76
|
Pinto-Meza A, Fernández A, Bruffaerts R, Alonso J, Kovess V, De Graaf R, de Girolamo G, Matschinger H, Haro JM. Dropping out of mental health treatment among patients with depression and anxiety by type of provider: results of the European Study of the Epidemiology of Mental Disorders. Soc Psychiatry Psychiatr Epidemiol 2011; 46:273-80. [PMID: 20186531 DOI: 10.1007/s00127-010-0195-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Dropping out from mental health treatment is a major problem because mental health treatments delivered for inadequate durations are ineffective. The aim of this study was to compare treatment dropout rates by type of provider, dropout risk by number of visit, and to ascertain factors associated with treatment dropout. METHODS A cross-sectional household survey of a representative sample of 626 out of 21,425 non-institutionalized adults from the general population of six European countries was carried out. Dropout was defined as terminating treatment before recommendation. RESULTS Dropout from all treating providers during a 12-month period was 14%. Among psychiatrists, psychologists, and general practitioners figures were: 19.6, 20.3, and 20.3%, respectively. While the hazard risk for dropping out was higher during the first three visits to GPs and psychologists, it was stable for psychiatrists. Older age, female gender, and living in large or midsize urban areas were associated with a decreased risk of dropping out. CONCLUSIONS Efforts for increasing patients' proportion completing adequate courses of care for mental disorders in Europe should focus on the first visits, especially those made to the general medical care.
Collapse
|
77
|
Holzinger A, Matschinger H, Schomerus G, Carta MG, Angermeyer MC. The loss of sadness: the public's view. Acta Psychiatr Scand 2011; 123:307-13. [PMID: 21219269 DOI: 10.1111/j.1600-0447.2010.01669.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE With the exception of bereavement, the diagnosis of major depressive disorder in the DSM-IV does not take into account the context in which the symptoms occur. Recent criticism has maintained that common sense suggests making a distinction between depression as mental disorder and sorrow as 'normal' reaction to social stress. This study sets out to investigate whether the public does in fact make this distinction. METHOD In spring 2009, a population-based survey was conducted by phone in the city of Vienna (n = 1205). A fully structured interview was carried out which began with the presentation of a vignette describing a diagnostically unlabeled case of depression, with or without provision of information about preceding stressful life events. RESULTS Respondents presented with vignettes containing information on loss events were less likely to define depressive symptoms as indication of mental illness. They were also not as willing to recommend professional help. And if they were, they tended to less frequently recommend seeking help from someone with a medical background. CONCLUSION In contrast to the conceptualization in the DSM-IV, the public tends to perceive depressive symptoms differently depending on the context in which they occur.
Collapse
|
78
|
Olbrich S, Sander C, Matschinger H, Mergl R, Trenner M, Schönknecht P, Hegerl U. Brain and Body. J PSYCHOPHYSIOL 2011. [DOI: 10.1027/0269-8803/a000061] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The temporal dynamics of electroencephalogram (EEG)-vigilance as a measure of tonic cortical arousal are discussed as pathogenetic factors in neuropsychiatric disorders. Although there is broad knowledge about the interaction of cortical arousal and activity of the autonomous nervous system (ANS) during different sleep stages, the association and temporal interaction between fine-graded EEG-vigilance stages and markers of sympathetic and parasympathetic activity during the transition from wakefulness to sleep onset warrants more detailed exploration and was focus of the presented study. A 15-min resting-EEG, electrocardiogram (ECG), and skin conductance level (SCL) were recorded from 54 healthy subjects. Using an EEG-algorithm (VIGALL), 1-s segments were classified into seven different vigilance stages. Associations and temporal interactions between EEG-vigilance stages and heart rate variability (HRV), heart rate (HR), and SCL were computed using correlation analysis, regression analysis, and cross-correlations of EEG-vigilance and ANS time series. EEG-vigilance stages and ANS activity showed a significant association between increased HRV parameters including total and (normalized) very low frequency power and low vigilance stages. Regression analysis revealed significantly increased values of SCL and HR for high vigilance stages in comparison to lower ones. In these relationships, for SCL but not HR most of the covariance was explained by the effect of time. Phasic increases in EEG-vigilance were paralleled by significant increases of HR but not of SCL. Cross-correlations between EEG-vigilance and ANS time series yielded highest correlations when there was no or only a minimal temporal lag. ANS activity during the transition from wakefulness to sleep onset gradually changes along with different fine-graded EEG-vigilance stages. Associations between cortical and autonomic activity are better reflected by HR than by SCL.
Collapse
|
79
|
Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 2010; 46:105-12. [PMID: 21169612 DOI: 10.1093/alcalc/agq089] [Citation(s) in RCA: 371] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Stigma is likely to aggravate the severe medical and social consequences of alcohol dependence. We aim to explore the characteristics of the alcohol dependence stigma by comparing it with the stigma of other conditions. METHODS On the basis of a systematic literature search, we identified 17 representative population studies published before July 2010 that examine aspects of the stigma of alcoholism and simultaneously of other mental, medical or social conditions. Seven surveys were located in Europe, five in North America, three in New Zealand and one each in Brazil and Ethiopia, respectively. RESULTS Compared with people suffering from other, substance-unrelated mental disorders, alcohol-dependent persons are less frequently regarded as mentally ill, are held much more responsible for their condition, provoke more social rejection and more negative emotions, and they are at particular risk for structural discrimination. Only with regard to being a danger, they are perceived to be at a similarly negative level to that of people suffering from schizophrenia. CONCLUSION Alcoholism is a particularly severely stigmatized mental disorder. Cultural differences are likely, but under-researched. We discuss possible reasons for the differences between the stigma of alcoholism and of other mental diseases and the consequences for targeted anti-stigma initiatives.
Collapse
|
80
|
König HH, Heider D, Lehnert T, Riedel-Heller SG, Angermeyer MC, Matschinger H, Vilagut G, Bruffaerts R, Haro JM, de Girolamo G, de Graaf R, Kovess V, Alonso J. Health status of the advanced elderly in six European countries: results from a representative survey using EQ-5D and SF-12. Health Qual Life Outcomes 2010; 8:143. [PMID: 21114833 PMCID: PMC3009699 DOI: 10.1186/1477-7525-8-143] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 11/29/2010] [Indexed: 12/17/2022] Open
Abstract
Background Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort. Aims of the study To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health. Methods In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health. Results 68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean. Conclusions More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.
Collapse
|
81
|
Luck T, Luppa M, Briel S, Matschinger H, König HH, Bleich S, Villringer A, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: incidence and risk factors: results of the leipzig longitudinal study of the aged. J Am Geriatr Soc 2010; 58:1903-10. [PMID: 20840461 DOI: 10.1111/j.1532-5415.2010.03066.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To provide information on age- and sex-specific incidence rates of mild cognitive impairment (MCI) and risk factors for incident MCI. DESIGN Prospective longitudinal cohort. SETTING Leipzig Longitudinal Study of the Aged, a population-based German study of the epidemiology of dementia and mild cognitive impairment. PARTICIPANTS At baseline, 1,692 subjects aged 75 and older were included in the sample. MEASUREMENTS Trained psychologists and physicians conducted structured clinical interviews including neuropsychological assessment and questions about sociodemographics, familial history of dementia, activities of daily living, subjective memory impairment, and lifestyle (alcohol consumption, smoking) at participants' homes. Structured third-party interviews were conducted with proxies. Incidence was calculated according to the person-years-at-risk method. Cox proportional hazards models were used to examine the association between risk factors and incident MCI. RESULTS During an 8-year follow-up period, 26.4% (n=137) of the 519 study participants (population at risk) were identified as incident MCI cases (person-years=1,791.1). The overall incidence rate of MCI was 76.5 (95% confidence interval=64.7-90.4) per 1,000 person-years. Older age, subjective memory impairment, impairment in instrumental activities of daily living, and antecedent lower cognitive performance were found to be significantly associated with the development of future MCI. CONCLUSION MCI is highly incident in the elderly population. For the purpose of early detection of dementia, subjective memory impairment should be taken seriously as a possible prestage of MCI.
Collapse
|
82
|
Riedel-Heller S, Luck T, Matschinger H, Luppa M. Mild Cognitive Impairment: Incidence and Risk factors – Results of the Leipzig Longitudinal Study of the Aged (LEILA75+). DAS GESUNDHEITSWESEN 2010. [DOI: 10.1055/s-0030-1266326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
83
|
Corrieri S, Heider D, Matschinger H, Lehnert T, Raum E, König HH. Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review. Int J Equity Health 2010; 9:20. [PMID: 20701794 PMCID: PMC2925341 DOI: 10.1186/1475-9276-9-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 08/11/2010] [Indexed: 11/18/2022] Open
Abstract
Background In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. Methods Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. Results Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. Conclusions While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.
Collapse
|
84
|
Fullana MA, Vilagut G, Rojas-Farreras S, Mataix-Cols D, de Graaf R, Demyttenaere K, Haro JM, de Girolamo G, Lépine JP, Matschinger H, Alonso J. Obsessive-compulsive symptom dimensions in the general population: results from an epidemiological study in six European countries. J Affect Disord 2010; 124:291-9. [PMID: 20022382 DOI: 10.1016/j.jad.2009.11.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 11/03/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of obsessive-compulsive symptom dimensions and their sociodemographic and psychopathological correlates at the population level are unknown. METHOD Obsessive-compulsive symptom dimensions and mental disorders were assessed with the Composite International Diagnostic Interview 3.0 in a random subsample (n=2804) of individuals participating in a cross-sectional survey of the adult general population of six European countries. RESULTS The lifetime prevalence of any obsessive-compulsive symptom dimension was 13%. Harm/Checking was the most prevalent dimension (8%) followed by Somatic obsessions (5%) and Symmetry/Ordering (3%). Females were more likely to have symptoms in Contamination/Cleaning (OR=3, 95%CI=1.06-8.51) and Somatic obsessions (OR=1.88, 95%CI=1.05-3.37). All symptom dimensions were associated with an increased risk of most mental (but not physical) disorders. There were some differences in prevalence between countries. LIMITATIONS The interference associated with each symptom dimension could not be assessed. Few direct data are available on the validity of the CIDI to assess obsessive-compulsive symptom dimensions. CONCLUSIONS Obsessive-compulsive symptom dimensions are relatively frequent in the general population. Their sociodemographic and psychopathological correlates may be slightly different in clinical and community samples. They are associated with an increased risk of most mental disorders.
Collapse
|
85
|
de Graaf R, Radovanovic M, van Laar M, Fairman B, Degenhardt L, Aguilar-Gaxiola S, Bruffaerts R, de Girolamo G, Fayyad J, Gureje O, Haro JM, Huang Y, Kostychenko S, Lépine JP, Matschinger H, Mora MEM, Neumark Y, Ormel J, Posada-Villa J, Stein DJ, Tachimori H, Wells JE, Anthony JC. Early cannabis use and estimated risk of later onset of depression spells: Epidemiologic evidence from the population-based World Health Organization World Mental Health Survey Initiative. Am J Epidemiol 2010; 172:149-59. [PMID: 20534820 DOI: 10.1093/aje/kwq096] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Early-onset cannabis use is widespread in many countries and might cause later onset of depression. Sound epidemiologic data across countries are missing. The authors estimated the suspected causal association that links early-onset (age <17 years) cannabis use with later-onset (age > or =17 years) risk of a depression spell, using data on 85,088 subjects from 17 countries participating in the population-based World Health Organization World Mental Health Survey Initiative (2001-2005). In all surveys, multistage household probability samples were evaluated with a fully structured diagnostic interview for assessment of psychiatric conditions. The association between early-onset cannabis use and later risk of a depression spell was studied using conditional logistic regression with local area matching of cases and controls, controlling for sex, age, tobacco use, and other mental health problems. The overall association was modest (controlled for sex and age, risk ratio = 1.5, 95% confidence interval: 1.4, 1.7), was statistically robust in 5 countries, and showed no sex difference. The association did not change appreciably with statistical adjustment for mental health problems, except for childhood conduct problems, which reduced the association to nonsignificance. This study did not allow differentiation of levels of cannabis use; this issue deserves consideration in future research.
Collapse
|
86
|
Stegmann ME, Ormel J, de Graaf R, Haro JM, de Girolamo G, Demyttenaere K, Kovess V, Matschinger H, Vilagut G, Alonso J, Burger H. Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 2010; 124:38-44. [PMID: 19939461 PMCID: PMC3659772 DOI: 10.1016/j.jad.2009.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/30/2009] [Accepted: 10/31/2009] [Indexed: 01/11/2023]
Abstract
BACKGROUND The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor. METHODS Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression. RESULTS All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease. LIMITATIONS Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation. CONCLUSIONS Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.
Collapse
|
87
|
Luppa M, Luck T, Matschinger H, König HH, Riedel-Heller SG. Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+). BMC Health Serv Res 2010; 10:186. [PMID: 20584341 PMCID: PMC2909999 DOI: 10.1186/1472-6963-10-186] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/29/2010] [Indexed: 11/22/2022] Open
Abstract
Background In previous decades a substantial number of community-based studies mostly including dementia cases examined predictors of nursing home admission (NHA) among elderly people. However, no one study has analysed predictors of NHA for individuals without developing dementia before NHA. Methods Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA. Results Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. Conclusions Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.
Collapse
|
88
|
Holzinger A, Matschinger H, Drexler V, Angermeyer M. „Was denken Sie was ein Psychiater macht? … Und was denken Sie macht ein Psychotherapeut?”. PSYCHIATRISCHE PRAXIS 2010; 37:329-34. [DOI: 10.1055/s-0030-1248435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
89
|
Stein DJ, Chiu WT, Hwang I, Kessler RC, Sampson N, Alonso J, Borges G, Bromet E, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, He Y, Kovess-Masfety V, Levinson D, Matschinger H, Mneimneh Z, Nakamura Y, Ormel J, Posada-Villa J, Sagar R, Scott KM, Tomov T, Viana MC, Williams DR, Nock MK. Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS One 2010; 5:e10574. [PMID: 20485530 PMCID: PMC2869349 DOI: 10.1371/journal.pone.0010574] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/16/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues. METHODOLOGY/PRINCIPAL FINDINGS Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries. CONCLUSIONS/SIGNIFICANCE This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.
Collapse
|
90
|
König HH, Born A, Günther O, Matschinger H, Heinrich S, Riedel-Heller SG, Angermeyer MC, Roick C. Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders. Health Qual Life Outcomes 2010; 8:47. [PMID: 20444251 PMCID: PMC2873595 DOI: 10.1186/1477-7525-8-47] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 05/05/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The EQ-5D is a generic questionnaire which generates a health profile as well as index scores for health-related quality of life that may be used in cost-utility analysis. AIMS OF THE STUDY To examine validity and responsiveness of the EQ-5D in patients with anxiety disorders. METHODS 389 patients with anxiety disorders completed the EQ-5D at baseline and 6-month follow-up. Subjective measures of quality of life (WHOQOL-BREF) and psychopathology (BAI, BDI-II, BSQ, ACQ, MI) were used for comparison. Validity was analyzed by assessing associations between EQ-5D scores and related other scores. Responsiveness was analyzed by calculating effect sizes of differences in scores between baseline and follow-up for 3 groups indicating more, constant or less anxiety. Meaningful difference scores for shifting to less or more anxiety were derived by means of regression analysis. RESULTS 88.4% of respondents reported problems in at least one of the EQ-5D dimension at baseline; the mean EQ VAS score was 63.8. The EQ-5D dimension most consistently associated with the measures used for comparison was 'anxiety/depression'. EQ VAS and EQ-5D index scores were highly correlated (|r|>0.5) with scores of the WHOQOL-BREF dimensions 'physical', 'mental' and 'overall' as well as BAI and BDI-II. The EQ-5D index tended to be the most responsive score. Standardized meaningful difference scores were not significantly different between EQ VAS, EQ-5D index and measures used for comparison. CONCLUSIONS The EQ-5D seems to be reasonably valid and moderately responsive in patients with anxiety disorders. The EQ-5D index may be suitable for calculating QALYs in economic evaluation of health care interventions for patients with anxiety disorders. TRIAL REGISTRATION Current Controlled Trials ISRCTN15716049.
Collapse
|
91
|
Stein DJ, Ruscio AM, Lee S, Petukhova M, Alonso J, Andrade LHSG, Benjet C, Bromet E, Demyttenaere K, Florescu S, de Girolamo G, de Graaf R, Gureje O, He Y, Hinkov H, Hu C, Iwata N, Karam EG, Lepine JP, Matschinger H, Oakley Browne M, Posada-Villa J, Sagar R, Williams DR, Kessler RC. Subtyping social anxiety disorder in developed and developing countries. Depress Anxiety 2010; 27:390-403. [PMID: 20037919 PMCID: PMC2851829 DOI: 10.1002/da.20639] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. METHODS The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. RESULTS Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. CONCLUSION No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.
Collapse
|
92
|
Kessler RC, Birnbaum H, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ. Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety 2010; 27:351-64. [PMID: 20037917 PMCID: PMC3139270 DOI: 10.1002/da.20634] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late life. METHODS We investigated this issue by studying age differences in co-morbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys of respondents in 10 developed countries (n=52,485) and 8 developing countries (n=37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical co-morbidity. Physical conditions were assessed with a standard chronic conditions checklist. RESULTS Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of co-morbid mental disorders generally either decreased or remained stable with age, while co-morbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while co-morbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. CONCLUSIONS The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly.
Collapse
|
93
|
Olbrich S, Sander C, Trenner M, Matschinger H, Schönknecht P, Hegerl U. EEG-vigilance and the autonomic nervous system. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
94
|
Schomerus G, Holzinger A, Matschinger H, Lucht M, Angermeyer M. Einstellung der Bevölkerung zu Alkoholkranken. PSYCHIATRISCHE PRAXIS 2010; 37:111-8. [DOI: 10.1055/s-0029-1223438] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
95
|
Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, Bruffaerts R, Kovess V, Matschinger H, Vilagut G. Perceived stigma among individuals with common mental disorders. J Affect Disord 2009; 118:180-6. [PMID: 19285349 DOI: 10.1016/j.jad.2009.02.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 02/09/2009] [Accepted: 02/09/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Severe mental disorders are associated with social distance from the general population, but there is lack of data on the stigma reported by individuals with common mental disorders. AIMS To identify the correlates and the impact of stigma among individuals with common mental disorders. METHODS Cross-sectional, household interview survey of 8796 representing the non-institutionalized adults of Belgium, France, Germany, Italy, the Netherlands and Spain. Two perceived stigma questions (embarrassment and discrimination) were asked to respondents with significant disability. Health-related quality of life measured by the SF-12, work and activity limitation and social limitation were also assessed. RESULTS Among the 815 participants with a 12-month mental disorder and significant disability, 14.8% had perceived stigma. Stigma was significantly associated with low education, being married/living with someone and being unemployed. Perceived stigma was associated with decreased quality of life (SF-12 PCS score -4.65; p<0.05), higher work and role limitation and higher social limitation. CONCLUSION Individuals with mental disorders are more likely to report stigma if they have lower education, are married, or are unemployed. Perceived stigma is associated with considerably decrease in quality of life and role functioning. Health professionals and society at large must be aware of these findings, which suggest that fighting stigma should be a public health priority.
Collapse
|
96
|
Schomerus G, Matschinger H, Angermeyer MC. Attitudes that determine willingness to seek psychiatric help for depression: a representative population survey applying the Theory of Planned Behaviour. Psychol Med 2009; 39:1855-1865. [PMID: 19379538 DOI: 10.1017/s0033291709005832] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many people suffering from mental disorders do not seek appropriate help. We have examined attitudes that further or hinder help-seeking for depression with an established socio-psychological model, the Theory of Planned Behaviour (TPB), comparing models for respondents with and without depressive symptoms. METHOD A qualitative preparatory study (n=29) elicited salient behavioural (BB), normative (NB) and control beliefs (CB) that were later included in the TPB questionnaire. Telephone interviews with a representative population sample in Germany (n=2303) started with a labelled vignette describing symptoms of a major depression, followed by items covering the components of the TPB. Intention to see a psychiatrist for the problem described was elicited at the beginning and at the end of the interview. We screened participants for current depressive symptoms using the mood subscale of the Patient Health Questionnaire (PHQ-9). RESULTS In non-depressed respondents (n=2167), a TPB path model predicted 42% of the variance for the first and 51% for the second question on intention. In an analogous model for depressed respondents (n=136), these values increased to 50% and 61% respectively. Path coefficients in both models were similar. In both depressed and non-depressed persons, attitude towards the behaviour was more important than the subjective norm, whereas perceived behavioural control was of minor influence. CONCLUSIONS Willingness to seek psychiatric help for depression can largely be explained by a set of attitudes and beliefs as conceptualized by the TPB. Our findings suggest that changing attitudes in the general population are likely to effect help-seeking when people experience depressive symptoms.
Collapse
|
97
|
König HH, Born A, Heider D, Matschinger H, Heinrich S, Riedel-Heller SG, Surall D, Angermeyer MC, Roick C. Cost-effectiveness of a primary care model for anxiety disorders. Br J Psychiatry 2009; 195:308-17. [PMID: 19794198 DOI: 10.1192/bjp.bp.108.058032] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care. AIMS To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care. METHOD In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up. RESULTS No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <euro50 000 per quality-adjusted life year was below 10%. CONCLUSIONS The optimised care model did not prove to be cost-effective.
Collapse
|
98
|
Riedel-Heller S, Luck T, Matschinger H, Luppa M. Was Kohortenstudien für die Versorgungsforschung leisten können: Empirische Ergebnisse zur Institutionalisierung aus der Leipziger Langzeitstudie in der Altenbevölkerung (LEILA 75+). DAS GESUNDHEITSWESEN 2009. [DOI: 10.1055/s-0029-1239215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
99
|
Conrad I, Kilian R, Matschinger H, Angermeyer M, Riedel-Heller S. Lebensqualität älterer pflegender Angehöriger von Demenzkranken. DAS GESUNDHEITSWESEN 2009. [DOI: 10.1055/s-0029-1239279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
100
|
Schomerus G, Matschinger H, Angermeyer M. The stigma of psychiatric treatment and help-seeking intentions for depression. DAS GESUNDHEITSWESEN 2009. [DOI: 10.1055/s-0029-1239270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|