas of functioning. The symptoms occur in response to an identifiable psychosocial stressor (e.g., cancer diagnosis) are less severe than in diagnosable mental disorders such as major depressive disorder or generalized anxiety disorder and do not represent normal bereavement. (Refer to the Adjustment Disorders section of this summary for more information.)

    Anxiety disorders: Anxiety disorders are a group of mental disorders whose common symptoms include excessive anxiety, worry, fear, apprehension, and/or dread. Although some anxiety can be adaptive—particularly in response to stressors such as cancer—anxiety disorders are excessive, unwarranted, often illogical fears, worry, and dread. The DSM-5 includes generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, specific phobia, obsessive-compulsive disorder, and post-traumatic stress disorder as types of anxiety disorders.[6] (Refer to the Anxiety Disorders: Description and Etiology section of this summary for more information.)

    Enlarge The distress continuum. Psychosocial distress exists on a continuum that ranges from normal adjustment issues to syndromes that meet the full diagnostic criteria for a mental disorder.

    References
    1. Brennan J: Adjustment to cancer - coping or personal transition? Psychooncology 10 (1): 1-18, 2001 Jan-Feb. [PUBMED Abstract]
    2. Folkman S, Greer S: Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psychooncology 9 (1): 11-9, 2000 Jan-Feb. [PUBMED Abstract]
    3. Nicholas DR, Veach TA: The psychosocial assessment of the adult cancer patient. Prof Psychol 31 (2): 206-15, 2000.
    4. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Distress Management. Version 2.2021. Plymouth Meeting, Pa: National Comprehensive Cancer Network, 2021. Available online with free registration. Last accessed May 11, 2021.
    5. Fashoyin-Aje LA, Martinez KA, Dy SM: New patient-centered care standards from the commission on cancer: opportunities and challenges. J Support Oncol 10 (3): 107-11, 2012 May-Jun. [PUBMED Abstract]
    6. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association, 2013.

    Statistics from Altmetric.com

    The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. According to the National Health Commission (https://news.qq.com//zt2020/page/feiyan.htm), there were 75 599 confirmed COVID-19 cases worldwide, including 74 675 in China, and more than 2000 deaths by 20 February, 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives.

    The COVID-19 epidemic has caused serious threats to people’s physical health and lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. The main purpose of this study is to measure the prevalence and severity of this psychological distress, gauge the current mental health burden on society, and therefore provide a concrete basis for tailoring and implementing relevant mental health intervention policies to cope with this challenge efficiently and effectively.

    This study is the first nationwide large-scale survey of psychological distress in the general population of China during the tumultuous time of the COVID-19 epidemic. A self-report questionnaire was designed to survey peritraumatic psychological distress during the epidemic. Data collection began on 31 January 2020, the day when the WHO announced the Novel Coronavirus Pneumonia of China as a Public Health Emergency of International Concern (PHEIC). Leveraging the Siuvo Intelligent Psychological Assessment Platform, we presented QR codes of the questionnaire online openly accessible to the general public nationwide. The questionnaire incorporated relevant diagnostic guidelines for specific phobias and stress disorders specified in the International Classification of Diseases, 11th Revision and expert opinions from psychiatrists. In addition to demographic data (ie, province, gender, age, education and occupation), the COVID-19 Peritraumatic Distress Index (CPDI) inquired about the frequency of anxiety, depression, specific phobias, cognitive change, avoidance and compulsive behaviour, physical symptoms and loss of social functioning in the past week, ranging from 0 to 100. A score between 28 and 51 indicates mild to moderate distress. A score ≥52 indicates severe distress. Psychiatrists from the Shanghai Mental Health Center verified the content validity of the CPDI. The Cronbach’s alpha of CPDI is 0.95 (p<0.001).

    This study received a total of 52 730 valid responses from 36 provinces, autonomous regions and municipalities, as well as from Hong Kong, Macau and Taiwan by 10 February 2020. Among all the respondents, 18 599 were males (35.27%) and 34 131 were females (64.73%). The mean (SD) CPDI score of the sample was 23.65 (15.45). Almost 35% of the respondents experienced psychological distress (29.29% of the respondents’ scores were between 28 and 51, and 5.14% of the respondents’ scores were ≥52). Multinomial logistic regression analyses showed that one’s CPDI score was associated with their gender, age, education, occupation and region. Female respondents showed significantly higher psychological distress than their male counterparts (mean (SD)=24.87 (15.03) vs 21.41 (15.97), p<0.001). It is in accordance with results from previous research which concluded that women are much more vulnerable to stress and more likely to develop post-traumatic stress disorder.1 People under 18 years had the lowest CPDI scores (mean (SD)=14.83 (13.41)). Individuals between 18 and 30 years of age or above 60 presented the highest CPDI scores (mean (SD)=27.76 (15.69) and 27.49 (24.22), respectively). Two major protective factors may explain the low distress level in juveniles: a relatively low morbidity rate among this age group, and limited exposure to the epidemic due to home quarantine. Higher scores among the young adult group (18–30 years) seem to confirm findings from previous research: young people tend to obtain a large amount of information from social media that can easily trigger stress.2 Since the highest mortality rate occurred among the elderly during the epidemic, it is not surprising that elderly people are more likely to be psychologically impacted. Similarly, people with higher education tended to have more distress, probably because of high self-awareness of their health.3 It is noteworthy that migrant workers experienced the highest level of distress (mean (SD)=31.89 (23.51), F=1602.501, p<0.001) among all occupations. The concern about virus exposure in public transportation when returning to work, their worries about delays in work time and subsequent deprivation of their anticipated income may explain the high stress level.4 The CPDI score of respondents in the middle region of China (including Hubei, the centre of the epidemic) was the highest (mean (SD) 30.94 (19.22), F=929.306, p<0.001), since this region was affected by the epidemic most severely. Meanwhile, psychological distress levels were also influenced by availability of local medical resources, efficiency of the regional public health system, and prevention and control measures taken against the epidemic situation.5 6 For example, Shanghai is at high risk of carriers of the COVID-19 virus entering the city because of the large population of migrant workers. The distress level is not spiking. This is probably because of the fact that Shanghai has one of the best public health systems in China.

    Three major events during the COVID-19 epidemic may have caused public panic: (1) the official confirmation of human-to-human transmission of COVID-19 on 20 January (2) the strict quarantine of Wuhan on 22 January and (3) WHO’s announcement of PHEIC on 31 January. This study began on 31 January. Results also indicated that as time passes, distress levels among the public have been significantly descending, with the lowest distress level during the Lantern Festival (8 February). This decrease can partly be attributed to the effective prevention and control measures taken by the Chinese Government, including the nationwide quarantine, medical support and resources from all over the country, effective measures (such as public education, strengthening individual protection, medical isolation, controlling of population mobility, reducing gatherings) to stop the spread of the virus.

    Findings of this study suggest the following recommendations for future interventions: (1) more attention needs to be paid to vulnerable groups such as the young, the elderly, women and migrant workers (2) accessibility to medical resources and the public health service system should be further strengthened and improved, particularly after reviewing the initial coping and management of the COVID-19 epidemic (3) nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine, should be established and (4) a comprehensive crisis prevention and intervention system including epidemiological monitoring, screening, referral and targeted intervention should be built to reduce psychological distress and prevent further mental health problems.


    ICD-10 Diagnostic Criteria (For Research)

    A. The general criteria of personality disorder must be met:

    • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').
    • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).
    • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.
    • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
    • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.
    • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.
      Feelings of excessive doubt and caution.
        (E.g., "I'm a very cautious person.")
        (E.g., "I'm fussy about little details.")
        (E.g., "I spend too much time trying to do things perfectly.")
        (E.g., "People think I'm too strict about rules and regulations.")
        (E.g., "I work so hard I don't have any time left for anything else.")
        (E.g., "People think I am too stiff or formal.")
        (E.g., "It's hard for me to get used to a new way of doing things.")
        (E.g., "I usually try to get people to do things my way.")

      Depression Questionnaire: 30 Survey Questions

      A depression questionnaire is a set of depression screening questions asked to gather information that will give you insights into a person mental health and well being.

      Good mental health and well being improve the quality of life. In the current fast-paced world, stress is a major factor that is affecting people all across the globe. Major corporations have started using mindfulness and meditation techniques to reduce work stress on their employees. Depression affects people in many ways and can have various symptoms. They can range from mild to severe. Mild depression can mean you are simply feeling low in spirit, while severe depression can have fatal thoughts like being suicidal or feeling that your life has no meaning to it. There has been an increase in such cases in recent years and hence it has become quite important to identify depression at an early stage and tackle the issue appropriately.

      For example, a person has been laid-off by a company and it is getting very difficult to find a new job. Because of such an incident, the individual has started feeling hopeless, low self-esteem, and has a lack of sleep. Such bad times can make an individual feel they have been a failure and can cause severe depression. In such a case, a depression questionnaire can help to assess the severity of their condition and thus appropriate actions can be taken to cure depression.

      Similarly here’s another example, a student is feeling depressed because of constant bullying, low grades, and peer pressure. In such a situation, a depression survey for students can shed some light on how severe the condition is and what are the facilities provided by the school/college to tackle such cases.

      This information can help them get back to academic life and be more productive in the tasks they are required to perform.

      30 Depression survey questions for a questionnaire

      Here’s how to create a good survey design for a depression questionnaire using appropriate survey questions.

      Depression survey questions to evaluate mental health and identify the level of depression.

      Please state to your level of agreement, for the following things that have been observed in the last week

      1. All the tasks you have performed, are taking much more time than usual.
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree
        1. Completely agree
        2. Somewhat agree
        3. Neutral
        4. Somewhat disagree
        5. Completely disagree

        Depression questions to test an individual’s knowledge about depression (Used to test the knowledge of new doctors)

        1. A patient has 4 symptoms of depression. What do you think about the severity of his condition?
          1. Not depressed
          2. Mild depression
          3. Moderate depression
          4. Severe depression
          1. Prescribe an antidepressant
          2. Prescribe venlafaxine
          3. Advise self-help or psychological intervention
          4. Advise psychological intervention along with SSRI.
          1. Paroxetine
          2. Fluvoxamine
          3. Venlafaxine
          4. Mirtazapine
          1. Completely agree
          2. Somewhat agree
          3. Neutral
          4. Somewhat disagree
          5. Completely disagree
          6. Don’t know
          1. Antidepressants
          2. CBT
          3. A combination of CBT and Antidepressants
          4. Other psychological therapies
          1. Completely agree
          2. Somewhat agree
          3. Neutral
          4. Somewhat disagree
          5. Completely disagree
          6. Don’t know
          1. Completely agree
          2. Somewhat agree
          3. Neutral
          4. Somewhat disagree
          5. Completely disagree
          6. Don’t know
          1. Imipramine
          2. Benzodiazepines
          3. Sedating antihistamines
          4. Clomipramine
          5. Antipsychotics
          1. Minor
          2. Mild
          3. Moderate
          4. Dysthymia
          1. Addiction
          2. Increased likelihood of patient stopping treatment because of side effects
          3. Withdrawal symptoms
          4. Toxicity in overdose
          1. Completely agree
          2. Somewhat agree
          3. Neutral
          4. Somewhat disagree
          5. Completely disagree
          6. Don’t know
          1. SSRI’s
          2. Tricyclic antidepressants
          3. Course of Venlafaxine
          1. Do you have any comments/suggestions regarding improvement in depression treatment?

          The above questions are used by depression specialists to test the knowledge of new doctors. Such questions are very specific and can be understood by medical professionals only.


          Definitions

          To effectively match patient needs with treatment interventions, health care professionals must be able to distinguish the periodic difficulties that characterize normal adjustment from more-serious mental disorders. To assist in this evaluation, health care professionals need to understand the distinctions among a variety of related concepts, as defined below.

          Normal adjustment: Adjustment or psychosocial adaptation to cancer has been defined as an ongoing process in which the individual patient tries to manage emotional distress, solve specific cancer-related problems, and gain mastery of or control over cancer-related life events.[1-3] Adjustment to cancer is not a unitary, single event but rather a series of ongoing coping responses to the multiple tasks associated with living with cancer. (Refer to the Normal Adjustment section of this summary for more information.)

          Psychosocial distress: Distress in cancer has been defined as “a multifactorial unpleasant experience of a psychological (i.e., cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, its physical symptoms, and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis.”[4,5] (Refer to the Psychosocial Distress section of this summary for more information.)

          Adjustment disorders: The adjustment disorders, a diagnostic category of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5),[6] are characterized by the presence of clinically significant emotional or behavioral symptoms that result in marked distress or significant impairment in social, occupational, or other important areas of functioning. The symptoms occur in response to an identifiable psychosocial stressor (e.g., cancer diagnosis) are less severe than in diagnosable mental disorders such as major depressive disorder or generalized anxiety disorder and do not represent normal bereavement. (Refer to the Adjustment Disorders section of this summary for more information.)

          Anxiety disorders: Anxiety disorders are a group of mental disorders whose common symptoms include excessive anxiety, worry, fear, apprehension, and/or dread. Although some anxiety can be adaptive—particularly in response to stressors such as cancer—anxiety disorders are excessive, unwarranted, often illogical fears, worry, and dread. The DSM-5 includes generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, specific phobia, obsessive-compulsive disorder, and post-traumatic stress disorder as types of anxiety disorders.[6] (Refer to the Anxiety Disorders: Description and Etiology section of this summary for more information.)

          Enlarge The distress continuum. Psychosocial distress exists on a continuum that ranges from normal adjustment issues to syndromes that meet the full diagnostic criteria for a mental disorder.

          References
          1. Brennan J: Adjustment to cancer - coping or personal transition? Psychooncology 10 (1): 1-18, 2001 Jan-Feb. [PUBMED Abstract]
          2. Folkman S, Greer S: Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psychooncology 9 (1): 11-9, 2000 Jan-Feb. [PUBMED Abstract]
          3. Nicholas DR, Veach TA: The psychosocial assessment of the adult cancer patient. Prof Psychol 31 (2): 206-15, 2000.
          4. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Distress Management. Version 2.2021. Plymouth Meeting, Pa: National Comprehensive Cancer Network, 2021. Available online with free registration. Last accessed May 11, 2021.
          5. Fashoyin-Aje LA, Martinez KA, Dy SM: New patient-centered care standards from the commission on cancer: opportunities and challenges. J Support Oncol 10 (3): 107-11, 2012 May-Jun. [PUBMED Abstract]
          6. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association, 2013.

          Assessing Sleep Problems of Older Adults

          Psychological Measures

          Psychological distress or dysfunction may well be the appropriate focus of treatment to improve sleep. Clinicians or researchers interested in the psychological correlates of sleep disorder may use measures of global psychological functioning, such as the Brief Symptom Inventory ( Derogatis, 1993 ). Measures of a specific psychological disorder, such as anxiety or depression, can be used such as the Beck Depression Inventory ( Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 ), or the State Trait Anxiety Inventory ( Spielberger, Gorsuch, & Lushene, 1970 ). Finally, health care providers may choose to assess cognitive functioning, with a brief questionnaire, such as the Short Portable Mental Status questionnaire (Pfieffer, 1975). Such measures are used to gain a snapshot of a patient's psychological status and to determine if a more comprehensive psychological evaluation is warranted. Unless severe cognitive deficit, psychopathology or personality disorder is suspected, lengthy and costly measures such as neuropsychological assessment batteries or comprehensive personality assessments are typically not warranted.


          Monitoring Children&rsquos Mental Health

          Public health surveillance &ndash which is the collection and monitoring of information about health among the public over time &ndash is a first step to better understand childhood mental disorders and promote children&rsquos mental health. Ongoing and systematic monitoring of mental health and mental disorders will help

          • increase understanding of the mental health needs of children
          • inform research on factors that increase risk and promote prevention
          • find out which programs are effective at preventing mental disorders and promoting children&rsquos mental health and
          • monitor if treatment and prevention efforts are effective.

          CDC issues first comprehensive report on children&rsquos mental health in the United States

          A report from the Centers for Disease Control and Prevention (CDC), Mental Health Surveillance Among Children &mdashUnited States, 2005&ndash2011, describes federal efforts on monitoring mental disorders, and presents estimates of the number of children with specific mental disorders. The report was developed in collaboration with key federal partners, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute of Mental Health (NIMH), and Health Resources and Services Administration (HRSA). It is an important step towards better understanding these disorders and the impact they have on children.

          This is the first report to describe the number of U.S. children aged 3&ndash17 years who have specific mental disorders, compiling information from different data sources covering the period 2005&ndash2011. It provides information on childhood mental disorders where there is recent or ongoing monitoring. These include ADHD, disruptive behavioral disorders such as oppositional defiant disorder and conduct disorder, autism spectrum disorders, mood and anxiety disorders including depression, substance use disorders, and Tourette syndrome. The report also includes information on a few indicators of mental health, specifically, mentally unhealthy days and suicide.


          Suing For Emotional Distress

          It is often very difficult to recover damages for injuries that resulted in emotional distress. Unlike a broken bone or other physical injury, it is often hard to definitively prove your injuries. Thus, it is important to understand the different types of emotional distress claims that you may make before attempting to file a lawsuit based on emotional distress.

          Emotional distress, also known as “ mental anguish ,” is a non-physical and mainly psychological injury that may be asserted in civil lawsuits. In short, the law recognizes emotional distress as a state of mental suffering that occurs because of an experience caused by the negligence or intentional acts of another, usually of a physical nature.

          Bystanders or individuals who personally experienced the emotional trauma, along with their relatives, may be able to assert a civil lawsuit alleging emotional distress. Emotional distress may be exhibited by feelings of humiliation/shame, insomnia, depression, self-destructive thoughts, anxiety, stress, or another emotional response resulting from a traumatic event.

          It is important to note that in most cases, you may only be able to sue for emotional damages if the incident in question resulted in physical harm. However, as of June 2019, some courts have recognized a right to award monetary damages for emotional distress claims without a showing of actual physical harm in cases of sexual harassment or defamation .

          In these cases expert witness testimony from a therapist or psychiatrist may be used to prove a plaintiff’s case of emotional distress, as well as evaluate the range of monetary damages associated with the injury.

          Contents

          Is it Hard to Sue for Emotional Distress?

          As noted above, emotional distress cases are tricky, due to the nature of having to prove an injury that you cannot physically see (like chronic anxiety versus a broken leg) Therefore, cases in which emotional distress damages are claimed must be backed by solid documentation that will prove to the court that you have suffered actual damages.

          In some cases this may mean a therapist, doctor, or psychologist diagnosing you with depression, post traumatic stress disorder (“PTSD”), or other mental health condition. This means that the use of expert witness is often necessary to help prove to a court that you both suffered an actual injury and the amount of damages that resulted from that injury. Because of the use of expert witnesses, suing for emotional distress is often very expensive.

          However, if you have a valid claim for severe emotional distress, a personal injury attorney may take your case on a contingency fee basis, which will save you from having to pay high case fees yourself.

          In addition to the numerous amount of evidence you must have to prove damages, you must also be able to prove the other elements of an emotional distress claim. This means you must prove that the incident that caused the emotional distress was due to the intentional or reckless acts of a person who acted with extreme or outrageous conduct, and it resulted in your suffering of severe emotional distress.

          Outrageous conduct means more than mere insults, threats, annoyances, or petty oppressions. For example, someone shouting at you that they hope you die would not result in a valid claim of emotional distress, but someone falsely informing you that your child or a close family member had been killed may.

          What is the Zone of Danger?

          Most jurisdictions require that a person making a claim for emotional distress be within the “zone of danger.” In legal terms, the zone of danger is the area within which one is in actual physical peril from the negligent conduct of another person. This means that often in order to recover for emotional distress, you must either be directly injured yourself or you were also in danger of physical injury.

          For example, if you were in a car wreck with your family due to the negligent driving of a drunk person , you may be able to recover for the emotional distress you suffered from both your physical injuries and injuries to your family.

          Another example is where a drunk driver drives onto a sidewalk and hits a child walking with their family. In that case, the family members, who were also in danger of being physically injured by the driver, may recover for the emotional distress that they suffered.

          When Can I Bring My Emotional Distress Claim?

          Importantly, emotional distress claims have a time limit in which they must be brought, known as a “ statute of limitations .” Thus, it is important that you consult with an attorney immediately in order to make sure that your claims are brought within the time limit specified by your local jurisdiction. A typical statute of limitations period for most claims of negligent or intentional infliction of emotional distress is two years from the date of injury.

          What Type of Emotional Distress Claims are Available?

          As noted above, there are two main types of emotional distress claims. The different types of claims available for emotional distress include:

          • Negligent Infliction of Emotional Distress: This claim for emotional distress occurs when a defendant’s actions are accidental or unintentional. However, there must still be a causal connection between the defendant’s action and the emotional distress the plaintiff suffers. For instance, cases where a person witnessed the death or injury to their family member from a drunk driver may qualify for negligent infliction of emotional distress and
          • Intentional Infliction of Emotional Distress: This claim for emotional distress occurs when a defendant’s actions are intentional or reckless. For example, an employer having you fired and escorting you out in handcuffs may be humiliating, that treatment would likely not rise to a level of intentional infliction of emotional distress.
            • However, a case where you have been diagnosed with post traumatic stress disorder due to having been repeatedly subject to bullying and workplace harassment, and your employer knew but took not action, may be likely to succeed.

            Do I Need a Lawyer to Sue for Emotional Distress?

            As can be seen, proving an emotional distress claim is often a difficult matter, especially where you do not also have a physical injury. Further, emotional distress cases are often very expensive to bring, due to the nature of having to hire expert witnesses, such as a therapist, doctor, or psychologist to prove the extent of your injuries and the amount of money needed to allow for a proper recovery.

            Additionally, state laws will vary as to what will be required to properly prove a claim for emotional distress. For all of these reasons, consulting with a well qualified and knowledgeable personal injury attorney may be in your best interests.

            An experienced personal injury attorney will help evaluate your case, build evidence to prove your injuries, hire expert witnesses, represent you in court, and even may take you case on a contingency fee basis to help you with the hire case fees associated with cases involving claims for emotional distress.


            RELATIONSHIP OF THE CLINICAL SIGNIFICANCE CRITERION TO DSM-IV’S DEFINITION OF MENTAL DISORDER

            The first sentence of the paragraph in DSM-IV explaining the clinical significance criterion states that “the definition of mental disorder in the introduction to DSM-IV requires that there be clinically significant impairment or distress.” Thus, the clinical significance criterion is claimed merely to incorporate part of the definition of mental disorder into the diagnostic criteria sets. However, this is not the case. The relevant sentence from the DSM-IV definition of mental disorder is, “In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. (DSM-IV, p. xxi emphasis added)

            A careful reading of this long sentence indicates that the DSM definition recognizes, first, that there are harms other than distress and impairment that might be associated with having a mental disorder and, second, that disorder may be diagnosed in situations where a condition has not yet caused harm in the form of distress or impairment but is likely to do so in the future. Analogously, in physical medicine, a tumor may be asymptomatic but still be considered a disorder because with time it is likely to cause symptoms.

            A second and more fundamental divergence between DSM’s definition of mental disorder and the clinical significance criterion is the different way in which disability (impairment) is conceptualized. In the definition of mental disorder, disability refers to impairment of any important areas of functioning, which could include either role functioning or biological functions (such as sleep, attention, or sexual arousal), whereas the clinical significance criterion, as noted above, seems to exclusively refer to social, occupational, or other role functioning. The clinical significance criterion thus imposes an impairment requirement that is much narrower than that required by the mental disorder definition. As we discuss below, this change leads to a problem of potential false negatives.

            Most important, the heart of DSM’s definition is not addressed by the clinical significance criterion: “Whatever its original cause, it [the syndrome or pattern] must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual” (DSM-IV, pp. xxi–xxii). As we will show, the failure of the clinical significance criterion to address the key concept of underlying dysfunction leads to its failure to eliminate false positives from several important categories of disorders.


            Gender Dysphoria: DSM-5 Reflects Shift In Perspective On Gender Identity

            Editor's Note: With the release of the latest edition of the mental health manual, the Diagnostic and Statistical Manual of Mental Disorders (the DSM), LiveScience takes a close look at some of the disorders it defines. This series asks the fundamental question: What is normal, and what is not?

            The latest edition of the mental health manual used by psychiatrists to diagnose disorders reveals a change in thinking on gender identity. The perspective change is similar to a decision made in 1973, when the American Psychiatric Association eliminated homosexuality from its disorders' list.

            In the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released on May 22, the now-defunct diagnosis of gender identity disorder (GID) receives a new name, gender dysphoria, which reflects a new emphasis.

            Both GID and gender dysphoria describe a condition in which someone is intensely uncomfortable with their biological gender and strongly identifies with, and wants to be, the opposite gender. Some of these people may live as their desired gender, and may even seek gender reassignment surgery that can allow them to trade, for example, a penis for a clitoris and a scrotum for a vagina. [5 Surprising Facts About Gay Conversion Therapy]

            In the old DSM-IV, GID focused on the "identity" issue -- namely, the incongruity between someone's birth gender and the gender with which he or she identifies. While this incongruity is still crucial to gender dysphoria, the drafters of the new DSM-5 wanted to emphasize the importance of distress about the incongruity for a diagnosis. (The DSM-5 uses the term gender rather than sex to allow for those born with both male and female genitalia to have the condition.)

            This shift reflects recognition that the disagreement between birth gender and identity may not necessarily be pathological if it does not cause the individual distress, said Robin Rosenberg, a clinical psychologist and co-author of the psychology textbook "Abnormal Psychology" (Worth Publishers, 2009). For instance, many transgender people -- those who identify with a gender different than the one they were assigned at birth -- are not distressed by their cross-gender identification and should not be diagnosed with gender dysphoria, Rosenberg said.

            Transgender people and their allies have pointed out that distress in gender dysphoria is not an inherent part of being transgender. This sets it apart from many other disorders in the DSM, because if someone is depressed, for example, he or she is, almost by definition, distressed as part of depression. In contrast, the distress that accompanies gender dysphoria arises as a result of a culture that stigmatizes people who do not conform to gender norms, Rosenberg said.

            In this regard, the change resembles the elimination of homosexuality from the manual 40 years ago.

            "The concept underlying eliminating homosexuality from the DSM was recognizing that you can be homosexual and psychological healthy or be homosexual and psychologically screwed up. Being homosexual didn't have to be the issue," Rosenberg said.

            The DSM-5 also separates the diagnosis of gender dysphoria for children from that of adolescents and adults. The characteristics of gender dysphoria vary with age, and many children with gender dysphoria outgrow it as they age, the manual notes.


            ICD-10 Diagnostic Criteria (For Research)

            A. The general criteria of personality disorder must be met:

            • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').
            • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).
            • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.
            • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
            • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.
            • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.
              Feelings of excessive doubt and caution.
                (E.g., "I'm a very cautious person.")
                (E.g., "I'm fussy about little details.")
                (E.g., "I spend too much time trying to do things perfectly.")
                (E.g., "People think I'm too strict about rules and regulations.")
                (E.g., "I work so hard I don't have any time left for anything else.")
                (E.g., "People think I am too stiff or formal.")
                (E.g., "It's hard for me to get used to a new way of doing things.")
                (E.g., "I usually try to get people to do things my way.")

              Statistics from Altmetric.com

              The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. According to the National Health Commission (https://news.qq.com//zt2020/page/feiyan.htm), there were 75 599 confirmed COVID-19 cases worldwide, including 74 675 in China, and more than 2000 deaths by 20 February, 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives.

              The COVID-19 epidemic has caused serious threats to people’s physical health and lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. The main purpose of this study is to measure the prevalence and severity of this psychological distress, gauge the current mental health burden on society, and therefore provide a concrete basis for tailoring and implementing relevant mental health intervention policies to cope with this challenge efficiently and effectively.

              This study is the first nationwide large-scale survey of psychological distress in the general population of China during the tumultuous time of the COVID-19 epidemic. A self-report questionnaire was designed to survey peritraumatic psychological distress during the epidemic. Data collection began on 31 January 2020, the day when the WHO announced the Novel Coronavirus Pneumonia of China as a Public Health Emergency of International Concern (PHEIC). Leveraging the Siuvo Intelligent Psychological Assessment Platform, we presented QR codes of the questionnaire online openly accessible to the general public nationwide. The questionnaire incorporated relevant diagnostic guidelines for specific phobias and stress disorders specified in the International Classification of Diseases, 11th Revision and expert opinions from psychiatrists. In addition to demographic data (ie, province, gender, age, education and occupation), the COVID-19 Peritraumatic Distress Index (CPDI) inquired about the frequency of anxiety, depression, specific phobias, cognitive change, avoidance and compulsive behaviour, physical symptoms and loss of social functioning in the past week, ranging from 0 to 100. A score between 28 and 51 indicates mild to moderate distress. A score ≥52 indicates severe distress. Psychiatrists from the Shanghai Mental Health Center verified the content validity of the CPDI. The Cronbach’s alpha of CPDI is 0.95 (p<0.001).

              This study received a total of 52 730 valid responses from 36 provinces, autonomous regions and municipalities, as well as from Hong Kong, Macau and Taiwan by 10 February 2020. Among all the respondents, 18 599 were males (35.27%) and 34 131 were females (64.73%). The mean (SD) CPDI score of the sample was 23.65 (15.45). Almost 35% of the respondents experienced psychological distress (29.29% of the respondents’ scores were between 28 and 51, and 5.14% of the respondents’ scores were ≥52). Multinomial logistic regression analyses showed that one’s CPDI score was associated with their gender, age, education, occupation and region. Female respondents showed significantly higher psychological distress than their male counterparts (mean (SD)=24.87 (15.03) vs 21.41 (15.97), p<0.001). It is in accordance with results from previous research which concluded that women are much more vulnerable to stress and more likely to develop post-traumatic stress disorder.1 People under 18 years had the lowest CPDI scores (mean (SD)=14.83 (13.41)). Individuals between 18 and 30 years of age or above 60 presented the highest CPDI scores (mean (SD)=27.76 (15.69) and 27.49 (24.22), respectively). Two major protective factors may explain the low distress level in juveniles: a relatively low morbidity rate among this age group, and limited exposure to the epidemic due to home quarantine. Higher scores among the young adult group (18–30 years) seem to confirm findings from previous research: young people tend to obtain a large amount of information from social media that can easily trigger stress.2 Since the highest mortality rate occurred among the elderly during the epidemic, it is not surprising that elderly people are more likely to be psychologically impacted. Similarly, people with higher education tended to have more distress, probably because of high self-awareness of their health.3 It is noteworthy that migrant workers experienced the highest level of distress (mean (SD)=31.89 (23.51), F=1602.501, p<0.001) among all occupations. The concern about virus exposure in public transportation when returning to work, their worries about delays in work time and subsequent deprivation of their anticipated income may explain the high stress level.4 The CPDI score of respondents in the middle region of China (including Hubei, the centre of the epidemic) was the highest (mean (SD) 30.94 (19.22), F=929.306, p<0.001), since this region was affected by the epidemic most severely. Meanwhile, psychological distress levels were also influenced by availability of local medical resources, efficiency of the regional public health system, and prevention and control measures taken against the epidemic situation.5 6 For example, Shanghai is at high risk of carriers of the COVID-19 virus entering the city because of the large population of migrant workers. The distress level is not spiking. This is probably because of the fact that Shanghai has one of the best public health systems in China.

              Three major events during the COVID-19 epidemic may have caused public panic: (1) the official confirmation of human-to-human transmission of COVID-19 on 20 January (2) the strict quarantine of Wuhan on 22 January and (3) WHO’s announcement of PHEIC on 31 January. This study began on 31 January. Results also indicated that as time passes, distress levels among the public have been significantly descending, with the lowest distress level during the Lantern Festival (8 February). This decrease can partly be attributed to the effective prevention and control measures taken by the Chinese Government, including the nationwide quarantine, medical support and resources from all over the country, effective measures (such as public education, strengthening individual protection, medical isolation, controlling of population mobility, reducing gatherings) to stop the spread of the virus.

              Findings of this study suggest the following recommendations for future interventions: (1) more attention needs to be paid to vulnerable groups such as the young, the elderly, women and migrant workers (2) accessibility to medical resources and the public health service system should be further strengthened and improved, particularly after reviewing the initial coping and management of the COVID-19 epidemic (3) nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine, should be established and (4) a comprehensive crisis prevention and intervention system including epidemiological monitoring, screening, referral and targeted intervention should be built to reduce psychological distress and prevent further mental health problems.


              Depression Questionnaire: 30 Survey Questions

              A depression questionnaire is a set of depression screening questions asked to gather information that will give you insights into a person mental health and well being.

              Good mental health and well being improve the quality of life. In the current fast-paced world, stress is a major factor that is affecting people all across the globe. Major corporations have started using mindfulness and meditation techniques to reduce work stress on their employees. Depression affects people in many ways and can have various symptoms. They can range from mild to severe. Mild depression can mean you are simply feeling low in spirit, while severe depression can have fatal thoughts like being suicidal or feeling that your life has no meaning to it. There has been an increase in such cases in recent years and hence it has become quite important to identify depression at an early stage and tackle the issue appropriately.

              For example, a person has been laid-off by a company and it is getting very difficult to find a new job. Because of such an incident, the individual has started feeling hopeless, low self-esteem, and has a lack of sleep. Such bad times can make an individual feel they have been a failure and can cause severe depression. In such a case, a depression questionnaire can help to assess the severity of their condition and thus appropriate actions can be taken to cure depression.

              Similarly here’s another example, a student is feeling depressed because of constant bullying, low grades, and peer pressure. In such a situation, a depression survey for students can shed some light on how severe the condition is and what are the facilities provided by the school/college to tackle such cases.

              This information can help them get back to academic life and be more productive in the tasks they are required to perform.

              30 Depression survey questions for a questionnaire

              Here’s how to create a good survey design for a depression questionnaire using appropriate survey questions.

              Depression survey questions to evaluate mental health and identify the level of depression.

              Please state to your level of agreement, for the following things that have been observed in the last week

              1. All the tasks you have performed, are taking much more time than usual.
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree
                1. Completely agree
                2. Somewhat agree
                3. Neutral
                4. Somewhat disagree
                5. Completely disagree

                Depression questions to test an individual’s knowledge about depression (Used to test the knowledge of new doctors)

                1. A patient has 4 symptoms of depression. What do you think about the severity of his condition?
                  1. Not depressed
                  2. Mild depression
                  3. Moderate depression
                  4. Severe depression
                  1. Prescribe an antidepressant
                  2. Prescribe venlafaxine
                  3. Advise self-help or psychological intervention
                  4. Advise psychological intervention along with SSRI.
                  1. Paroxetine
                  2. Fluvoxamine
                  3. Venlafaxine
                  4. Mirtazapine
                  1. Completely agree
                  2. Somewhat agree
                  3. Neutral
                  4. Somewhat disagree
                  5. Completely disagree
                  6. Don’t know
                  1. Antidepressants
                  2. CBT
                  3. A combination of CBT and Antidepressants
                  4. Other psychological therapies
                  1. Completely agree
                  2. Somewhat agree
                  3. Neutral
                  4. Somewhat disagree
                  5. Completely disagree
                  6. Don’t know
                  1. Completely agree
                  2. Somewhat agree
                  3. Neutral
                  4. Somewhat disagree
                  5. Completely disagree
                  6. Don’t know
                  1. Imipramine
                  2. Benzodiazepines
                  3. Sedating antihistamines
                  4. Clomipramine
                  5. Antipsychotics
                  1. Minor
                  2. Mild
                  3. Moderate
                  4. Dysthymia
                  1. Addiction
                  2. Increased likelihood of patient stopping treatment because of side effects
                  3. Withdrawal symptoms
                  4. Toxicity in overdose
                  1. Completely agree
                  2. Somewhat agree
                  3. Neutral
                  4. Somewhat disagree
                  5. Completely disagree
                  6. Don’t know
                  1. SSRI’s
                  2. Tricyclic antidepressants
                  3. Course of Venlafaxine
                  1. Do you have any comments/suggestions regarding improvement in depression treatment?

                  The above questions are used by depression specialists to test the knowledge of new doctors. Such questions are very specific and can be understood by medical professionals only.



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