Social correlates of mental, neurological, and substance use disorders in China and India: a review

Mental disorders in adults from Ribeirão Preto, Brazil: a cross-sectional analysis of two birth cohorts

BACKGROUND

In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psychiatric comorbidities among young adults (22-23 years old) and adults (37-38 years old) from Ribeirão Preto, a city located in the Northeast of the São Paulo state, with approximately 700,000 inhabitants, and to explore associations with sociodemographic variables, suicide risk, and health service usage. Second, we aimed to evaluate the performance of the Self-Report Questionnaire (SRQ-20) as a screening tool for mental disorders to be applied to the local population.

METHODS

Participants from the 1978/1979 and 1994 Ribeirão Preto birth cohorts were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the SRQ-20 at mean ages of 22-23, and 37-38 years, respectively.

RESULTS

Our sample comprised 1,769 individuals from the 1978/1979 cohort and 1,037 from the 1994 cohort. The prevalence of mental disorders ranged from 28.6% (1978/79) to 31% (1994), with frequent comorbid diagnoses (42.7% and 43.3%, respectively). Men and women had a similar prevalence of mental disorders in the younger cohort, while women had a higher prevalence in the older cohort. Low educational attainment was associated with higher rates of diagnosis. In both cohorts, alcohol and other psychoactive substance use was higher among those with a psychiatric diagnosis. Although those with a psychiatric diagnosis were less satisfied with their own health, only one-fifth had seen a mental health professional in the previous year. A psychiatric diagnosis increased the suicide risk by 5.6 to 9.1 times. Regarding the SRQ-20, the best cutoff points were 5/6 for men and 7/8 for women, with satisfactory performance.

CONCLUSIONS

The prevalence and comorbidity of mental disorders were high in both cohorts and comparable to those in larger Brazilian cities. However, few individuals with a diagnosis had sought specialized care. These data suggest that the mental health gap is still significant in Brazil.

Modifiable risk factors for dementia in India: A cross-sectional study revisiting estimates and reassessing prevention potential and priorities

Background

About 16% of worldwide dementia cases are in India. Evaluating the prospects for dementia prevention in India requires knowledge of context-specific risk factors, as relationships between risk factors and dementia observed in high-income countries (HICs) may not apply.

Methods

We computed population attributable fractions (PAFs) for dementia in India by estimating associations between risk factors and dementia, their prevalence and communality, within the same nationally representative sample of 4,096 Indians aged 60 and older, surveyed through the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD).

Results

The risk factor with the largest PAF (>20%) was no education, followed by vision impairment (14%), physical inactivity (12%), and social isolation (8%). According to our estimates, eliminating exposure to risk factors significantly associated with dementia would potentially prevent up to 70% of dementia cases in India.

Discussion

Previous estimates, based on samples limited to specific geographic areas and using risk factors' definitions and relative risks from HICs, may not correctly estimate the real opportunities for preventing dementia in India or identify the most critical areas for intervention.

Use of psychoactive substances and alcohol during the first three waves of the COVID-19 pandemic: Croatian experience

Increased prevalence and severity of both substance and behavioral addictions are among the most harmful consequences of the COVID-19 outbreak.

To determine the sociodemographic characteristics, COVID-19-related stressors, and stress, anxiety, and depression symptoms that may predict the use and changes in the use of psychoactive substances (PS) during the first three COVID-19 waves in Croatia.

The cross-sectional online survey included 1,118 adult participants (220 men and 898 women; mean age: 35.1 [SD = 12.3] years; age range: 18-78) from general adult population. Sociodemographic data were collected, and ad-hoc developed questionnaires on COVID-19-related stressors, PS use before and during the pandemic, CAGE Alcohol Questionnaire, Impact of Event Scale, and Hospital Anxiety Depression Scale were applied.

The PS use increased in 31% of participants. The use of tobacco, caffeine, alcohol, cannabinoids, and anxiolytics showed the greatest increase in the last year (tobacco 7.1%; caffeine 5.8%; alcohol 6.4%; cannabinoids 2.5%; and anxiolytics 3.9%). Alcohol consumption during the pandemic increased in 16.8% of participants who consumed alcohol before the pandemic, with 4.5% of them reporting problematic alcohol use (PAU). The tested model demonstrated relatively good model-data fit and significantly predicted 11.8% increase in the use of PS and 9.8% of PAU.

Being married or in a relationship and severe anxiety and depression symptoms predicted increased use of PS and PAU, while higher education level and ever being diagnosed with COVID-19 predicted only increased use of PS.

Suicide prevention for substance using youth experiencing homelessness: study protocol for a randomized controlled trial

BACKGROUND

While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective suicide prevention intervention that can be readily adopted by communities that serve these youth.

METHODS

Three hundred (N = 300) YEH with recent substance use and suicidal ideation or a recent suicide attempt will be recruited from the streets as well as a drop-in center serving YEH. After the baseline assessment, all youth will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N = 150) or to SAU alone (N = 150). SAU includes outreach, advocacy, and service linkage whereas YEH who receive CTSP will also receive ten CTSP sessions and an optional nine booster sessions. Follow-up assessments will be conducted at 3, 6, 9, and 12 months post-baseline. Theoretically derived mediators (e.g., cognitive distortions) will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation, and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity, and cost associated with the delivery of our intervention approach using a mixed-methods approach.

DISCUSSION

This study adds to a very small number of clinical trials seeking to prevent lethal suicide among a very high-risk group by addressing suicidal ideation directly rather than underlying conditions. It is hypothesized that youth receiving CTSP + SAU will show greater reductions in suicidal ideation (primary outcome), substance use, and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors.

TRIAL REGISTRATION

NCT05994612. Date of Registration: August 16, 2023.

Association of perceived childhood socio-economic status and health with depressive symptoms among middle-aged and older adults in India: using data from LASI Wave I, 2017-2018

BACKGROUND

Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people's life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India.

METHODS

The data for the study was drawn from national representative survey "Longitudinal Ageing Study in India (LASI)" Wave I, 2017-2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population.

RESULTS

Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category.

CONCLUSIONS

Childhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Prevalence and gender difference in depression in primary health care in India: A systematic review and meta-analysis

Background

Depression contributes to the major burden of mental illness in India. Assessment of burden is essential to develop interventions to address the problem at the primary care level.

Materials and Methods

We carried out a systematic review and meta-analysis of studies documenting the prevalence of depression in primary care in India. A wide literature search strategy was developed using keywords and Medical Subject Headings. The literature search was done in MEDLINE (via PubMed), IndMed, and major Indian psychiatric journal websites. The protocol was registered at PROSPERO. Bias assessment was carried out using a Cochrane risk of bias tool.

Results

A total of 186 studies were identified after an initial search, of which 17 were included in the final analysis using pre-specified inclusion and exclusion criteria. The aggregate point prevalence of depression at the primary care level of the 17 studies using the random-effect model was 23.0% (95% CI: 16.0-30.0%). Significant heterogeneity was reported among the studies attributed majorly to a variety of study tools for assessing depression. Sub-group analysis revealed the higher aggregated prevalence of depression among females as compared to males at the primary care level.

Conclusion

The study provided updated evidence of higher and gender differential burden of depression at the primary care level in India.

Proposing an integrative, dynamic and transdiagnostic model for addictions: dysregulation phenomena of the three main modes of the predostatic mind

Several theories have been proposed to explain the complex diagnostic aspects related to addiction disorders and their development. Recent frameworks tend to focus on dimensional perspectives of symptoms rather than categorical systems, since substance use disorders are frequently comorbid with other psychiatric and especially personality disorders. However, useful transdiagnostic models that could integrate clinical evaluation derived from neuroscientific theories are lacking. In the present manuscript, the authors propose a model based on a new paradigm, in an attempt to better explain this complex, multifaceted phenomenon. The new paradigm presupposes that emotions and behavior are a response to risk prediction. Individuals make choices and engage in actions to manage potential risks/rewards in order to seek or maintain homeostasis in their internal and external environments - a mechanism that the authors call predostatic (predictive mechanism with homeostatic purpose). The model considers three main modes of the predostatic mind: (1) Alarm Mode, activated by high and/or imminent risk prediction; (2) Seek Mode, activated by long-term risk or reward prediction; and (3) Balance Mode, a self-regulating state of mind related to low risk prediction, a soothing system and a calm state. Addiction is seen as a chronic dysregulation of organism systems leading to internalizing or externalizing phenomena mainly related to the Seek and Alarm Modes, which are persistently activated by reward and risk prediction, respectively, thus hindering Balance. Addiction neuroscience research has shown that chronic drug use or engagement in addictive behaviors can lead to neuroadaptations in the brain reward circuitry, disrupting normal balance and the regulation of reward processes. This dysregulation can contribute to persistent drug-seeking/addictive behaviors despite negative consequences. This newly proposed dynamic and integrative model, named dysregulation based on externalizing and internalizing phenomena of the three main modes of the predostatic mind (DREXI3), proposes six dysregulation dimensions with basic emotional and behavioral symptoms, such as neurophysiological alterations, impulsivity, compulsion, cognitive impairment/psychosis, mood, and anxiety/anger. In this paper, the authors explain the rationale behind DREXI3 and present some hypothetical clinical examples to better illustrate the use of the model in clinical practice. The development of this innovative model could possibly guide tailored treatment interventions in the addiction field.

Progress towards universal health coverage in the context of mental disorders in India: evidence from national sample survey data

BACKGROUND

Universal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India.

METHODS

Data from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses.

RESULTS

Self-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18-2.52, p < 0.05) among the richest income group population compared to the poorest in India. The private sector was a major service provider of mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63% of individuals with a mental disorder who reported private sector hospitalization noted unavailability or poor service quality at public facilities. Only 23% of individuals hospitalized had health insurance coverage at All India level. However, health insurance coverage among poorest economic class was a meagre 3.4%. Average out-of-pocket expenditure during hospitalization (public: 123 USD; private: 576 USD) and outpatient care (public: 8 USD; private: 37 USD) was significantly higher in the private sector than in the public sector. Chances of facing catastrophic health expenditure at 10% threshold were 23.33 times (95% CI: 10.85-50.17; p < 0.001) higher under private sector than public sector during hospitalization. Expenditure on medicine, as the share of total medical expenditure, was highest for hospitalization (public: 45%, private:39.5%) and outpatient care (public: 74.1%, private:39.7%).

CONCLUSIONS

Social determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. For achieving UHC in mental disorders, India needs to address the gaps in access and financial protection for individuals with mental disorders.

TRIAL REGISTRATION

Not applicable.

Presenting Pattern and Psychiatric Comorbidities in Rural versus Urban Substance Dependent Patients: A Hospital-Based Cross-Sectional Study

Background

"Locality" is a significant factor in substance initiation, maintenance, and relapse. The pattern of substance dependence among rural and urban populations varies across studies and is scarcely studied, warranting further research. To compare presenting patterns (sociodemographic and drug-related variables), reasons for substance use, and psychiatric comorbidities (prevalence, type, and severity) between rural and urban substance-dependent groups.

Materials and Methods

This study was a cross-sectional analytical study in a government de-addiction center, including rural and urban patient groups aged 18-65. International Classification of Diseases, Tenth Revision (ICD-10) criteria, and severity of dependence scale were used for diagnosing substance dependence. After detoxification, psychiatric comorbidity was assessed using brief psychiatric rating scale, Young's mania rating scale, and patient health questionnaire - somatic, anxiety, and depression symptoms scale. Post-analysis was performed to assess socioeconomic variables and access to de-addiction services.

Results

The final sample was 500 (250 rural and 250 urban). The post-analysis sample size was 386 (211 rural and 175 urban). The mean age was 38.2 ± 12.4 years, mostly males (n = 495, 99%). Substance frequency was opioids (92%)> benzodiazepines (24.8%) > alcohol (22%) > cannabis (1.6%) for rural and opioids (91.2%) > alcohol (29.6%) > benzodiazepines (14.8%) > cannabis (2%) for urban patients. More than half of patients had comorbid nicotine dependence. Rural patients were more benzodiazepine dependent (P = 0.007), and urban were more opioid + alcohol dependent (P = 0.001). Rural patients had higher age (P = 0.012), less education (P < 0.001), positive family history of substance (P = 0.028), daily wagers, and farmers (P < 0.001) than urban patients who were younger, students (P = 0.002), businessmen and government employed (P < 0.001). Urban patients expended more on drugs (P < 0.001), had higher treatment attempts (P = 0.008), and had better availability and accessibility of de-addiction services (P < 0.001). More rural users initiated substances to "enhance performance," whereas urban ones initiated for "stress relief/novelty" (P < 0.001). For treatment seeking, "External pressure" was a more common reason in urban patients (P < 0.001), who also had more psychiatric comorbidities (P = 0.026).

Conclusion

Significant pattern differences exist between rural and urban substance dependents, warranting emphasis on locality-specific factors for appropriate intervention.

The effects of environmental factors associated with childhood urbanicity on brain structure and cognition

Urbanization is a trend lasting for more than one century worldwide. Four hundred ninety male and female adult Chinese Han participants with different urban and rural childhoods were included in this study. Early-life urban environment was found benefit for total grey matter volume (GMV), dorsolateral prefrontal cortex (DLPFC) GMV, temporal pole (TP) GMV and cognition function, and negatively correlated with medial prefrontal cortex (MPFC) GMV. Regression analysis showed that maternal education was a protective factor for total and DLPFC GMVs, while having siblings was better for MPFC GMV. Total, DLPFC and TP GMVs acts mediation effects between childhood urbanicity and different cognitive domains. These findings may suggest some pros and cons on brain structure associated with childhood urbanicity and related environmental factors.

Regional years of life lost, years lived with disability, and disability-adjusted life-years for severe mental disorders in Guangdong Province, China: a real-world longitudinal study

BACKGROUND

To understand the magnitude and spatial-temporal distribution of the regional burden attributable to severe mental disorders is of great essential and high policy relevance. The study aimed to address the burden of severe mental disorders by evaluating the years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) in Guangdong, China.

METHODS

We undertook a longitudinal study based on a multicenter database established by the Health Commission of Guangdong, involving a total of 21 prefectures and four economic regions in the Guangdong province. A total of 520,731 medical records from patients with severe mental disorders were collected for 2010-2020. Data were analyzed via an integrated evaluation framework by synthesizing prevalence estimates, epidemiological adjustment as well as comorbidity assessment to develop internally consistent estimates of DALY. DALY changes during 2010-2020 were decomposed by population growth and aging and further grouped by Socio-demographic Index (SDI). DALYs were projected to 2030 by the weighted median annualized rate of change in 2010-2020.

RESULTS

In 2010-2020, the average DALYs for severe mental disorders reached 798,474 (95% uncertainty interval [UI]: 536,280-1,270,465) person-years (52.2% for males, and 47.8% for females). Severe mental disorders led to a great amount of disease burden, especially in Guangzhou, Shenzhen, and Foshan cities. Schizophrenia and mental retardation with mental disorders were the two leading sources of the burden ascribed to severe mental disorders. Population growth and aging could be accountable for the increasing burden of severe mental disorders. Economic regions with higher SDI carried a greater burden but had lower annualized rates of change in DALYs. The overall burden of severe mental disorders is projected to rise modestly over the next decade.

CONCLUSIONS

The findings urge prioritization of initiatives focused on public mental health, prevention strategies, health resources reallocation, and active involvement of authorities to effectively address the anticipated needs.

Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders

Background

Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs.

Methods

A national population-based case–control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009–2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers.

Results

Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit – as compared to licit – SUDs were younger (mean quotient = 0.72 [0.71–0.72]), more often had low education level (RR = 1.68 [1.63–1.73]), were less often in paid work (RR = 0.74 [0.72–0.76]) and had lower income (mean quotient = 0.61 [0.60–0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation.

Conclusion

Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13199-5.

Keeping up with the Wangs: individual and contextual influences on mental wellbeing and depressive symptoms in China

Background

In recent decades, China has experienced dramatic changes to its social and economic environment, which has affected the distribution of wellbeing across its citizens. While several studies have investigated individual level predictors of wellbeing in the Chinese population, less research has been done looking at contextual effects. This cross-sectional study looks at the individual and contextual effects of (regional) education, unemployment and marriage (rate) on individual happiness, life satisfaction and depressive symptomatology.

Methods

Data were collected from over 29,000 individuals (aged 18 to 110, 51.91% female) in the China Family Panel Studies, and merged with county level census data obtained from the 2010 China Population Census and Statistical Yearbook. To explore contextual effects, we used multilevel models accounting for the hierarchical structure of the data.

Results

We found that a one-year increase in education was associated with a 0.17% increase in happiness and a 0.16% decrease in depressive symptoms. Unemployed men were 1% less happy, 1% less satisfied with life and reported 0.84% more depressive symptoms than employed men while minimal effects were seen for women. Single, divorced and widowed individuals had worse outcomes than married individuals (ranging from 2.96 to 21% differences). We found interaction effects for education and employment. Less educated individuals had greater happiness and less depressive symptoms in counties with higher average education compared to counterparts in less educated counties. In contrast, more educated individuals were less satisfied with life in more educated counties, an effect that is possibly due to social comparison. Employed individuals had lower life satisfaction in areas of high unemployment, while levels were constant for the unemployed. A 1% increase in county marriage rate was associated with 0.33 and 0.24% increases in happiness and life satisfaction respectively, with no interactions. We speculate that this effect could be due to greater social cohesion in the neighbourhood.

Conclusions

Our results show that policies designed to improve employment and marriage rates will be beneficial for all, while interventions to encourage positive social comparison strategies may help to offset the negative effects of increasing neighbourhood average education on the highly educated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12869-8.

[Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective]

Posttraumatic stress disorder and substance use disorder often co-occur within the health care system. Their comorbidity is associated with more serious acute clinical symptomatology, more frequent hospital admissions in state of emergency and significantly lower chances of improvement by psychological and pharmacological treatment. Their comorbidity contributes to dramatically unfavourable courses of illness as regards all biopsychosocial levels. The survey presented will discuss empirical findings from various perspectives: general epidemiology, substance use disorder as risk factor of trauma and PTSD, trauma and PTSD as risk factor of SUD, neurobiological effects of SUD converging towards neurobiology of PTSD, shared common factors of genetics/epigenetics, personality traits, and early developmental stress and trauma. The main focus of analysis will be put on processes that are intrinsically linked to the development and course of both disorders.

Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study

Background

Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system.

Methods

A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement.

Results

79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.

Conclusions

An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-022-00523-0.

Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings

BACKGROUND

Two OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services.

METHOD

We employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China).

RESULTS

Median risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72).

CONCLUSION

Both OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.

Advancing urban mental health research: from complexity science to actionable targets for intervention

Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.

A Comparison of Depression and Anxiety among University Students in Nine Countries during the COVID-19 Pandemic

The mental health of young adults, particularly students, is at high risk during the COVID-19 pandemic. The purpose of this study was to examine differences in mental health between university students in nine countries during the pandemic. The study encompassed 2349 university students (69% female) from Colombia, the Czech Republic (Czechia), Germany, Israel, Poland, Russia, Slovenia, Turkey, and Ukraine. Participants underwent the following tests: Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Exposure to COVID-19 (EC-19), Perceived Impact of Coronavirus (PIC) on students' well-being, Physical Activity (PA), and General Self-Reported Health (GSRH). The one-way ANOVA showed significant differences between countries. The highest depression and anxiety risk occurred in Turkey, the lowest depression in the Czech Republic and the lowest anxiety in Germany. The χ2 independence test showed that EC-19, PIC, and GSRH were associated with anxiety and depression in most of the countries, whereas PA was associated in less than half of the countries. Logistic regression showed distinct risk factors for each country. Gender and EC-19 were the most frequent predictors of depression and anxiety across the countries. The role of gender and PA for depression and anxiety is not universal and depends on cross-cultural differences. Students' mental health should be addressed from a cross-cultural perspective.

Klotho, BDNF, NGF, GDNF Levels and Related Factors in Withdrawal Period in Chronic Cannabinoid Users

Klotho and neurotropic factors have recently been shown to be related to some psychiatric disorders and neurocognitive disorders, but there is no study on this issue within substance users. In this study, brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glial derived neurotrophic factor (GDNF) and klotho serum levels of a patient group consisting of 27 chronic cannabis users according to the DSM-V and 27 healthy volunteers were compared, and their relationships with other the clinical features of other patients were evaluated. Clinical scales, the Buss-Perry Aggression Scale, and the Substance Craving Scale were repeated on the first day of hospitalisation and on the seventh day of withdrawal. BDNF, GDNF, NGF and klotho levels were analysed using the ELISA method. There was no differences between the cannabinoid use disorder group and the control group regarding their klotho and other neurotrophic levels, but initiation age of cannabis use was negatively correlated with these levels. In addition, there was a relationship between verbal aggression scores and BDNF and NGF levels. There was a positive correlation between klotho and neurotrophic factors in all groups (patient group Day 1, patient group Day 7, control group) (p < 0.01). When comparing the difference between the correlations using the cocor (a comprehensive solution for the statistical comparison of correlations), the klotho-GDNF and klotho-NGF correlations for the first day of the patient group and the control group were different. In this study, rather than a difference in klotho levels and neurotropic factors, a significant relationship between these markers and each other and clinical parameters was demonstrated; further studies are needed to understand the exact mechanism.

Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross-sectional study

BACKGROUND

Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life.

METHODS

The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated.

RESULTS

About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only.

CONCLUSION

The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.

Childhood Socioeconomic Status and Depressive Symptoms of Young Adults: Mediating Role of Childhood Trauma

Background: Studies have shown that low childhood socioeconomic status (SES) is associated with a high prevalence of depressive symptoms. Childhood trauma, as a potential consequence of low SES, may play an important part, but the mediation effect of childhood trauma remains to be elucidated. Methods: A cross-sectional survey was conducted among 1,807 university students. The MacArthur Scale of Subjective Social Economic Status-Youth Version, Childhood Trauma Questionnaire, and Beck Depression Inventory were used to measure childhood SES, childhood trauma, and current depressive symptoms, respectively. A structural equation model (SEM) was employed to demonstrate the mediating role of childhood trauma on the association between childhood SES and depressive symptoms. Results: The SEM demonstrated that childhood SES had significant indirect effects upon depressive symptoms via childhood trauma. Childhood trauma accounted for 89.3% of the total effect, indicating a profound mediation effect. Conclusions: The effect of childhood SES on the depressive symptoms of young adults was mediated by childhood trauma, which emphasizes the importance of early prevention and intervention of child neglect/abuse.

Prevalence of Common mental disorders in older adults: Results from the National Mental Health Survey of India

OBJECTIVE

We estimate the prevalence of common mental disorders (CMD) among older adults and compare them with that of younger adults at the national level.

METHOD

We analysed data on older adults from the National Mental Health Survey of India undertaken across 6 regions and 12 states of India during 2015-16. Multi-stage cluster sampling technique was adopted which permitted state level and subsequently pooled national estimates. Mini International NeuroPsychiatric Interview (MINI) adult version 6.0 was used for measuring psychiatric morbidity.

RESULTS

Older adults had a higher lifetime (6.93%) and current (3.53%) prevalence of depressive disorders as compared to the younger adults (4.96% and 2.54%). There was no difference in the prevalence of anxiety disorders in different agegroups. The most prevalent anxiety disorder in older adults was specific phobias (1.72%) followed by agoraphobia (1.6%). All CMD in the older population were more common in females, those living in urban metros, the unemployed, who were not currently married and those with lower household income.

DISCUSSION

These findings support planning better mental health policies and programs for older adults in India.

The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017

BACKGROUND

Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017.

METHODS

We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates.

FINDINGS

In 2017, 197·3 million (95% UI 178·4-216·4) people had mental disorders in India, including 45·7 million (42·4-49·8) with depressive disorders and 44·9 million (41·2-48·9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r²=0·33, p=0·0009) and males (r²=0·19, p=0·015). The contribution of mental disorders to the total DALYs in India increased from 2·5% (2·0-3·1) in 1990 to 4·7% (3·7-5·6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33·8%, 29·5-38·5), followed by anxiety disorders (19·0%, 15·9-22·4), idiopathic developmental intellectual disability (IDID; 10·8%, 6·3-15·9), schizophrenia (9·8%, 7·7-12·4), bipolar disorder (6·9%, 4·9-9·6), conduct disorder (5·9%, 4·0-8·1), autism spectrum disorders (3·2%, 2·7-3·8), eating disorders (2·2%, 1·7-2·8), and attention-deficit hyperactivity disorder (ADHD; 0·3%, 0·2-0·5); other mental disorders comprised 8·0% (6·1-10·1) of DALYs. Almost all (>99·9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period.

INTERPRETATION

One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia: a cross-sectional study

BACKGROUND

Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders.

METHODS

A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP).

RESULTS

Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%.

CONCLUSIONS

High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.

Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women

OBJECTIVES

The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance.

METHODS

Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score.

RESULTS

Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively.

CONCLUSIONS

Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A419.

Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders

Background

The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants' perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community.

Methods

Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, "Monash-Shenzhen Primary Healthcare Leaders Programs" conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain's Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations.

Results

Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors' incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital.

Conclusions

Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation's mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence.

Uncovering the hidden impacts of inequality on mental health: a global study

Women are nearly twice as likely as men to suffer from mental illness. This gender disparity in depressive disorders may relate to social inequalities and living standards across nations. Currently, these disparities were not reflected at the level of health policies. This study utilized global data for depressive disorders and socioeconomic data from the United Nations' World Bank databases and Global Burden of Disease database to demonstrate the correlation between social inequality and gender disparities in mental health. This study investigated the association among the ratio of female to male depressive disorder rates, gross domestic product, the GINI Index, and the gender inequality index for 122 countries. The research yielded some major findings. First, there exists a significant correlation between gender inequality and gender disparities in mental health. Second, the GINI index is significantly associated with male-but not female-depressive disorder rates. Third, gender disparities in depressive disorders are associated with a country's wealth. These findings can help to inform society, policy-makers, and clinicians to improve the overall health level globally.

Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that is aligned with the Sustainable Development Goals, to use this framework to systematically review evidence regarding these social determinants, and to identify potential mechanisms and targets for interventions. We did a systematic review of reviews using a conceptual framework comprising demographic, economic, neighbourhood, environmental events, and social and culture domains. We included 289 articles in the final Review. This study sheds new light on how the Sustainable Development Goals are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders.

Prevalence of Depression in the Community from 30 Countries between 1994 and 2014

The prevalence of depression may be affected by changes in psychiatric practices and the availability of online mental health information in the past two decades. This study aimed to evaluate the aggregate prevalence of depression in communities from different countries between 1994 and 2014 and to explore the variations in prevalence stratified by geographical, methodological and socio-economic factors. A total of 90 studies were identified and met the inclusion criteria (n = 1,112,573 adults) with 68 studies on single point prevalence, 9 studies on one-year prevalence, and 13 studies on lifetime prevalence of depression. A random-effects model meta-analysis that was performed to calculate the aggregate point, one-year and lifetime prevalence of depression calculated prevalences of 12.9%, 7.2% and 10.8% respectively. Point prevalence of depression was significantly higher in women (14.4%), countries with a medium human development index (HDI) (29.2%), studies published from 2004 to 2014 (15.4%) and when using self-reporting instruments (17.3%) to assess depression. Heterogeneity was identified by meta-regression and subgroup analysis, and response rate, percentage of women and year of publication, respectively, were determined contribute to depression prevalence. This meta-analysis allows benchmarking of the prevalence of depression during the era when online health information emerged, facilitating future comparisons.

Relationship of drinking motives with alcohol consumption and alcohol-related problems identified in a representative community-based study from Ningxia, China

BACKGROUND

Drinking motives have been linked to alcohol consumption and drinking-related problems in western countries, but evidence about this relationship is largely lacking for Asian countries. We aim to assess the relationship between drinking motives and drinking-related outcomes in China, where alcohol use disorders are an increasingly important contributor to the overall burden of illness.

METHODS

Validated Chinese versions of the Drinking Motives Questionnaire-Revised (DMQ-R) and the Alcohol Use Disorder Identification Test (AUDIT) were used to assess drinking motives and drinking-related outcomes among 612 current drinkers identified from a cross-sectional survey of a representative sample of 2425 adults living in Ningxia Province in 2013. Structural equation modeling was used to estimate the relationships linking specific drinking motives ('enhancement', 'conformity', 'social' and 'coping') to drinking-related outcomes ('level of alcohol consumption', 'alcohol dependence' and 'adverse consequences').

FINDINGS

The enhancement motive is significantly associated with the level of alcohol consumption (β=0.52, 95% CI=0.27, 0.78). The conformity motive is associated with higher levels of alcohol dependence (β=0.74, 95% CI=0.50, 0.98) and adverse consequences of drinking (β=0.43, 95% CI=0.04, 0.81). The social motive and drinking to cope motive are not significantly associated with any of the three drinking outcomes.

INTERPRETATION

The relationships between drinking motives and drinking-related outcomes in China are quite different from those reported in western countries. This study highlights the need to consider local context when adapting prevention or intervention strategies developed in western countries to address the problem of the harmful use of alcohol in China.

Predictors, help-seeking behaviour and treatment coverage for depression in adults in Sehore district, India

BACKGROUND

National Mental Health Survey found that in India, the point prevalence of major depressive disorder (MDD) was 2.7% and the treatment gap was 85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and the treatment gap was 80%.

AIMS

To describe the baseline prevalence of depression among adults, association of various demographic and socioeconomic variables with depression and estimation of contact coverage for the same.

METHOD

Population-based cross-sectional survey of 3220 adults in Sehore district of Madhya Pradesh, India. The outcome of interest was a probable diagnosis of depression that was measured using the Patient Health Questionnaire (PHQ-9) and the proportion of individuals with depression (PHQ-9>9) who sought care for the same. The data were analysed using simple and multiple log-linear regression.

RESULTS

Low educational attainment, unemployment and indebtedness were associated with both moderate/severe depression (PHQ-9 score >9) and severe depression only (PHQ-9 score >14), whereas age, caste and marital status were associated with only moderate or severe depression. Religion, type of house, land ownership and amount of loan taken were not associated with either moderate/severe or only severe depression. The contact coverage for moderate/severe depression was 13.08% (95% CI 10.2-16.63).

CONCLUSIONS

There is an urgent need to bridge the treatment gap by targeting individuals with social vulnerabilities and integrating evidence-based interventions in primary care.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Social Epidemiology and Global Mental Health: Expanding the Evidence from High-Income to Low- and Middle-Income Countries

PURPOSE OF THE REVIEW

The vast majority of research on the social determinants of mental health has been generated from high-income country (HIC) populations, even as the greatest health disparities, and greatest disease burden, is observed in lower- and middle-income countries (LMICs). The goal of this review is to examine the evidence base on how key social epidemiology constructs relate to mental health in LMIC contexts. A special focus is on points of departure from the HIC knowledge base, gaps in overall understanding, and opportunities for social epidemiology to make a significant contribution.

RECENT FINDINGS

A growing body of literature suggests that there is significant heterogeneity, both in the direction and magnitude, of association between factors such as socioeconomic status, income inequality, gender, and social networks/supports and mental health in LMIC. For example, higher levels of education and being married can be risk factors for worse mental health among women in certain contexts. However, many studies have methodological limitations that make causal inference difficult. Poverty alleviation interventions offer a unique opportunity to examine the impact of improving economic resources and mental health.

SUMMARY

Much remains unknown about the impact of key social factors on mental health in LMIC. Findings from HICs may not apply to LMIC populations, since the meaning and distribution of a given social variable may differ significantly from what is commonly observed in HICs. These points of departure point to opportunities for social epidemiology to make a contribution to the field of global mental health.

Prevalence, correlates, comorbidity, and age of onset of alcohol use disorders in adult males from five provinces in China

BACKGROUND

This study integrates data from high-quality mental health surveys in five provinces in China to examine the prevalence, demographic correlates, age of onset, and comorbidity of alcohol use disorder (AUD).

METHODS

The five cross-sectional surveys initially screened a representative sample of 74,752 community-living adults (94% response rate) from a sampling population including over 12% of China's adult population. Psychiatrists then administered a detailed diagnostic exam to an enriched sample of 21,015 respondents (95% response rate). The prevalence of AUD in females in China is below 0.5%, so we limited our analysis to 9619 males who completed the diagnostic interview.

RESULTS

Using meta-analyses to summarize estimates across the five locations, the current (30-day) prevalence of AUD among adult Chinese males was 9.8% (95% CI=5.7-16.9%), but there was wide cross-province variation. After adjusting for age and other demographic variables, the prevalence of AUD was significantly lower in single men than in married men (OR=0.4, CI=0.2-0.7), lower in men who were not currently working than in men who were currently working (OR=0.7, CI=0.5-0.96), and lower in men with comorbid mental disorders than in men without comorbid mental disorders (OR=0.4, CI=0.2-0.8). The risk of developing AUD peaked at 30 years of age.

CONCLUSIONS

Substantial differences in the demographic correlates and age of onset of AUD in men in China compared to those reported in other countries highlight the importance of understanding the country-specific and region-specific profile of AUD before developing intervention and prevention strategies.

Prevalence of mental, neurological, and substance use disorders in China and India: a systematic analysis

BACKGROUND

Population-representative prevalence data for mental, neurological, and substance use disorders are essential for evidence-based decision making. As a background to the China-India Mental Health Alliance Series, we aim to examine the availability of data and report prevalence for the most common mental, neurological, and substance use disorders in China and India from the Global Burden of Disease study 2013 (GBD 2013).

METHODS

In this systematic analysis, data sources were identified from GBD 2013 for the prevalence of mental, neurological, and substance use disorders in China and India published up to Dec 31, 2013. We calculated the proportion of the population represented by the data with the adjusted population coverage (APC) method adjusting for age, sex, and population size. We developed prevalence models with DisMod-MR 2.0, a Bayesian meta-regression instrument used to pool population-representative epidemiological data as part of GBD 2013. We report estimates and 95% uncertainly intervals (95% UI) for 15 mental, neurological, and substance use disorders for China and India in 1990 and 2013, and benchmark these against those for other BRICS countries (Brazil, Russia, and South Africa) in 2013.

FINDINGS

Few population-representative data were found for the disorders, with an average coverage of 15% of the population of the Chinese mainland and 1% of the population of India. For men in both China and India, major depressive disorder, anxiety disorders, and alcohol dependence were the most common mental, neurological, and substance use disorders. Prevalence of major depressive disorder was 2·2% (95% UI 1·5-2·8) in Chinese men and 3·5% (2·4-4·6) in Indian men; prevalence of anxiety disorders was 2·0% (1·1-3·2) and 1·9% (1·2-2·3), respectively. For women, anxiety disorders, major depressive disorder, and dysthymia were the most common. Prevalence of major depressive disorder was 3·3% (2·3-4·1) in Chinese women and 4·7% (95% UI 3·3-6·2) in Indian women; prevalence of anxiety disorders was 3·3% (1·6-5·3) and 4·1% (3·3-5·0), respectively. Schizophrenia was more prevalent in China (0·5%, 95% UI 0·4-0·5) than in India (0·2%; 0·2-0·2).

INTERPRETATION

More data for mental, neurological, and substance use disorders are needed for India and China but the large population and geographic scale of these countries present challenges to population-representative data collection.

FUNDING

China-India Mental Health Alliance, China Medical Board.