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m
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b
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s
[
1
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,
[
2
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.
T
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s
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th
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co
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m
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ality
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life
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d
welf
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ev
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lv
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n
g
tr
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[
3
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4
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t
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in
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ab
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m
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h
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lth
[
5
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–
[
7
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,
a
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iq
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[
8
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,
[
9
]
.
T
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ticle
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ar
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f
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m
en
tal
h
ea
lth
in
t
o
p
o
s
itiv
e
an
d
n
eg
ativ
e
d
im
en
s
io
n
s
.
Yet,
e
x
is
tin
g
m
e
asu
r
em
en
t
to
o
ls
o
f
ten
f
all
s
h
o
r
t
o
f
f
u
lly
en
co
m
p
ass
in
g
th
i
s
m
o
d
el'
s
n
u
an
ce
d
co
m
p
lex
ity
[
1
]
,
[
3
]
,
[
1
0
]
.
T
h
is
s
tu
d
y
s
ee
k
s
to
b
r
id
g
e
th
is
g
ap
b
y
r
ef
in
in
g
a
n
d
v
alid
ati
n
g
a
m
en
tal
h
ea
lth
m
ea
s
u
r
em
en
t to
o
l ta
ilo
r
ed
f
o
r
th
e
co
lleg
iate
d
em
o
g
r
ap
h
ic,
g
r
o
u
n
d
e
d
in
th
e
d
u
al
-
co
n
tin
u
a
p
ar
ad
ig
m
.
W
h
ile
th
e
p
o
ten
tial
o
f
th
is
m
o
d
el
is
v
ast
,
we
ac
k
n
o
wled
g
e
th
e
i
n
tr
icac
ies
an
d
l
im
itatio
n
s
p
r
esen
t
in
ca
p
tu
r
in
g
th
e
f
lu
id
an
d
m
u
ltifa
ce
ted
n
atu
r
e
o
f
m
en
tal
h
ea
lth
.
Ou
r
o
b
jectiv
e
is
to
ad
v
an
ce
t
h
e
d
ev
elo
p
m
en
t
o
f
p
s
y
ch
o
lo
g
ical
m
ea
s
u
r
em
en
t
to
o
ls
an
d
tak
e
a
p
r
o
ac
tiv
e
s
tep
t
o
war
d
s
e
n
h
an
cin
g
m
e
n
tal
h
ea
lth
in
ter
v
e
n
tio
n
s
an
d
,
u
ltima
tely
,
th
e
q
u
ality
o
f
life
a
n
d
welf
ar
e
with
in
th
e
ac
ad
em
ic
c
o
m
m
u
n
i
ty
.
T
h
r
o
u
g
h
th
is
en
d
ea
v
o
u
r
,
w
e
aim
to
co
n
tr
ib
u
te
a
r
o
b
u
s
t,
r
eliab
le,
a
n
d
cu
ltu
r
ally
s
en
s
itiv
e
in
s
tr
u
m
en
t
th
at
ca
n
s
er
v
e
as
a
co
r
n
er
s
to
n
e
f
o
r
f
u
tu
r
e
r
esear
ch
a
n
d
p
r
ac
tice
in
m
en
tal
h
ea
lth
ass
es
s
m
en
t.
In
ex
a
m
in
in
g
m
en
tal
h
ea
lth
th
r
o
u
g
h
th
e
len
s
o
f
th
e
d
u
al
-
co
n
tin
u
a
m
o
d
el,
we
d
elin
ea
te
two
p
r
in
cip
al
d
im
en
s
io
n
s
th
at
o
f
f
er
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
p
s
y
ch
o
lo
g
ical
s
tates
[
4
]
,
[
1
0
]
,
[
1
1
]
.
T
h
e
f
ir
s
t
d
im
en
s
io
n
e
n
ca
p
s
u
lates
th
e
p
o
s
itiv
e
attr
ib
u
tes
o
f
p
s
y
c
h
o
lo
g
ical
well
-
b
ein
g
,
ch
ar
ac
ter
is
ed
b
y
a
n
a
b
u
n
d
an
ce
o
f
p
o
s
itiv
e
em
o
tio
n
s
,
r
o
b
u
s
t
s
o
cial
co
n
n
ec
tio
n
s
,
an
d
a
p
r
o
n
o
u
n
ce
d
s
en
s
e
o
f
s
atis
f
ac
tio
n
with
o
n
e'
s
life
tr
ajec
to
r
y
[
4
]
,
[
1
2
]
,
[
1
3
]
.
T
h
ese
elem
e
n
ts
co
llectiv
ely
f
o
s
ter
a
co
n
d
u
civ
e
e
n
v
ir
o
n
m
en
t
f
o
r
t
h
r
iv
in
g
m
e
n
tal
h
ea
lth
,
u
n
d
er
s
co
r
i
n
g
th
e
im
p
o
r
tan
ce
o
f
cu
ltiv
atin
g
th
ese
p
o
s
itiv
e
e
x
p
er
ien
ce
s
.
C
o
n
v
er
s
ely
,
th
e
s
ec
o
n
d
d
im
e
n
s
io
n
o
f
th
e
m
o
d
el
b
r
i
n
g
s
to
lig
h
t
th
e
ad
v
er
s
e
asp
ec
ts
o
f
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
,
wh
ich
in
clu
d
e
m
an
if
e
s
tatio
n
s
o
f
an
x
iety
,
d
ep
r
ess
io
n
,
an
d
a
d
im
i
n
is
h
ed
s
en
s
e
o
f
co
n
t
r
o
l
o
v
er
o
n
e'
s
em
o
tio
n
al
s
tate
[
2
]
,
[
1
4
]
,
[
1
5
]
.
T
h
is
d
im
en
s
io
n
em
p
h
asizes
th
ese
f
ac
to
r
s
'
d
etr
im
en
tal
im
p
ac
t
o
n
an
in
d
iv
id
u
al'
s
o
v
er
all
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
.
T
h
e
d
u
al
-
co
n
tin
u
a
m
o
d
el
t
h
u
s
ad
v
o
ca
te
s
f
o
r
a
h
o
lis
tic
ap
p
r
o
ac
h
t
o
m
en
tal
h
ea
lth
,
ac
k
n
o
wled
g
in
g
th
e
co
e
x
is
ten
ce
o
f
p
o
s
itiv
e
an
d
n
eg
ativ
e
d
im
en
s
io
n
s
an
d
th
e
n
ec
ess
ity
o
f
a
d
d
r
ess
in
g
b
o
th
to
ac
h
ie
v
e
o
p
tim
al
p
s
y
ch
o
lo
g
ical
eq
u
ilib
r
iu
m
.
I
n
co
n
clu
s
io
n
,
th
e
d
u
al
-
c
o
n
tin
u
a
m
o
d
el
p
r
o
v
i
d
es
a
n
u
a
n
ce
d
f
r
am
ewo
r
k
f
o
r
u
n
d
er
s
ta
n
d
in
g
m
e
n
tal
h
ea
lth
,
ad
v
o
ca
ti
n
g
f
o
r
th
e
s
im
u
ltan
eo
u
s
cu
ltiv
atio
n
o
f
p
o
s
itiv
e
p
s
y
ch
o
lo
g
ical
attr
ib
u
te
s
an
d
th
e
ef
f
ec
tiv
e
m
an
ag
em
en
t
o
f
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
.
T
h
is
b
alan
ce
d
ap
p
r
o
ac
h
is
p
iv
o
tal
in
f
o
s
ter
in
g
a
c
o
m
p
r
eh
e
n
s
iv
e
an
d
r
esil
ien
t state
o
f
m
en
tal
well
-
b
ein
g
.
T
h
is
s
tu
d
y
aim
ed
to
test
th
e
m
en
tal
h
ea
lth
m
ea
s
u
r
em
en
t
in
s
tr
u
m
en
t,
f
r
am
ed
with
in
t
h
e
d
u
al
-
co
n
tin
u
a
m
o
d
el,
th
r
o
u
g
h
a
tr
ip
ar
tite
ev
al
u
atio
n
p
r
o
ce
s
s
.
I
n
itially
,
th
e
r
e
s
ea
r
ch
p
r
o
b
es
in
to
t
h
e
ef
f
icac
y
o
f
a
c
o
m
p
r
e
h
en
s
iv
e
24
-
item
m
e
n
tal
h
ea
lth
s
ca
le,
d
esig
n
ed
to
e
n
ca
p
s
u
late
th
e
ess
en
ce
o
f
h
ig
h
p
s
y
c
h
o
lo
g
ical
we
ll
-
b
ein
g
ju
x
tap
o
s
ed
ag
ain
s
t
lo
w
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
,
aim
in
g
to
ca
p
tu
r
e
a
b
r
o
a
d
s
p
ec
tr
u
m
o
f
m
e
n
tal
h
ea
lth
in
d
icato
r
s
.
Su
b
s
eq
u
en
tly
,
th
e
f
o
c
u
s
n
ar
r
o
ws
to
a
1
2
-
item
s
ca
le
d
ed
icate
d
to
ass
es
s
in
g
p
s
y
ch
o
l
o
g
ical
well
-
b
ein
g
,
m
ar
k
e
d
b
y
p
o
s
itiv
e
em
o
tio
n
s
,
f
u
lf
illi
n
g
s
o
cial
co
n
n
ec
tio
n
s
,
an
d
an
o
v
er
ar
ch
in
g
s
en
s
e
o
f
s
atis
f
ac
tio
n
with
life
.
T
h
e
th
ir
d
an
d
f
in
al
p
h
ase
d
elv
es
in
to
a
1
2
-
item
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
s
ca
le,
m
eticu
lo
u
s
ly
cr
af
ted
to
g
au
g
e
th
e
lev
els
o
f
an
x
iety
,
d
e
p
r
ess
iv
e
s
y
m
p
to
m
s
,
an
d
p
er
ce
iv
ed
lo
s
s
o
f
co
n
tr
o
l,
elem
en
ts
in
d
icativ
e
o
f
p
s
y
ch
o
lo
g
ical
tu
r
m
o
il.
E
ac
h
s
tag
e
o
f
th
is
m
eth
o
d
ical
in
q
u
ir
y
is
u
n
d
er
p
in
n
e
d
b
y
th
e
o
b
jectiv
e
to
r
ig
o
r
o
u
s
ly
test
an
d
af
f
ir
m
th
e
v
alid
ity
o
f
th
e
m
en
tal
h
ea
lth
s
ca
les,
en
s
u
r
in
g
t
h
ey
ac
c
u
r
ately
r
ef
l
ec
t
th
e
n
u
an
ce
d
d
im
e
n
s
io
n
s
o
f
m
en
tal
h
ea
lth
as
p
r
o
p
o
s
ed
b
y
t
h
e
d
u
al
-
co
n
tin
u
a
m
o
d
el,
th
e
r
eb
y
c
o
n
tr
ib
u
tin
g
a
r
o
b
u
s
t
to
o
l
f
o
r
th
e
ass
ess
m
en
t o
f
m
en
tal
h
ea
lth
in
d
iv
er
s
e
p
o
p
u
latio
n
s
.
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h pro
ce
du
re
T
h
is
r
esear
ch
f
o
cu
s
es
o
n
r
ef
in
in
g
an
d
e
n
h
an
cin
g
m
en
tal
h
ea
lth
ass
es
s
m
en
t
to
o
ls
'
ac
cu
r
ac
y
in
u
n
iv
er
s
ity
s
ettin
g
s
.
A
v
ital
asp
ec
t
o
f
th
is
im
p
r
o
v
e
m
en
t
in
v
o
lv
es
s
tr
ateg
ically
r
ed
u
cin
g
r
esp
o
n
s
e
o
p
tio
n
s
f
o
r
s
u
r
v
ey
q
u
esti
o
n
s
.
W
h
ile
th
e
o
r
ig
in
al
f
o
r
m
at
p
r
o
v
i
d
ed
f
iv
e
p
o
ten
tial
a
n
s
wer
s
,
th
is
s
tu
d
y
ad
v
o
ca
tes
f
o
r
a
m
o
r
e
s
tr
ea
m
lin
ed
ap
p
r
o
ac
h
b
y
o
f
f
er
in
g
o
n
ly
f
o
u
r
c
h
o
ices,
in
ten
tio
n
ally
o
m
itti
n
g
th
e
n
e
u
tr
al
o
p
ti
o
n
.
T
h
is
ad
ju
s
tm
en
t
aim
s
to
elicit
m
o
r
e
d
ef
in
itiv
e
r
esp
o
n
s
es
f
r
o
m
u
n
iv
e
r
s
ity
s
tu
d
en
ts
,
p
o
ten
tially
lea
d
in
g
to
m
o
r
e
p
r
o
s
p
er
o
u
s
an
d
m
o
r
e
ac
tio
n
ab
le
in
s
ig
h
ts
.
B
y
ap
p
ly
in
g
th
is
r
ef
in
ed
ap
p
r
o
ac
h
to
a
s
et
o
f
2
4
m
eticu
lo
u
s
ly
ch
o
s
en
q
u
esti
o
n
s
an
d
d
ep
lo
y
in
g
th
em
am
o
n
g
m
a
n
y
u
n
iv
er
s
ity
s
tu
d
en
ts
,
th
e
s
tu
d
y
s
ee
k
s
to
g
ath
er
s
u
b
s
tan
tial
d
ata.
T
h
is
in
itiativ
e
is
n
o
t
ju
s
t
ab
o
u
t
to
o
l
r
e
f
in
em
en
t;
it'
s
ab
o
u
t
im
p
r
o
v
in
g
th
e
d
ep
th
an
d
r
eliab
ilit
y
o
f
m
en
tal
h
ea
lt
h
ev
alu
atio
n
s
in
th
e
ac
ad
em
ic
en
v
ir
o
n
m
e
n
t,
th
er
eb
y
f
o
s
ter
in
g
a
b
etter
u
n
d
er
s
tan
d
in
g
o
f
s
tu
d
e
n
t m
en
tal
h
ea
lth
in
u
n
iv
er
s
ity
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
V
a
lid
a
tin
g
p
s
yc
h
o
metric p
r
o
p
erti
es o
f d
u
a
l
-
co
n
tin
u
a
mo
d
els
fo
r
u
n
ivers
ity
s
tu
d
en
t …
(
R
a
h
ma
t A
z
iz
)
427
2
.
2
.
Da
t
a
c
o
llect
io
ns
T
h
e
d
ata
we
r
e
o
b
tain
ed
u
s
in
g
th
e
Azir
a
Me
n
tal
Hea
lth
Scales
(
AM
HS
-
24)
.
T
h
e
s
ca
le
m
ea
s
u
r
ed
two
asp
ec
ts
o
f
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
(
p
o
s
itiv
e
em
o
ti
o
n
s
,
p
o
s
itiv
e
s
o
cial
r
elatio
n
s
h
ip
s
an
d
li
f
e
s
atis
f
ac
tio
n
)
an
d
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
(
a
n
x
i
e
ty
,
d
e
p
r
e
s
s
i
o
n
a
n
d
l
o
s
s
o
f
c
o
n
t
r
o
l
)
.
T
h
i
s
m
e
a
s
u
r
i
n
g
i
n
s
t
r
u
m
e
n
t
i
s
i
n
t
h
e
f
o
r
m
o
f
a
L
i
k
er
t
s
c
a
l
e
w
i
t
h
f
o
u
r
a
n
s
w
e
r
ch
o
i
c
e
s
.
T
h
e
f
o
u
r
a
n
s
w
e
r
c
h
o
i
c
e
s
a
r
e
v
e
r
y
s
t
r
o
n
g
l
y
a
g
r
e
e
(
V
S
A
)
,
a
g
r
e
e
(
A
)
,
d
i
s
a
g
r
e
e
(
D
)
,
a
n
d
s
t
r
o
n
g
l
y
d
i
s
a
g
r
ee
(
SD)
.
A
s
c
o
r
e
is
g
i
v
e
n
b
y
a
s
s
i
g
n
i
n
g
v
a
l
u
e
s
o
f
4
,
3
,
2
,
a
n
d
1
f
o
r
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
f
ac
to
r
s
an
d
1
,
2
,
3
an
d
4
f
o
r
p
s
y
c
h
o
lo
g
ical
d
is
tr
ess
co
m
p
o
n
e
n
ts
to
ass
ess
m
en
tal
h
ea
lth
.
2
.
3
.
Resea
rc
h su
bje
ct
s
T
h
e
s
tu
d
y
s
u
b
jects
to
talled
th
r
ee
h
u
n
d
r
ed
a
n
d
twelv
e
s
tu
d
en
t
s
f
r
o
m
I
s
lam
ic
h
i
g
h
er
e
d
u
ca
ti
o
n
in
E
ast
J
av
a,
I
n
d
o
n
esia.
Su
b
ject
s
elec
tio
n
is
b
ased
o
n
th
e
n
ee
d
f
o
r
a
n
ad
eq
u
ate
n
u
m
b
er
o
f
is
s
u
es,
tak
in
g
in
t
o
ac
co
u
n
t
th
e
b
alan
ce
o
f
g
e
n
d
er
(
m
ale
an
d
f
em
ale)
an
d
d
ep
ar
tm
e
n
t
(
I
s
lam
ic
ed
u
ca
tio
n
,
s
o
cial
ed
u
ca
tio
n
,
p
s
y
ch
o
lo
g
y
,
ac
co
u
n
tan
c
y
,
m
an
ag
em
e
n
t,
law,
Ar
ab
ic
lan
g
u
ag
e,
E
n
g
lis
h
lan
g
u
ag
e,
m
ath
e
m
atics,
ar
ch
itectu
r
e,
b
io
lo
g
y
,
m
ed
icin
e)
.
T
h
e
ag
e
o
f
th
e
s
u
b
j
ec
ts
r
an
g
ed
f
r
o
m
1
9
to
2
3
y
ea
r
s
(
m
ea
n
2
0
.
3
0
,
s
tan
d
ar
d
d
e
v
iatio
n
1
.
1
5
)
.
T
h
e
s
tu
d
y
u
s
ed
3
1
2
s
tu
d
e
n
ts
to
test
a
m
e
n
tal
h
ea
lth
to
o
l
,
wh
ich
is
a
g
o
o
d
n
u
m
b
er
f
o
r
th
is
k
in
d
o
f
r
esear
ch
[
1
6
]
.
T
h
is
m
an
y
p
ar
ticip
an
ts
m
ak
e
th
e
r
esu
lts
m
o
r
e
r
eliab
le
an
d
h
elp
en
s
u
r
e
th
e
to
o
l
w
o
r
k
s
as
it
s
h
o
u
ld
,
as
in
p
r
ev
io
u
s
s
tu
d
ies
[
1
7
]
,
[
1
8
]
.
T
h
e
s
tu
d
en
ts
wer
e
f
r
o
m
d
if
f
er
e
n
t
b
ac
k
g
r
o
u
n
d
s
a
n
d
g
e
n
d
er
s
,
m
a
k
in
g
t
h
e
f
in
d
in
g
s
ap
p
licab
le
f
o
r
a
wid
e
r
an
g
e
o
f
u
n
i
v
er
s
ity
s
tu
d
en
ts
.
Ho
wev
er
,
th
e
s
tu
d
y
m
en
tio
n
s
th
at
m
o
r
e
r
esear
ch
is
n
ee
d
ed
with
d
if
f
e
r
en
t
k
in
d
s
o
f
s
tu
d
en
ts
to
m
ak
e
s
u
r
e
th
e
to
o
l
wo
r
k
s
wel
l
f
o
r
ev
er
y
o
n
e.
Ov
er
all,
th
e
s
ize
an
d
m
ak
eu
p
o
f
th
e
s
tu
d
y
g
r
o
u
p
wer
e
well
-
ch
o
s
en
f
o
r
t
h
e
s
tu
d
y
'
s
g
o
als,
b
u
t m
o
r
e
wo
r
k
is
n
ee
d
ed
to
c
o
n
f
ir
m
th
ese
r
esu
lts
T
ab
le
1
.
T
ab
le
1
.
P
r
o
f
ile
o
f
r
esear
c
h
s
u
b
ject
(
N=
3
1
2
)
D
e
mo
g
r
a
p
h
i
c
p
r
o
f
i
l
e
N
P
e
r
c
e
n
t
a
g
e
G
e
n
d
e
r
M
a
l
e
1
5
6
50
F
e
mal
e
1
5
6
50
D
e
p
a
r
t
me
n
t
I
sl
a
mi
c
e
d
u
c
a
t
i
o
n
26
8
.
3
3
S
o
c
i
a
l
e
d
u
c
a
t
i
o
n
26
8
.
3
3
P
sy
c
h
o
l
o
g
y
26
8
.
3
3
A
c
c
o
u
n
t
a
n
c
y
26
8
.
3
3
M
a
n
a
g
e
m
e
n
t
26
8
.
3
3
La
w
26
8
.
3
3
A
r
a
b
i
c
l
a
n
g
u
a
g
e
26
8
.
3
3
En
g
l
i
sh
l
a
n
g
u
a
g
e
26
8
.
3
3
M
a
t
h
e
ma
t
i
c
s
26
8
.
3
3
A
r
c
h
i
t
e
c
t
u
r
e
26
8
.
3
3
B
i
o
l
o
g
y
26
8
.
3
3
M
e
d
i
c
i
n
e
26
8
.
3
3
A
g
e
(
M
e
a
n
=
2
0
.
3
0
,
S
D
=
1
.
1
5
)
1
8
y
e
a
r
s
o
l
d
12
3
.
8
1
9
y
e
a
r
s
o
l
d
66
2
1
.
2
2
0
y
e
a
r
s
o
l
d
1
1
0
3
5
.
3
2
1
y
e
a
r
s
o
l
d
74
2
3
.
7
2
2
y
e
a
r
s
o
l
d
39
1
2
.
5
2
3
y
e
a
r
s
o
l
d
11
3
.
5
T
ab
le
1
d
em
o
n
s
tr
ated
th
at
t
h
e
e
q
u
al
g
en
d
er
d
is
tr
ib
u
tio
n
an
d
th
e
wid
e
r
an
g
e
o
f
d
ep
ar
tm
e
n
tal
af
f
iliatio
n
s
am
o
n
g
th
e
3
1
2
r
esear
c
h
s
u
b
je
cts
in
d
icate
a
d
elib
er
ate
ef
f
o
r
t
to
en
s
u
r
e
d
iv
er
s
ity
an
d
r
ep
r
es
en
tativ
en
ess
in
th
e
s
am
p
le,
wh
ich
en
h
a
n
ce
s
th
e
s
tu
d
y
'
s
v
alid
i
ty
.
T
h
e
f
o
c
u
s
o
n
a
y
o
u
n
g
er
d
e
m
o
g
r
a
p
h
ic,
with
a
m
ea
n
ag
e
o
f
2
0
.
3
0
,
s
u
g
g
ests
th
at
th
e
r
esear
ch
is
p
ar
ticu
lar
ly
r
elev
an
t
to
y
o
u
n
g
ad
u
lts
,
p
o
ten
tially
o
f
f
er
in
g
in
s
ig
h
ts
in
to
th
is
ag
e
g
r
o
u
p
'
s
p
er
s
p
ec
tiv
es
an
d
b
eh
av
io
u
r
s
.
Ho
wev
er
,
t
h
e
co
n
ce
n
t
r
atio
n
with
in
a
n
ar
r
o
w
ag
e
r
a
n
g
e
m
ig
h
t
lim
it
th
e
f
in
d
in
g
s
'
ap
p
licab
ilit
y
to
b
r
o
a
d
er
p
o
p
u
latio
n
s
.
T
h
e
m
eth
o
d
o
lo
g
ical
ch
o
ices
r
ef
lecte
d
in
th
e
ta
b
le
u
n
d
er
s
co
r
e
th
e
s
tu
d
y
'
s
p
o
ten
tial stre
n
g
th
s
in
ter
m
s
o
f
d
iv
e
r
s
ity
an
d
f
o
cu
s
w
h
ile
also
h
in
tin
g
at
its
s
co
p
e
li
m
itatio
n
s
.
2
.
4
.
Da
t
a
a
na
ly
s
is
T
h
e
d
ata
wer
e
an
aly
s
ed
t
o
te
s
t
th
e
r
eliab
ilit
y
o
f
th
e
in
s
tr
u
m
en
ts
u
s
ed
to
m
ea
s
u
r
e
m
e
n
tal
h
ea
lth
.
R
eliab
ilit
y
r
ef
er
s
to
th
e
ex
ten
t
to
wh
ich
m
ea
s
u
r
em
e
n
t
r
esu
lts
ar
e
co
n
s
is
ten
t
wh
en
r
ep
e
ated
.
I
n
th
is
s
tu
d
y
,
r
eliab
ilit
y
test
in
g
aim
ed
to
d
eter
m
in
e
th
e
co
n
s
is
ten
cy
o
f
m
en
tal
h
ea
lth
in
s
tr
u
m
en
ts
.
R
eliab
il
ity
ca
lcu
latio
n
s
ar
e
m
ad
e
af
ter
ea
ch
item
h
as
b
ee
n
test
ed
f
o
r
v
alid
ity
t
h
r
o
u
g
h
em
p
ir
ical
test
in
g
.
An
item
is
v
alid
i
f
it
h
as
a
co
r
r
ec
ted
item
-
to
tal
co
r
r
elatio
n
o
f
m
o
r
e
th
an
.
3
0
0
.
At
th
e
s
am
e
tim
e,
th
e
r
eliab
ilit
y
o
f
th
e
m
ea
s
u
r
in
g
in
s
tr
u
m
e
n
t
is
d
ec
lar
ed
v
alid
i
f
a
C
r
o
n
b
ac
h
a
lp
h
a
v
alu
e
o
f
m
o
r
e
th
a
n
.
6
0
0
i
s
o
b
tain
ed
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
4
2
5
-
433
428
3.
RE
SU
L
T
AND
DI
SCUS
SI
O
N
3
.
1
.
Resul
t
s
T
h
is
s
ec
tio
n
o
u
tlin
es
th
e
o
u
tc
o
m
es
o
f
th
r
ee
k
e
y
r
esear
ch
f
in
d
in
g
s
.
I
n
itially
,
it
is
estab
lis
h
ed
th
at
m
en
tal
h
ea
lth
ca
n
b
e
co
n
ce
p
tu
alis
ed
th
r
o
u
g
h
a
d
u
al
-
m
o
d
el
f
r
a
m
ewo
r
k
.
Su
b
s
eq
u
e
n
tly
,
th
e
d
is
cu
s
s
io
n
s
h
if
ts
to
p
s
y
ch
o
lo
g
ical
well
-
b
ei
n
g
,
h
ig
h
lig
h
tin
g
t
h
r
ee
m
ain
co
m
p
o
n
e
n
ts
:
p
o
s
itiv
e
em
o
tio
n
s
,
en
r
ich
in
g
s
o
cial
co
n
n
ec
tio
n
s
,
an
d
o
v
er
all
life
s
atis
f
ac
tio
n
.
T
h
e
f
in
al
p
ar
t
o
f
th
e
f
in
d
in
g
s
d
elv
es
in
to
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
,
f
o
cu
s
in
g
o
n
p
r
ev
alen
t iss
u
es su
ch
as a
n
x
iety
,
d
ep
r
ess
io
n
,
an
d
a
p
er
ce
iv
e
d
lack
o
f
co
n
tr
o
l.
3
.
1
.
1
.
T
he
re
s
ult
o
f
t
he
re
lia
bil
it
y
estim
a
t
es o
f
t
he
m
ent
a
l
hea
lt
h sca
le
T
h
e
r
eliab
ilit
y
a
n
aly
s
is
o
f
th
e
Alp
h
a
C
r
o
n
b
ac
h
tec
h
n
iq
u
e
,
a
p
p
lied
to
2
4
item
s
o
n
t
h
e
m
e
n
tal
h
ea
lth
s
ca
le
co
v
er
in
g
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
an
d
s
tr
ess
asp
ec
ts
,
co
n
f
ir
m
ed
t
h
e
v
alid
ity
o
f
all
item
s
.
T
h
e
d
etaile
d
f
in
d
in
g
s
ar
e
p
r
esen
ted
in
T
ab
l
e
2
.
T
ab
le
2
p
r
esen
ts
a
r
eliab
ilit
y
an
aly
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ates o
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3
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d
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ately
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ate
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ies
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cted
b
y
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er
s
[
1
]
,
[
2
]
,
[
1
9
]
.
Si
m
ilar
to
th
eir
wo
r
k
,
we
f
o
u
n
d
h
ig
h
r
eliab
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y
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ef
f
icien
ts
th
at
u
n
d
e
r
s
co
r
e
th
e
m
o
d
el'
s
ef
f
icac
y
in
co
m
p
r
e
h
e
n
s
iv
ely
ca
p
tu
r
in
g
th
e
s
p
ec
tr
u
m
o
f
m
en
tal
h
ea
lt
h
.
T
h
is
alig
n
m
en
t
s
tr
en
g
th
en
s
th
e
ar
g
u
m
en
t
f
o
r
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e
d
u
al
-
c
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a
m
o
d
el'
s
ap
p
licab
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y
in
d
iv
er
s
e
s
ett
in
g
s
,
h
ig
h
lig
h
tin
g
its
r
o
b
u
s
tn
ess
in
as
s
es
s
in
g
m
en
tal
h
ea
lth
d
im
en
s
io
n
s
.
C
o
n
v
er
s
ely
,
o
u
r
s
tu
d
y
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r
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ts
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n
u
an
ce
d
c
o
n
tr
ast
to
th
e
o
th
er
r
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ch
er
[
3
]
,
wh
o
also
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alid
ated
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en
tal
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ea
lth
co
n
tin
u
u
m
-
s
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o
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t
f
o
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m
s
a
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tin
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a
m
o
d
els,
alb
eit
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d
if
f
er
e
n
t
co
n
te
x
ts
.
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h
ile
o
u
r
f
in
d
in
g
s
co
r
r
o
b
o
r
at
e
th
e
o
v
e
r
all
u
tili
ty
an
d
r
eliab
i
lity
o
f
th
e
d
u
al
-
c
o
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tin
u
a
m
o
d
e
ls
,
th
e
id
en
tific
atio
n
o
f
two
item
s
with
wea
k
er
co
r
r
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n
s
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o
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r
s
tu
d
y
s
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g
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e
s
ts
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o
ten
tial
ar
ea
f
o
r
r
ef
in
e
m
en
t
n
o
t
ex
p
licitly
ad
d
r
ess
ed
in
th
eir
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esear
ch
.
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h
is
d
iv
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g
en
ce
in
d
icate
s
th
at
wh
ile
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e
f
o
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n
d
atio
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asp
ec
ts
o
f
th
e
d
u
al
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c
o
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tin
u
a
m
o
d
el
h
o
ld
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its
ap
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licatio
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ig
h
t
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en
e
f
it
f
r
o
m
c
o
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tex
t
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s
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c
ad
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en
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to
en
h
a
n
c
e
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i
s
io
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d
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elev
a
n
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ar
ticu
lar
ly
in
t
h
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co
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te
x
t o
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u
n
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er
s
ity
s
tu
d
en
t m
en
tal
h
ea
lth
ass
ess
m
en
ts
.
Ou
r
f
in
d
i
n
g
s
len
d
s
u
b
s
tan
tial
s
u
p
p
o
r
t
to
th
e
d
u
al
-
c
o
n
tin
u
a
m
o
d
el
o
f
m
e
n
tal
h
ea
lth
,
e
ch
o
in
g
th
e
f
o
u
n
d
atio
n
al
co
n
tr
ib
u
tio
n
s
o
f
s
ch
o
lar
s
[
2
0
]
–
[
2
2
]
.
T
h
eir
p
io
n
ee
r
in
g
wo
r
k
in
d
ev
el
o
p
in
g
an
d
ap
p
ly
in
g
th
e
d
u
al
-
co
n
tin
u
a
f
r
a
m
ewo
r
k
is
b
o
ls
ter
ed
b
y
o
u
r
s
tu
d
y
,
wh
ich
co
n
f
ir
m
s
th
e
m
o
d
el'
s
ef
f
ec
tiv
en
ess
in
ca
p
tu
r
in
g
th
e
co
m
p
lex
in
ter
p
lay
b
etwe
en
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
a
n
d
d
is
tr
ess
.
T
h
is
v
alid
atio
n
r
ein
f
o
r
ce
s
th
e
m
o
d
el'
s
p
r
em
is
e
th
at
well
-
b
ein
g
an
d
d
i
s
tr
ess
ar
e
n
o
t
m
er
ely
o
p
p
o
s
ite
en
d
s
o
f
a
s
in
g
le
co
n
tin
u
u
m
b
u
t
d
is
tin
ct
co
n
s
tr
u
cts
th
at
co
llectiv
ely
i
n
f
o
r
m
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
m
en
tal
h
ea
lth
.
Mo
r
eo
v
er
,
th
e
im
p
licatio
n
s
o
f
o
u
r
r
esear
ch
ex
te
n
d
to
t
h
e
n
u
an
ce
d
co
m
p
r
eh
e
n
s
io
n
o
f
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
an
d
d
is
tr
ess
,
in
lin
e
with
th
eo
r
ies
an
d
e
m
p
ir
ical
f
in
d
in
g
s
b
y
r
es
ea
r
ch
er
s
[
1
0
]
,
[
2
3
]
,
[
2
4
]
.
Ou
r
s
tu
d
y
n
o
t
o
n
ly
af
f
ir
m
s
th
e
d
u
al
-
co
n
tin
u
a
m
o
d
el'
s
s
tr
u
ctu
r
e
b
u
t
als
o
en
r
ich
es
th
e
d
is
co
u
r
s
e
o
n
th
e
c
o
m
p
o
n
en
ts
o
f
well
-
b
ein
g
an
d
th
ei
r
s
ig
n
if
ican
t
in
f
lu
en
ce
o
n
m
en
tal
h
ea
lth
.
B
y
id
en
tif
y
in
g
s
p
ec
if
ic
ar
ea
s
with
in
th
e
m
o
d
e
l
th
at
m
ay
r
eq
u
ir
e
r
ef
i
n
em
en
t,
o
u
r
wo
r
k
s
u
g
g
ests
av
en
u
es
f
o
r
f
u
r
th
er
e
x
p
lo
r
atio
n
an
d
p
o
te
n
tial
en
h
an
ce
m
e
n
t
o
f
th
e
m
o
d
el,
th
er
e
b
y
co
n
tr
ib
u
ti
n
g
to
a
m
o
r
e
r
e
f
in
ed
an
d
em
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ir
ically
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r
o
u
n
d
e
d
u
n
d
er
s
tan
d
in
g
o
f
m
en
tal
h
ea
lt
h
d
y
n
am
ics.
T
h
e
im
p
licatio
n
s
f
o
r
th
e
m
ea
s
u
r
em
en
t
o
f
m
en
tal
h
ea
lth
f
r
o
m
o
u
r
s
tu
d
y
a
r
e
s
u
b
s
tan
tial.
O
u
r
f
i
n
d
in
g
s
u
n
d
er
s
co
r
e
th
e
e
f
f
ec
tiv
en
ess
o
f
th
e
d
u
al
-
co
n
tin
u
a
m
o
d
el
in
c
ap
tu
r
in
g
th
e
in
t
r
icate
asp
ec
ts
o
f
m
en
tal
well
-
b
ei
n
g
an
d
d
is
tr
ess
,
th
er
eb
y
o
f
f
er
in
g
a
co
m
p
r
eh
e
n
s
iv
e
f
r
a
m
ewo
r
k
f
o
r
ass
ess
in
g
m
en
tal
h
ea
l
th
.
T
h
is
en
h
an
ce
d
u
n
d
er
s
tan
d
i
n
g
aid
s
i
n
th
e
d
e
v
elo
p
m
en
t
o
f
m
o
r
e
n
u
a
n
ce
d
an
d
ac
cu
r
ate
to
o
ls
f
o
r
m
e
n
tal
h
ea
lth
ev
al
u
atio
n
,
en
ab
lin
g
p
r
ac
titi
o
n
er
s
an
d
r
ese
ar
ch
er
s
to
b
etter
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tify
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n
d
a
d
d
r
ess
th
e
d
iv
er
s
e
n
ee
d
s
o
f
in
d
iv
id
u
als
[
2
5
]
–
[
2
7
]
.
Fu
r
th
er
m
o
r
e
,
th
e
id
en
tific
atio
n
o
f
s
p
ec
if
ic
ar
ea
s
with
in
th
e
m
o
d
el
th
at
m
ay
r
e
q
u
ir
e
r
e
f
in
em
en
t
s
u
g
g
ests
o
p
p
o
r
tu
n
ities
f
o
r
im
p
r
o
v
in
g
t
h
e
p
r
ec
is
io
n
an
d
r
elev
an
ce
o
f
m
en
tal
h
ea
lth
ass
ess
m
en
ts
,
c
o
n
tr
ib
u
tin
g
to
m
o
r
e
ef
f
ec
tiv
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in
ter
v
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n
tio
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tr
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an
d
s
u
p
p
o
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t sy
s
tem
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tailo
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in
d
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id
u
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p
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ien
ce
s
o
f
m
en
tal
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.
Ou
r
s
tu
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y
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h
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h
o
w
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tan
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is
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o
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o
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m
e
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n
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ities
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lly
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ed
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s
im
p
ac
t
[
6
]
,
[
7
]
,
[
2
8
]
.
W
e
f
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d
th
e
d
u
al
-
co
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m
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ts
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m
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tal
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h
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lls
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with
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esear
ch
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s
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[9
]
,
[
2
9
]
,
[
3
0
]
,
to
cr
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t
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ital
m
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4.
CO
NCLU
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O
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Ou
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RE
F
E
R
E
NC
E
S
[
1
]
J
.
M
a
s
o
n
S
t
e
p
h
e
n
s
,
M
.
I
a
s
i
e
l
l
o
,
K
.
A
l
i
,
J
.
v
a
n
A
g
t
e
r
e
n
,
a
n
d
D
.
B
.
F
a
s
s
n
a
c
h
t
,
“
T
h
e
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m
p
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t
a
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m
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h
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g
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c
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l
d
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s
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s
:
U
s
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g
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t
h
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m
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l
H
e
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l
t
h
,
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B
e
h
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v
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l
S
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s
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v
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l
.
1
3
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o
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5
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M
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y
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3
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i
:
1
0
.
3
3
9
0
/
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s
1
3
0
5
0
4
3
6
.
[
2
]
I
.
P
.
K
h
u
m
a
l
o
,
R
.
A
p
p
i
a
h
,
a
n
d
A
.
W
i
l
s
o
n
F
a
d
i
j
i
,
“
M
e
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s
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p
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t
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t
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s
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A
f
r
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c
a
:
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v
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d
p
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P
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1
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p
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.
2
0
2
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8
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8
.
[
3
]
A
.
J
.
T
h
a
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e
r
,
M
.
R
.
W
e
e
k
s
,
a
n
d
C
.
R
.
C
o
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k
,
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2
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7
.
[
4
]
N
.
K
i
n
g
,
C
.
M
.
D
a
v
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s
o
n
,
a
n
d
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.
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D
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:
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2
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a
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d
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n
H
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a
v
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n
(
H
B
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)
s
t
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d
y
,
”
B
M
J
O
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n
,
v
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1
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9
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2
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-
2
0
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0
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0
4
1
4
8
9
.
[
5
]
D
.
N
a
s
r
u
l
l
a
h
e
t
a
l
.
,
“
P
s
y
c
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a
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m
p
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c
t
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m
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w
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k
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s
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f
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1
9
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n
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(
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.
[
6
]
M
.
E
y
u
b
o
g
l
u
e
t
a
l
.
,
“
T
r
a
d
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t
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b
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y
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n
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s
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R
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z
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c
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c
a
n
b
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tac
ted
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m
a
il
:
m
a
n
g
e
stu
ti
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in
-
m
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lan
g
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a
c
.
id
.
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