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Follett D, Hitchcock C, Dalgleish T, Stretton J. Reduced social risk-taking in depression. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:156-164. [PMID: 36808959 PMCID: PMC9940639 DOI: 10.1037/abn0000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Evolutionary models of depression posit that depressed mood represents an adaptive response to unacceptably low social status, motivating the inhibition of social risk-taking in favor of submissive behaviors which reduce the likelihood of social exclusion. We tested the hypothesis of reduced social risk taking using a novel adaptation of the Balloon Analogue Risk Task (BART) in participants with major depressive disorder (MDD; n = 27) and never-depressed comparison participants (n = 35). The BART requires participants to pump up virtual balloons. The more the balloon is pumped up, the more money a participant gains on that trial. However, more pumps also increase the risk the balloon will burst such that all money is lost. Prior to performing the BART, participants took part in a team induction in small groups in order to prime social-group membership. Participants then completed two conditions of the BART: an Individual condition where they risked only their own money, and a Social condition, where they risked the money of their social group. The groups did not differ in their performance in the individual condition (Cohen's d = 0.07). However, the MDD group risked fewer pumps in the Social condition than the never-depressed group (d = 0.57). The study supports the notion of an aversion to social risk-taking in depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Singer S, Blanck J, Scholz I, Büttner M, Maier L. Hängen die Stundenkontingente für ambulante Psychotherapie zur Behandlung von Depressionen mit deren Schweregrad zusammen? DER NERVENARZT 2022; 93:1143-1149. [PMID: 35947172 PMCID: PMC9630213 DOI: 10.1007/s00115-022-01374-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
Fragestellung Vor dem Hintergrund der Debatte um eine mögliche Festlegung des Leistungsumfangs für ambulante Psychotherapie anhand der Diagnose haben wir untersucht, ob in der aktuellen Versorgungspraxis bei Patienten mit Depressionen die Anzahl der beantragten sowie die der vom Gutachter befürworteten Stunden mit dem Schweregrad der Erkrankung zusammenhängen. Methode Aus einer Zufallsstichprobe von 1000 Anträgen auf Kostenübernahme für ambulante analytische oder tiefenpsychologisch fundierte Psychotherapie wurden jene herausgesucht, in denen eine Depressionsdiagnose mit Schweregradeinschätzung (ICD-10 F32 oder F33) entweder im Bericht oder auf dem Antragsformular kodiert worden war. Die Zahl der beantragten und der befürworteten Stunden pro Antrag wurde extrahiert. Bei Umwandlungs- und Fortführungsanträgen wurden dabei auch die im Vorfeld stattgefundenen Therapiestunden berücksichtigt. Ein möglicher Zusammenhang des Schweregrads der Depression mit der Zahl der beantragten bzw. der vom Gutachter befürworteten Stunden wurde anhand von Spearman-Rangkorrelationen überprüft. Ergebnisse Insgesamt 521 Anträge (52 %) enthielten eine F32- und/oder eine F33-Diagnose. Davon waren 63 (12 %) als leicht kodiert, 349 (67 %) als mittelgradig und 50 (10 %) als schwer. Im Median wurden 75 h bei leichter sowie je 50 h bei mittelgradiger bzw. bei schwerer Depression beantragt, wobei die Zahlen innerhalb der Gruppen stark variierten (10 bis 327 h) und der Zusammenhang zwischen Schweregrad und beantragter Stundenzahl gering war (Rho −0,10). Die befürworteten Stundenkontingente waren im Median 74 (leichte Depression), 50 (mittelgradig) und 50 (schwer) Stunden, auch hier war die Spannweite hoch (0 bis 327 h) und die Korrelation gering (Rho −0,11). Diskussion Es gibt keine Anhaltspunkte dafür, dass Psychotherapeuten die benötigten Stundenkontingente allein anhand des Schweregrads der Diagnose festlegen.
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Affiliation(s)
- Susanne Singer
- Abt. Epidemiologie und Versorgungsforschung, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Deutschland.
- , Mainz, Deutschland.
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Seah D, Chan CT, Ma S, James L, Heng D, Subramaniam M. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med J 2022; 63:196-202. [PMID: 32798362 PMCID: PMC9251260 DOI: 10.11622/smedj.2020124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Darren Seah
- Family Medicine Department, National Healthcare Group Polyclinics, Singapore
| | - Chun Ting Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 266] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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Riley ED, Delucchi K, Rubin S, Weiser SD, Vijayaraghavan M, Lynch K, Tsoh JY. Ongoing tobacco use in women who experience homelessness and unstable housing: A prospective study to inform tobacco cessation interventions and policies. Addict Behav 2022; 125:107125. [PMID: 34673360 DOI: 10.1016/j.addbeh.2021.107125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women. METHODS We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use. RESULTS Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR/5 yrs: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39). CONCLUSION Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.
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Keramat SA, Alam K, Ahinkorah BO, Islam MS, Islam MI, Hossain MZ, Ahmed S, Gow J, Biddle SJH. Obesity, Disability and Self-Perceived Health Outcomes in Australian Adults: A Longitudinal Analysis Using 14 Annual Waves of the HILDA Cohort. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:777-788. [PMID: 34522108 PMCID: PMC8434893 DOI: 10.2147/ceor.s318094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both obesity and disability have been widely recognised as major public health challenges because they play significant roles in determining self-perceived general and mental health. Longitudinal studies of the relationship between obesity and disability with self-reported health outcomes are scarce. Therefore, the objective of the present study is to examine the relationship between obesity and disability with self-perceived general and mental health among Australian adults aged 15 years and above. METHODS Data were extracted from the most recent 14 waves (waves 6 through 19) of the annual individual person dataset of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The longitudinal random-effects logistic regression model was adopted to investigate the relationships between obesity and disability with self-reported health outcomes. RESULTS The results revealed that obese individuals and adults with some form of disability are more likely to report poor or fair general and mental health. The odds of self-reporting poor or fair general health were 2.40 and 6.07 times higher among obese (aOR: 2.40, 95% CI: 2.22-2.58) and adults with some form of disability (aOR: 6.07, 95% CI: 5.77-6.39), respectively, relative to adults with healthy weight and those without disability . The results also showed that self-rated poor or fair mental health were 1.22 and 2.40 times higher among obese adults (aOR: 1.22, 95% CI: 1.15-1.30) and adults with disability (aOR: 2.40, 95% CI: 2.30-2.51), respectively, compared to their healthy weight peers and peers without disability. CONCLUSION As governmental and non-governmental organisations seek to improve the community's physical and mental well-being, these organisations need to pay particular attention to routine health care prevention, specific interventions, and treatment practices, especially for obese and/or people with disabilities.
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Affiliation(s)
- Syed Afroz Keramat
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | | | - Md Sariful Islam
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Md Irteja Islam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Md Zobayer Hossain
- Development Studies Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Sazia Ahmed
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- School of Accounting, Economics, and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Ma M, Shi Z, Wu H, Ma X. Clinical implications of panic attack in Chinese patients with somatoform disorders. J Psychosom Res 2021; 146:110509. [PMID: 33984592 DOI: 10.1016/j.jpsychores.2021.110509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Somatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder. METHODS In this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M.I.N·I.) were divided into two groups depending on with or without comorbidity of a panic attack, somatoform disorder with a panic attack (SPA, n = 88) and those without panic attack (SNPA, n = 253). Patient Health Questionnaire (PHQ-15), Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale was used to identify correlations between SPA group and SNPA group, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on somatic, depressive and anxiety symptoms separately. RESULTS The SPA group's PHQ-15, PHQ-9 and GAD-7 scores were significantly higher than those of the SNPA group. Multiple linear regression analyses revealed that the associated factors for PHQ-15 were gender and panic disorder. PHQ-9 was just significantly associated with panic disorder. GAD-7 was significantly associated with education degree and panic disorder. CONCLUSIONS Our results suggest that somatoform disorder patients with panic attack suffered more severe clinical symptoms than those without a panic attack.
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Affiliation(s)
- Min Ma
- Wuhan Mental Health Center, Wuhan, China
| | - Zhidao Shi
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Arnaud A, Suthoff E, Tavares RM, Zhang X, Ravindranath AJ. The Increasing Economic Burden with Additional Steps of Pharmacotherapy in Major Depressive Disorder. PHARMACOECONOMICS 2021; 39:691-706. [PMID: 33908024 PMCID: PMC8166719 DOI: 10.1007/s40273-021-01021-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Major depressive disorder (MDD) is a common and serious disorder with significant impact on patients and families. The goal of this retrospective cohort study was to determine the economic burden among patients with MDD stratified by number of treatment lines needed for episode resolution. METHODS Truven Health Analytics MarketScan® claims data were used to identify US patients (≥ 18 years) who were diagnosed with MDD and started on an antidepressant between 2013 and 2017. A generalized linear model estimated direct and employment-related costs for the first 12 months following initiation of treatment across cohorts with increasing number of lines of MDD pharmacotherapy. Analyses were adjusted for demographics and clinical factors. RESULTS A total of 73,597 patients with MDD comprising the commercial (n = 66,459) and Medicare (n = 7138) populations met selection criteria. Patients who completed treatment for their episode with a single line of antidepressant had the lowest total adjusted direct costs (commercial $9975; Medicare $14,628) followed by those who completed with two lines (commercial $11,723; Medicare $15,526) and those treated with three or more lines of antidepressant regimens (commercial $21,259; Medicare $20,964). Patients who completed treatment with two lines as opposed to one incurred significantly higher direct costs (commercial +$1748, p < 0.0001; Medicare +$898, p = 0.0092). Patients who completed treatment with one line had the lowest employment-related costs compared to other groups. CONCLUSIONS There was an increased economic burden associated with delay of episode resolution as early as the second line compared to the first line in MDD.
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Affiliation(s)
| | | | | | - Xuan Zhang
- Boston Strategic Partners, Inc, Boston, MA, USA
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Korczak DJ, Cleverley K, Birken CS, Pignatiello T, Mahmud FH, McCrindle BW. Cardiovascular Disease Risk Factors Among Children and Adolescents With Depression. Front Psychiatry 2021; 12:702737. [PMID: 34489758 PMCID: PMC8418089 DOI: 10.3389/fpsyt.2021.702737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: To examine CVD risk factors among children and adolescents with Major Depressive Disorder (MDD). Methods: A cross-sectional study of 77 children and adolescents (mean age 14.1 years, 74% female) referred to a pediatric depression program. MDD was assessed using a semi-structured diagnostic interview. Cardiovascular assessments included family cardiovascular disease (CVD) history, cigarette smoking, body mass index (BMI), blood pressure, lipid and glucose concentrations. CVD risk factors among healthy weight and overweight/obese participants were compared. Results: Forty-six percent of participants had a family history of early CVD. On examination, 25% of participants had a BMI in overweight/obese range, and 25% of children had pre-hypertension (14%) or hypertension (11%). Total cholesterol levels were elevated among 28% of participants. Overweight/obese participants had increased non-HDL cholesterol concentrations compared with healthy-weight participants (36 vs. 10%, p = 0.01). There were no significant differences between healthy and overweight/obese groups for other CVD risk factors, including HDL cholesterol concentration, plasma glucose concentration, hypertension, cigarette smoking, and family history of early CVD. More than half (52%) of participants had at least two CVD risk factors. Conclusion: CVD risk factors are prevalent among children and adolescents with MDD. Routine CVD risk factor screening may be warranted among MDD youth, regardless of BMI, and may provide a valuable opportunity for prevention of future CVD.
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Affiliation(s)
- Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tony Pignatiello
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Farid H Mahmud
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada.,The Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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He Y, Sun N, Wang Z, Zou W. Effect of repetitive transcranial magnetic stimulation (rTMS) for insomnia: a protocol for a systematic review. BMJ Open 2019; 9:e029206. [PMID: 31315870 PMCID: PMC6661550 DOI: 10.1136/bmjopen-2019-029206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of insomnia. A systematic review of the available literature on this topic is warranted. The systematic review described in this protocol aims to investigate the efficacy of rTMS as a physical therapy in patients with insomnia. METHODS AND ANALYSIS This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will retrieve relevant literatures across the following electronic bibliographic databases: CENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG and VIP. A manual search of the reference lists of all relevant articles will be performed for any additional studies. We will include randomised controlled trials published in English and Chinese examining efficacy of rTMS on patients with insomnia. Two reviewers will independently complete the article selection, data extraction and rating. PEDro scale will be used to assess the methodological quality of the included studies. Narrative and quantitative synthesis will be done accordingly. ETHICS AND DISSEMINATION Ethical approval will not be required for this review. The results of this review will be disseminated in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42018115033.
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Affiliation(s)
- Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Nianyi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Zhiqiang Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
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Jesulola E, Micalos P, Baguley IJ. Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model - are we there yet? Behav Brain Res 2017; 341:79-90. [PMID: 29284108 DOI: 10.1016/j.bbr.2017.12.025] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023]
Abstract
A number of factors (biogenic amine deficiency, genetic, environmental, immunologic, endocrine factors and neurogenesis) have been identified as mechanisms which provide unitary explanations for the pathophysiology of depression. Rather than a unitary construct, the combination and linkage of these factors have been implicated in the pathogenesis of depression. That is, environmental stressors and heritable genetic factors acting through immunologic and endocrine responses initiate structural and functional changes in many brain regions, resulting in dysfunctional neurogenesis and neurotransmission which then manifest as a constellation of symptoms which present as depression.
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Affiliation(s)
- Emmanuel Jesulola
- Paramedicine Discipline, Charles Sturt University, Bathurst Campus, NSW Australia.
| | - Peter Micalos
- Paramedicine Discipline, Charles Sturt University, Bathurst Campus, NSW Australia
| | - Ian J Baguley
- Brain Injury Rehabilitation Service, Westmead Hospital, Hawkesbury Rd, Wentworthville, NSW Australia
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Cognitive impairment as measured by the THINC-integrated tool (THINC-it): Association with psychosocial function in major depressive disorder. J Affect Disord 2017; 222:14-20. [PMID: 28667888 DOI: 10.1016/j.jad.2017.06.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/11/2017] [Accepted: 06/17/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD. METHODS Adults aged 18-65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS). RESULTS Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps < .01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR = .14, p = .01) and SDS domains of work/school (RR = .15, p = .03), family and home responsibilities (RR = .15, p = .02), and economic days lost (RR = .18, p =.03). Depression severity was most strongly associated with SDS social life (RR = .08, p < .01) and economic days underproductive (RR = .07, p < .01). Objective cognitive function was not significantly associated with any SDS outcomes. LIMITATIONS The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted. CONCLUSIONS Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.
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Walters JL, Baxter K, Chapman H, Jackson T, Sethuramachandran A, Couldridge M, Joshi HR, Kundra P, Liu X, Nair D, Sullivan B, Shotwell MS, Jense RJ, Kassebaum NJ, McQueen KAK. Chronic Pain and Associated Factors in India and Nepal: A Pilot Study of the Vanderbilt Global Pain Survey. Anesth Analg 2017; 125:1616-1626. [PMID: 28806206 DOI: 10.1213/ane.0000000000002360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Evaluation and treatment of chronic pain worldwide are limited by the lack of standardized assessment tools incorporating consistent definitions of pain chronicity and specific queries of known social and psychological risk factors for chronic pain. The Vanderbilt Global Pain Survey (VGPS) was developed as a tool to address these concerns, specifically in the low- and middle-income countries where global burden is highest. METHODS The VGPS was developed using standardized and cross-culturally validated metrics, including the Brief Pain Inventory and World Health Organization Disability Assessment Scale, as well as the Pain Catastrophizing Scale, the Fibromyalgia Survey Questionnaire along with queries about pain attitudes to assess the prevalence of chronic pain and disability along with its psychosocial and emotional associations. The VGPS was piloted in both Nepal and India over a 1-month period in 2014, allowing for evaluation of this tool in 2 distinctly diverse cultures. RESULTS Prevalence of chronic pain in Nepal and India was consistent with published data. The Nepali cohort displayed a pain point prevalence of 48%-50% along with some form of disability present in approximately one third of the past 30 days. Additionally, 11% of Nepalis recorded pain in 2 somatic sites and 39% of those surveyed documented a history of a traumatic event. In the Indian cohort, pain point prevalence was approximately 24% to 41% based on the question phrasing, and any form of disability was present in 6 of the last 30 days. Of the Indians surveyed, 11% reported pain in 2 somatic sites, with only 4% reporting a previous traumatic event. Overall, Nepal had significantly higher chronic pain prevalence, symptom severity, widespread pain, and self-reported previous traumatic events, yet lower reported pain severity. CONCLUSIONS Our findings confirm prevalent chronic pain, while revealing pertinent cultural differences and survey limitations that will inform future assessment strategies. Specific areas for improvement identified in this VGPS pilot study included survey translation methodology, redundancy of embedded metrics and cultural limitations in representative sampling and in detecting the prevalence of mental health illness, catastrophizing behavior, and previous traumatic events. International expert consensus is needed.
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Affiliation(s)
- Jenna L Walters
- From the *Department of Anesthesiology and Pain Medicine, Vanderbilt University, Nashville, Tennessee; †University of Washington School of Medicine, Seattle, Washington; ‡Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Institute of National Importance, Pondicherry, India; §Casper, Wyoming; ∥Nepal Medical College, Kathmandu, Nepal; ¶Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee; #Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Institute of National Importance, Pondicherry, India; **Behavioral Neuroscience Program, Western Washington University, Bellingham, Washington; ††Department of Anesthesiology and Pain Medicine and Global Health Adjunct, University of Washington, Seattle, Washington; ‡‡Department of Pediatric Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington; §§Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; and ∥∥Department of Anesthesiology, Director of Vanderbilt Anesthesia Global Health and Development Affiliate Faculty, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Jackson T, Thomas S, Stabile V, Han X, Shotwell M, McQueen KAK. Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: A Narrative Review. Anesth Analg 2017; 122:2028-39. [PMID: 27195643 DOI: 10.1213/ane.0000000000001287] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally, 8 of the top 12 disabling conditions are related either to chronic pain or to the psychological conditions strongly associated with persistent pain. In this narrative review, we explore the demographic and psychosocial associations with chronic pain exclusively from low- and middle-income countries (LMICs) and compare them with current global data. One hundred nineteen publications in 28 LMICs were identified for review; associations with depression, anxiety, posttraumatic stress, insomnia, disability, gender, age, rural/urban location, education level, income, and additional sites of pain were analyzed for each type of chronic pain without clear etiology. Of the 119 publications reviewed, pain was described in association with disability in 50 publications, female gender in 40 publications, older age in 34 publications, depression in 36 publications, anxiety in 19 publications, and multiple somatic complaints in 13 publications. Women, elderly patients, and workers, especially in low-income and low-education subgroups, were more likely to have pain in multiple sites, mood disorders, and disabilities. In high-income countries, multisite pain without etiology, female gender, and association with mood disturbance and disability may be suggestive of a central sensitization syndrome (CSS). Because each type of prevalent chronic pain without known etiology reviewed had similar associations in LMICs, strategies for assessment and treatment of chronic pain worldwide should consider the possibility of prevalent CSS. Recognition is especially critical in resource-poor areas, because treatment of CSS is vastly different than localized chronic pain.
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Affiliation(s)
- Tracy Jackson
- From the *Department of Anesthesiology and Pain Medicine, Vanderbilt Outpatient Pain Clinics, Vanderbilt University, Nashville, Tennessee; †University of Tennessee Health Science Center, Memphis, Tennessee; ‡Operation Smile International Headquarters, Virginia Beach, Virginia; §Vanderbilt University School of Medicine, Nashville, Tennessee; ∥Department of Biostatistics, Vanderbilt University, Nashville, Tennessee; and ¶Department of Anesthesiology, Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:321-330. [PMID: 27426694 DOI: 10.1016/j.jad.2016.06.051] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are common in people with a bipolar disorder (BD). This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in persons with BD based on national or international surveys of household populations. METHODS Studies published from 1990 to Dec 31, 2015 were identified from MEDLINE, EMBASE. psychINFO, and CINAHL databases and reference lists. We calculated prevalence rates and conducted meta-analysis with random-effects model. RESULTS We identified 9 unique surveys of which two surveys were repeated 10 years later using independent samples. The total sample size was 218,397 subjects. The mean prevalence for any illicit drug use disorder was 17%, for alcohol use disorder (AUD) it was 24% and SUD it was 33%. The strongest associations were found between BD and illicit drug use (pooled odds ratio (OR) 4.96, 95% CI 3.98-6.17) followed closely by BD and AUD (OR 4.09, 95% CI 3.37-4.96). The association was higher for BD respondents using illicit drugs compared to bipolar II respondents (ORs 7.48 vs. 3.30). LIMITATIONS Some of the meta-analysis grouped illicit substances together without taking into consideration types of substance use which may differ widely between countries and over time. All included studies were cross-sectional so onset and causality can not be determined. CONCLUSIONS The meta-analysis revealed that people with an alcohol use disorder were 4.1 times of greater risk of having a BD compared to those without an AUD. The risks were even higher for illicit drug users where they were 5.0 times of greater risk of having BD compared to non-users. These data confirm strong associations between co-occurring SUDs and BD, indicating a need for more informative studies to help develop better interventions in treating persons with BD and comorbid SUDs.
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Barbaglia G, Adroher ND, Vilagut G, Bruffaerts R, Bunting B, Caldas de Almeida JM, Florescu S, de Girolamo G, de Graaf R, Haro JM, Hinkov H, Kovess-Masfety V, Matschinger H, Alonso J. Health conditions and role limitation in three European Regions: a public-health perspective. GACETA SANITARIA 2016; 31:2-10. [PMID: 27765441 DOI: 10.1016/j.gaceta.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. METHODS Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. RESULTS Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. CONCLUSION The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.
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Affiliation(s)
- Gabriela Barbaglia
- Agency for Health and Quality Assessment of Catalonia (AQuAS), Barcelona, Spain; Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain
| | - Núria D Adroher
- University of Lucerne, Faculty of Humanities and Social Sciences, Department of Health Science and Health Policy, Lucerne, Switzerland
| | - Gemma Vilagut
- Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, KU Leuven (UPC-KUL), Leuven, Belgium
| | - Brentan Bunting
- University of Ulster, School of Psychology, Research Institute of Psychology, Northern Ireland, United Kingdom
| | | | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat (Barcelona), España; CIBER en Salud Mental (CIBERSAM), Spain
| | - Hristo Hinkov
- National Center for Public Health Protection, Department of Mental Health, Sofia, Bulgaria
| | - Vivianne Kovess-Masfety
- Université Paris Descartes, Department of Epidemiology, Evaluation and Health policies, Paris, France
| | - Herbert Matschinger
- University of Leizpig, Department of Social Medicine, Occupational Health and Public Health, Leipzig, Germany
| | - Jordi Alonso
- Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
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Ahmadzad-Asl M, Davoudi F, Zarei N, Mohammad-Sadeghi H, Rasoulian M. Domestic violence against women as a risk factor for depressive and anxiety disorders: findings from domestic violence household survey in Tehran, Iran. Arch Womens Ment Health 2016; 19:861-9. [PMID: 26984712 DOI: 10.1007/s00737-016-0626-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/29/2016] [Indexed: 11/25/2022]
Abstract
Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6 ± 0.9 and 22 ± 0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3-14.6) and 2.6 (1.6-4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.
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Affiliation(s)
- Masoud Ahmadzad-Asl
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farnoush Davoudi
- Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Noushin Zarei
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Rasoulian
- Mental Health Research Center, Tehran Psychiatry Institute, Iran University of Medical Sciences, Tehran, Iran.
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Abdin E, Ong C, Chong SA, Vaingankar JA, Subramaniam M. Days Out of Role Due to Mental and Physical Conditions: Results from the Singapore Mental Health Study. PLoS One 2016; 11:e0148248. [PMID: 26840741 PMCID: PMC4739696 DOI: 10.1371/journal.pone.0148248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/16/2016] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the current study was to evaluate the relative contributions of mental and physical conditions to days out of role among adults aged 18 years and above in Singapore. Methods The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older. Diagnosis of mental disorders was established using the Composite International Diagnostic Interview; while chronic physical conditions were established using a checklist. Days out of role were assessed using a WHO Disability Assessment Schedule item. Multivariate regression analyses were used to estimate individual-level and societal-level effects of disorders. Results Overall, 8.7% of respondents reported at least one day out of role, with a mean of 5.8 days. The most disabling conditions at the individual level were cancer (118.9 additional days), cardiovascular diseases (93.5), and bipolar disorder (71.0). At the societal level, cardiovascular diseases contributed the highest population attributable risk proportion (45%), followed by cancer (39.3%), and hypertension (13.5%). Conclusions Mental and physical conditions are linked to significant losses in productivity for society as well as role disability for individuals, underscoring the need to enhance prevention and intervention efforts to increase overall productivity and improve individual functioning.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - Clarissa Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Lai HMX, Cleary M, Sitharthan T, Hunt GE. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug Alcohol Depend 2015; 154:1-13. [PMID: 26072219 DOI: 10.1016/j.drugalcdep.2015.05.031] [Citation(s) in RCA: 488] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. METHODS A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. RESULTS There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. CONCLUSIONS This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.
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Affiliation(s)
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, NSW, Australia.
| | | | - Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
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Jarman L, Martin A, Venn A, Otahal P, Taylor R, Teale B, Sanderson K. Prevalence and correlates of psychological distress in a large and diverse public sector workforce: baseline results from Partnering Healthy@Work. BMC Public Health 2014; 14:125. [PMID: 24498884 PMCID: PMC3931478 DOI: 10.1186/1471-2458-14-125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background Depressive and anxiety disorders are common among working adults and costly to employers and individuals. Mental health screening is often an important initial strategy, but the resultant data are often of unknown representativeness and difficult to interpret. In a public sector workforce, this study used a brief screener for depression/anxiety to: a) compare prevalence of high psychological distress obtained from a researcher survey with an employer survey and population norms and b) verify whether expected correlates were observed in a screening setting. Methods Participants were public servants working for an Australian state government. High psychological distress (Kessler-10 ≥22) stratified by age and sex was compared for a random weighted sample researcher survey (n = 3406) and an anonymous volunteer employer survey (n = 7715). Prevalence ratios (PR) were estimated from log binomial regression. Results Referencing the researcher survey, prevalence of high psychological distress was greater by age and sex in the employer survey but was only dependably higher for men when compared with population norms. Modelling suggested this may be due to work stress (effort-reward imbalance) (PR = 3.19, 95% CI 1.45-7.01) and casual/fixed-term employment (PR 2.64, 95% CI 1.26-5.56). Conclusions Depression and anxiety screening using typical employer survey methods could overestimate prevalence but expected correlates are observed in a screening setting. Guidance for employers on screening and interpretation should be provided to encourage engagement with mental health prevention and treatment programs in the workplace.
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Affiliation(s)
- Lisa Jarman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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Andrade LH, Baptista MC, Alonso J, Petukhova M, Bruffaerts R, Kessler RC, Silveira CM, Siu ER, Wang YP, Viana MC. Days out-of-role due to common physical and mental health problems: results from the São Paulo Megacity Mental Health Survey, Brazil. Clinics (Sao Paulo) 2013; 68:1392-9. [PMID: 24270949 PMCID: PMC3812560 DOI: 10.6061/clinics/2013(11)02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/22/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil. METHODS The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area.
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Affiliation(s)
- Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
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Effects of common mental disorders and physical conditions on role functioning in Spain. GACETA SANITARIA 2013; 27:480-6. [DOI: 10.1016/j.gaceta.2013.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 11/22/2022]
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Johansen A, Schirmer H, Stubhaug A, Nielsen CS. Persistent post-surgical pain and experimental pain sensitivity in the Tromsø study: comorbid pain matters. Pain 2013; 155:341-348. [PMID: 24145207 DOI: 10.1016/j.pain.2013.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/04/2013] [Accepted: 10/15/2013] [Indexed: 01/14/2023]
Abstract
In a large survey incorporating medical examination (N=12,981), information on chronic pain and surgery was collected, and sensitivity to different pain modalities was tested. Tolerance to the cold pressor test was analysed with survival statistics for 10,486 individuals, perceived cold pressor pain intensity was calculated for 10,367 individuals, heat pain threshold was assessed for 4,054 individuals, and pressure pain sensitivity for 4,689 individuals. Persistent post-surgical pain, defined by self-report, was associated with lower cold pressor tolerance (sex-adjusted hazard ratio=1.34, 95% confidence interval=1.08-1.66), but not when adjusting for other chronic pain. Other experimental pain modalities did not differentiate between individuals with or without post-surgical pain. Of the individuals with chronic pain (N=3352), 6.2% indicated surgery as a cause, although only 0.5% indicated surgery as the only cause. The associations found between persistent post-surgical pain and cold pressor tolerance is largely explained by the co-existence of chronic pain from other causes. We conclude that most cases of persistent post-surgical pain are coexistent with other chronic pain, and that, in an unselected post-surgical population, persistent post-surgical pain is not significantly associated with pain sensitivity when controlling for comorbid pain from other causes. A low prevalence of self-reported persistent pain from surgery attenuates statistically significant associations. We hypothesize that general chronic pain is associated with central changes in pain processing as expressed by reduced tolerance for the cold pressor test.
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Affiliation(s)
- Aslak Johansen
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway Department of Community Medicine, University of Tromsø, Norway Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Major depression is estimated in these surveys to be a commonly occurring disorder. Although estimates of lifetime prevalence and course vary substantially across countries for reasons that could involve both substantive and methodological processes, the cross-national data are clear in documenting meaningful lifetime prevalence with wide variation in age-of-onset and high risk of lifelong chronic-recurrent persistence. A number of sociodemographic correlates of major depression are found consistently across countries, and cross-national data also document associations with numerous adverse outcomes, including difficulties in role transitions (e.g., low education, high teen childbearing, marital disruption, unstable employment), reduced role functioning (e.g., low marital quality, low work performance, low earnings), elevated risk of onset, persistence and severity of a wide range of secondary disorders, and increased risk of early mortality due to physical disorders and suicide.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Alonso J, Vilagut G, Adroher ND, Chatterji S, He Y, Andrade LH, Bromet E, Bruffaerts R, Fayyad J, Florescu S, de Girolamo G, Gureje O, Haro JM, Hinkov H, Hu C, Iwata N, Lee S, Levinson D, Lépine JP, Matschinger H, Medina-Mora ME, O'Neill S, Ormel JH, Posada-Villa JA, Ismet Taib N, Xavier M, Kessler RC. Disability mediates the impact of common conditions on perceived health. PLoS One 2013; 8:e65858. [PMID: 23762442 PMCID: PMC3675077 DOI: 10.1371/journal.pone.0065858] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 05/02/2013] [Indexed: 02/05/2023] Open
Abstract
Background We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2–51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.
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Affiliation(s)
- Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain ; Pompeu Fabra University, Barcelona, Spain.
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McIntyre RS, Cha DS, Jerrell JM, Soczynska JK, Woldeyohannes HO, Taylor V, Kaidanovich-Beilin O, Alsuwaidan M, Ahmed AT. Obesity and mental illness: implications for cognitive functioning. Adv Ther 2013; 30:577-88. [PMID: 23839214 DOI: 10.1007/s12325-013-0040-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 02/07/2023]
Abstract
A priority research and clinical agenda is to identify determinants of cognitive impairment in individuals with neuropsychiatric disorders (NPD). The bidirectional association between NPD and cognitive performance has been reported to be mediated and/or moderated by obesity in a subset of individuals. Obesity can be conceptualized as a neurotoxic phenotype among individuals with NPD as evidenced by alterations in the structure and function of neural circuits and disseminated networks, diminished cognitive performance, and adverse effects on illness trajectory. The neurotoxic effect of obesity provides a rationale for screening, treating, and preventing obesity in neuropsychiatric populations. Research endeavors that aim to refine mediators and moderators of this association as well as novel strategies to reverse the injurious process of obesity on cognition are warranted.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Positive Emotion Regulation and Psychopathology: A Transdiagnostic Cultural Neuroscience Approach. J Exp Psychopathol 2013; 4:502-528. [PMID: 24812583 DOI: 10.5127/jep.030412] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is burgeoning interest in the study of positive emotion regulation and psychopathology. Given the significant public health costs and the tremendous variance in national prevalence rates associated with many disorders of positive emotion, it is critical to reach an understanding of how cultural factors, along with biological factors, mutually influence positive emotion regulation. Progress in this domain has been relatively unexplored, however, underscoring the need for an integrative review and empirical roadmap for investigating the cultural neuroscientific contributions to positive emotion disturbance for both affective and clinical science domains. The present paper thus provides a multidisciplinary, cultural neuroscience approach to better understand positive emotion regulation and psychopathology. We conclude with a future roadmap for researchers aimed at harnessing positive emotion and alleviating the burden of mental illness cross-culturally.
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Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 2013; 70:300-310. [PMID: 23303463 PMCID: PMC3886236 DOI: 10.1001/2013.jamapsychiatry.55 10.1001/2013.jamapsychiatry.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
CONTEXT Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). OBJECTIVES To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. DESIGN Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. SETTING Face-to-face household interviews with adolescents and questionnaires for parents. PARTICIPANTS A total of 6483 adolescents 13 to 18 years of age and their parents. MAIN OUTCOME MEASURES Lifetime suicide ideation, plans, and attempts. RESULTS The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. CONCLUSIONS Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA.
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Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 2013; 70:300-10. [PMID: 23303463 PMCID: PMC3886236 DOI: 10.1001/2013.jamapsychiatry.55] [Citation(s) in RCA: 1000] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). OBJECTIVES To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. DESIGN Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. SETTING Face-to-face household interviews with adolescents and questionnaires for parents. PARTICIPANTS A total of 6483 adolescents 13 to 18 years of age and their parents. MAIN OUTCOME MEASURES Lifetime suicide ideation, plans, and attempts. RESULTS The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. CONCLUSIONS Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA.
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Vitiello MV, McCurry SM, Rybarczyk BD. The Future of Cognitive Behavioral Therapy for Insomnia: What Important Research Remains to Be Done? J Clin Psychol 2013; 69:1013-21. [DOI: 10.1002/jclp.21948] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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de Graaf R, Tuithof M, van Dorsselaer S, ten Have M. Comparing the effects on work performance of mental and physical disorders. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1873-83. [PMID: 22434047 DOI: 10.1007/s00127-012-0496-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate work loss days due to absenteeism and presenteeism associated with commonly occurring mental and physical disorders. METHODS In a nationally representative face-to-face survey (Netherlands Mental Health Survey and Incidence Study-2) including 4,715 workers, the presence of 13 mental and 10 chronic physical disorders was assessed using the Composite International Diagnostic Interview 3.0 and a physical disorder checklist. Questions about absent days due to illness and days of reduced quantitative and qualitative functioning while at work were based on the WHO Disability Assessment Schedule. Total work loss days were defined as the sum of the days of these three types of loss, where days of reduced functioning were counted as half. Both individual and population-level effects of disorders on work loss were studied, taking comorbidity into account. RESULTS Any mental disorder was associated with 10.5 additional absent days, 8.0 days of reduced-qualitative functioning and 12.0 total work loss days. For any physical disorder, the number of days was 10.7, 3.5 and 11.3, respectively. Adjusted for comorbidity, drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of additional total work loss days. At population-level, major depression, chronic back pain, respiratory disorders, drug abuse and digestive disorders contributed the most. Annual total work loss costs per million workers were estimated at <euro>360 million for any mental disorder; and <euro>706 million for any physical disorder. CONCLUSIONS Policies designed to lessen the impact of commonly occurring disorders on workers will contribute to a reduction in absenteeism and presenteeism. As the indirect costs of (mental) disorders are much higher than their medical costs, prevention and treatment of these conditions may be cost-effective.
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Affiliation(s)
- Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands.
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Kessler RC, Avenevoli S, McLaughlin KA, Green JG, Lakoma MD, Petukhova M, Pine DS, Sampson NA, Zaslavsky AM, Merikangas KR. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med 2012; 42:1997-2010. [PMID: 22273480 PMCID: PMC3448706 DOI: 10.1017/s0033291712000025] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). METHOD A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders. RESULTS Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders. CONCLUSIONS Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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Gadermann AM, Alonso J, Vilagut G, Zaslavsky AM, Kessler RC. Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depress Anxiety 2012; 29:797-806. [PMID: 22585578 PMCID: PMC4005614 DOI: 10.1002/da.21924] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/13/2012] [Accepted: 01/28/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Disease burden estimates rarely consider comorbidity. Using a recently developed methodology for integrating information about comorbidity into disease burden estimates, we examined the comparative burdens of nine mental and 10 chronic physical disorders in the National Comorbidity Survey Replication (NCS-R). METHODS Face-to-face interviews in a national household sample (n = 5,692) assessed associations of disorders with scores on a visual analog scale (VAS) of perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate these associations. Simulation was used to estimate incremental disorder-specific effects adjusting for comorbidity. RESULTS The majority of respondents (74.9%) reported one or more disorders. Of respondents with disorders, 73.8-98.2% reported having at least one other disorder. The best-fitting model to predict VAS scores included disorder main effects and interactions for number of disorders. Adjustment for comorbidity reduced individual-level disorder-specific burden estimates substantially, but with considerable between-disorder variation (0.07-0.69 ratios of disorder-specific estimates with and without adjustment for comorbidity). Four of the five most burdensome disorders at the individual level were mental disorders based on bivariate analyses (panic/agoraphobia, bipolar disorder, posttraumatic stress disorder, major depression) but only two based on multivariate analyses, adjusting for comorbidity (panic/agoraphobia, major depression). Neurological disorders, chronic pain conditions, and diabetes were the other most burdensome individual-level disorders. Chronic pain conditions, cardiovascular disorders, arthritis, insomnia, and major depression were the most burdensome societal-level disorders. CONCLUSIONS Adjustments for comorbidity substantially influence estimates of disease burden, especially those of mental disorders, underlining the importance of including information about comorbidity in studies of mental disorders.
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Affiliation(s)
- Anne M. Gadermann
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain, and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain, and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Correspondence to: Ronald C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA US 02115. Tel. 617-432-3587, Fax 617-432-3588,
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Kessler RC, Berglund PA, Coulouvrat C, Fitzgerald T, Hajak G, Roth T, Shahly V, Shillington AC, Stephenson JJ, Walsh JK. Insomnia, comorbidity, and risk of injury among insured Americans: results from the America Insomnia Survey. Sleep 2012; 35:825-34. [PMID: 22654202 DOI: 10.5665/sleep.1884] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
STUDY OBJECTIVES To estimate associations of broadly defined insomnia (i.e., meeting inclusion criteria for International Classification of Diseases, Tenth Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) diagnosis) with workplace/nonworkplace injuries controlling for comorbid conditions among workers in the America Insomnia Survey (AIS). DESIGN/SETTING Cross-sectional telephone survey. PARTICIPANTS National sample of 4,991 employed health plan subscribers (age 18 yr and older). INTERVENTIONS None. MEASUREMENTS AND RESULTS Broadly defined insomnia with duration of at least 12 mo was assessed with the Brief Insomnia Questionnaire (BIQ). Injuries in the 12 mo before interview were assessed with a standard self-report measure of injuries causing role impairment or requiring medical attention. Eighteen comorbid condition clusters were assessed with medical/pharmacy claims records and self-reports. Insomnia had significant gross associations (odds ratios, ORs) with both workplace and nonworkplace injuries (OR 2.0 and 1.5, respectively) in logistic regression analyses before controlling for comorbid conditions. The significant population attributable risk proportions (PARPs) of total injuries with insomnia was 4.6% after controlling for comorbid conditions. Only 2 other conditions had PARPs exceeding those of insomnia. The associations of insomnia with injuries did not vary significantly with worker age, sex, or education, but did vary significantly with comorbid conditions. Specifically, insomnia was significantly associated with workplace and nonworkplace injuries (OR 1.8 and 1.5, respectively) among workers having no comorbid conditions, with workplace but not nonworkplace injuries (OR 1.8 and 1.2, respectively) among workers having 1 comorbid condition, and with neither workplace nor nonworkplace injuries (OR 0.9 and 1.0, respectively) among workers having 2 or more comorbid conditions. CONCLUSIONS The associations of insomnia with injuries vary with comorbid conditions in ways that could have important implications for targeting workplace interventions.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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Wittchen HU, Schönfeld S, Thurau C, Trautmann S, Galle M, Mark K, Hauffa R, Zimmermann P, Schaefer J, Steudte S, Siegert J, Höfler M, Kirschbaum C. Prevalence, incidence and determinants of PTSD and other mental disorders: design and methods of the PID-PTSD+3 study. Int J Methods Psychiatr Res 2012; 21:98-116. [PMID: 22605681 PMCID: PMC6878265 DOI: 10.1002/mpr.1356] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 10/23/2011] [Accepted: 03/15/2012] [Indexed: 11/08/2022] Open
Abstract
Investigation of the prevalence, incidence, and determinants of post-traumatic stress disorders (PTSD) and other mental disorders associated with military deployment in international missions poses several methodological and procedural challenges. This paper describes the design and sampling strategies, instruments, and experimental procedures applied in a study programme aimed to examine military deployment-related mental health and disorders (prevalence and trajectories) and to identify vulnerability and risk factors (e.g. age, gender, type of mission, rank, and duration of deployment and a wide range of neurobiological, psychological, social, and behavioural factors). The study comprised two components. The first component, a cross-sectional study, included 1483 deployed and 889 non-deployed German soldiers (response rate, 93%) who served during the 2009 International Security Assistance Force (ISAF) mission. A standardized diagnostic instrument (Composite International Diagnostic Interview, CIDI) coupled with established questionnaires was administered to detect and diagnose PTSD and a broad spectrum of mental disorders and mental health problems. The second component, a prospective-longitudinal study, included 621 soldiers examined before (2011) and after return (2012) from the ISAF mission. In addition to the CIDI and questionnaires, several experimental behavioural tests and biological markers were implemented to probe for incident mental disorders, mental health problems and risk factors. Our methods are expected to provide greater precision than previous studies for estimating the risk for incident deployment-related and non-deployment-related disorders and their risk factors. We expect the findings to advance our understanding of a wide spectrum of adverse mental health outcomes beyond PTSD.
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Affiliation(s)
- Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
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Abstract
The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.
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Affiliation(s)
- Ronald C. Kessler
- Corresponding author for proofs and reprints: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, (617) 432-3587, (617) 432-3588 (fax), (email)
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Friedman A, Shaldubina A, Flaumenhaft Y, Weizman A, Yadid G. Monitoring of Circadian Rhythms of Heart Rate, Locomotor Activity, and Temperature for Diagnosis and Evaluation of Response to Treatment in an Animal Model of Depression. J Mol Neurosci 2010; 43:303-8. [DOI: 10.1007/s12031-010-9441-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 08/05/2010] [Indexed: 12/31/2022]
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