The main outcome measure reported in this paper is nonspecific psychological distress as measured by the K10. This measure comprises 10 questions that ask respondents how often they have experienced certain symptoms during the preceding four weeks and responses are scored on a scale of 1 to 5 depending on how frequently each symptom is experienced, where 1 = 'none of the time', and 5 = 'all of the time'. Thus, a minimum score is 10, indicating no psychological distress, and a maximum score is 50, indicating the most severe level of psychological distress. Scores on the K10 are subsequently categorized into four levels: low (scores of 10-15); moderate (scores of [16] [17] [18] [19] [20] [21] ; 'high' (scores of [22] [23] [24] [25] [26] [27] [28] [29] and 'very high' (scores of 30-50) [27] .