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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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Reininghaus U, Rauschenberg C, Schick A, Hartmann JA. [Public mental health from an international perspective: from "shifting the curve" to inclusion of vulnerable populations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:371-378. [PMID: 36847854 PMCID: PMC9969372 DOI: 10.1007/s00103-023-03673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
In recent years, efforts in the field of public mental health have increased that seek to promote mental health and mental health literacy at population level and yield advances in the prevention, treatment and care of mental health conditions. This paper provides an overview of contemporary conceptualisations of indicators and determinants of public mental health as well as population-based intervention strategies from an international perspective. Current conceptual and methodological challenges of so-called high-risk, whole-population and vulnerable population strategies are critically discussed. Future efforts in research, policy and practice need to address fundamental causes of social and health inequalities, drawing on all societal fields, to contribute to improving population mental health.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien. .,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien.
| | - Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Jessica A. Hartmann
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland ,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australien
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Reininghaus U, Schomerus G, Hölling H, Seidler A, Gerhardus A, Gusy B, Riedel-Heller S. „Shifting the Curve“: Neue Entwicklungen und Herausforderungen im Bereich der Public Mental Health. PSYCHIATRISCHE PRAXIS 2022; 50:160-164. [PMID: 36096131 DOI: 10.1055/a-1823-5191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungIn der nationalen und internationalen Forschung nimmt das noch relativ junge Fach der Public Mental Health einen immer wichtigeren Stellenwert ein. Allerdings bleibt eine zentrale Herausforderung, dieses Fach in seiner Interdisziplinarität abzubilden und den Diskurs im Spannungsfeld von Public Health, psychiatrischer Epidemiologie, psychischer Gesundheitsförderung, Prävention und Versorgungsforschung zu führen, um sein innovatives Potenzial vollständig auszuschöpfen. In diesem Spannungsfeld stellen sich eine Reihe von grundsätzlichen konzeptionellen und methodischen Fragen, die in diesem Essay unter Bezugnahme auf die Populationsstrategie von Geoffrey Rose exemplarisch auch hinsichtlich fundamentaler Ursachen von sozialen und gesundheitlichen Ungleichheiten erörtert und adressiert werden sollen, mit dem letztendlichen Ziel, die Grundlage zur Erfassung und Veränderung von psychischer Gesundheit auf Populationsebene zu verbessern.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health; Zentralinstitut für Seelische Gesundheit, Public Mental Health, ZI Seelische Gesundheit Mannheim
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Heike Hölling
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut
| | - Andreas Seidler
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden
| | - Ansgar Gerhardus
- Abteilung für Versorgungsforschung, Institut für Public Health und Pflegeforschung, Universität Bremen
| | - Burkhard Gusy
- Fachbereich Erziehungswissenschaft und Psychologie, Arbeitsbereich Public Health: Prävention und psychosoziale Gesundheitsforschung, Freie Universität Berlin
| | - Steffi Riedel-Heller
- Medizinische Fakultät, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig
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Scott J, Crouse JJ, Ho N, Iorfino F, Martin N, Parker R, McGrath J, Gillespie NA, Medland S, Hickie IB. Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults. PLoS One 2021; 16:e0252550. [PMID: 34086749 PMCID: PMC8177455 DOI: 10.1371/journal.pone.0252550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The heterogeneity and comorbidity of major mental disorders presenting in adolescents and young adults has fostered calls for trans-diagnostic research. This study examines early expressions of psychopathology and risk and trans-diagnostic caseness in a community cohort of twins and non-twin siblings. METHODS Using data from the Brisbane Longitudinal Twin Study, we estimated median number of self-rated psychiatric symptoms, prevalence of subthreshold syndromes, family history of mood and/or psychotic disorders, and likelihood of subsequent trans-diagnostic caseness (individuals meeting diagnostic criteria for mood and/or psychotic syndromes). Next, we used cross-validated Chi-Square Automatic Interaction Detector (CHAID) analyses to identify the nature and relative importance of individual self-rated symptoms that predicted trans-diagnostic caseness. We examined the positive and negative predictive values (PPV; NPV) and accuracy of all classifications (Area under the Curve and 95% confidence intervals: AUC; 95% CI). RESULTS Of 1815 participants (Female 1050, 58%; mean age 26.40), more than one in four met caseness criteria for a mood and/or psychotic disorder. Examination of individual factors indicated that the AUC was highest for subthreshold syndromes, followed by family history then self-rated psychiatric symptoms, and that NPV always exceeded PPV for caseness. In contrast, the CHAID analysis (adjusted for age, sex, twin status) generated a classification tree comprising six trans-diagnostic symptoms. Whilst the contribution of two symptoms (need for sleep; physical activity) to the model was more difficult to interpret, CHAID analysis indicated that four self-rated symptoms (sadness; feeling overwhelmed; impaired concentration; paranoia) offered the best discrimination between cases and non-cases. These four symptoms showed different associations with family history status. CONCLUSIONS The findings need replication in independent cohorts. However, the use of CHAID might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders.
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Affiliation(s)
- Jan Scott
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Jacob J. Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Martin
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - John McGrath
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Sarah Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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van Lankveld J, Wolfs K, Grauvogl A. Gender Differences in the Relationship of Sexual Functioning with Implicit and Explicit Sex Liking and Sex Wanting: A Community Sample Study. JOURNAL OF SEX RESEARCH 2020; 57:860-871. [PMID: 30489161 DOI: 10.1080/00224499.2018.1542656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The present study aimed to investigate associations of automatic and controlled cognition with sexual functioning, and moderation of these associations by working memory capacity in a community sample of heterosexual women (N = 65) and men (N = 51). Participants performed two single-target Implicit Association Tests (ST-IATs) to assess implicit liking and wanting of erotic stimuli. The Sexual Opinion Survey (SOS) was used to assess explicit liking of sex. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) were used to assess sexual function. Working memory capacity was assessed using the Towers of Hanoi task and mood using the Hospital Anxiety and Depression Scale (HADS). In female participants, higher levels of sexual functioning co-occurred with stronger implicit associations of erotic stimuli with wanting, whereas implicit sex liking was unrelated to level of sexual functioning. In male participants, higher levels of sexual functioning co-occurred with lower implicit liking of erotic stimuli, whereas implicit sex wanting was unrelated to sexual functioning. Higher erotophilia scores were related to higher levels of sexual functioning in both women and men, but anxiety and depression symptoms were unrelated to sexual functioning. Working memory capacity did not moderate the associations between erotophilia and sexual functioning.
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Affiliation(s)
- Jacques van Lankveld
- Department of Psychology and Educational Sciences, Open University of the Netherlands
- AltraCura , Geleen, The Netherlands
| | - Kenny Wolfs
- Department of Psychology and Educational Sciences, Open University of the Netherlands
- AltraCura , Geleen, The Netherlands
| | - Andrea Grauvogl
- Department of Psychology and Educational Sciences, Open University of the Netherlands
- AltraCura , Geleen, The Netherlands
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6
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Klaus F, Chumbley JR, Seifritz E, Kaiser S, Hartmann-Riemer M. Loss Aversion and Risk Aversion in Non-Clinical Negative Symptoms and Hypomania. Front Psychiatry 2020; 11:574131. [PMID: 33173521 PMCID: PMC7538829 DOI: 10.3389/fpsyt.2020.574131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
In the field of behavioral decision-making, "loss aversion" is a behavioral phenomenon in which individuals show a higher sensitivity to potential losses than to gains. Conversely, "risk averse" individuals have an enhanced sensitivity/aversion to options with uncertain consequences. Here we examine whether hypomania or negative symptoms predict the degree of these choice biases. We chose to study these two symptom dimensions because they present a common theme across many syndromes with compromised decision-making. In our exploratory study, we employed a non-clinical sample to dissociate the hypomanic from negative symptom dimension regarding choice behavior. We randomly selected a sample of 45 subjects from a student population (18-37 years) without self-reported psychiatric diagnoses (n = 835). We stratified them based on percentiles into a low hypomania/low negative symptoms (n = 15), a hypomania (n = 15), and a negative symptoms group (n = 15) using the hypomanic personality scale (HPS-30) and community assessment of psychic experiences (CAPE). Participants completed a loss aversion task consisting of forced binary choices between a monetary gamble and a riskless choice without gain or loss. We found a reduced loss aversion in participants with higher negative symptoms. In addition, risk aversion was reduced in participants with higher hypomania and negative symptoms compared to low hypomania/negative symptoms. This study adds to the understanding of underlying psychological mechanisms of loss and risk aversion. Given the partially opposing nature of hypomania and negative symptoms, further work is needed to examine whether they affect loss and risk aversion via dissociable mechanisms.
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Affiliation(s)
- Federica Klaus
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Justin R Chumbley
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Matthias Hartmann-Riemer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Tomitaka S, Kawasaki Y, Ide K, Akutagawa M, Ono Y, Furukawa TA. Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population. Sci Rep 2019; 9:11982. [PMID: 31427587 PMCID: PMC6700099 DOI: 10.1038/s41598-019-47322-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.
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Affiliation(s)
- Shinichiro Tomitaka
- Department of Mental Health, Panasonic Health Center, Tokyo, Japan. .,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.,Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Maiko Akutagawa
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Haga SM, Drozd F, Lisøy C, Wentzel-Larsen T, Slinning K. Mamma Mia - A randomized controlled trial of an internet-based intervention for perinatal depression. Psychol Med 2019; 49:1850-1858. [PMID: 30191779 PMCID: PMC6650775 DOI: 10.1017/s0033291718002544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND Studies suggest that 10-15% of perinatal women experience depressive symptoms. Due to the risks, problems with detection, and barriers to treatment, effective universal preventive interventions are needed. The aim of this study was to assess the effectiveness of an automated internet intervention ('Mamma Mia') on perinatal depressive symptoms. Mamma Mia is tailored specifically to the perinatal phase and targets risk and protective factors for perinatal depressive symptoms. METHODS A total of 1342 pregnant women were randomized to an intervention ('Mamma Mia') and control group. Data were collected at gestational week (gw) 21-25, gw37, 6 weeks after birth, and 3 and 6 months after birth. We investigated whether (1) the intervention group displayed lower levels of depressive symptoms compared with the control group, (2) the effect of Mamma Mia changed over time, (3) the effect on depressive symptoms was moderated by baseline depressive symptoms, previous depression, and parity, and (4) this moderation changed by time. Finally, we examined if the prevalence of mothers with possible depression [i.e. Edinburgh Postnatal Depression Scale (EPDS)-score ⩾10] differed between the intervention and control group. RESULTS Participants in the Mamma Mia group displayed less depressive symptoms than participants in the control group during follow-up [F(1) = 7.03, p = 0.008]. There were indications that the effect of Mamma Mia was moderated by EPDS score at baseline. The prevalence of women with EPDS-score ⩾10 was lower in the Mamma Mia group at all follow-up measurements. CONCLUSIONS The study demonstrated the effects of the automated web-based universal intervention Mamma Mia on perinatal depressive symptoms.
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Affiliation(s)
- Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Tore Wentzel-Larsen
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo,Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Department of Psychology, University of Oslo, Oslo,Norway
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9
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Razak F, Subramanian SV, Sarma S, Kawachi I, Berkman L, Davey Smith G, Corsi DJ. Association between population mean and distribution of deviance in demographic surveys from 65 countries: cross sectional study. BMJ 2018; 362:k3147. [PMID: 30076132 PMCID: PMC6073428 DOI: 10.1136/bmj.k3147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine whether conditions related to scarcity at the left side of the distribution (anaemia, severe chronic energy deficiency, and underweight) are as strongly related to population means as conditions of excess at the right side of the distribution (overweight and obesity). DESIGN Observational study. SETTING 65 countries, with nationally representative cross sectional data from 1994 to 2014 obtained from the Demographic Health Surveys. PARTICIPANTS Non-pregnant women aged 20-49. Sample of 65 countries and n=524 380 for analysis of BMI; sample of 44 countries and n=316 465 for analysis of haemoglobin. MAIN OUTCOME MEASURES The association between mean and prevalence of each category. For BMI, prevalence of severe chronic energy deficiency (SCED, BMI <16.0), underweight (BMI <18.5), overweight (BMI >25) and obese (BMI >30.) were measured; for haemoglobin, prevalence of anaemia (haemoglobin <12.0 g/dL) and severe anaemia (haemoglobin <8.0 g/dL) were examined. RESULTS There was a strong association between mean BMI and prevalence of overweight (r2=0.98; r=0.99; β=8.3 (8.0 to 8.6)) and obesity (r2=0.93; r=0.97; β=4.2 (3.9 to 4.5)). For left sided conditions, a moderate to strong association was found between mean BMI and prevalence of underweight (r2=0.67; r=-0.82; β=-2.7 (-3.1 to -2.2)), and a weaker association for SCED (r2=0.38; r=-0.61; β=-0.32 (-0.43 to -0.22)). There was a moderate association between mean haemoglobin and prevalence of anaemia (r2=0.46; r=-0.68; β=-10.8 (-14.5 to -7.1)) and a weaker association with severe anaemia (r2=0.30; r=-0.55; β=-0.55 (-0.81 to -0.29)). CONCLUSIONS The associations between population means and prevalence of conditions of scarcity such as low BMI and anaemia were substantially weaker than the associations of mean BMI with conditions of excesses such as overweight and obesity.
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Affiliation(s)
- Fahad Razak
- Division of General Internal Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1W8, Canada
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, 716, Boston, MA 02115-6096, USA
| | | | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, 716, Boston, MA 02115-6096, USA
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Daniel J Corsi
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
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10
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Chinekesh A, Hosseini SA, Mohammadi F, Motlagh ME, Baradaran Eftekhari M, Djalalinia S, Ardalan G. An explanatory model for the concept of mental health in Iranian youth. F1000Res 2018; 7:52. [PMID: 29560255 PMCID: PMC5832920 DOI: 10.12688/f1000research.12893.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master’s degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.
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Affiliation(s)
- Ahdieh Chinekesh
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi
- Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Esmael Motlagh
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran.,Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Monir Baradaran Eftekhari
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Department of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Non communicable Diseases Research Center, EMRI, Tehran University of Medical Sciences, Tehran, Iran
| | - Gelayol Ardalan
- Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
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Razak F, Davey Smith G, Subramanian SV. The idea of uniform change: is it time to revisit a central tenet of Rose's "Strategy of Preventive Medicine"? Am J Clin Nutr 2016; 104:1497-1507. [PMID: 27935518 DOI: 10.3945/ajcn.115.127357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/19/2016] [Indexed: 01/22/2023] Open
Abstract
A mean-centric view of populations, whereby a change in the mean of a health variable at the population level is assumed to result in uniform change across the distribution, is a core component of Geoffrey Rose's concept of the "population strategy" to disease prevention. This idea also has a critical role in Rose's observation that individuals who are considered abnormal or sick (the rightward tail of the distribution) and those who are considered normal (the center) are very closely related, and that true preventive medicine must focus on shifting the normal or average. In this Perspective, we revisit these core tenets of Rose's concept of preventive medicine after providing an overview of the key concepts that he developed. We examine whether these assumptions apply to population changes in body mass index (BMI) and show that there is considerable evidence of a widening of the BMI distribution in populations over time. We argue that, with respect to BMI, the idea of using statistical measures of a population solely on the basis of means and the assumption that populations are coherent entities that change uniformly over time may not fully capture the true nature of changes in the population. These issues have important implications for how we assess and interpret the health of populations over time with implications for the balance between universal and targeted strategies aimed at improving health.
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Affiliation(s)
- Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.,Harvard Center for Population and Development Studies, Cambridge, MA
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit and.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; and
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA; .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Honings S, Drukker M, Groen R, van Os J. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med 2016; 46:237-251. [PMID: 26419206 DOI: 10.1017/s0033291715001841] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. METHOD A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. RESULTS The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk. CONCLUSIONS PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.
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Affiliation(s)
- S Honings
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - M Drukker
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - R Groen
- Faculty of Psychology and Neuroscience,Maastricht University,Maastricht,The Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network,Maastricht University Medical Centre,Maastricht,The Netherlands
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Papassotiropoulos A, de Quervain DJF. Failed drug discovery in psychiatry: time for human genome-guided solutions. Trends Cogn Sci 2015; 19:183-7. [PMID: 25727774 DOI: 10.1016/j.tics.2015.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 12/15/2022]
Abstract
Our knowledge about the molecular and neural mechanisms of emotional and cognitive processes has increased exponentially in the past decades. Unfortunately, there has been no translation of this knowledge into the development of novel and improved pharmacological treatments for psychiatric disorders. We comment on some of the reasons for failed drug discovery in psychiatry, particularly on the use of ill-suited disease models and on the use of diagnostic constructs unrelated to the underlying biological mechanisms. Furthermore, we argue that the use of human genetic findings together with biologically informed phenotypes and advanced data-mining methodology will catalyze the identification of promising drug targets and, finally, will lead to improved therapeutic outcomes.
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Affiliation(s)
- Andreas Papassotiropoulos
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Basel, Switzerland; University of Basel, Psychiatric University Clinics, Basel, Switzerland; University of Basel, Department Biozentrum, Life Sciences Training Facility, Basel, Switzerland; University of Basel, Transfaculty Research Platform, Basel, Switzerland.
| | - Dominique J F de Quervain
- University of Basel, Psychiatric University Clinics, Basel, Switzerland; University of Basel, Transfaculty Research Platform, Basel, Switzerland; University of Basel, Department of Psychology, Division of Cognitive Neuroscience, Basel, Switzerland.
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Wong ST, Manca D, Barber D, Morkem R, Khan S, Kotecha J, Williamson T, Birtwhistle R, Patten S. The diagnosis of depression and its treatment in Canadian primary care practices: an epidemiological study. CMAJ Open 2014; 2:E337-42. [PMID: 25485260 PMCID: PMC4251512 DOI: 10.9778/cmajo.20140052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A diagnosis of depression is common in primary care practices, but data are lacking on the prevalence in Canadian practices. We describe the prevalence of the diagnosis among men and women, patient characteristics and drug treatment in patients diagnosed with depression in the primary care setting in Canada. METHODS Using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, we examined whether the prevalence of a depression diagnosis varied by patient characteristics, the number of chronic conditions and the presence of the following chronic conditions: hypertension, diabetes, chronic obstructive pulmonary disease, osteoarthritis, dementia, epilepsy and parkinsonism. We used regression models to examine whether patient characteristics and type of comorbidity were associated with a depression diagnosis. RESULTS Of the 304 412 patients who had at least 1 encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012, 14% had a diagnosis of depression. Current or past smokers and women with a high body mass index had higher rates of depression. One in 4 patients with a diagnosis of depression also had another chronic condition; those with depression had 1.5 times more primary care visits. About 85% of patients with depression were prescribed medication, most frequently selective serotonin reuptake inhibitors, followed by atypical antipsychotics. INTERPRETATION Our data provide information on the prevalence of a depression diagnosis in primary care and associations with being female, having a chronic condition, smoking history and obesity in women. Our findings may inform research and assist primary care providers with early detection and interventions in at-risk patient populations.
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Affiliation(s)
- Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC ; School of Nursing, University of British Columbia, Vancouver, BC
| | - Donna Manca
- Department of Family Medicine, University of Alberta, Edmonton, Alta
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Ont
| | - Rachael Morkem
- Department of Family Medicine, Queen's University, Kingston, Ont
| | - Shahriar Khan
- Department of Family Medicine, Queen's University, Kingston, Ont
| | - Jyoti Kotecha
- Department of Family Medicine, Queen's University, Kingston, Ont
| | - Tyler Williamson
- Department of Family Medicine, Queen's University, Kingston, Ont. ; Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Richard Birtwhistle
- Department of Family Medicine, Queen's University, Kingston, Ont. ; Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alta. ; Department of Psychiatry, University of Calgary, Calgary, Alta
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Kendrick T. Depression in primary care: what more do we need to know? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:439-41. [PMID: 23972104 DOI: 10.1177/070674371305800801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tony Kendrick
- Professor of Primary Care, Primary and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, England
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Wigman JTW, van Os J, Thiery E, Derom C, Collip D, Jacobs N, Wichers M. Psychiatric diagnosis revisited: towards a system of staging and profiling combining nomothetic and idiographic parameters of momentary mental states. PLoS One 2013; 8:e59559. [PMID: 23555706 PMCID: PMC3610753 DOI: 10.1371/journal.pone.0059559] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mental disorders may be reducible to sets of symptoms, connected through systems of causal relations. A clinical staging model predicts that in earlier stages of illness, symptom expression is both non-specific and diffuse. With illness progression, more specific syndromes emerge. This paper addressed the hypothesis that connection strength and connection variability between mental states differ in the hypothesized direction across different stages of psychopathology. METHODS In a general population sample of female siblings (mostly twins), the Experience Sampling Method was used to collect repeated measures of three momentary mental states (positive affect, negative affect and paranoia). Staging was operationalized across four levels of increasing severity of psychopathology, based on the total score of the Symptom Check List. Multilevel random regression was used to calculate inter- and intra-mental state connection strength and connection variability over time by modelling each momentary mental state at t as a function of the three momentary states at t-1, and by examining moderation by SCL-severity. RESULTS Mental states impacted dynamically on each other over time, in interaction with SCL-severity groups. Thus, SCL-90 severity groups were characterized by progressively greater inter- and intra-mental state connection strength, and greater inter- and intra-mental state connection variability. CONCLUSION Diagnosis in psychiatry can be described as stages of growing dynamic causal impact of mental states over time. This system achieves a mode of psychiatric diagnosis that combines nomothetic (group-based classification across stages) and idiographic (individual-specific psychopathological profiles) components of psychopathology at the level of momentary mental states impacting on each other over time.
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Affiliation(s)
- Johanna T W Wigman
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
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17
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Huppert FA, So TTC. Flourishing Across Europe: Application of a New Conceptual Framework for Defining Well-Being. SOCIAL INDICATORS RESEARCH 2013; 110:837-861. [PMID: 23329863 PMCID: PMC3545194 DOI: 10.1007/s11205-011-9966-7] [Citation(s) in RCA: 426] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2011] [Indexed: 05/06/2023]
Abstract
Governments around the world are recognising the importance of measuring subjective well-being as an indicator of progress. But how should well-being be measured? A conceptual framework is offered which equates high well-being with positive mental health. Well-being is seen as lying at the opposite end of a spectrum to the common mental disorders (depression, anxiety). By examining internationally agreed criteria for depression and anxiety (DSM and ICD classifications), and defining the opposite of each symptom, we identify ten features of positive well-being. These combine feeling and functioning, i.e. hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self esteem, and vitality. An operational definition of flourishing is developed, based on psychometric analysis of indicators of these ten features, using data from a representative sample of 43,000 Europeans. Application of this definition to respondents from the 23 countries which participated in the European Social Survey (Round 3) reveals a four-fold difference in flourishing rate, from 41% in Denmark to less than 10% in Slovakia, Russia and Portugal. There are also striking differences in country profiles across the 10 features. These profiles offer fresh insight into cultural differences in well-being, and indicate which features may provide the most promising targets for policies to improve well-being. Comparison with a life satisfaction measure shows that valuable information would be lost if well-being was measured by life satisfaction. Taken together, our findings reinforce the need to measure subjective well-being as a multi-dimensional construct in future surveys.
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Affiliation(s)
- Felicia A. Huppert
- Well-Being Institute & Department of Psychiatry, University of Cambridge, Box 189, Addenbrooke’s Hospital, Cambridge, CB2 2QQ UK
| | - Timothy T. C. So
- Well-Being Institute & Department of Psychiatry, University of Cambridge, Box 189, Addenbrooke’s Hospital, Cambridge, CB2 2QQ UK
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Sham PC, Sterne A, Purcell S, Cherny S, Webster M, Rijsdijk F, Asherson P, Ball D, Craig I, Eley T, Goldberg D, Gray J, Mann A, Owen M, Plomin R. GENESiS: creating a composite index of the vulnerability to anxiety and depression in a community-based sample of siblings. ACTA ACUST UNITED AC 2012. [DOI: 10.1375/twin.3.4.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is considerable evidence for a unitary and dimensional view of the genetic vulnerability to symptoms of anxiety and depression. The GENESiS (Genetic Environmental–Nature of Emotional States in Siblings) Study aims to use a multivariate approach to detect genetic loci that contribute to individual differences in this vulnerability dimension. The study used the UK General Practice Research Framework to generate a community-based sample of siblings. Questionnaire measures of anxiety/depression included the short form of the neuroticism scale from the revised Eysenck Personality Questionnaire (EPQ-N), the General Health Questionnaire (GHQ-12), and the anxious arousal and high positive affect subscales from the Mood and Anxiety Symptoms Questionnaire (MASQ-AA and MASQ-HPA). Genetic model-fitting of 2658 unselected sibships provided evidence for a single common genetic (familial) factor that accounted for a substantial proportion of the genetic variances and covariances of these four measures. Using the parameter estimates of this model, we constructed a composite index of this common genetic factor. This index, which has a sib correlation of 0.22, will be used as a quantitative phenotype in the molecular genetic phase of GENESiS. Twin Research (2000) 3, 316–322.
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19
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Anae M, Moewaka Barnes H, McCreanor T, Watson P. Towards Promoting Youth Mental Health in Aotearoa/New Zealand: Holistic ‘Houses’ of Health. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2002.9721855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Groot PC. Patients can diagnose too: How continuous self-assessment aids diagnosis of, and recovery from, depression. J Ment Health 2010; 19:352-62. [PMID: 20636115 DOI: 10.3109/09638237.2010.494188] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A dichotomous ICD-10 or DSM-IV diagnosis of depression does not fully capture its natural phenotype: a dimensional continuum of environmentally reactive fluctuations in mood. Therefore, ICD and DSM labels of depression, although useful from a service perspective, fail to help patients directly. This paper will show, using the author's experiences as an example, that patients with mood disorders can "diagnose" the natural phenotype, in the sense that systematic recording of painful fluctuations in environmentally reactive moods by the patient him- or herself may: (i) not only provide an accurate assessment of depression, but (ii) result in a process of conscious awareness of aberrant responses to the environment - a first step on the way to recovery. METHOD The author developed a rudimentary but useable method to diagnose his dynamic mood fluctuations over the years. The continuous assessment method allowed him to systematically score his mood and activities every day, enabling him to study and analyse in detail the course and context of mood symptoms over time. RESULTS With time, this initial strategy evolved into a new, more informed, more empowered diagnosis of his problems and ultimately contributed to a more resilient mind set with regard to mood changes and ways of active rather than avoidant coping with them. CONCLUSIONS Many people with mood problems receive a DSM label but are not taught to engage in diagnosing what depression is: a dynamic pattern of environmentally reactive mood responses. Continuous diagnostic self-assessment strategies may help patients to learn, adjust and cope with their emotional vulnerabilities expressed as dimensional and reactive variation in mood. Patients can be empowered to diagnose experiences as a means to understand the sources and consequences of continuous mood variation over time.
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Affiliation(s)
- Peter C Groot
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, 6200MD Maastricht, The Netherlands.
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21
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Bartram DJ, Sinclair JMA, Baldwin DS. Interventions with potential to improve the mental health and wellbeing of UK veterinary surgeons. Vet Rec 2010; 166:518-23. [DOI: 10.1136/vr.b4796] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D. J. Bartram
- Division of Clinical Neurosciences: Mental Health Group; School of Medicine; University of Southampton; Royal South Hants Hospital; Brintons Terrace Southampton SO14 0YG
| | - J. M. A. Sinclair
- Division of Clinical Neurosciences: Mental Health Group; School of Medicine; University of Southampton; Royal South Hants Hospital; Brintons Terrace Southampton SO14 0YG
| | - D. S. Baldwin
- Division of Clinical Neurosciences: Mental Health Group; School of Medicine; University of Southampton; Royal South Hants Hospital; Brintons Terrace Southampton SO14 0YG
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Simons CJP, Jacobs N, Derom C, Thiery E, Jolles J, van Os J, Krabbendam L. Cognition as predictor of current and follow-up depressive symptoms in the general population. Acta Psychiatr Scand 2009; 120:45-52. [PMID: 19133876 DOI: 10.1111/j.1600-0447.2008.01339.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies have reported an association between depression and poor cognitive functioning. Unknown is to what degree such associations are merely state-related or reflect an enduring depression vulnerability. This study examined whether cognitive deficits predict current and/or follow-up (sub)clinical depressive symptoms in the general population. METHOD A population-based sample of 569 female twins and 43 of their sisters completed a neuropsychological battery. Cross-sectional and prospective associations between depressive symptoms measured at the subclinical [Symptom Checklist-90 (SCL-90)] and clinical level (Structured Clinical Interview for DSM-IV disorders) and neuropsychological factors (episodic memory and information processing speed) were examined. RESULTS Structured Clinical Interview for DSM-IV disorders baseline depressive symptoms were significantly associated with information processing speed but not with episodic memory. Episodic memory was significantly associated with follow-up SCL-90 depressive symptoms. CONCLUSION Being depressed is accompanied by slower information processing. Poor memory functioning may be a predictor for the onset of subclinical depressive symptoms.
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Affiliation(s)
- C J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University, European Graduate School of Neuroscience, Maastricht, the Netherlands
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23
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Huppert FA. Psychological Well-being: Evidence Regarding its Causes and Consequences. Appl Psychol Health Well Being 2009. [DOI: 10.1111/j.1758-0854.2009.01008.x] [Citation(s) in RCA: 341] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huppert FA. A New Approach to Reducing Disorder and Improving Well-Being. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2009; 4:108-11. [DOI: 10.1111/j.1745-6924.2009.01100.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychological science has usually approached the treatment of disorder through research on individual combinations of risk and protective factors (including life experiences, thinking styles, behaviors, social relationships and genes) and the application of interventions that focus on improvements in the individual. However, we can do better than this. Not only should we be aiming to enhance well-being rather than merely reducing disorder, but we should also be doing so for the majority of people rather than the few who have a disorder. In this article, I focus on the mental health spectrum and make the case for a broad population-based approach. I argue that a very small shift in the population mean of the underlying symptoms or risk factors can do more to enhance well-being and reduce disorder than would any amount of intervention with individuals who need help. Examples from research on alcohol abuse and psychological distress are presented to illustrate the value of a population-based approach.
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Patel V, Goodman A. Researching protective and promotive factors in mental health. Int J Epidemiol 2007; 36:703-7. [PMID: 17646185 DOI: 10.1093/ije/dym147] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Affiliation(s)
- Huibert Burger
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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27
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King M, Weich S, Torres-González F, Švab I, Maaroos HI, Neeleman J, Xavier M, Morris R, Walker C, Bellón-Saameño JA, Moreno-Küstner B, Rotar D, Rifel J, Aluoja A, Kalda R, Geerlings MI, Carraça I, de Almeida MC, Vicente B, Saldivia S, Rioseco P, Nazareth I. Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 2006; 6:6. [PMID: 16409633 PMCID: PMC1368984 DOI: 10.1186/1471-2458-6-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 01/12/2006] [Indexed: 11/16/2022] Open
Abstract
Background Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation. Methods/design This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent. Discussion Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.
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Affiliation(s)
- Michael King
- Department of Mental Health Sciences, UCL, London, UK
| | - Scott Weich
- Division of Health in the Community, University of Warwick, Coventry, UK
| | | | - Igor Švab
- Dept. of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Miguel Xavier
- Faculdade Ciências Médicas, University of Lisbon, Lisbon, Portugal
| | - Richard Morris
- Department of Primary Care and Population Sciences, UCL, London, UK
| | - Carl Walker
- Department of Mental Health Sciences, UCL, London, UK
| | | | | | - Danica Rotar
- Dept. of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Rifel
- Dept. of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Anu Aluoja
- Faculty of Medicine, University of Tartu, Tartu, Estonia5
| | - Ruth Kalda
- Faculty of Medicine, University of Tartu, Tartu, Estonia5
| | | | | | | | - Benjamin Vicente
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Pedro Rioseco
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Irwin Nazareth
- Department of Primary Care and Population Sciences, UCL and Scientific Director, Medical Research Council General Practice Research Framework, UCL, London, UK
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Evans J, Heron J, Lewis G, Araya R, Wolke D. Negative self-schemas and the onset of depression in women: longitudinal study. Br J Psychiatry 2005; 186:302-7. [PMID: 15802686 DOI: 10.1192/bjp.186.4.302] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Beck's cognitive theory of depression has received little empirical support. AIMS To test whether those with negative self-schemas were at risk of onset of depression. METHOD Data were collected by postal questionnaire from 12,003 women recruited during early pregnancy; questionnaires included measures of depressive symptoms and negative self-schemas. Regular questionnaires were sent during pregnancy and following childbirth. RESULTS Of 8540 women not depressed when recruited, 8.6% (95% CI 8.0-9.2) became depressed 14 weeks later. Those in the highest tertile for negative self-schema score were more likely to become depressed than those in the lowest tertile (odds ratio 3.04, 95% CI 2.48-3.73). The association remained after adjustment for baseline depressive symptoms and previous depression (OR 1.6, 95% CI 1.27-2.02) and was of similar magnitude for onset 3 years later. CONCLUSIONS Holding a negative self-schema is an independent risk factor for the onset of depression in women. This finding supports a key element of Beck's cognitive theory. Understanding more about how negative self-schemas arise should help inform preventive policies.
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Affiliation(s)
- Jonathan Evans
- Division of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK.
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Kiejna A, Wojtyniak B, Rymaszewska J. Prevalence of psychiatric morbidity in Polish population - national health interview survey. Acta Neuropsychiatr 2004; 16:295-300. [PMID: 26984542 DOI: 10.1111/j.0924-2708.2004.00105.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the prevalence of psychiatric morbidity in Polish population. SUBJECTS AND METHODS The national health interview survey was based on entire non-institutionalized Polish population by means of randomized, stratified (urban and rural census tracks) two-stage method (over 39 000 respondents). Prevalence of psychiatric morbidity was based on General Health Questionnaire-12. RESULTS Psychiatric morbidity was noted in almost 1/4 of women and 1/5 of men in Poland, with small differences between urban and rural population. Every 10th woman reported such complaints at the age up to 25 years and every second above 75 years of age. Divorced and widowed respondents, irrespective of gender, have psychiatric disorders more frequently than compared groups. Higher prevalence of psychiatric morbidity was noted in out of work and especially disabled persons. The higher the level of education, the lower the frequency of psychiatric morbidity was observed. CONCLUSION Presented survey enabled to evaluate prevalence of psychiatric morbidity in Polish representative sample. Findings should trigger more extended epidemiological studies. The requirement for epidemiological investigations increases in reform-awaiting health care system in Poland, for at least one reason that the improvement of the quality of services is closely associated with a detailed recognition of the problem.
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Affiliation(s)
- Andrzej Kiejna
- 1Department of Psychiatry, Medical University, Wroclaw, Poland
| | - Bogdan Wojtyniak
- 2Department of Medical Statistics, National Institute of Hygiene, Warsaw, Poland
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Linden M, Zäske H, Ahrens B. Correlates of suicidal ideation in general healthcare patients - Results of the WHO Collaborative Study on Psychological Problems in General Health Care (WHO-PPGHC). Int J Psychiatry Clin Pract 2003; 7:17-25. [PMID: 24937237 DOI: 10.1080/136515003100310001022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the WHO study on Psychological Problems in General Health Care (WHO-PPGHC), a random sample of 5438 patients from 15 international centres were investigated to study prevalence and type of mental disorders by use of standardized methods. Using the General Health Questionnaire, 9.7% of the practice attenders admitted that they have or recently had suicidal ideations. In a logistic regression analysis, predictors of suicidal ideation were hopelessness, presence of an ICD-10 diagnosis, social disability in terms of occupational role functioning and daily routine, and lack of social adaptation in terms of lower age and being less educated. The predictors are discussed in an explanatory model of suicidal ideation in general healthcare. Implications for patient care in general healthcare are discussed.
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Affiliation(s)
- M Linden
- Outpatient Research Group Department of Psychiatry, Free University of Berlin Teltow/Berlin
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Thomas R, Evans S, Gately C, Stordy J, Huxley P, Rogers A, Robson B. State-event relations among indicators of susceptibility to mental distress in Wythenshawe in the UK. Soc Sci Med 2002; 55:921-35. [PMID: 12220094 DOI: 10.1016/s0277-9536(01)00226-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper explores the utility of concepts drawn from psychosocial theory as predictors of the proneness to mental distress among the residential population of a large suburban council estate (Wythenshawe, South Manchester). In this respect, items are selected and tested to form composite variables measuring individual ratings with regard to notions of structural risk, personal vulnerability, goal-setting behaviour, quality of life, and the frequency of life events and restricted opportunities. Mental distress is enumerated on the standard GHQ12-point scale. The design makes the distinction between composite variables that record persistent states and those which count events and aspirations immediate to the individual's present experience. To examine the consequences of this difference between indicators of prevalence and incidence, our analysis adopts a two-stage multiple regression format. The first examines these state-event interactions among the composite variables, while the second tests the separate significance of these types as predictors of GHQ12. The findings reveal significant proportions of the variation in GHQ12 are be explained either by associations with the ageing process or by those linked to subjective indicators of the quality of life. In contrast, structural deprivation correlates less significantly with the reporting of psychiatric distress in this socially homogeneous population. The discussion considers the methodological implications of these relationships for understanding common mental health problems together with their connotations for health policy.
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Weich S, Burton E, Blanchard M, Prince M, Sproston K, Erens B. Measuring the built environment: validity of a site survey instrument for use in urban settings. Health Place 2001; 7:283-92. [PMID: 11682328 DOI: 10.1016/s1353-8292(01)00019-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There are few reliable measures of place with which to study the effects of socio-economic context on health. We report on the development and inter-rater reliability of a 27-item observer-rated built environment site survey checklist (BESSC). Across eleven 'housing areas' (defined as areas of homogeneity in housing form) and two raters, kappa coefficients were > or =0.5 for fifteen categorical items, and intra-class correlation coefficients exceeded 0.6 for a further three continuous measures. Ratings on several BESSC items were associated to a statistically significant degree with the prevalence of depression and residents' dissatisfaction with 'their area as a place to live'. BESSC items may prove to be valuable descriptors of the urban built environment in future studies.
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Affiliation(s)
- S Weich
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
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Coombes L, Coffey J, Bartlett H. Policy and Practice in Mental Health Promotion in England: An Overview. JOURNAL OF INTEGRATED CARE 2001. [DOI: 10.1108/14769018200100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The importance of mental health promotion is increasingly being recognised as a policy issue in the UK, although little is known yet about progress towards implementing mental health promotion approaches within mental health services. This paper presents an overview of the topic, and reports on a survey of local authorities in England to identify examples of good practice in mental health promotion and the extent to which they are underpinned by evidence.
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Abstract
Schizophrenia is a severe mental illness that affects 1% of the population. The diagnosis is made according to current diagnostic systems of DSM-IV (American Psychiatric Association, 1994) and ICD-10 (World Health Association, 1992) on the basis of characteristic 'positive' and 'negative' symptoms. The traditional medical model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. This paper reviews evidence for the continuity of psychotic symptoms with normal experiences, focusing on the symptoms of hallucinations and delusions. It concludes by discussing the theoretical and treatment implications of such a continuum.
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van Os J, Park SB, Jones PB. Neuroticism, life events and mental health: evidence for person-environment correlation. Br J Psychiatry Suppl 2001; 40:s72-7. [PMID: 11315229 DOI: 10.1192/bjp.178.40.s72] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is some evidence that genetic effects on the likelihood of experiencing stressful life events (SLEs) are mediated by heritable traits such as cognitive ability (CA) and neuroticism (N). AIMS To examine whether the association between CA, N and mental ill-health is driven in part by a predisposition to experience depressogenic SLEs. METHOD Childhood measures of N and CA were available in a birth cohort of 5362 individuals. At ages 36 and 43 years, mental state and occurrence of SLEs in the previous year were assessed. Using a path-analytic approach, models with and without a hypothesised influence of N and CA on the occurrence of SLEs were compared. RESULTS The fit of the model with childhood N having a direct influence on SLEs was good with chi 2 = 5.72, d.f. = 4, P = 0.22 at age 36 years and chi 2 = 3.50, d.f. = 5, P = 0.62 at age 43. The fit of the model was significantly worse without this path at both ages (36 years: chi 2 = 42.5, d.f. = 1, P < 0.001; 43 years chi 2 = 15.3, d.f. = 1, P < 0.001). No consistent differences were seen in comparisons of models with CA. CONCLUSIONS The results are congruent with the suggestion that genetic effects on SLEs are mediated by personal characteristics. Part of the well-established association between N and minor psychiatric disorder may be mediated by an indirect effect of N on the likelihood of experiencing SLEs.
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Affiliation(s)
- J van Os
- Department of Psychiatry and Neuropsychology, University of Maastricht, European Graduate School of Neuroscience, Maastricht, The Netherlands
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Abstract
BACKGROUND It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health. AIMS To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income. METHOD Cross-sectional survey of 8191 adults aged 16-75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire. RESULTS The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31,95% C1 1.05-1.65; P: = 0.02). The opposite was true for those with the lowest incomes. CONCLUSIONS Income inequality was associated with worse mental health among the most affluent individuals.
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Affiliation(s)
- S Weich
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London.
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Abstract
Because depressive illness is so prevalent, the majority of patients are managed in primary care, without recourse to specialist services. Primary care management is seen to fall short of the standards set in secondary care, but unfortunately there is as yet relatively little evidence from primary care to guide management in this distinctive patient population. Guidelines have been introduced as a means of quality management, and their value in improving care has been assessed in trials. To date, the benefits of the implementation of guidelines have been marginal at best. By contrast, strategies which improve the access of patients to specialist services do seem to be beneficial. There is also evidence that such strategies may be associated with 'cost-offset'. Choice of antidepressant medication for maximum cost benefit should also be informed by an evidence base, which is beginning to be accumulated. Further research on this topic in the primary care context is still needed.
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Affiliation(s)
- R Peveler
- Community Clinical Sciences Division, University of Southampton, UK
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Ostler K, Thompson C, Kinmonth AL, Peveler RC, Stevens L, Stevens A. Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care: the Hampshire Depression Project. Br J Psychiatry 2001; 178:12-7. [PMID: 11136204 DOI: 10.1192/bjp.178.1.12] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health inequalities exist for many disorders, but the contribution of deprivation to the prevalence and outcome of depressive symptoms in primary care populations has been infrequently studied. AIMS To examine the influence of Jarman under-privileged area (UPA) scores on the prevalence and outcome of depressive symptoms in general practice patients. METHOD 18 414 patients attending 55 representative practices completed the Hospital Anxiety and Depression Scale and a questionnaire for employment status. Outcome of those screening positive was assessed at 6 weeks and 6 months. RESULTS The UPA score accounted for 48.3% of the variance between practices in prevalence of depressive symptoms. Attending a high UPA score practice predicted persistence of depressive symptoms to 6 months. CONCLUSIONS The socio-economic deprivation of a practice locality is a powerful predictor of the prevalence and persistence of depressive symptoms.
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Affiliation(s)
- K Ostler
- Community Based Clinical Sciences Research Division, Faculty of Medicine, Health and Biological Sciences, University of Southampton
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Rogers A, Huxley P, Thomas R, Robson B, Evans S, Stordy J, Gately C. Evaluating the impact of a locality based social policy intervention on mental health: conceptual and methodological issues. Int J Soc Psychiatry 2001; 47:41-55. [PMID: 11694057 DOI: 10.1177/002076400104700404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urban regeneration initiatives provide an opportunity for examining the impact of changes in socio-economic circumstances on the mental health of different groups and individuals within localities. This paper sets out the conceptual and methodological bases for evaluating the impact of a population based social policy intervention on mental health. We suggest the need to integrate a range of disciplinary and methodological developments in research on health inequalities in exploring the impact of urban regeneration on mental health. A combination of multi-level modelling, subjective indicators and narrative accounts of individuals about mental health in the context of locality and personal changes are central for developing theories and methods appropriate for exploring the action and interaction of effects operating between structural and individual/agency levels.
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Affiliation(s)
- A Rogers
- National Primary Care Research and Development Centre, University of Manchester.
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Abstract
The aims of the present study were to compare the current and lifetime prevalences for major and subthreshold affective disorders in elderly subjects in the general population, to assess the influence of demographic variables on prevalence rates, and to examine co-morbidity between these disorders. Major and subthreshold disorders were diagnosed in 286 subjects (aged >/= 60 years). Four-point-nine percent of the subjects had a lifetime diagnosis of major depression, 31.8% either minor or recurrent brief depression, 6.6% a major anxiety disorder, and 18.5% a subthreshold anxiety disorder. The risk for current and lifetime subthreshold anxiety was higher in females than in males, the lifetime prevalence for subthreshold anxiety disorders was increased in elderly subjects and subjects with low professional levels. Increased co-morbidity between major and subthreshold depressive and anxiety disorders could not be observed. In the elderly, subthreshold depressive and anxiety disorders are frequent, more so than major affective disorders. The presence of subthreshold anxiety disorders, but not subthreshold depression, is influenced by age, gender, and previous professional level. Further research focusing on detection, evaluation of risk factors and the relevance for the quality of life in the elderly general population is needed.
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Affiliation(s)
- R Heun
- Department of Psychiatry, University of Bonn, Venusberg, D-53105 Bonn, Germany
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Abstract
The common mental disorders, mainly anxiety and depression, constitute a major public health problem, incurring considerable costs in terms of use of health services and time lost from work. Risk factors include low socioeconomic status, poverty and poor housing, as well as stressful life events and difficulties such as demanding child care, separation or divorce, bereavement, loss of employment and caring for a dependant relative. Population approaches are probably necessary to reduce significantly the burden of such mental health problems, but health care measures are far from negligible. Primary care professionals have regular opportunities to identify people at risk of mental health problems and refer them to welfare and social support services (primary prevention). A number of interventions among high-risk groups have been shown to be effective, including problem-solving training and cognitive-behavioural approaches. The most important tasks in primary care are to identify people with depression, alcohol and drug misuse and eating disorders as early as possible in the course of their illness and to institute effective treatment (secondary prevention). Primary care teams should also join in shared care arrangements for patients with chronic disabling mental illnesses, in order to prevent recurrences and relapses (tertiary prevention).
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Weich S, Lewis G. Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain. J Epidemiol Community Health 1998; 52:8-14. [PMID: 9604035 PMCID: PMC1756605 DOI: 10.1136/jech.52.1.8] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To test the hypothesis that poor material standard of living is independently associated with the prevalence of the common mental disorders after adjusting for occupational social class, and to estimate the population impact of poor material standard of living on the prevalence of these disorders. DESIGN Cross sectional survey. Prevalence of the common mental disorders was assessed using the General Health Questionnaire, a self administered measure of psychiatric morbidity. PARTICIPANTS 9064 adults aged 16-75 living in private households in England, Wales, and Scotland. MAIN RESULTS The common mental disorders were significantly associated with poor material standard of living, including low household income (OR 1.24, 95% CI 1.00, 1.54) and not saving from income (OR 1.29, 95% CI 1.15, 1.45), after adjusting for occupational social class and other potential confounders. An independent association was also found with occupational social class of the head of household among women, but not men, after adjusting for material standard of living. The adjusted population attributable fraction for poor material standard of living (using a five item index) was 24.0%. CONCLUSIONS Like mortality and physical morbidity, common mental disorders are associated with a poor material standard of living, independent of occupational social class. These findings support the view that recent widening of inequalities in material standards of living in the United Kingdom pose a substantial threat to health.
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Affiliation(s)
- S Weich
- Department of Psychiatry, Royal Free Hospital, School of Medicine, London
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Boyle FM, Dunne MP, Najman JM, Western JS, Turrell G, Wood C, Glennon S. Psychological distress among female sex workers. Aust N Z J Public Health 1997; 21:643-6. [PMID: 9470273 DOI: 10.1111/j.1467-842x.1997.tb01770.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The prevalence and correlates of psychological distress were examined in a sample of 171 female sex workers in Queensland. It was found that 28 per cent were above the GHQ-28 threshold for mild psychiatric morbidity, a rate that is not appreciably different from that of women in the general community. The sample included only eight street sex workers, all of whom reported significant distress. Logistic regression analyses showed that a history of injecting drug use, an early age at leaving home and wanting to leave the sex industry were independent predictors of poor mental health. Distressed sex workers reported fewer sexual health examinations and less consistent condom use with their clients than those who were not distressed.
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Affiliation(s)
- F M Boyle
- Department of Social and Preventive Medicine, University of Queensland, Brisbane
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Whittington JE, Huppert FA. Changes in the prevalence of psychiatric disorder in a community are related to changes in the mean level of psychiatric symptoms. Psychol Med 1996; 26:1253-1260. [PMID: 8931171 DOI: 10.1017/s0033291700035972] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The paper of Anderson et al. (1993), based on cross-sectional data, showed that minor psychiatric disorder in a population is linearly related to the mean number of psychiatric symptoms in the population. The present investigation asks whether the same relationship holds longitudinally as well as cross-sectionally. Data from a 7-year follow-up of a general population sample demonstrate, for the first time, that a relationship exists between changes in prevalence of psychiatric disorder and changes in the mean number of psychiatric symptoms in a given population. Moreover, the relationship is linear; a one-point decrease in mean scores on the GHQ-30 is associated with a 6% decrease in prevalence of disorder.
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Abstract
Anderson et al. (1993) presented two models of psychiatric morbidity that they claimed represented 'individual'-based and 'community'-based explanations. They used data from the Health and Lifestyle Survey to test the models and concluded that the data support a 'community'-based explanation. Their deductions from the models appear to be flawed, nevertheless, their conclusion may be valid.
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Boyle FM, Dunne MP, Najman JM, Western JS, Turrell G, Wood C, Glennon S. Psychological distress among female sex workers. Aust N Z J Public Health 1977. [DOI: 10.1111/j.1467-842x.1977.tb01129.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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