1
|
Boukhari FZ, Belayachi S, Essayagh F, Terkiba O, Naji AA, Amine M, Lambaki A, Essayagh M, Essayagh S, Essayagh T. Self-reported depression and its risk factors among hypertensive patients, Morocco: a cross-sectional study. Sci Rep 2024; 14:11196. [PMID: 38755268 PMCID: PMC11099232 DOI: 10.1038/s41598-024-61390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Hypertensive patients are at an elevated risk of developing mental diseases such as depression, which can impair their quality of life. The purpose of this study is to measure the prevalence of self-reported depression among hypertensive patients treated at primary health care facilities in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 1053 hypertensive patients attending primary health care facilities in Marrakech was conducted. A face-to-face questionnaire was used to collect socio-demographic, behavioral, and clinical data, as well as hypertension treatment characteristics and the care-patient-physician triad. The Patient Health Questionnaire-9 was used to assess self-reported depression. To identify self-reported depression risk factors, multivariate logistic regression was used. Depressive symptoms were reported by 56.1% of hypertensive patients. The patients' average age was 63.2 ± 9.5 years, and 508 (85.9%) were female. Female sex, stress, a low-salt diet, pain and physical discomfort, an urban living environment, a lack of self-monitoring of hypertension, an unsatisfactory relationship with the healthcare system, a family history of hypertension, and the perception of adverse effects of the antihypertensive drug were all associated with self-reported depression. Self-reported depression is prevalent among hypertensive patients in Marrakech. The mental health component should be emphasized while addressing hypertensive patients in primary health care facilities.
Collapse
Affiliation(s)
- Fatima Zahra Boukhari
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Safae Belayachi
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Firdaous Essayagh
- Faculté des sciences juridiques, économiques et sociales, Laboratoire droit privé et enjeux de développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Othmane Terkiba
- Institut supérieur des sciences de la santé, Laboratoire sciences et technologies de la santé, Hassan First University of Settat, Settat, Morocco
| | - Ahmed Anouar Naji
- Faculté des sciences juridiques, économiques et sociales, Laboratoire droit privé et enjeux de développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Mohammed Amine
- Faculty of medicine and pharmacy, Clinical research service, Mohammed VI university hospital center, Department of public health, epidemiology and community medicine, Laboratory of biosciences and health, Cadi Ayyad University, Marrakech, Morocco
| | - Abdellah Lambaki
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
| | - Meriem Essayagh
- Office national de sécurité sanitaire des produits alimentaires, Oriental, Morocco
| | - Sanah Essayagh
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Touria Essayagh
- Institut supérieur des sciences de la santé, Laboratoire sciences et technologies de la santé, Hassan First University of Settat, Settat, Morocco
| |
Collapse
|
2
|
Zhang Y, Wu T, Yu H, Fu J, Xu J, Liu L, Tang C, Li Z. Green spaces exposure and the risk of common psychiatric disorders: A meta-analysis. SSM Popul Health 2024; 25:101630. [PMID: 38405164 PMCID: PMC10885792 DOI: 10.1016/j.ssmph.2024.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To explore the effects of green spaces exposure on common psychiatric disorders. Methods PubMed, Embase, Web of Science and MEDLINE were screened and articles published prior to November 15, 2023 were included. Analyses were performed on common psychiatric disorders, categorized into depression, anxiety, dementia, schizophrenia, and attention deficit hyperactivity disorder (ADHD). And the subgroup analyses were conducted for depression, anxiety, dementia, and schizophrenia. Results In total, 2,0064 studies were retrieved, 59 of which were included in our study; 37 for depression, 14 for anxiety, 8 for dementia, 7 for schizophrenia and 5 for ADHD. Green spaces were found to benefit the moderation of psychiatric disorders (OR = 0.91, 95% CI: 0.89 to 0.92). Green spaces positively influence depression (OR = 0.89, 95% CI: 0.86 to 0.93), regardless of the cross-sectional or cohort studies. Green spaces can also help mitigate the risk of anxiety (OR = 0.94, 95%CI:0.92 to 0.96). As an important index for measuring green spaces, a higher normalized difference vegetation index (NDVI) level related to a lower level of depression (OR = 0.95, 95%CI:0.91 to 0.98) and anxiety (OR = 0.95, 95%:0.92 to 0.98). The protection was also found in dementia (OR = 0.95, 95% CI: 0.93 to 0.96), schizophrenia (OR = 0.74, 95% CI: 0.67 to 0.82), and ADHD (OR = 0.89, 95% CI: 0.86 to 0.92) results. Conclusion Green spaces decrease the risk of psychiatric disorders, including depression, anxiety, dementia, schizophrenia, and ADHD. Further studies on green spaces and psychiatric disorders are needed, and more green spaces should be considered in city planning.
Collapse
Affiliation(s)
- Yimin Zhang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Tongyan Wu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Hao Yu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, The Second Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Jianfei Fu
- Department of Medical Records and Statistics, Ningbo First Hospital, Ningbo, China
| | - Jin Xu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Liya Liu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Chunlan Tang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Zhen Li
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| |
Collapse
|
3
|
Montorsi C, Fusco A, Van Kerm P, Bordas SPA. Predicting depression in old age: Combining life course data with machine learning. ECONOMICS AND HUMAN BIOLOGY 2024; 52:101331. [PMID: 38035653 DOI: 10.1016/j.ehb.2023.101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 09/29/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
With ageing populations, understanding life course factors that raise the risk of depression in old age may help anticipate needs and reduce healthcare costs in the long run. We estimate the risk of depression in old age by combining adult life course trajectories and childhood conditions in supervised machine learning algorithms. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we implement and compare the performance of six alternative machine learning algorithms. We analyse the performance of the algorithms using different life-course data configurations. While we obtain similar predictive abilities between algorithms, we achieve the highest predictive performance when employing semi-structured representations of life courses using sequence data. We use the Shapley Additive Explanations method to extract the most decisive predictive patterns. Age, health, childhood conditions, and low education predict most depression risk later in life, but we identify new predictive patterns in indicators of life course instability and low utilization of dental care services.
Collapse
Affiliation(s)
- Carlotta Montorsi
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research (LISER), 11, Porte des Sciences L-4366, Esch-sur-Alzette, Luxembourg; Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Insubria University, Department of Economics, 71, via Monte Generoso 21100, Varese, Italy.
| | - Alessio Fusco
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research (LISER), 11, Porte des Sciences L-4366, Esch-sur-Alzette, Luxembourg
| | - Philippe Van Kerm
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research (LISER), 11, Porte des Sciences L-4366, Esch-sur-Alzette, Luxembourg; Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Stéphane P A Bordas
- Department of Engineering, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
4
|
Chen THK, Horsdal HT, Samuelsson K, Closter AM, Davies M, Barthel S, Pedersen CB, Prishchepov AV, Sabel CE. Higher depression risks in medium- than in high-density urban form across Denmark. SCIENCE ADVANCES 2023; 9:eadf3760. [PMID: 37224254 PMCID: PMC10208571 DOI: 10.1126/sciadv.adf3760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/19/2023] [Indexed: 05/26/2023]
Abstract
Urban areas are associated with higher depression risks than rural areas. However, less is known about how different types of urban environments relate to depression risk. Here, we use satellite imagery and machine learning to quantify three-dimensional (3D) urban form (i.e., building density and height) over time. Combining satellite-derived urban form data and individual-level residential addresses, health, and socioeconomic registers, we conduct a case-control study (n = 75,650 cases and 756,500 controls) to examine the association between 3D urban form and depression in the Danish population. We find that living in dense inner-city areas did not carry the highest depression risks. Rather, after adjusting for socioeconomic factors, the highest risk was among sprawling suburbs, and the lowest was among multistory buildings with open space in the vicinity. The finding suggests that spatial land-use planning should prioritize securing access to open space in densely built areas to mitigate depression risks.
Collapse
Affiliation(s)
- Tzu-Hsin Karen Chen
- School of the Environment, Yale University, New Haven, CT, USA
- Yale Institute for Biospheric Studies, Yale University, New Haven, CT, USA
- Department of Urban Design and Planning, University of Washington, Seattle, WA, USA
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Department of Geosciences and Natural Resource Management (IGN), University of Copenhagen, København V, Denmark
| | - Henriette Thisted Horsdal
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
| | - Karl Samuelsson
- ISGlobal, Barcelona, Spain
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Gävle, Sweden
- Department of Geospatial and Computer Sciences, University of Gävle, Gävle, Sweden
| | - Ane Marie Closter
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
| | - Megan Davies
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Section of Epidemiology, University of Copenhagen, København K, Denmark
| | - Stephan Barthel
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Gävle, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Carsten Bøcker Pedersen
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus V, Denmark
| | - Alexander V. Prishchepov
- Department of Geosciences and Natural Resource Management (IGN), University of Copenhagen, København V, Denmark
| | - Clive E. Sabel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Department of Public Health, Aarhus University, Aarhus V, Denmark
| |
Collapse
|
5
|
Moussa S, Malaeb D, Obeid S, Hallit S. Correlates of Positivity Among a Sample of Lebanese University Students. Front Psychol 2022; 13:880437. [PMID: 35548518 PMCID: PMC9084318 DOI: 10.3389/fpsyg.2022.880437] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background People say it is hard to stay truly positive in Lebanon. Studies showed that 63% of Lebanese young adults are highly dissatisfied with their country. In fact, young adults are the most vulnerable population to stressors in Lebanon since their future is at stake and it is their time to shape their lives in a country that cripples them. This study aimed to assess factors (flourishing, religious coping, experiences in life, and the economic burden) associated with positivity among a sample of Lebanese university students despite the various stressors they are facing on top of the economic collapse and the COVID-19 pandemic. Methods This cross-sectional study was conducted between November and December 2021. A total of 333 participants (219 females and 114 males; mean age = 22.95 ± 4.79 years) was recruited through convenience sampling and snowball technique through several areas in Lebanon's governorates. A linear regression taking the positivity score as the dependent variable was adopted and all variables that showed a correlation > │0.24│ in absolute value were entered in the final model as independent. Results A linear regression taking the positivity score as the dependent variable showed that more positive experiences in life (Beta = 0.49; 95% CI 0.35-0.62), more flourishing (Beta = 0.10; 95% CI 0.05-0.14), living in rural area compared to urban (Beta = 3.06; 95% CI 2.02-4.11), and female gender (Beta = 1.56; 95% CI 0.50-2.61) were significantly associated with more positivity (Nagelkerke R 2 of the model = 45.8%). Conclusion This study demonstrated that the youth's positivity is strongly affected by age, gender, residency, and the country they live in that will both directly and indirectly shape their life experiences and their ability to flourish and prosper. Along with all the efforts done to help during this collapse and alleviate the stress that young adults are enduring, follow-up studies are still needed to determine accurate coping techniques that pushes these young adults to think positively in a country where negativity reigns and all else fails.
Collapse
Affiliation(s)
- Sara Moussa
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Department of Psychology, College of Humanities, Effat University, Jeddah, Saudi Arabia.,Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| |
Collapse
|
6
|
Oh H, Nicholson HL, Koyanagi A, Jacob L, Glass J. Urban upbringing and psychiatric disorders in the United States: A racial comparison. Int J Soc Psychiatry 2021; 67:307-314. [PMID: 32820966 DOI: 10.1177/0020764020950781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States. METHODS We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately. RESULTS The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders. CONCLUSIONS Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.
Collapse
Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harvey L Nicholson
- Sociology and Crimininology & Law, University of Florida, Gainesville, FL, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Joe Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| |
Collapse
|
7
|
Catalá P, Blanco S, Perez-Calvo S, Luque-Reca O, Bedmar D, Peñacoba C. Does the Rural Environment Influence Symptomatology and Optimize the Effectiveness of Disease Acceptance? A Study Among Women With Fibromyalgia. Front Psychol 2021; 12:658974. [PMID: 33995219 PMCID: PMC8116886 DOI: 10.3389/fpsyg.2021.658974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
The present study aims to explore whether the symptoms associated with fibromyalgia are contextually influenced by the area of residence (rural/urban). Furthermore, it is analyzed whether the effect of the acceptance of the disease on the emotional, cognitive and physical symptoms is moderated by the patients' place of residence. Using a cross-sectional design, a total of 234 women with fibromyalgia (mean age = 56.91 years; SD = 8.94) were surveyed, of which 55.13% resided in rural areas and 44.87% in urban areas. Self-reported questionnaires were used to assess pain severity, anxiety and depression, functional limitation, physical and mental fatigue and acceptance of the disease. The results show significant differences in acceptance (p = 0.040), pain (p < 0.001), and physical and mental fatigue (p = 0.003 and p = 0.004, respectively) between patients from rural and urban areas. The rural area patients presented higher levels of acceptance and pain and lesser levels of physical and mental fatigue compared to the urban area. The moderation analysis add that, only in patients from the rural area, the variables of physical symptoms (pain, functional limitation, and physical fatigue) were significantly and negatively associated with acceptance. This study addresses for the first time the role of the place of residence in suffering from fibromyalgia, suggesting that the rural or urban environment plays a relevant role in the severity and/or management of symptoms in fibromyalgia women. Limitations and practical implications are also discussed.
Collapse
Affiliation(s)
- Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Sheila Blanco
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | | | | | - Dolores Bedmar
- Pain Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
8
|
Rural-Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062818. [PMID: 33802054 PMCID: PMC7999321 DOI: 10.3390/ijerph18062818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.
Collapse
|
9
|
Schweda A, Weismüller B, Bäuerle A, Dörrie N, Musche V, Fink M, Kohler H, Teufel M, Skoda EM. Phenotyping mental health: Age, community size, and depression differently modulate COVID-19-related fear and generalized anxiety. Compr Psychiatry 2021; 104:152218. [PMID: 33232827 DOI: 10.1016/j.comppsych.2020.152218] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION When the first COVID-19 infections were reported in Germany, fear and anxiety spread faster than the pandemic itself. While moderate amounts of fear of a COVID-19 infection may be functional, generalized anxiety and the potentially resulting distress and psychopathology may possibly be detrimental to people's health. Authorities need to avoid a countrywide panic, on the one hand, but foster a realistic awareness of the actual threat, on the other hand. OBJECTIVES The current cross-sectional study aimed to investigate psychological reactions in response to the real or perceived infection threats. In particular, the analysis should reveal whether COVID-19-related fear and generalized anxiety in times of COVID-19 have distinct correlates. METHODS A nationwide study was conducted from March 10th to May 4th 2020 in Germany (n = 15,308; 10,824 women, 4433 men, 51 other). Generalized anxiety was assessed using the GAD-7, while COVID-19-related fear was measured using a self-generated item. Both outcome variables were entered into linear regression models. Demographic information, depressive symptoms, trust in governmental interventions, subjective level of information regarding COVID-19 and media use were used to predict generalized anxiety and COVID-19-related fear. RESULTS The data revealed distinct correlates of COVID-19-related fear and generalized anxiety. Although COVID-19-related fear and generalized anxiety had overlapping predictors, such as neuroticism, they most prominently differed in age distribution and direction of an urban-rural disparity: generalized anxiety decreases with age, but COVID-19-related fear is most pronounced in elderly participants. Generalized anxiety is also more prevalent in rural communities, but COVID-19-related fear is elevated in metropoles. Furthermore, the presence of a risk disease increases COVID-19-related fear, but not generalized anxiety. CONCLUSION These results suggest that COVID-19-related fear is often justified considering the individual risk of infection or complication due to infection. Some of the characteristics that predict COVID-19-related fear leave generalized anxiety unaffected or show divergent predictive directions. The present findings hint toward two related, but discriminant constructs.
Collapse
Affiliation(s)
- Adam Schweda
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany.
| | - Benjamin Weismüller
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Alexander Bäuerle
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Nora Dörrie
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Venja Musche
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Madeleine Fink
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Hannah Kohler
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Martin Teufel
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| |
Collapse
|
10
|
Han X, Ku L. Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care. Health Aff (Millwood) 2020; 38:2061-2068. [PMID: 31794314 DOI: 10.1377/hlthaff.2019.00823] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Community health centers are a vital part of the primary and behavioral health care systems in rural areas. We compared behavioral health care staffing and services in rural and urban centers. In the period 2013-17 the overall staff-to-patient ratio in behavioral health rose by 66 percent in rural centers, faster than growth in urban centers (49 percent). Growth in both settings was mostly driven by clinical social workers and other licensed mental health providers; staffing by psychiatrists and psychologists changed only slightly. In rural centers the average adjusted increase in annual visits per additional behavioral health staff member was 411 for substance use disorders, slightly higher than at urban centers. Additional annual visits per additional staff member in rural centers were 539 for depression, 466 for anxiety, and 300 for other mental disorders, similar to the numbers in urban centers. Behavioral health staff currently participating in the National Health Service Corps (NHSC) contributed more to visits for depression and anxiety in rural centers, compared to both their urban counterparts and non-NHSC staff in rural centers. Enhancing behavioral health staffing in rural community health centers could help reduce the urban-rural gap in the availability of behavioral health services, but still more could be done.
Collapse
Affiliation(s)
- Xinxin Han
- Xinxin Han is a postdoctoral fellow at Tsinghua University School of Medicine, in Beijing, China. She was a senior research associate at the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, in Washington, D.C., when this article was written
| | - Leighton Ku
- Leighton Ku ( lku@gwu. edu ) is a professor in the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University
| |
Collapse
|
11
|
Abstract
RésuméLes auteurs font la revue des études récentes concernant l’épidémiologie de la dépression. Les études épidémiologiques de la dépression dans la population générale sont difficiles à interpréter, du fait de différences dans l'identification des cas et de variations dans les procédures de diagnostic entre les études. Mais il y a eu un progrés considérable avec le récent développement des méthodes d’identifications de cas, fiables et valides, comme les RDC et le DSM-III. D’autres problémes méthodologiques concernent le choix de la population et le choix des différentes mesures du risque.Des données examinées, on peut tirer les estimations suivantes : la prévalence sur six mois de la dépression majeure est de 1% à 3% chez l’homme, et 3% à 5% chez la femme; la prévalence sur la vie entiere (proportion des sujets qui ont déjà présenté le trouble) est de 3% à 6% chez l’homme et 5% à 10% chez la femme. L’estimation du risque morbide (ou risque sur la vie entiére) est plus difficile. Le principal probléme provient de l’effet de cohorte de naissance: il semble que les taux de troubles affectifs majeurs sont en train d’augmenter dans les cohortes nées apres la Seconde Guerre mondiale.Aussi, les auteurs proposent une estimation des risques sur la vie entiére qui ne peut être que prudente: 6 à 10% chez l’homme, 12 à 20% chez la femme. Ils envisagent aussi l’épidemiologie de la dépression sous l’angle de la mortalité: les troubles affectifs sont associés non seulement à un haut risque de suicide mais aussi à une mortalité générale augmentée.
Collapse
|
12
|
Jansson L, Sonnander K, Wiesel FA. Clients with long-term mental disabilities in a Swedish county—conditions of life, needs of support and unmet needs of service provided by the public health and social service sectors. Eur Psychiatry 2020; 18:296-305. [PMID: 14611925 DOI: 10.1016/j.eurpsy.2003.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractObjectiveThe purpose of the study was to identify and describe conditions of life and needs of support and public service for clients with a mental disability in a Swedish county population.MethodsPublic health care and social service providers identified clients and completed a questionnaire concerning the clients’ conditions of life and their special needs. A consecutively recruited sample of clients completed a similar questionnaire.ResultsTotally, 1261 clients were identified. The prevalence of clients with mental disabilities was in the urban and rural areas, 6.4/1000 inhabitants and 4.5/1000 inhabitants, respectively. The most prevalent unmet need (42.9%) was to participate in social and scheduled activities. Almost half of the group was reported to need support in activities of daily living. Clients living in urban settings more often needed support with activities of daily living (P < 0.001), whereas clients living in rural settings more often needed support with job training (P < 0.001) or finding work (P < 0.01). Clients and psychiatric care providers reported the needs of the clients in the same areas; however, clients reported a fewer number of needs than did the care providers.ConclusionsBy using both psychiatric care and social service providers, effective case findings of clients with a mental disability were possible to achieve. In general, there was high agreement between psychiatric care providers and clients regarding the clients’ number of needs of support and their unmet needs of service. However, at the individual level, the agreement between client and psychiatric care providers was lower.
Collapse
Affiliation(s)
- Lennart Jansson
- Department of Neuroscience, Psychiatry, Ulleråker, Uppsala University Hospital, 750 17 Uppsala, Sweden.
| | | | | |
Collapse
|
13
|
Depressive symptoms and suicidal behavior among general population adolescents and young adults across Greece. Eur Psychiatry 2020. [DOI: 10.1017/s0924933800001929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SummaryThe authors conducted a home survey investigating the prevalence of self-reported symptoms of depression, suicidal ideation and suicidal attempts among a probability nationwide sample of 1316 adolescents aged 12-17 and 1114 young adults aged 18-24. Depressive symptoms were detected by the use of the Center for Epidemiologic Studies-Depression scale. 20.3% of adolescents and 35.7% of young adults were characterized as being depressed. Similar differences between the two age groups in the prevalence rates of suicidal ideation and attempts were observed. Suicide attempters of both age groups reported a higher number of depressive symptoms compared with the non attempters. Characteristics that distinguished the suicide attempters from the total sample were low rates of school attendance, use of substances, previous psychiatric help-seeking and additional mental health problems in families.
Collapse
|
14
|
Assari S. Ethnicity, educational attainment, and physical health of older adults in the United States. Aging Med (Milton) 2019; 2:104-111. [PMID: 31608316 PMCID: PMC6788632 DOI: 10.1002/agm2.12050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 12/29/2018] [Accepted: 01/01/2019] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Minorities' diminished returns theory suggests that socioeconomic status (SES) resources generate fewer health benefits for racial and ethnic minority groups, compared to the majority group. The current study aimed to compare Hispanic and non-Hispanic white older adults for the association between educational attainment and poor physical self-rated health (SRH). METHODS The first wave of the University of Michigan National Poll on Healthy Aging (UM-NPHA) included 1820 older adults who were 50-80 years old and were either non-Hispanic white (n = 1618) or Hispanic white (n = 202). The main independent variable of interest was educational attainment. The main dependent variable of interest was poor physical SRH. Gender, age, marital status, and employment status were covariates. Ethnicity was the focal effect modifier. RESULTS Overall, higher level of educational attainment was associated with better physical SRH. A significant interaction was found between ethnicity and level of educational attainment, which was indicative of a smaller physical SRH gain due to high educational attainment for Hispanic white compared to non-Hispanic white older adults. In ethnic-specific models, we found evidence suggesting that high educational attainment reduced the odds of poor physical SRH for non-Hispanic whites but not for Hispanic whites. CONCLUSION Compared to non-Hispanic whites, Hispanic whites gain less physical SRH benefits from their educational attainment.
Collapse
Affiliation(s)
- Shervin Assari
- Department of PsychologyUniversity of California Los Angeles (UCLA)Los AngelesCalifornia
- Center for Research on Ethnicity, Culture, and Health (CRECH)School of Public HealthUniversity of MichiganAnn ArborMichigan
- Department of PsychiatryUniversity of MichiganAnn ArborMichigan
| |
Collapse
|
15
|
Piccirillo ML, Levinson CA, Rodebaugh TL. The effect of urbanicity on internalizing disorders. J Clin Psychol 2019; 75:1129-1139. [PMID: 30817000 DOI: 10.1002/jclp.22766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/29/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Urbanicity is a known risk factor for psychopathology, yet the term urbanicity has been used to describe multiple constructs, resulting in mixed findings across the social sciences literature. METHODS We used the National Survey of American Life (N = 6,082) to construct a structural equation model of urbanicity and internalizing disorders. Urbanicity was measured using both neighborhood characteristics, as well as population-based measures. We hypothesized that urbanicity would predict higher rates of internalizing disorders. RESULTS Neighborhood quality (b* = 0.18, p < 0.001) was the strongest predictor of psychopathology in the final model. Population-based indicators were not significant predictors of internalizing disorders. CONCLUSIONS Results suggest that neighborhood characteristics, rather than population-based indicators, may be better predictors of psychopathology. Future research should continue to develop and examine structural interventions. Integration of allied mental health professionals may help to alleviate negative health outcomes associated with poor neighborhood quality.
Collapse
Affiliation(s)
- Marilyn L Piccirillo
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
16
|
Crossley NA, Alliende LM, Ossandon T, Castañeda CP, González-Valderrama A, Undurraga J, Castro M, Guinjoan S, Díaz-Zuluaga AM, Pineda-Zapata JA, López-Jaramillo C, Reyes-Madrigal F, León-Ortíz P, de la Fuente-Sandoval C, Czepielewski LS, Gama CS, Zugman A, Gadelha A, Jackowski A, Bressan R. Imaging Social and Environmental Factors as Modulators of Brain Dysfunction: Time to Focus on Developing Non-Western Societies. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:8-15. [PMID: 30396768 DOI: 10.1016/j.bpsc.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022]
Abstract
Social and environmental factors are known risk factors and modulators of mental health disorders. We here conducted a nonsystematic review of the neuroimaging literature studying the effects of poverty, urbanicity, and community violence, highlighting the opportunities of studying non-Western developing societies such as those in Latin America. Social and environmental factors in these communities are widespread and have a large magnitude, as well as an unequal distribution, providing a good opportunity for their characterization. Studying the effect of poverty in these settings could help to explore the brain effect of economic improvements, disentangle the effect of absolute and relative poverty, and characterize the modulating impact of poverty on the underlying biology of mental health disorders. Exploring urbanicity effects in highly unequal cities could help identify the specific factors that modulate this effect as well as examine a possible dose-response effect by studying megacities. Studying brain changes in those living among violence, which is particularly high in places such as Latin America, could help to characterize the interplay between brain predisposition and exposure to violence. Furthermore, exploring the brain in an adverse environment should shed light on the mechanisms underlying resilience. We finally provide examples of two methodological approaches that could contribute to this field, namely a big cohort study in the developing world and a consortium-based meta-analytic approach, and argue about the potential translational value of this research on the development of effective social policies and successful personalized medicine in disadvantaged societies.
Collapse
Affiliation(s)
- Nicolas A Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Center and Center for Integrative Neuroscience, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom.
| | - Luz Maria Alliende
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomas Ossandon
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Alfonso González-Valderrama
- Early Intervention Program, José Horwitz Psychiatric Institute, Santiago, Chile; School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Juan Undurraga
- Early Intervention Program, José Horwitz Psychiatric Institute, Santiago, Chile; Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Mariana Castro
- FLENI Foundation, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salvador Guinjoan
- FLENI Foundation, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ana M Díaz-Zuluaga
- Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | | | - Carlos López-Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia; Mood Disorders Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Pablo León-Ortíz
- Laboratory of Experimental Psychiatry, Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Leticia Sanguinetti Czepielewski
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clarissa S Gama
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andre Zugman
- Laboratory of Interdisciplinary Clinical Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ary Gadelha
- Laboratory of Interdisciplinary Clinical Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Andrea Jackowski
- Laboratory of Interdisciplinary Clinical Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Bressan
- Laboratory of Interdisciplinary Clinical Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
17
|
Assari S. Blacks' Diminished Return of Education Attainment on Subjective Health; Mediating Effect of Income. Brain Sci 2018; 8:E176. [PMID: 30213135 PMCID: PMC6162786 DOI: 10.3390/brainsci8090176] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Minorities' Diminished Return (MDR) can be defined as smaller health gains from socioeconomic status (SES) indicators, such as education attainment among ethnic minorities compared to the majority group. The current study tested whether income explains why Black and White adults differ in the association between education attainment and self-rated health (SRH). Methods: With a cross-sectional design, this study used data from Cycle 5 of the Health Information National Trends Survey (HINTS), 2017. With a nationally representative sample, the HINTS study generates results that are generalizable to US adults. This study included 2277 adults who were either non-Hispanic White (n = 1868; 82%) or non-Hispanic Black (n = 409; 18%). The independent variable was education attainment. The dependent variable was SRH, measured using a standard single item. Age, gender, and health insurance status were covariates. Ethnicity was the focal moderator. Income was the mediator. A structural equation model (SEM) was applied for data analysis. Results: Overall, higher education attainment was associated with better SRH, net of covariates. However, a significant interaction between ethnicity and education attainment suggested a smaller SRH gain from education for Blacks compared to Whites. This interaction could be explained by Black⁻White differences in income. Conclusion: Our study results suggests that labor market preferences may explain smaller effects of education attainment on SRH for Blacks relative to Whites. Given this finding and other studies documenting MDR, policies should reduce labor market discrimination, increasing job opportunities and reducing the racial pay gap for Blacks. Programs should help Blacks compete for prestigious and high-paying jobs.
Collapse
Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd.; Ann Arbor, MI 48109-2700, USA.
| |
Collapse
|
18
|
Assari S, Lapeyrouse LM, Neighbors HW. Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans. Behav Sci (Basel) 2018; 8:E50. [PMID: 29772799 PMCID: PMC5981244 DOI: 10.3390/bs8050050] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background: The minorities' diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black⁻White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities' diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.
Collapse
Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd.; Ann Arbor, MI 48109-2700, USA.
| | - Lisa M Lapeyrouse
- Department of Public Health and Health Sciences, University of Michigan, Flint, MI 48502, USA.
| | - Harold W Neighbors
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI 48502, USA.
| |
Collapse
|
19
|
Smith AJ, Ramana R. Mental health in rural areas: experience in south Cambridgeshire. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.22.5.280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mental health morbidity is perceived as being predominantly urban based. Little is known about the health of the UK's rural residents. This paper summarises existing knowledge of rural health and social indicators. There is a relative dearth of information in this area making the application of urban-based (and biased) factors perhaps unreliable. Some rural areas have levels of deprivation similar to urban areas, even using urban-biased factors, though they encounter specific problems of service provision and accessibility. Currently, there seems to be no valid method of measuring rural deprivation and comparing it with urban deprivation. We highlight this inequality by describing discrepancies in day care provision between urban and rural areas.
Collapse
|
20
|
Abstract
A significant proportion of people live and work in rural areas, and rural mental health is important wherever psychiatry is practised. There are inherent difficulties in conducting rural research, due in part to the lack of an agreed definition of rurality. Mental health is probably better in rural areas, with the exception of suicide, which remains highest in male rural residents. A number of aspects of rural life (such as the rural community, social networks, problems with access, and social exclusion) may all have particular implications for people with mental health problems. Further issues such as the effect of rural culture on help-seeking for mental illness, anonymity in small rural communities and stigma may further affect the recognition, treatment and maintenance of mental health problems for people in rural areas. Providing mental health services to remote and rural locations may be challenging.
Collapse
|
21
|
Van Dorn RA, Desmarais SL, Rade CB, Burris EN, Cuddeback GS, Johnson KL, Tueller SJ, Comfort ML, Mueser KT. Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial. Trials 2017; 18:365. [PMID: 28778175 PMCID: PMC5545037 DOI: 10.1186/s13063-017-2088-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. METHODS/DESIGN Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. DISCUSSION Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02214667 . Registered on 10 August 2014.
Collapse
Affiliation(s)
- Richard A Van Dorn
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Candalyn B Rade
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Elizabeth N Burris
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kiersten L Johnson
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Stephen J Tueller
- Risk Behavior and Family Research Program, RTI International, Research Triangle Park, Durham, NC, 27709, USA
| | - Megan L Comfort
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, 02215, USA
| |
Collapse
|
22
|
Gaviria SL, Alarcón RD, Espinola M, Restrepo D, Lotero J, Berbesi DY, Sierra GM, Chaskel R, Espinel Z, Shultz JM. Socio-demographic patterns of posttraumatic stress disorder in Medellin, Colombia and the context of lifetime trauma exposure. DISASTER HEALTH 2017; 3:139-150. [PMID: 28265488 DOI: 10.1080/21665044.2016.1263086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
Colombia, South America is currently transitioning to post-conflict status following 6 decades of armed conflict. The population has experienced extensive exposures to potentially traumatic events throughout the lifespan. Sources of trauma exposure include the prolonged armed insurgency, narco-trafficking violence, urban gang violence, violent actions of criminal bands, intra-familial violence, gender-based violence, and sex trafficking. Exposure to potentially traumatic events is related to a variety of psychiatric outcomes, in particular, posttraumatic stress disorder. Given this context of lifetime trauma exposure, socio-demographic patterns of posttraumatic stress disorder were explored in a sample of residents of Medellin, Colombia, the nation's second largest city and a nexus for multiple types of trauma exposure.
Collapse
Affiliation(s)
| | - Renato D Alarcón
- Universidad Peruana Cayetano Heredia, Lima, Peru; Mayo Clinic, Rochester, MN, USA
| | - Maria Espinola
- Department of Psychiatry and Behavioral Neuroscience, Clinical Psychiatry, University of Cincinnati College of Medicine , Cincinnati, OH, USA
| | - Diana Restrepo
- Department of Psychiatry, Universidad CES , Medellín, Colombia
| | - Juliana Lotero
- Department of Psychiatry, Universidad CES , Medellín, Colombia
| | - Dedsy Y Berbesi
- Department of Psychiatry, Universidad CES , Medellín, Colombia
| | | | - Roberto Chaskel
- Child and Adolescent Psychiatry, Fundación Santa Fe de Bogotá, Escuela Militar de Medicina, Escuela Militar Nueva Granada, Hospital Militar Central, Universidad El Bosque, Universidad de Los Andes , Bogotá, Colombia
| | - Zelde Espinel
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, and Jackson Memorial Hospital , Miami, FL, USA
| | - James M Shultz
- Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine , Miami, FL, USA
| |
Collapse
|
23
|
Blazer D. The Three Cs of a Scientific Autobiography: Curiosity, Circumstance, and Colleagues. Am J Geriatr Psychiatry 2016; 24:943-948. [PMID: 27633898 DOI: 10.1016/j.jagp.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Dan Blazer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3003, Durham, NC 27710.
| |
Collapse
|
24
|
Staley D, Wand RR. Obsessive-Compulsive Disorder: A Review of the Cross-Cultural Epidemiological Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136346159503200201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early clinical studies suggested that obsessive-compulsive disorder (OCD) was a rare disorder, but recent large-scale epidemiological research conducted in North America using standardized diagnostic criteria (DSM-III) report prevalence rates between 1 to 3%. A review of clinical and case reports of OCD among psychiatric population in non-Western countries reveals similar sociodemographic and clinical correlates for the disorder compared to Western findings. Epidemiological studies using translated versions of standardized diagnostic instruments and conducted in non-Western countries, report similar prevalence rates and clinical phenomenology for O CD as that found in Western settings. Methodological and measurement issues relevant to conducting valid cross- cultural psychiatric research are discussed in relationship to the diagnosis of OCD. The review concludes that OCD is generally similar in prevalence, sociodemographic characteristics and clinical features in both Western and non-Western countries for adult populations.
Collapse
|
25
|
Cairney J, Krause N. The Social Distribution of Psychological Distress and Depression in Older Adults. J Aging Health 2016; 17:807-35. [PMID: 16377773 DOI: 10.1177/0898264305280985] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study examines the associations between social position and mental health and explores whether differences in distress and depression by social position can be accounted for by differences in the major components of the stress process model. We extend previous work by including an ethnocultural measure alongside more traditional measures of social position. Method: Secondary data analysis of the 1994 National Population Health Survey. Results: Consistent with findings from studies of younger adults, mental health in later life is determined in part by age, gender, marital status, education, and ethnocultural factors. The data indicate that the life experiences connected to these social positions are largely responsible for these effects. Discussion: Our findings suggest that key social factors are related to mental health in late life, because one’s position in the social structure shapes the stressors they encounter and the resources they have at their disposal to cope with them.
Collapse
Affiliation(s)
- John Cairney
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, University of Toronto, 3rd Floor Tower T320, 33 Russell Street, Toronto, ON Canada.
| | | |
Collapse
|
26
|
Canino GJ, Rubio-Stipec M, Shrout P, Bravo M, Stolberg R, Bird HR. Sex Differences and Depression in Puerto Rico. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/j.1471-6402.1987.tb00917.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sex differences in rates of depressive disorders and depressive symptomatology, as measured by the Diagnostic Interview Schedule, are examined for an island-wide probability sample of Puerto Rico. Consistent with previous research, depression is significantly more prevalent in Puerto Rican women than men. Risk factors associated with depressive symptomatology are examined from a sex-role perspective. The results of multiple regression analyses show that even after demographic, health and marital and employment status variables are controlled, women continue to be at higher risk of depressive symptomatology than men. These results are interpreted within a cultural and sex-role perspective.
Collapse
|
27
|
Weaver A, Himle JA, Taylor RJ, Matusko NN, Abelson JM. Urban vs Rural Residence and the Prevalence of Depression and Mood Disorder Among African American Women and Non-Hispanic White Women. JAMA Psychiatry 2015; 72:576-83. [PMID: 25853939 PMCID: PMC4456259 DOI: 10.1001/jamapsychiatry.2015.10] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is a paucity of research among African Americans and rural residents. Little is known about the association between urbanicity and depression or about the interaction of urbanicity, race/ethnicity, and sex on depression and mood disorder prevalence. OBJECTIVE To examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month major depressive disorder (MDD) and mood disorder prevalence for African American women and non-Hispanic white women. DESIGN, SETTING, AND PARTICIPANTS The US National Survey of American Life data were used to examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month diagnoses of DSM-IV MDD and mood disorder among female respondents, who included noninstitutionalized African American, Caribbean black, and non-Hispanic white women in the United States between February 2001 and June 2003. Participants included 1462 African American women and 341 non-Hispanic white women recruited from the South because all suburban and rural National Survey of American Life respondents resided in this region. Bivariate multiple logistic regression and adjusted prevalence analyses were performed. Urban, suburban, or rural location (assessed via Rural-Urban Continuum Codes), self-reported race/ethnicity, and sociodemographic factors (age, education, household income, and marital status) were included in the analysis. MAIN OUTCOMES AND MEASURES Lifetime and 12-month MDD and mood disorder assessed via the World Mental Health Composite International Diagnostic Interview. RESULTS Compared with urban African American women, rural African American women had a significantly lower odds of meeting criteria for lifetime (odds ratio [OR], 0.39; 95% CI, 0.23-0.65) and 12-month (OR, 0.29; 95% CI, 0.18-0.46) MDD and for lifetime (F = 0.46; 95% CI, 0.29-0.73) and 12-month (F = 0.42; 95% CI, 0.26-0.66) mood disorder. However, the interaction of urbanicity and race/ethnicity suggested that rural non-Hispanic white women had a significantly higher odds of meeting criteria for lifetime (OR, 2.76; 95% CI, 1.22-6.24) and 12-month (OR, 9.48; 95% CI, 4.65-19.34) MDD and for lifetime (OR, 2.27; 95% CI, 1.06-4.87) and 12-month (OR, 5.99; 95% CI, 3.01-11.94) mood disorder than rural African American women. Adjusted prevalence analyses revealed significantly lower rates of lifetime (4.2%) and 12-month (1.5%) MDD among rural African American women than their urban counterparts (10.4% vs 5.3%; P ≤ .01). The same pattern was found for mood disorder, with rural African American women experiencing significantly lower rates of lifetime (6.7%) and 12-month (3.3%) mood disorder when compared to urban African American women (13.9% vs 7.6%; P ≤ .01) Conversely, rural non-Hispanic white women had significantly higher rates of 12-month MDD (10.3%) and mood disorder (10.3%) than their urban counterparts (3.7% vs 3.8%; P ≤ .01). CONCLUSIONS AND RELEVANCE Rural residence differentially influences MDD and mood disorder prevalence among African American women and non-Hispanic white women. These findings offer a first step toward understanding the cumulative effect of rural residence and race/ethnicity on women's depression prevalence, suggesting the need for further research in this area.
Collapse
Affiliation(s)
- Addie Weaver
- School of Social Work, University of Michigan, Ann Arbor
| | - Joseph A. Himle
- School of Social Work, University of Michigan, Ann Arbor2Department of Psychiatry, University of Michigan, Ann Arbor
| | - Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor3Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor
| | - Niki N. Matusko
- Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor
| | - Jamie M. Abelson
- Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor
| |
Collapse
|
28
|
Arévalo SP, Tucker KL, Falcón LM. Beyond cultural factors to understand immigrant mental health: Neighborhood ethnic density and the moderating role of pre-migration and post-migration factors. Soc Sci Med 2015; 138:91-100. [PMID: 26057720 DOI: 10.1016/j.socscimed.2015.05.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pre-migration and post-migration factors may influence the health of immigrants. Using a cross-national framework that considers the effects of the sending and receiving social contexts, we examined the extent to which pre-migration and post-migration factors, including individual and neighborhood level factors, influence depressive symptoms at a 2-year follow-up time point. Data come from the Boston Puerto Rican Health Study, a population-based prospective cohort of Puerto Ricans between the ages of 45 and 75 y. The association of neighborhood ethnic density with depressive symptomatology at follow-up was significantly modified by sex and level of language acculturation. Men, but not women, experienced protective effects of ethnic density. The interaction of neighborhood ethnic density with language acculturation had a non-linear effect on depressive symptomatology, with lowest depressive symptomatology in the second highest quartile of language acculturation, relative to the lowest and top two quartiles among residents of high ethnic density neighborhoods. Results from this study highlight the complexity, and interplay, of a number of factors that influence the health of immigrants, and emphasize the significance of moving beyond cultural variables to better understand why the health of some immigrant groups deteriorates at faster rates overtime.
Collapse
Affiliation(s)
- Sandra P Arévalo
- College of Health Sciences, Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Weed Hall, Lowell, MA 01854, USA.
| | - Katherine L Tucker
- College of Health Sciences, Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Weed Hall, Lowell, MA 01854, USA
| | - Luis M Falcón
- College of Fine Arts, Humanities and Social Sciences, University of Massachusetts at Lowell, 150 Wilder St., Lowell, MA 01854, USA
| |
Collapse
|
29
|
Lee EW, Park JH. Individual and socioeconomic contextual effects on depressive symptom in Korea: multilevel analysis of cross-sectional nationwide survey. J Korean Med Sci 2015; 30:186-93. [PMID: 25653491 PMCID: PMC4310946 DOI: 10.3346/jkms.2015.30.2.186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/01/2014] [Indexed: 11/24/2022] Open
Abstract
This study was aimed to examine the relationship between individual, socioeconomic context and depressive symptom among Korean population. Data were the Korean Community Health Survey (KCHS), a nationwide survey collected from 253 local communities including 230,715 adults aged 19 yr or over. To identify depressive symptom, the Center for Epidemiologic Studies Depression scale (CES-D) was used. This study employed multilevel logistic regression to analyze the hierarchical data that included individual and community level variables. The results of this study showed that people in the highest level of community income had a higher risk of depressive symptom compared with people in the lowest (OR, 1.6; 95% CI, 1.4-1.9). In a chi-square test for trend, the prevalence of depressive symptom was significantly increased with increased level of community income among all groups of the family income (P<0.001). Moreover a significant interaction was found between household income and community mean income (OR, 0.98; 95% CI, 0.97-0.99). Among individual level variables, age, sex, education, income, living alone, and the number of illnesses were associated with depressive symptom. This study identified that the level of community income has an inverse association, and its effect is especially stronger among low income individuals.
Collapse
Affiliation(s)
- Eun-Whan Lee
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| |
Collapse
|
30
|
Padhy SK, Sarkar S, Davuluri T, Patra BN. Urban living and psychosis--an overview. Asian J Psychiatr 2014; 12:17-22. [PMID: 25446903 DOI: 10.1016/j.ajp.2014.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/12/2014] [Accepted: 09/19/2014] [Indexed: 01/08/2023]
Abstract
Since more than half a century, the association of urbanicity with psychosis has been explored. The research interest initially stemmed from the finding of a higher proportion of cases of psychotic disorder coming for treatment from the inner parts of cities. Subsequently, interest in the relationship of urbanicity and schizophrenia expanded and various facets of this association were explored. This narrative review provides an overview of the relationship between urbanicity and psychosis, and evaluates the link from the standpoint of causality. The review further delves into the possible risk factors and mechanisms explaining this association; both biological ones like genetic vulnerability and infections, as well as environmental ones like pollution. Since the literature has primarily emerged from the developed western countries, the review draws attention to the caveats while extrapolating the results to a developing country scenario.
Collapse
Affiliation(s)
- Susanta K Padhy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | | | | | | |
Collapse
|
31
|
McCall-Hosenfeld JS, Mukherjee S, Lehman EB. The prevalence and correlates of lifetime psychiatric disorders and trauma exposures in urban and rural settings: results from the national comorbidity survey replication (NCS-R). PLoS One 2014; 9:e112416. [PMID: 25380277 PMCID: PMC4224442 DOI: 10.1371/journal.pone.0112416] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distinctions between rural and urban environments produce different frequencies of traumatic exposures and psychiatric disorders. We examine the prevalence of psychiatric disorders and frequency of trauma exposures by position on the rural-urban continuum. METHODS The National Comorbidity Survey Replication (NCS-R) was used to evaluate psychiatric disorders among a nationally-representative sample of the U.S. population. Rurality was designated using the Department of Agriculture's 2003 rural-urban continuum codes (RUCC), which differentiate counties into levels of rurality by population density and adjacency to metropolitan areas. Lifetime psychiatric disorders included post-traumatic stress disorder (PTSD), anxiety disorders, major depressive disorder, mood disorders, impulse-control disorders, and substance abuse. Trauma exposures were classified as war-related, accident-related, disaster-related, interpersonal or other. Weighted logistic regression models examined the odds of psychiatric disorders and trauma exposures by position on the rural-urban continuum, adjusted for relevant covariates. RESULTS 75% of participants were metropolitan, 12.2% were suburban, and 12.8% were from rural counties. The most common disorder reported was any anxiety disorder (38.5%). Drug abuse was more common among metropolitan (8.7%, p = 0.018), compared to nonmetropolitan (5.1% suburban, 6.1% rural) participants. A one-category increase in rurality was associated with decreased odds for war-related trauma (aOR = 0.86, 95%CI 0.78-0.95). Rurality was not associated with risk for any other lifetime psychiatric disorders or trauma exposure. DISCUSSION/CONCLUSIONS Contrary to the expectation of some rural primary care providers, the frequencies of most psychiatric disorders and trauma exposures are similar across the rural-urban continuum, reinforcing calls to improve mental healthcare access in resource-poor rural communities.
Collapse
Affiliation(s)
- Jennifer S. McCall-Hosenfeld
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Sucharita Mukherjee
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Erik B. Lehman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| |
Collapse
|
32
|
Regional disparities in psychiatric distress, violent behavior, and life satisfaction in Iranian adolescents: the CASPIAN-III study. J Dev Behav Pediatr 2014; 35:582-90. [PMID: 25370299 DOI: 10.1097/dbp.0000000000000103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the prevalence of violence behaviors, psychiatric distress, and life satisfaction among 10- to 18-year-old Iranian adolescents at national and regional disparities. METHODS In this national survey, 5570 students of age 10 to 18 years from urban and rural regions of 27 provinces of Iran were selected through stratified multistage sampling method. Violence behaviors, psychiatric distress, and life satisfaction were assessed by a questionnaire that was prepared based on WHO global school-based student health survey and the WHO-stepwise approach to noncommunicable diseases (Tools version 9.5). The country classification into 4 subnational regions was done based on combination of geography and socioeconomic status (SES). The data were analyzed by the SPSS software. RESULTS The prevalence of emotional, depressive, and anxiety problem among Iranian students was 17.7%, 16.3%, and 5.7%, respectively. The percentage of emotional and depressive problem differed significantly between different SES distress (p value <.001). The prevalence of bullying, victim, and physical fight was 27.1%, 32.7%, and 50.6% among students aged 10 to 18 years, respectively. Bullying and victim experience were linearly associated with regions' SES. Students who were living in the north-northeast region had maximum self-rated health and life satisfaction in Iran. CONCLUSIONS The results declared that psychiatric distress was more frequent in high SES distress, whereas violence behavior was more frequent in the lowest SES distress. Therefore, in communities with large variations in health and SES in regional level, health policies for primordial and primary prevention of mental and behavioral distress have to be made at regional levels.
Collapse
|
33
|
Breslau J, Marshall GN, Pincus HA, Brown RA. Are mental disorders more common in urban than rural areas of the United States? J Psychiatr Res 2014; 56:50-5. [PMID: 24857610 DOI: 10.1016/j.jpsychires.2014.05.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/02/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Abstract
Urban vs. rural residence is commonly cited as a risk factor for depression and other mental disorders, but epidemiological evidence for this relationship in the US is inconclusive. We examined three consecutive annual samples (2009-2011) of adolescents (age 12-17, N = 55,583) and adults (age 18 and over, N = 116,459) from the National Survey of Drug Use and Health (NSDUH) to compare the prevalence of major depression and other serious mental illness across four categories of urbanicity: (1) large metropolitan areas, (2) small metropolitan areas, (3) semi-rural areas, and (4) rural areas, with and without adjustment for other demographic risk factors. For adolescents, no association was observed between urbanicity and the prevalence of major depression, with or without statistical adjustments. For adults, no differences were found in the prevalence of major depression or serious mental illness between large metropolitan areas and rural areas, but the prevalence of both was slightly higher in the two intermediate urbanicity categories than in large metropolitan areas, with statistically significant odds ratios after adjustment ranging from 1.12 to 1.19. Contrary to expectations, the prevalence of mental disorders was not higher in the most urban compared with the most rural areas, suggesting that the move to identify mechanistic explanations for risk associated with the urban environment is premature. Evidence of slightly higher prevalence in small urban and semi-rural areas relative to large urban areas, reported for the first time, requires additional investigation.
Collapse
Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, 15213 PA, USA.
| | | | - Harold A Pincus
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, 15213 PA, USA
| | - Ryan A Brown
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, 15213 PA, USA
| |
Collapse
|
34
|
Goodwin RD, Taha F. Global health benefits of being raised in a rural setting: results from the National Comorbidity Survey. Psychiatry Clin Neurosci 2014; 68:395-403. [PMID: 24641788 DOI: 10.1111/pcn.12144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/25/2013] [Accepted: 12/01/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the association between being raised in a rural setting and physical and mental health among adults in the USA. METHODS Data were drawn from the National Comorbidity Survey (n = 8098), a household probability sample representative of adults aged 15-54 years in the USA. Multiple logistic regression analyses were used to determine the association between being raised in a rural area and the likelihood of mental disorders, physical disorders, suicide behavior, and parental mental health. Odds ratios (OR) with 95% confidence intervals were calculated, adjusting for differences in demographic characteristics. RESULTS Being raised in a rural setting was associated with decreased odds of ulcer (OR = 0.56 [0.34, 0.91]). Mental disorders (any lifetime) (OR = 0.74 [0.64, 0.85]), any anxiety disorder (OR = 0.75 [0.6, 0.92]) and any substance use disorder (OR = 0.79 [0.65, 0.94]) were significantly less likely among adults who were raised in a rural setting. Maternal psychopathology and exposure to trauma were significantly lower among those raised in a rural setting, compared with those who were not. These relations were not explained by sociodemographic differences. CONCLUSIONS These data provide preliminary evidence that being raised in a rural environment lowers the risk of mental and physical health problems in adulthood. Being raised in a rural community also appears to be associated with significantly lower likelihood of exposure to trauma and maternal psychopathology. Future studies that can identify potential protective factors and mechanisms underlying these pathways are needed next.
Collapse
Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | | |
Collapse
|
35
|
Krausz RM, Clarkson AF, Strehlau V, Torchalla I, Li K, Schuetz CG. Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1235-43. [PMID: 23299926 DOI: 10.1007/s00127-012-0649-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the standardized rates of mental disorder, health service use and barriers to care in a representatively diverse sample of homeless adults in three different sized urban centers in British Columbia, Canada. METHOD Five hundred homeless adults from Vancouver, Victoria and Prince George were recruited. The MINI-International Neuropsychiatric Interview PLUS was used to determine current and lifetime rates of mental disorder, mental disorder episodes and suicidality. Health service use and barriers to care were recorded. RESULTS Overall, 92.8 % of participants met criteria for a current mental disorder: 82.6 % for alcohol or drug dependence, 57.3 % anxiety disorder, 31.5 % mood disorder. Over half (53.4 %) met criteria for a concurrent disorder. Only 14.9 % had seen a psychiatrist and 12.7 % a mental health team in the year prior to the survey. Most common barriers included being poorly connected to the system of care and issues related to homelessness. Mental disorder rates across sites were high, however, differences were found that reflected the composition of the samples. CONCLUSION Improving the mental health state of the homeless will require significant capacity for mental health and concurrent disorder programming that is tailored to the community it intends to serve. Demographic features of the population may help in directing assessments of need.
Collapse
Affiliation(s)
- Reinhardt Michael Krausz
- Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Strauss JL, Zervakis JB, Stechuchak KM, Olsen MK, Swanson J, Swartz MS, Weinberger M, Marx CE, Calhoun PS, Bradford DW, Butterfield MI, Oddone EZ. Adverse impact of coercive treatments on psychiatric inpatients' satisfaction with care. Community Ment Health J 2013; 49:457-65. [PMID: 23054144 DOI: 10.1007/s10597-012-9539-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers' perceptions of coercion and its effects on satisfaction, including potential "downstream" effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients' satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients' satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.
Collapse
Affiliation(s)
- Jennifer L Strauss
- Center for Health Services Research in Primary Care, VISN 6 MIRECC, Bldg 6, 508 Fulton Street, Durham, NC 27705, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Barbosa-Leiker C, McPherson S, Cameron JM, Jathar R, Roll J, Dyck DG. Depression as a mediator in the longitudinal relationship between psychological stress and alcohol use. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2013.808711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
38
|
Rook GAW, Lowry CA, Raison CL. Microbial 'Old Friends', immunoregulation and stress resilience. EVOLUTION MEDICINE AND PUBLIC HEALTH 2013; 2013:46-64. [PMID: 24481186 PMCID: PMC3868387 DOI: 10.1093/emph/eot004] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic inflammatory diseases (autoimmunity, allergy and inflammatory bowel diseases) are increasing in prevalence in urban communities in high-income countries. One important factor is reduced exposure to immunoregulation-inducing macro- and microorganisms and microbiota that accompanied mammalian evolution (the hygiene hypothesis or 'Old Friends' mechanism). Reduced exposure to these organisms predisposes to poor regulation of inflammation. But inflammation is equally relevant to psychiatric disorders. Inflammatory mediators modulate brain development, cognition and mood, and accompany low socioeconomic status and some cases of depression in developed countries. The risk of all these conditions (chronic inflammatory and psychiatric) is increased in urban versus rural communities, and increased in immigrants, particularly if they move from a low- to a high-income country during infancy, and often the prevalence increases further in second generation immigrants, suggesting that critical exposures modulating disease risk occur during pregnancy and infancy. Diminished exposure to immunoregulation-inducing Old Friends in the perinatal period may enhance the consequences of psychosocial stressors, which induce increased levels of inflammatory mediators, modulate the microbiota and increase the risk for developing all known psychiatric conditions. In later life, the detrimental effects of psychosocial stressors may be exaggerated when the stress occurs against a background of reduced immunoregulation, so that more inflammation (and therefore more psychiatric symptoms) result from any given level of psychosocial stress. This interaction between immunoregulatory deficits and psychosocial stressors may lead to reduced stress resilience in modern urban communities. This concept suggests novel interpretations of recent epidemiology, and novel approaches to the increasing burden of psychiatric disease.
Collapse
Affiliation(s)
- Graham A W Rook
- Centre for Clinical Microbiology, Department of Infection, University College London (UCL), London, UK; Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA and Department of Psychiatry, College of Medicine and Norton School of Family and Consumer Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA
| | | | | |
Collapse
|
39
|
Kiani R, Tyrer F, Hodgson A, Berkin N, Bhaumik S. Urban-rural differences in the nature and prevalence of mental ill-health in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:119-127. [PMID: 22292906 DOI: 10.1111/j.1365-2788.2011.01523.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND In the general population there are statistically significant urban-rural differences in the rate of common mental disorders. In people with intellectual disability (ID) no study has attempted to address this issue. AIMS To compare the prevalence of mental illness, autism spectrum disorder (ASD) and behaviour disorder in people with ID living in urban areas with those living in rural areas. METHODS Cross-sectional study of 2713 individuals registered with an ID service. Participants were assigned to urban or rural groups using the Department for Environment Food and Rural Affairs rural/urban local authority classification for their district. The main outcome variable was a clinical diagnosis of mental illness, ASD and behaviour disorder. Differences between diagnoses of mental illness in urban and rural areas were evaluated using the chi-squared test for the difference in two independent proportions. RESULTS No differences were observed between gender, age and level of ID of service users based on their place of residence. But more people from an ethnic minority background were living in urban areas than rural areas. No differences were observed in the overall prevalence of mental illness by place of residence. However, the results showed that ASD was more common in people living in rural areas. CONCLUSIONS We found these results surprising and at odds with the majority of studies carried out in the general population and propose several reasons for the differences found. We believe that the results and further studies in this area will help inform health service provision for those with ID who live in different geographical areas.
Collapse
Affiliation(s)
- R Kiani
- Leicestershire Partnership NHS Trust, Leicester, UK.
| | | | | | | | | |
Collapse
|
40
|
Rosenthal BS, Wilson WC. Race/ethnicity and mental health in the first decade of the 21st century. Psychol Rep 2012; 110:645-62. [PMID: 22662417 DOI: 10.2466/02.13.pr0.110.2.645-662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent empirical studies on mental health generally report racial/ ethnic differences in depression rates but typically do not control for potential confounding by sample contextual variations in historical epoch, geographical location, and social demography. An empirical study of race/ethnicity differences in psychological distress is reported as an attempt to control these contexts by using a sample that is homogeneous in age, historical epoch, geography, and social demography (954 youth ages 18-19 living in a single, large urban community). No mean differences in psychological distress were observed among four racial/ethnic groups: Asians, African Americans, Latinos, and non-Hispanic Whites. A second analysis compared 17 different racial/ethnic groups defined in terms of family national origin. No differences in psychological distress were found among these groups. The findings are consistent with the view that race/ethnicity itself is not related to disparities in mental health.
Collapse
Affiliation(s)
- Beth Spenciner Rosenthal
- York College and The Graduate Center, The City University of New York, 94-20 Guy R. Brewer Boulevard, Jamaica, NY 11451, USA.
| | | |
Collapse
|
41
|
Albrecht SS, McVeigh KH. Investigation of the disparity between New York City and national prevalence of nonspecific psychological distress among Hispanics. Prev Chronic Dis 2012; 9:E52. [PMID: 22321144 PMCID: PMC3346816 DOI: 10.5888/pcd9.110104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In New York City, the age-adjusted prevalence of nonspecific psychological distress (NPD) among Hispanics is twice that of non-Hispanic whites; nationally, there is little Hispanic-white disparity. We aimed to explain the pattern of disparity in New York City. METHODS Data came from the 2006 National Health Interview Survey and 2006 Community Health Survey in New York City. Respondents with scores higher than 12 on the K6, a brief scale used to screen for mental health disorders, were defined as having NPD. Multivariate analyses controlled for Hispanic ancestry, socioeconomic status (education, employment, and income), nativity, language of interview, and health characteristics. RESULTS In New York City, the disparity between Hispanics and whites was fully explained after accounting for the disproportionate concentration of low socioeconomic status among Hispanics (odds ratio for NPD, 0.81; 95% confidence interval, 0.60-1.11). These factors also partially accounted for differences between Hispanics in New York City and the United States, but the prevalence of NPD overall in New York City remained elevated relative to the United States. CONCLUSION Elevated NPD prevalence among New York City Hispanics was primarily attributable to large disparities in socioeconomic status; differences between New York City and the United States remained but were not specific to Hispanics. Interventions in New York City aimed at addressing racial/ethnic disparities in health may overlap with those addressing socioeconomic inequalities. Further study into the higher overall prevalence of NPD in New York City will be necessary to inform the design and targeting of interventions.
Collapse
Affiliation(s)
- Sandra S Albrecht
- Center for Social Epidemiology and Population Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | | |
Collapse
|
42
|
Lin CH, Lee YY, Liu CC, Chen HF, Ko MC, Li CY. Urbanization and prevalence of depression in diabetes. Public Health 2011; 126:104-11. [PMID: 22178148 DOI: 10.1016/j.puhe.2011.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 06/13/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. STUDY DESIGN A descriptive correlation study design relating urbanization and prevalence of depression. METHODS Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. RESULTS The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. CONCLUSIONS There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.
Collapse
Affiliation(s)
- C H Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
43
|
Westphal M, Olfson M, Gameroff MJ, Wickramaratne P, Pilowsky DJ, Neugebauer R, Lantigua R, Shea S, Neria Y. Functional impairment in adults with past posttraumatic stress disorder: findings from primary care. Depress Anxiety 2011; 28:686-95. [PMID: 21681868 PMCID: PMC3647251 DOI: 10.1002/da.20842] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although many patients with posttraumatic stress disorder (PTSD) experience a reduction in posttraumatic symptoms over time, little is currently known about the extent of their residual functional impairment. This study examines functional impairment in primary care patients with a history of PTSD as compared to patients with current PTSD, and those who never developed PTSD following exposure to trauma. METHODS The sample consisted of 321 trauma-exposed low-income, predominantly Hispanic adults attending a large urban primary care practice. PTSD was assessed with the Lifetime Composite International Diagnostic Interview and other psychiatric disorders with the SCID-I. Physical and mental health-related quality of life was assessed with the Medical Outcome Health Survey (SF-12), and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report. RESULTS Logistic regression analyses controlling for gender, psychiatric comorbidity, and interpersonal traumas showed that although patients with past PTSD function significantly better than patients with current PTSD, they experience persisting deficits in mental health-related quality of life compared to trauma-exposed patients who never developed PTSD. Overall, results revealed a continuum of severity in psychiatric comorbidity, functioning, and quality of life, with current PTSD associated with the most impairment, never having met criteria for PTSD with the least impairment, and history of PTSD falling in between. CONCLUSIONS In this primary care sample, adults with a history of past PTSD but no current PTSD continued to report enduring functional deficits, suggesting a need for ongoing clinical attention.
Collapse
Affiliation(s)
- Maren Westphal
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York 10032, USA.
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York,Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
| | - Marc J. Gameroff
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York,Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
| | - Priya Wickramaratne
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York,Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
| | - Daniel J. Pilowsky
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York,Division of Epidemiology, New York State Psychiatric Institute, New York City, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
| | - Richard Neugebauer
- Division of Epidemiology, New York State Psychiatric Institute, New York City, New York,G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Rafael Lantigua
- Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Steven Shea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York,Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Yuval Neria
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York City, New York,Division of Epidemiology, New York State Psychiatric Institute, New York City, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
| |
Collapse
|
44
|
Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol 2011; 46:567-75. [PMID: 20376426 DOI: 10.1007/s00127-010-0222-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies of urban-rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference. AIMS This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents. METHOD Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality. RESULTS Significant bivariate urban-rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one's home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression. CONCLUSIONS These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.
Collapse
|
45
|
Ruggiero KJ, Gros DF, McCauley J, de Arellano MA, Danielson CK. Rural adults' use of health-related information online: data from a 2006 National Online Health Survey. Telemed J E Health 2011; 17:329-34. [PMID: 21524201 DOI: 10.1089/tmj.2010.0195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine access and use of health-related information online in rural versus nonrural Internet users, using national data from the 2006 Pew Internet and American Life Project. MATERIALS AND METHODS A national telephone survey of 2,928 adults in August 2006 yielded a sample of 1,992 adults who use the Internet regularly. A structured interview was administered to assess frequency of Internet use and access and use of health-related information online. RESULTS Most Internet-using rural adults search for health-related information online; two-thirds seek information about specific medical problems and over half seek information about treatment. Three-fifths of rural adults surveyed stated that online health-related information affected the decisions they made in health maintenance and managing treatment of an illness. More than one-third reported being significantly helped by information they found, whereas one-fourth reported being confused. Comparisons between rural and nonrural Internet users suggested that rural users were more likely to seek information about smoking cessation (χ(2)[1, N=1,990]=7.91, p<0.01) and mental health issues (χ(2)[1, N=1,988]=3.71, p=0.05), less likely to seek information about a particular doctor or hospital (χ(2)[1, N=1,983]=15.49, p<0.001), and more likely to report being helped (χ(2)[1, N=1,534]=5.24, p<0.05)-but also confused (χ(2)[1, N=1,592]=9.83, p<0.01)-by information they found. CONCLUSIONS Rural Americans are increasingly using the Internet to acquire information about chronic disease, mental health, doctors, and treatment options. Priorities should include further development and rigorous evaluation of online resources to ensure high-quality, more direct tailoring of resources to rural families and development of tools to assist consumers in assessing the credibility of online information.
Collapse
Affiliation(s)
- Kenneth J Ruggiero
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | | | | | | | | |
Collapse
|
46
|
Villegas L, McKay K, Dennis CL, Ross LE. Postpartum Depression Among Rural Women From Developed and Developing Countries: A Systematic Review. J Rural Health 2010; 27:278-88. [PMID: 21729155 DOI: 10.1111/j.1748-0361.2010.00339.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laura Villegas
- Social Equity and Health Research Section, Centre for Addiction and Mental Health, Toronto, Canada
| | | | | | | |
Collapse
|
47
|
Maggi S, Ostry A, Callaghan K, Hershler R, Chen L, D'Angiulli A, Hertzman C. Rural-urban migration patterns and mental health diagnoses of adolescents and young adults in British Columbia, Canada: a case-control study. Child Adolesc Psychiatry Ment Health 2010; 4:13. [PMID: 20465838 PMCID: PMC2877002 DOI: 10.1186/1753-2000-4-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 05/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The identification of mental health problems early in life can increase the well-being of children and youth. Several studies have reported that youth who experience mental health disorders are also at a greater risk of developing psychopathological conditions later in life, suggesting that the ability of researchers and clinicians to identify mental health problems early in life may help prevent adult psychopathology. Using large-scale administrative data, this study examined whether permanent settlement and within-province migration patterns may be linked to mental health diagnoses among adolescents (15 to 19 years old), young adults (20 to 30 years old), and adults (30 years old and older) who grew up in rural or urban communities or migrated between types of community (N = 8,502). METHODS We conducted a nested case-control study of the impact of rural compared to urban residence and rural-urban provincial migration patterns on diagnosis of mental health. Conditional logistic regression models were run with the following International Classification of Diseases, 9th Revision (ICD-9) mental health diagnoses as the outcomes: neurotic disorders, personality disorder, acute reaction to stress, adjustment reaction, depression, alcohol dependence, and nondependent drug abuse. Analyses were conducted controlling for paternal mental health and sociodemographic characteristics. RESULTS Mental health diagnoses were selectively associated with stability and migration patterns. Specifically, adolescents and young adults who were born in and grew up in the same rural community were at lower risk of being diagnosed with acute reaction to stress (OR = 0.740) and depression (OR = 0.881) compared to their matched controls who were not born in and did not grow up in the same rural community. Furthermore, adolescents and young adults migrating between rural communities were at lower risk of being diagnosed with adjustment reaction (OR = 0.571) than those not migrating between rural communities. No differences were found for diagnoses of neurotic disorders, personality disorder, alcohol dependence, and nondependent drug abuse. CONCLUSIONS This study provides some compelling evidence of the protective role of rural environments in the development of specific mental health conditions (i.e., depression, adjustment reaction, and acute reaction to stress) among the children of sawmill workers in Western Canada.
Collapse
Affiliation(s)
- Stefania Maggi
- Institute of Interdisciplinary Studies and Department of Psychology, Dunton Tower Room 2210, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Aleck Ostry
- Department of Geography, University of Victoria, PO BOX 3060 STN CSC, Victoria, BC, V8W 3R4, Canada
| | - Kristy Callaghan
- Thompson Rivers University, Box 3010, 900 McGill Road, Kamloops, BC, V2C 5N3, Canada
| | - Ruth Hershler
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lisa Chen
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Amedeo D'Angiulli
- Institute of Interdisciplinary Studies and Department of Psychology, Dunton Tower Room 2210, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Clyde Hertzman
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| |
Collapse
|
48
|
Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010; 121:84-93. [PMID: 19624573 DOI: 10.1111/j.1600-0447.2009.01438.x] [Citation(s) in RCA: 493] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Reviews of urban-rural differences in psychiatric disorders conclude that urban rates may be marginally higher and, specifically, somewhat higher for depression. However, pooled results are not available. METHOD A meta-analysis of urban-rural differences in prevalence was conducted on data taken from 20 population survey studies published since 1985. Pooled urban-rural odds ratios (OR) were calculated for the total prevalence of psychiatric disorders, and specifically for mood, anxiety and substance use disorders. RESULTS Significant pooled urban-rural OR were found for the total prevalence of psychiatric disorders, and for mood disorders and anxiety disorders. No significant association with urbanization was found for substance use disorders. Adjustment for various confounders had a limited impact on the urban-rural OR. CONCLUSION Urbanization may be taken into account in the allocation of mental health services.
Collapse
Affiliation(s)
- J Peen
- Research Department, Arkin Mental Health Institute Amsterdam, 1070 AV Amsterdam, the Netherlands.
| | | | | | | |
Collapse
|
49
|
Kelly BD, O'Callaghan E, Waddington JL, Feeney L, Browne S, Scully PJ, Clarke M, Quinn JF, McTigue O, Morgan MG, Kinsella A, Larkin C. Schizophrenia and the city: A review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophr Res 2010; 116:75-89. [PMID: 19897342 DOI: 10.1016/j.schres.2009.10.015] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 10/05/2009] [Accepted: 10/18/2009] [Indexed: 10/20/2022]
Abstract
Urbanicity has been repeatedly associated with increased incidence of schizophrenia. This article (a) presents results of a prospective study of urbanicity and schizophrenia in Ireland and (b) reviews the literature relating to urbanicity and schizophrenia. We prospectively compared incidence of schizophrenia and other psychoses in urban and rural catchment areas (over 4years and 7years, respectively) using face-to-face, DSM-III-R diagnostic interviews. Incidence of schizophrenia in males was higher in urban compared to rural areas, with an age-adjusted incidence rate ratio (IRR) of 1.92 (1.52-2.44) for males and 1.34 (1.00-1.80) for females. Incidence of affective psychosis was lower in urban compared to rural areas for males (IRR 0.48; 0.34-0.67) and females (IRR 0.60; 0.43-0.83). These findings are consistent with the literature, which provides persuasive evidence that risk for schizophrenia increases with urban birth and/or upbringing, especially among males. Register-based studies support this conclusion more consistently than studies using face-to-face diagnostic interviews, the difference being related to power. The mechanism of association is unclear but may relate to biological or social/environmental factors or both, acting considerably before psychotic symptoms manifest. There is a diversity of potential candidates, including air pollution, cannabis and social exclusion. Urbanicity may have a synergistic effect with genetic vulnerability. Future research is likely to focus on the relationship between urbanicity and neural maldevelopment, the possibility of rural protective factors (e.g. social capital, low social fragmentation), urbanicity in developing countries, cultural variables and geographical location, and associations between urbanicity and other disorders (e.g. affective psychosis).
Collapse
Affiliation(s)
- Brendan D Kelly
- Department of Psychiatry, University College Dublin, Dublin 7, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Gavin AR, Walton E, Chae DH, Alegria M, Jackson JS, Takeuchi D. The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians and non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies. Psychol Med 2010; 40:51-61. [PMID: 19460189 PMCID: PMC2788678 DOI: 10.1017/s0033291709006023] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined whether there were associations between individual measures of socio-economic status (SES) and the 12-month prevalence of major depressive disorder (MDD) in representative samples of Blacks, Latinos, Asians and Whites in the USA. METHOD The data used were from the Collaborative Psychiatric Epidemiology Studies (CPES). RESULTS There was an association between household income and MDD among Whites. However, the association was not statistically significant. Statistically significant associations were present between educational attainment and MDD among Whites. Among both Whites and Latinos, being out of the labor force was significantly associated with MDD. In analyses by nativity, being out of the labor force was significantly associated with MDD among US-born and foreign-born Latinos. CONCLUSIONS Significant associations between various measures of SES and MDD were consistently observed among White and, in some cases, Latino populations. Future studies should continue to examine sociopsychological factors related to SES that increase the risk of MDD among people from racial-ethnic communities.
Collapse
Affiliation(s)
- A R Gavin
- School of Social Work, University of Washington, Seattle, WA 98105-6299, USA.
| | | | | | | | | | | |
Collapse
|