Rapid onset of comorbidity of common mental disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Day-to-day affect fluctuations in adults with childhood trauma history: a two-week ecological momentary assessment study

BACKGROUND

Childhood trauma (CT) may increase vulnerability to psychopathology through affective dysregulation (greater variability, autocorrelation, and instability of emotional symptoms). However, CT associations with dynamic affect fluctuations while considering differences in mean affect levels across CT status have been understudied.

METHODS

346 adults (age = 49.25 ± 12.55, 67.0% female) from the Netherlands Study of Depression and Anxiety participated in ecological momentary assessment. Positive and negative affect (PA, NA) were measured five times per day for two weeks by electronic diaries. Retrospectively-reported CT included emotional neglect and emotional/physical/sexual abuse. Linear regressions determined associations between CT and affect fluctuations, controlling for age, sex, education, and mean affect levels.

RESULTS

Compared to those without CT, individuals with CT reported significantly lower mean PA levels (Cohen's d = -0.620) and higher mean NA levels (d = 0.556) throughout the two weeks. CT was linked to significantly greater PA variability (d = 0.336), NA variability (d = 0.353), and NA autocorrelation (d = 0.308), with strongest effects for individuals reporting higher CT scores. However, these effects were entirely explained by differences in mean affect levels between the CT groups. Findings suggested consistency of results in adults with and without lifetime depressive/anxiety disorders and across CT types, with sexual abuse showing the smallest effects.

CONCLUSIONS

Individuals with CT show greater affective dysregulation during the two-week monitoring of emotional symptoms, likely due to their consistently lower PA and higher NA levels. It is essential to consider mean affect level when interpreting the impact of CT on affect dynamics.

The association between child maltreatment and problematic alcohol use in adulthood in a large multi-ethnic cohort: the HELIUS study

AIMS

There is evidence that child maltreatment is associated with problematic alcohol use later in life. However, previous epidemiological studies that have examined the link between child maltreatment and adult problematic alcohol use have not considered ethnic differences. Therefore, the purpose of the current study was to investigate the relationship between child maltreatment and adult problematic alcohol use among six ethnic groups in the Netherlands, in a large, urban sample.

METHODS

This study used baseline data from the Healthy Life in an Urban Setting (HELIUS) study: a large-scale, multi-ethnic prospective cohort study conducted in Amsterdam, the Netherlands. Child maltreatment, current problematic alcohol use and several potential confounders (e.g. parental alcohol use) were assessed in participants (N = 23 356) of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. With logistic regression analyses, we examined effect modification by ethnicity on the association between child maltreatment and problematic alcohol use. Furthermore, we explored effect modification by ethnicity for specific types of child maltreatment, namely: physical, sexual and psychological abuse and emotional neglect.

RESULTS

Effect modification by ethnicity was present. Stronger associations between child maltreatment and problematic alcohol use were found in all ethnic minority groups compared to the Dutch reference group. Particularly strong associations between all four types of child maltreatment and alcohol use problems were found for the Moroccan origin group.

CONCLUSIONS

This study adds to a growing body of evidence that child maltreatment is associated with problematic alcohol use in adulthood. In addition, our findings indicate that ethnicity impacts this relationship. Although problematic alcohol use was more prevalent in the Dutch origin group, associations with child maltreatment were stronger in ethnic minority groups. Future studies on child maltreatment and alcohol use problems should also examine ethnic disparities and should further unravel how these disparities can be explained.

Childhood trauma and LPS-stimulated inflammation in adulthood: Results from the Netherlands Study of Depression and Anxiety

BACKGROUND

Childhood trauma (CT) is robustly associated with psychiatric disorders including major depressive and anxiety disorders across the life span. The innate immune system may play a role in the relation between CT and stress-related psychopathology. However, whether CT influences the innate production capacity of cytokine levels following ex vivo stimulation by lipopolysaccharide (LPS), is currently unknown.

METHODS

Using data from the Netherlands Study of Depression and Anxiety (NESDA, n=1237), we examined whether CT (emotional neglect, emotional, physical, and sexual abuse before the age of 16), assessed by the Childhood Trauma Interview, was associated with levels in supernatants of interferon (IFN)γ, interleukin-2 (IL-2), IL-4, IL-6, IL-8, IL-10, IL-18, monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein (MIP)-1α, MIP-1β, matrix metalloproteinase-2 (MMP-2), TNFα and TNFβ after ex vivo stimulation with LPS. Cytokines were analysed individually and cumulatively (overall inflammation index and number of cytokines in high-risk quartile (HRQ)) using linear regression analyses.

RESULTS

After adjustment for demographic, lifestyle, and health-related covariates, total CT severity was associated with the overall inflammation index (β = 0.085, P_FDR = 0.011), the number of cytokines in HRQ (β = 0.063, P_FDR = 0.036), and individual markers of IL-2 (β = 0.067, P_FDR = 0.036), IL-6 (β = 0.091 P_FDR = 0.011), IL-8 (β = 0.085 P_FDR = 0.011), IL-10 (β = 0.094 P_FDR = 0.011), MCP-1 (β = 0.081 P_FDR = 0.011), MIP-1α (β = 0.061 P_FDR = 0.047), MIP1-β (β = 0.077 P_FDR = 0.016), MMP-2 (β = 0.070 P_FDR = 0.027), and TNFβ (β = 0.078 P_FDR = 0.016). Associations were strongest for individuals with severe CT, reporting multiple types or higher frequencies of trauma. Half of the findings persisted after adjustment for psychiatric status. The findings were consistent across different CT types.

CONCLUSION

Childhood Trauma is associated with increased LPS-stimulated cytokine levels, with evidence for a dose-response relationship. Our results highlight a dysregulated innate immune system capacity in adults with CT, which could contribute to an increased vulnerability for psychopathology and somatic disorders across the lifespan.

Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study

BACKGROUND

Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. However, whether CT is more strongly linked to specific clinical features of these disorders remains inconclusive. The current study comprehensively examined cross-sectional and longitudinal associations between CT and depressive/anxiety symptomatology in a large adult sample with current and remitted depressive and/or anxiety disorders.

METHODS

Baseline (n = 1803), 2-year (n = 1735), 4-year (n = 1585), and 6-year follow-up (n = 1475) data from the Netherlands Study of Depression and Anxiety were used. CT (emotional neglect, emotional/physical/sexual abuse) was assessed at baseline, while depressive/anxiety symptomatology with relevant dimensions (e.g., mood/cognitive, melancholic, general distress, and somatic depression) was assessed at each wave using self-reported questionnaires. Linear regressions and linear mixed models determined cross-sectional and longitudinal associations.

RESULTS

Individuals with CT, especially, severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology (Cohen's d = 0.674), mood/cognitive depression (d = 0.691), melancholic depression (d = 0.587), general distress (d = 0.561), and somatic depression severity (d = 0.549). Differences were lower, but still highly significant for anxiety (d = 0.418), worry (d = 0.362), and fear/phobic symptomatology (d = 0.359). Effects were consistent across CT types and maintained over six years.

LIMITATIONS

Retrospectively-reported CT.

CONCLUSIONS

CT is a risk factor for depressive and anxiety symptomatology across all dimensions and enduring over multiple years. Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.

Association and Effects of Trauma, Displacement, and Illicit Drug Use on Psychiatric Illnesses in Khyber Pakhtunkhwa, Pakistan

Methodology

Data were accumulated from all patients seen in outpatient clinics from October to December 2020. No inpatients or community samples were included in the research. Verbal consent and approval from the local ethical committee were obtained beforehand. ICD-10 diagnostic criteria were used for all psychiatric diagnoses.

Results

A total of 500 patients were seen with a gender distribution of 51% females and 49% males. Patients aged 18-65 years comprised 79% of this sample; 52% had no formal education. A total of 43% lived in settled areas; 37% were from Afghanistan; 13% from tribal areas, and 7% were from the Swat region. Thirty percent had no medical history, and 40% reported no prior contact with psychiatric service. Anxiety spectrum disorders were more prevalent in females, and psychotic and drug-related illnesses were more prevalent in males. More than half the patients seen were considered fit for psychotherapy referral but could not engage because of the lack of such services near their homes. The significance of the results obtained was assessed using the Chi-squared test, using SPSS v.22. A p-value of less than 0.05 was considered significant.

Conclusion

Almost 40% of patients were admitted due to some form of trauma history, predominantly terrorism-related, displacement, and other losses. Two in three people reported current or past drug use, with tetrahydrocannabinol (THC) being the most commonly used drug, followed by sedatives, opioids/pain relief medications, amphetamines, or methamphetamine (ICE), and others (e.g., alcohol). There was a significant rise in drug use/trauma history in the tribal areas, Afghanistan, and Swat region compared to the local population of settled areas. Common psychiatric illnesses were as expected in the sample studied.

'The Drugs Did For Me What I Couldn't Do For Myself': A Qualitative Exploration of the Relationship Between Mental Health and Amphetamine-Type Stimulant (ATS) Use

Substance use and mental ill health constitute a major public health burden, and a key global policy priority is to reduce illicit and other harmful substance use. Amphetamine-type stimulants (ATS) are the second most used class of illicit drugs and a range of mental health issues have been documented amongst users. This paper explores the relationship between mental health and ATS use, through a thematic analysis of qualitative interviews with n = 18 current and former ATS users in England. The findings are presented by trajectory point of; (1) Initiation of ATS use; (2) continued and increased ATS use and (3) decreased and remitted ATS use. This work helps to develop understanding around the complex and bi-directional relationship between ATS use and mental health. Many ATS users lead chaotic lives and engage in multiple risk behaviours, however there is a need to better understand and conceptualise the dynamic interaction between different individual, social, environment and cultural factors that determine individuals’ mental health and substance use. There is no ‘one size fits all’ approach to prevention and treatment, and these findings highlight the need for more joined-up, tailored and holistic approaches to intervention development.

Childhood Trauma in Adult Depressive and Anxiety Disorders: An Integrated Review on Psychological and Biological Mechanisms in the NESDA Cohort

BACKGROUND

Childhood trauma (CT) has adverse consequences on mental health across the lifespan. The understanding of how CT increases vulnerability for psychiatric disorders is growing. However, lack of an integrative approach to psychological and biological mechanisms of CT hampers further advancement. This review integrates CT findings across explanatory levels from a longitudinal adult cohort - the Netherlands Study of Depression and Anxiety (NESDA).

METHODS

We reviewed all studies (k = 37) from the NESDA cohort (n = 2981) published from 2009 to 2020 containing CT findings related to psychopathology and potential psychological and biological mechanisms of CT.

RESULTS

CT was associated with a higher risk of anxiety and depressive disorders with the strongest associations in the comorbid group. CT predicted the onset of these disorders, recurrence, and poorer outcomes (more comorbidity and chronicity). CT was associated with maladaptive personality characteristics and cognitions (e.g., higher neuroticism and negative self-associations), mild stress systems dysregulations (heightened levels of cortisol and inflammation), advanced biological aging (increased epigenetic aging and telomere attrition), poorer lifestyle (higher smoking rate and body mass index), somatic health decline (e.g., increased metabolic syndrome dysregulations), and brain alterations (e.g., reduced mPFC volume and increased amygdala reactivity).

LIMITATIONS

Literature review of one cohort using mixed analytical approaches.

CONCLUSION

CT impacts the functioning of the brain, mind, and body, which together may contribute to a higher vulnerability for affective disorders. It is essential to employ an integrative approach combining different sources of data to understand the mechanisms of CT better.

Association of Recent Stressful Life Events With Mental and Physical Health in the Context of Genomic and Exposomic Liability for Schizophrenia

Importance

Both adulthood stressful life events (SLEs) and liability for schizophrenia have been associated with poor mental and physical health in the general population, but their interaction remains to be elucidated to improve population-based health outcomes.

Objective

To test whether recent SLEs interact with genetic and environmental liability for schizophrenia in models of mental and physical health.

Design, Setting, and Participants

The Netherlands Mental Health Survey and Incidence Study-2 is a population-based prospective cohort study designed to investigate the prevalence, incidence, course, and consequences of mental disorders in the Dutch general population. Participants were enrolled from November 5, 2007, to July 31, 2009, and followed up with 3 assessments during 9 years. Follow-up was completed on June 19, 2018, and data were analyzed from September 1 to November 1, 2019.

Exposures

Recent SLEs assessed at each wave and aggregate scores of genetic and environmental liability for schizophrenia: polygenic risk score for schizophrenia (PRS-SCZ) trained using the Psychiatric Genomics Consortium analysis results and exposome score for schizophrenia (ES-SCZ) trained using an independent data set.

Main Outcomes and Measures

Independent and interacting associations of SLEs with ES-SCZ and PRS-SCZ on mental and physical health assessed at each wave using regression coefficients.

Results

Of the 6646 participants included at baseline, the mean (SD) age was 44.26 (12.54) years, and 3672 (55.25%) were female. The SLEs were associated with poorer physical health (B = -3.22 [95% CI, -3.66 to -2.79]) and mental health (B = -3.68 [95% CI, -4.05 to -3.32]). Genetic and environmental liability for schizophrenia was associated with poorer mental health (ES-SCZ: B = -3.07 [95% CI, -3.35 to -2.79]; PRS-SCZ: B = -0.93 [95% CI, -1.31 to -0.54]). Environmental liability was also associated with poorer physical health (B = -3.19 [95% CI, -3.56 to -2.82]). The interaction model showed that ES-SCZ moderated the association of SLEs with mental (B = -1.08 [95% CI, -1.47 to -0.69]) and physical health (B = -0.64 [95% CI, -1.11 to -0.17]), whereas PRS-SCZ did not. Several sensitivity analyses confirmed these results.

Conclusions and Relevance

In this study, schizophrenia liability was associated with broad mental health outcomes at the population level. Consistent with the diathesis-stress model, exposure to SLEs, particularly in individuals with high environmental liability for schizophrenia, was associated with poorer health. These findings underline the importance of modifiable environmental factors during the life span for population-based mental health outcomes.

Childhood trauma and dysregulation of multiple biological stress systems in adulthood: Results from the Netherlands Study of Depression and Anxiety (NESDA)

BACKGROUND

Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. Although dysregulated biological stress systems may underlie the enduring effect of CT, the relation between CT and separate and cumulative activity of the major stress systems, namely, the hypothalamic-pituitary-adrenal (HPA)-axis, the immune-inflammatory system, and the autonomic nervous system (ANS), remains inconclusive.

METHODS

In the Netherlands Study of Depression and Anxiety (NESDA, n = 2778), we determined whether self-reported CT (as assessed by the Childhood Trauma Interview) was associated with separate and cumulative markers of the HPA-axis (cortisol awakening response, evening cortisol, dexamethasone suppression test cortisol), the immune-inflammatory system (C-reactive protein, interleukin-6, tumor necrosis factor-α), and the ANS (heart rate, respiratory sinus arrhythmia, pre-ejection period) in adulthood.

RESULTS

Almost all individuals with CT (n = 1330) had either current or remitted depressive and/or anxiety disorder (88.6%). Total-sample analyses showed little evidence for CT being significantly associated with the separate or cumulative stress systems' activity in adulthood. These findings were true for individuals with and without depressive and/or anxiety disorders. To maximize contrast, individuals with severe CT were compared to healthy controls without CT. This yielded slight, but significantly higher levels of cortisol awakening response (AUCg, β = .088, p =  .007; AUCi, β = .084, p =  .010), cumulative HPA-axis markers (β = .115, p =  .001), C-reactive protein (β = .055, p = .032), interleukin-6 (β = .053, p =  .038), cumulative inflammation (β = .060, p =  .020), and cumulative markers across all systems (β = .125, p =  .0003) for those with severe CT, partially explained by higher rates of smoking, body mass index, and chronic diseases.

CONCLUSION

While our findings do not provide conclusive evidence on CT directly dysregulating stress systems, individuals with severe CT showed slight indications of dysregulations, partially explained by an unhealthy lifestyle and poorer health.

Altered Neural Processing of Threat-Related Information in Children and Adolescents Exposed to Violence: A Transdiagnostic Mechanism Contributing to the Emergence of Psychopathology

OBJECTIVE

Exposure to violence in childhood is associated with increased risk for multiple forms of internalizing and externalizing psychopathology. We evaluated how exposure to violence in early life influences neural responses to neutral and threat-related stimuli in childhood and adolescence, developmental variation in these associations, and whether these neural response patterns convey transdiagnostic risk for psychopathology over time.

METHOD

Participants were 149 youths (75 female and 74 male), aged 8 to 17 years (mean = 12.8, SD = 2.63), who had experienced physical abuse, sexual abuse, or domestic violence (n = 76) or had never experienced violence (n = 73). Participants underwent functional magnetic resonance imaging scanning while passively viewing fearful, neutral, and scrambled faces presented rapidly in a block design without specific attentional demands. Internalizing and externalizing psychopathology were assessed concurrently with the scan and 2 years later and were used to compute a transdiagnostic general psychopathology factor (p factor).

RESULTS

Exposure to violence was associated with reduced activation in the dorsal anterior cingulate cortex (dACC) and frontal pole (1,985 voxels, peak x, y, z = 6, 4, 40) when viewing fearful (versus scrambled) faces, and reduced activation in dorsomedial prefrontal cortex and superior frontal gyrus (1,970 voxels, peak x, y, z = 16, 64, 10) when viewing neutral faces, but not amygdala activation or connectivity. Lower dACC response to fearful faces predicted increase in the p factor 2 years later (B = -0.186, p = .031) and mediated the association of violence exposure with longitudinal increases in the p factor.

CONCLUSION

Reduced recruitment of the dACC-a region involved in salience processing, conflict monitoring, and cognitive control-in response to threat-related cues may convey increased transdiagnostic psychopathology risk in youths exposed to violence.

Ethnic and sex differences in the association of child maltreatment and depressed mood. The HELIUS study

BACKGROUND

Maltreatment in childhood increases the risk of depression later in life. The influence of ethnicity and sex on this relationship is less well understood.

OBJECTIVE

This paper examines ethnic and sex differences in rates of child maltreatment (CM) and depressed mood in adulthood and investigates whether the association between CM and depressed mood in adulthood is influenced by ethnicity and sex.

PARTICIPANTS AND SETTING

Baseline data from the multiethnic HELIUS study (Amsterdam, the Netherlands) was analyzed and consisted of 22,551 participants aged 18-70 years from Dutch, African Surinamese, South Asian-Surinamese, Turkish, Moroccan, or Ghanaian ethnic backgrounds.

METHODS

Physical, sexual and psychological abuse, and emotional neglect in childhood were self-reported and depressed mood was measured using the Patient Health Questionnaire-9.

RESULTS

Logistic regression analyses demonstrated that emotional neglect and psychological abuse both have significant positive relationships with depressed mood. Furthermore, these associations were consistent across ethnic groups. The addition of ethnicity-by-maltreatment interaction terms to a main effects model revealed that Ghanaians who reported physical abuse in childhood were the only ethnic group with significantly increased odds for depressed mood (OR = 2.62, p =  .001), with the same being true for Moroccans who experienced sexual abuse in childhood (OR = 1.91, p =  .008). No sex differences were found in the relationships between CM and depressed mood.

CONCLUSIONS

The association between different types of CM and depressive symptoms may not always be uniform across ethnic groups. Greater understanding of the nuances present in these relationships is required to develop effective prevention and intervention strategies for multiethnic populations.

Differential relations of suicidality in depression to brain activation during emotional and executive processing

Suicidal behavior is highly prevalent in major depressive disorder (MDD), though not present in all patients. It is unclear whether the tendency for suicidal behavior is associated with a unique functional neuroanatomical signature identifiable through neuroimaging. In this study, we investigated brain activation in suicidal and non-suicidal patients with MDD during facial emotion processing and executive control. Functional magnetic resonance imaging (fMRI) data from the NESDA-fMRI study (MDD patients N = 103, healthy controls N = 26, HC) were analyzed. Patients were divided in a group of suicide attempters (N = 18, SA), suicide ideators (N = 31, SI) and a patient-control group (N = 73, PC). A gender discrimination task with emotional faces and the Tower of London executive planning task were investigated. An ANOVA was performed to compare brain activation among suicidal patients (SA + SI), PC and HC first and then among SI, SA, PC and HC. Significance was determined as meeting p < .05 family wise error (FWE) corrected at the voxel-level. We observed that SA patients showed lower activation in the bilateral fusiform gyri during emotional faces processing compared to SI, PC and HC. No group differences were found during executive planning. Results were independent of childhood emotional maltreatment, depression severity, anxiety severity, use of psychotherapy and SSRI-use. Results suggest that a propensity for suicidal behavior in MDD is associated with abnormal emotional processing but not executive functioning, represented by altered face processing compared to non-suicidal patients and controls. While in need of replication, these results indicate that altered fusiform gyrus activation during emotion processing may serve as a marker for suicidality.

The association of childhood maltreatment with depression and anxiety is not moderated by the oxytocin receptor gene

BACKGROUND

The oxytocin receptor (OXTR) gene may be involved in resilience or vulnerability towards stress, and hence in the development of stress-related disorders. There are indications that OXTR single nucleotide polymorphisms (SNPs) interact with early life stressors in predicting levels of depression and anxiety. To replicate and extend these findings, we examined whether three literature-based OXTR SNPs (rs2254298, rs53576, rs2268498) interact with childhood maltreatment in the development of clinically diagnosed depression and anxiety disorders.

METHODS

We included 2567 individuals from the Netherlands Study of Depression and Anxiety. This sample consisted of 387 healthy controls, 428 people with a current or past depressive disorder, 243 people with a current or past anxiety disorder, and 1509 people with both lifetime depression and anxiety diagnoses. Childhood maltreatment was measured with both an interview and via self-report. Additional questionnaires measured depression and anxiety sensitivity.

RESULTS

Childhood maltreatment was strongly associated with both lifetime depression and anxiety diagnoses, as well as with depression and anxiety sensitivity. However, the OXTR SNPs did not moderate these associations nor had main effects on outcomes.

CONCLUSIONS

The three OXTR gene SNPs did not interact with childhood maltreatment in predicting lifetime depression and anxiety diagnoses or sensitivity. This stresses the importance of replication studies with regard to OXTR gene variants in general populations as well as in clearly established clinical samples.

A hierarchical causal taxonomy of psychopathology across the life span

We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record

Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants

BACKGROUND

This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory.

METHOD

This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants.

RESULTS

The results showed large unadjusted prospective associations between neuroticism and symptoms/diagnosis of anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect.

CONCLUSION

High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.

Psychotic Experiences and Risk of Violence Perpetration and Arrest in the General Population: A Prospective Study

Background

In cross-sectional, general population studies, psychotic experiences have been associated with an increased risk of physical violence perpetration and arrest. However, longitudinal research on this topic is lacking. Moreover, it remains unclear whether subjects with psychotic experiences are also at risk of displaying psychological violence. The present study aims to investigate these associations.

Method

The longitudinal association between baseline psychotic experiences and six-year incidence of violence perpetration and three-year incidence of arrest was studied in a prospective cohort of 6646 general population adults. Logistic regression analyses with varying levels of adjustment were performed in the complete sample and in subsamples stratified by presence or absence of baseline mental disorders.

Results

The presence of psychotic experiences at baseline increased the risk of physical violence, psychological violence and arrest at follow-up. However, adjustment for dimensional measures of psychopathology and contextual confounders reduced all associations considerably. After adjustment, both clinically validated (OR = 3.59, 95% CI 1.09–11.81) and self-reported hallucinations (OR = 2.83, 95% CI 1.05 7.65) remained significantly associated with physical violence perpetration. Self-reported (OR = 3.06, 95% CI 1.55–6.03) and clinically validated delusions (OR = 3.24, 95% CI 1.47–7.13) were associated with an increased risk of arrest. There was no significant association between psychotic experiences and incident psychological violence in the fully adjusted model.

Conclusion

Specific psychotic experiences may differentially predict physical violence perpetration and arrest, even after adjustment for demographics, dimensional measures of psychopathology and contextual confounders. However, more longitudinal research with larger sample sizes is required to confirm these findings.

Path analysis of relationship among personality, perceived stress, coping, social support, and psychological outcomes

AIM: To provide a structural model of the relationship between personality traits, perceived stress, coping strategies, social support, and psychological outcomes in the general population.

METHODS: This is a cross sectional study in which the study group was selected using multistage cluster and convenience sampling among a population of 4 million. For data collection, a total of 4763 individuals were asked to complete a questionnaire on demographics, personality traits, life events, coping with stress, social support, and psychological outcomes such as anxiety and depression. To evaluate the comprehensive relationship between the variables, a path model was fitted.

RESULTS: The standard electronic modules showed that personality traits and perceived stress are important determinants of psychological outcomes. Social support and coping strategies were demonstrated to reduce the increasing cumulative positive effects of neuroticism and perceived stress on the psychological outcomes and enhance the protective effect of extraversion through decreasing the positive effect of perceived stress on the psychological outcomes.

CONCLUSION: Personal resources play an important role in reduction and prevention of anxiety and depression. In order to improve the psychological health, it is necessary to train and reinforce the adaptive coping strategies and social support, and thus, to moderate negative personality traits.

Brain Activation During Emotional Memory Processing Associated with Subsequent Course of Depression

Major depressive disorder (MDD) is characterized by a heterogeneous course and identifying patients at risk for an unfavorable course is difficult. Neuroimaging studies may identify brain predictors of clinical course and may help to further unravel the neurobiological processes underlying an unfavorable course. We investigated whether brain activation during an emotional memory paradigm is associated with depressive course. To this end, we followed 74 MDD patients and 45 healthy controls (HCs) for 2 years. At baseline, participants performed an emotional word-encoding and -recognition task during functional magnetic resonance imaging. Activation patterns were compared between patients with fast remission (n=22), remission with recurrence (n=23), non-remission (n=29), and HCs. Additionally, linear relations of brain activation and time to remission during the follow-up period were investigated across patients. We observed that during encoding of negative words, non-remitters showed higher activation of the left insula than HCs. Groups also differed in activation of the right hippocampus and left amygdala during negative encoding, with a trend for higher activation in non-remitters compared with HCs. Furthermore, hippocampal activation during negative word encoding was significantly and positively correlated with time to remission, irrespective of illness severity. Our findings suggest that higher activation in the left insula could serve as a neural marker of a naturalistic non-remitting course, whereas higher hippocampal activation is associated with delayed remission. Longitudinal analyses should clarify whether abnormal activation progresses further as a function of time with depression or may serve as load-independent markers of MDD course.

An admixture analysis of age of onset in agoraphobia

BACKGROUND

Age of onset is an important epidemiological indicator in characterizing disorders׳ subtypes according to demographic, clinical and psychosocial determinants. While investigated in various psychiatric conditions, age of onset and related characteristics in agoraphobia have yet to be examined. In light of the new diagnostic status in the DSM-5 edition of agoraphobia as independent from panic disorder, research on agoraphobia as a stand-alone disorder is needed.

METHODS

Admixture analysis was used to determine the best-fitting model for the observed ages at onset of 507 agoraphobia patients participating in the Netherlands Study of Depression and Anxiety (age range 18-65). Associations between agoraphobia age of onset and different demographic, clinical and psychosocial determinants were examined using multivariate logistic regression analysis.

RESULTS

Admixture analyses identified two distributions of age of onset, with 27 as the cutoff age (≤27; early onset, >27; late onset). Early onset agoraphobia was only independently associated with family history of anxiety disorders (p<0.01) LIMITATIONS: Age of onset was assessed retrospectively, and analyses were based on cross-sectional data.

CONCLUSION

The best distinguishing age of onset cutoff of agoraphobia was found to be 27. Early onset agoraphobia might constitute of a familial subtype. As opposed to other psychiatric disorders, early onset in agoraphobia does not indicate for increased clinical severity and/or disability.

Long-lasting effects of affective disorders and childhood trauma on dispositional optimism

BACKGROUND

Dispositional optimism, a personality trait characterized by generalized positive expectations towards the future, is thought to remain rather stable over time. It is however largely unknown to what extent affective disorders and its risk factors affect dispositional optimism.

METHODS

We examined the association between (lifetime) affective disorders and childhood trauma with dispositional optimism in a sample of 2104 subjects (aged 18-65 years) from the Netherlands Study of Depression and Anxiety (NESDA). Dispositional optimism was measured with the Life Orientation Test Revised (LOT-R). Diagnoses of depressive and anxiety disorders were based on the Composite Interview diagnostic Instrument (CIDI).Childhood trauma was assessed using the Childhood Trauma Interview (CTI) and life-events with the List of Threatening Events Questionnaire (LTQ).

RESULTS

The 2104 participants were on average 46.0 (SD 13.1) years old and 65.8% were female. Multivariate analyses showed that dispositional optimism was inversely associated with current affective disorders (depression: B=-1.089 and anxiety: B=-1.066, both p<0.001), but also with remitted affective disorders (depression: B=-0.822 and anxiety: B=-0.558, both p<0.001) and severity of depression (B=-4.230; p<0.001). A history of childhood emotional maltreatment (B=-0.905, p<0.001) was related to lower optimism, whilst positive life-events were associated with higher levels of optimism (B=0.235, p>0.001).

LIMITATIONS

The cross-sectional design hampers inferences about causality.

CONCLUSION

Lower levels of dispositional optimism are associated with stage of affective disorders, even after remission, and a history of childhood emotional maltreatment. Identification of the risk factors contributes to understand fluctuations in dispositional optimism.

Hypoactive medial prefrontal cortex functioning in adults reporting childhood emotional maltreatment

Childhood emotional maltreatment (CEM) has adverse effects on medial prefrontal cortex (mPFC) morphology, a structure that is crucial for cognitive functioning and (emotional) memory and which modulates the limbic system. In addition, CEM has been linked to amygdala hyperactivity during emotional face processing. However, no study has yet investigated the functional neural correlates of neutral and emotional memory in adults reporting CEM. Using functional magnetic resonance imaging, we investigated CEM-related differential activations in mPFC during the encoding and recognition of positive, negative and neutral words. The sample (N = 194) consisted of patients with depression and/or anxiety disorders and healthy controls (HC) reporting CEM (n = 96) and patients and HC reporting no abuse (n = 98). We found a consistent pattern of mPFC hypoactivation during encoding and recognition of positive, negative and neutral words in individuals reporting CEM. These results were not explained by psychopathology or severity of depression or anxiety symptoms, or by gender, level of neuroticism, parental psychopathology, negative life events, antidepressant use or decreased mPFC volume in the CEM group. These findings indicate mPFC hypoactivity in individuals reporting CEM during emotional and neutral memory encoding and recognition. Our findings suggest that CEM may increase individuals' risk to the development of psychopathology on differential levels of processing in the brain; blunted mPFC activation during higher order processing and enhanced amygdala activation during automatic/lower order emotion processing. These findings are vital in understanding the long-term consequences of CEM.

The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey

Introduction

Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use of specific substances, and iii) to determine whether specific psychiatric disorders were associated with use of specific substances in the South African population.

Methods

Data were drawn from the South African Stress and Health (SASH) study, a nationally-representative, cross-sectional survey of South African households that forms part of a World Health Organisation (WHO) World Mental Health (WMH) initiative to standardise information on the global burden of mental illness and its correlates. Data from a subset (n = 1766; aged 18 to 30 years) of the SASH sample of 4351 individuals were analysed. The Composite International Diagnostic Interview Version 3 (CIDI 3.0) was used to elicit basic demographic details and information regarding mental illness and substance use. Multiple regression analyses, adjusted for age and gender, were used to identify associations between mental disorders and substance use.

Results

Significant associations were found between substance use and mood and anxiety disorders, with a particularly strong relationship between cannabis use and mental disorder.

Conclusion

The results are consistent with those from previous studies, and reinforce the argument that comorbid substance use and mental disorders constitute a major public health burden.

Interaction of neuropeptide Y genotype and childhood emotional maltreatment on brain activity during emotional processing

Neuropeptide Y (NPY) has been associated with stress reactivity in affective disorders and is most densely expressed in the amygdala. An important stressor associated with affective disorders is the experience of childhood emotional maltreatment (CEM). We investigated whether the interaction of NPY risk genotype and CEM would affect brain activation. From The Netherlands Study of Depression and Anxiety, 33 healthy controls and 85 patients with affective disorders were scanned with functional magnetic resonance imaging while making gender decisions of emotional facial expressions. Results showed interactions between genotype and CEM, within carriers of the risk genotype, CEM was associated with higher amygdala activation, whereas CEM did not influence activation in non-risk carriers. In the posterior cingulate cortex (PCC), less activation was seen in those with CEM and the risk genotype, whereas genotype did not influence PCC activation in those without CEM. In addition, those carrying the risk genotype and with experience of CEM made a faster gender decision than those without CEM. Thus, the combined effect of carrying NPY risk genotype and a history of CEM affected amygdala and PCC reactivity, areas related to emotion, self-relevance processing and autobiographical memory. These results are consistent with the notion that the combination of risk genotype and CEM may cause hypervigilance.

Parent, sibling and peer associations with subtypes of psychiatric and substance use disorder comorbidity in offspring

BACKGROUND

Parental substance use disorder (SUD) is associated with a range of negative offspring outcomes and psychopathology, but the clustering of these outcomes into subtypes has seldom been examined, nor have the familial and environmental contexts of these subtypes been reported. The present study examines the clustering of offspring lifetime substance use and psychiatric disorders into subtypes and characterizes them in terms of familial and non-familial influences using an offspring-of-twins design.

METHOD

Telephone-administered diagnostic interviews were used to collect data on psychiatric disorders and SUD from 488 twin fathers, 420 biological mothers and 831 offspring. Latent class analysis (LCA) was used to derive subtypes of lifetime comorbidity in offspring. Familial risk and environmental variables associated with each subtype (i.e., parenting, childhood physical or sexual abuse, perceived sibling and peer substance use) were identified using multinomial logistic regression.

RESULTS

Four classes identified by LCA were characterized as (1) unaffected, (2) alcohol abuse/dependence, (3) alcohol abuse/dependence comorbid with anxiety and depression, and (4) alcohol, cannabis abuse/dependence and nicotine dependence comorbid with conduct disorder. Inconsistent parenting, childhood physical/sexual abuse, and perceived sibling and peer substance use were significantly associated with profiles of offspring comorbidity after adjusting for familial vulnerability. Some associations were specific (i.e., perceived peer alcohol use to the AUD class), while others were general (peer smoking to all 3 comorbidity classes).

CONCLUSIONS

We observed distinct subtypes of psychiatric and SUD comorbidity in adolescents and young adults. Subtypes of offspring psychopathology have varied associations with parental psychopathology, family environment, and sibling and peer behaviors.

Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes

To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

BDNF val66met affects hippocampal volume and emotion-related hippocampal memory activity

The val(66)met polymorphism on the BDNF gene has been reported to explain individual differences in hippocampal volume and memory-related activity. These findings, however, have not been replicated consistently and no studies to date controlled for the potentially confounding impact of early life stress, such as childhood abuse, and psychiatric status. Using structural and functional MRI, we therefore investigated in 126 depressed and/or anxious patients and 31 healthy control subjects the effects of val(66)met on hippocampal volume and encoding activity of neutral, positive and negative words, while taking into account childhood abuse and psychiatric status. Our results show slightly lower hippocampal volumes in carriers of a met allele (n=54) relative to val/val homozygotes (n=103) (P=0.02, effect size (Cohen's d)=0.37), which appeared to be independent of childhood abuse and psychiatric status. For hippocampal encoding activity, we found a val(66)met-word valence interaction (P=0.02) such that carriers of a met allele showed increased levels of activation in response to negative words relative to activation in the neutral word condition and relative to val/val homozygotes. This, however, was only evident in the absence of childhood abuse, as abused val/val homozygotes showed hippocampal encoding activity for negative words that was comparable to that of carriers of a met allele. Neither psychiatric status nor memory accuracy did account for these associations. In conclusion, BDNF val(66)met has a significant impact on hippocampal volume independently of childhood abuse and psychiatric status. Furthermore, early adverse experiences such as childhood abuse account for individual differences in hippocampal encoding activity of negative stimuli but this effect manifests differently as a function of val(66)met.

The impact of childhood abuse and recent stress on serum brain-derived neurotrophic factor and the moderating role of BDNF Val66Met

RATIONALE

Recent findings show lowered brain-derived neurotrophic factor (BDNF) levels in major depressive disorder (MDD). Exposure to stressful life events may (partly) underlie these BDNF reductions, but little is known about the effects of early or recent life stress on BDNF levels. Moreover, the effects of stressful events on BDNF levels may in part be conditional upon a common variant on the BDNF gene (Val(66)Met; RS6265), with the Met allele being associated with a decrease in activity-dependent secretion of BDNF compared to the Val allele.

METHODS

We investigated cross-sectionally in 1,435 individuals with lifetime MDD the impact of childhood abuse (CA) and recent life events on serum BDNF levels and assessed whether the impact of these events was moderated by the BDNF Val(66)Met polymorphism.

RESULTS

Overall, BDNF Met carriers had reduced serum BDNF levels when exposed to CA in a dose-dependent way. Moreover, exposure to recent life events was also associated with decreases in BDNF levels, but this was independent of BDNF Val(66)Met. Moreover, when not exposed to CA, Met carriers had higher BDNF levels than the Val/Val individuals, who did not show decreases in BDNF associated with CA. Finally, these findings were only apparent in the MDD group without comorbid anxiety.

CONCLUSIONS

These gene-environment interactions on serum BDNF levels suggest that Met carriers are particularly sensitive to (early) stressful life events, which extends previous findings on the moderating role of the BDNF Val(66)Met polymorphism in the face of stressful life events.

Psychiatric history and subthreshold symptoms as predictors of the occurrence of depressive or anxiety disorder within 2 years

BACKGROUND

Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently.

AIMS

To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period.

METHOD

This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology-Self Report and the Beck Anxiety Inventory.

RESULTS

Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone.

CONCLUSIONS

A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.

Genetic and environmental influences on psychiatric comorbidity: a systematic review

BACKGROUND

The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse.

METHODS

We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity.

RESULTS

Ninety-four articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments make an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/life events, family and peer social connections, and socioeconomic and academic difficulties.

LIMITATIONS

Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times.

CONCLUSIONS

Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions.

Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use

OBJECTIVE

The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn.

METHOD

We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use.

RESULTS

Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06-4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21-4.36, P = 0.01), independent of depression severity.

CONCLUSION

The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia.

The association between psychopathology and substance use in young people: a review of the literature

This article reviews the recent literature on the association between psychopathology and substance use in young people. An electronic literature search, using PSYCINFO/PSYCLIT and PUBMED/MEDLINE, yielded 93 English-language articles for the period 1990-2008. Of these articles, 89 (95.7%) reported studies conducted in developed countries, 57 (61.3%) had community or population samples, 38 (40.9%) had sample sizes ranging from 500 to 2000 subjects, and 33 (36.7%) had sample sizes of between 50 and 500. The most commonly-used assessment tool (n = 29, 31.2%) was the Diagnostic Interview Schedule. Evidence exists for associations between depression and cigarette smoking, between anxiety and cigarette smoking, and between anxiety and alcohol use. The strength of the associations is increased with greater frequency and quantity of substance use, and is influenced by the nature of the psychopathology, the specific substances of use, and demographic factors such as gender, age or developmental stage. The need for more longitudinal studies on community populations, and increased access to funds and resources for researchers in developing countries is highlighted.

Correlates of comorbid mental disorders in a regional community-based sample

OBJECTIVE

The common coexistence of psychiatric disorders has been identified as a significant factor contributing to the disability associated with mental illness. Identifying indicators to the development of coexisting disorders has potential clinical implications. This study aimed to investigate the correlates and impact of coexisting disorders in a rural setting.

DESIGN

Cross-sectional analyses of data from a cohort interviewed in two phases.

SETTING

A regional community sample in Northern New South Wales, Australia.

PARTICIPANTS

A total of 1407 participants were interviewed and 968 were re-interviewed at follow up.

MAIN OUTCOME MEASURES

Multinomial logistic regression modelling compared subjects with multiple psychiatric disorders with those with a single disorder for sociodemographic characteristics, measures of personal and social vulnerability, psychological distress, functional disabilities and help-seeking behaviours.

RESULTS

Participants with coexisting disorders were more likely to be male, report a history of severe childhood assault and had higher levels of neuroticism, psychological distress and help-seeking behaviour.

CONCLUSIONS

The findings suggest the role of early developmental factors on the complexity and severity of adult mental illness in a rural setting and the significant clinical consequences of comorbidity.

Estimating co-occurring behavioral trajectories within a neighborhood context: a case study of multivariate transition models for clustered data

Comorbidity is well-documented in psychiatric and risk behavior epidemiology. The authors present a novel application of clustered multivariate transition models to study comorbidity within a clustered context. The authors used data from the Project on Human Development in Chicago Neighborhoods (1995-2002) to assess trajectories in substance use, problems with police, and antisocial behavior among 1,517 participants in 80 neighborhoods followed from ages 12-15 years through ages 18-21 years. The authors used pairwise odds ratios to quantify behavior comorbidity at the individual and neighborhood levels. Risk behaviors co-occurred within individuals at specific points in time: antisocial behavior and substance use were 3.37 times more likely to co-occur within an individual at wave 1, as compared with the co-occurrence of any 2 behaviors from different individuals, while substance use and police problems were 2.94 times more likely to co-occur than substance use and antisocial behavior at wave 2. The authors also evaluated sequential comorbidity. Antisocial behavior was sequentially comorbid with substance use and police problems: 31% of youths who had reported antisocial behavior at baseline reported police problems or drug use at wave 2. These models can prove instrumental in answering the persistent questions about possible sequential relations among problem behaviors.

Neurophysiological and genetic distinctions between pure and comorbid anxiety disorders

Anxiety disorders are often comorbid with major depression (MD) and alcohol use disorders (AUD). Two common functional polymorphisms in catechol-O-methyltransferase (COMT Val158Met) and brain-derived neurotrophic factor (BDNF Val66Met) genes have been implicated in the neurobiology of anxiety and depression. We hypothesized that attentional response and working memory (auditory P300 event-related potential and Weschler Adult Intelligence Scale, Revised digit symbol scores) as well as genetic vulnerability would differ between pure anxiety disorders and comorbid anxiety. Our study sample comprised 249 community-ascertained men and women with lifetime DSM-III-R diagnoses. We analyzed groups of participants with pure anxiety disorders, pure MD, pure AUD, comorbid anxiety, and no psychiatric disorder. Participants were well at the time of testing; state anxiety and depressed mood measures were at most only mildly elevated. Individuals with pure anxiety disorders had elevated P300 amplitudes (P=0.0004) and higher digit symbol scores (P<0.0001) compared with all the other groups. Individuals with comorbid anxiety had the greatest proportion of COMT Met158 and BDNF Met66 alleles (P=0.009) as well as higher harm avoidance-neuroticism (P<0.0005) than all other groups. Our results suggest that there may be two vulnerability factors for anxiety disorders with differing genetic susceptibility: (a) heightened attention and better working memory with mildly elevated anxiety-neuroticism, a constellation that may be protective against other psychopathology; and (b) poorer attention and working memory with greater anxiety-neuroticism, a constellation that may also increase vulnerability to AUD and MD. This refinement of the anxiety phenotype may have implications for therapeutic interventions.

Familiality of major depressive disorder and gender differences in comorbidity

OBJECTIVE

Gender differences exist in the prevalence and psychiatric comorbidity of major depressive disorder (MDD). This study investigates whether familiality of MDD contributes to observed gender differences in comorbidity.

METHOD

Familial (f-MDD) and non-familial (nf-MDD) MDD cases from a population sample were assessed for comorbid dysthymia, anxiety disorders and alcohol-related disorders using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were performed to examine the effect of f-MDD on gender differences in comorbidity, adjusted for confounders.

RESULTS

Women with f-MDD reported significantly more comorbid dysthymia and generalized anxiety disorder (GAD) than their male counterparts; women with nf-MDD reported significantly more comorbid simple phobias and agoraphobia than their male counterparts. Gender differences in comorbid panic disorder and alcohol-related disorders occurred independently of the familial load. Adjustment for age of onset, severity and recurrence of MDD did not change these results.

CONCLUSION

Models to explain comorbidity patterns of MDD differ by gender. Familiality of MDD should be taken into account.

Child abuse and health-related quality of life in adulthood

Past research has indicated that child abuse is related to mental and physical health conditions and that mental and physical health conditions are related to decreased health-related quality of life (HRQOL). However, little is known about the independent relationship between child abuse and HRQOL. For the current analysis, data were from the nationally representative Netherlands Mental Health Survey and Incidence Study. Multiple linear regression analyses tested the relationships between child abuse and current HRQOL (SF-36) after adjusting for the effects of sociodemographic variables and numerous psychiatric disorders and physical health conditions. Neglect, psychological abuse, physical abuse, severe sexual abuse, and number of types of child abuse experienced were associated with reduced mental HRQOL. Psychological abuse, physical abuse, and number of types of child abuse experienced were associated with reduced physical HRQOL. Child abuse is an important determinant of HRQOL. The ability to successfully reduce the occurrence of child abuse or provide early intervention after child abuse occurs may help to improve HRQOL in the general population.

Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys

PURPOSE OF REVIEW

To consider comorbidity across multiple classes of disorders in data derived from recent large-scale community surveys.

RECENT FINDINGS

There has been substantial recent progress in our understanding of patterns and implications of comorbidity of mental disorders. There is now converging evidence on the magnitude and specific patterns of comorbidity in international studies worldwide. There is increasing recognition of comorbidity of mental and physical disorders. Comorbidity of mental disorders and substance abuse has now been recognized universally, and the results of treatment and prevention studies incorporating comorbidity are now beginning to emerge.

SUMMARY

Comorbidity has been shown to be an index of more severe course and outcome of mental disorders. Systematic inclusion of comorbidity into clinical evaluation and treatment will enhance the effectiveness of intervention with these conditions. Prevention of the development of secondary conditions as a consequence of primary disorders should reduce the impact of these conditions on both the individual and society.

Personality traits in unaffected twins discordant for affective disorder

OBJECTIVE

To examine whether a high genetic liability to develop affective disorder is associated with specific personality traits.

METHOD

A cross-sectional, high-risk, case-control study. Through nation-wide registers, healthy monozygotic (MZ) and dizygotic (DZ) twins with (high-risk twins) and without (the control group/low-risk twins) a co-twin history of affective disorder were identified. Personality traits were compared for a total of 211 high-risk and low-risk twins.

RESULTS

In univariate analyses, the high-risk twins had a higher level of neuroticism than the control twins (P = 0.03). In multivariate analyses, a high genetic liability to affective disorder was not significantly associated with neuroticism but correlated to sex, minor psychopathology and recent life events.

CONCLUSION

A high genetic liability to affective disorder showed an association with neuroticism, but the association interacts with other predictors of affective disorder such as female gender, minor psychopathology and recent adversity.

Psychiatric morbidity is related to a chain of prenatal and perinatal adversities

BACKGROUND

Most studies on the effects of early risk factors on future mental health focus on specific obstetric complications as risk factors for specific disorders. However, obstetric complications rarely occur in isolation, and the same holds for psychiatric problems.

AIMS

To study prenatal and perinatal risk factors for psychiatric multimorbidity in early adulthood and to determine whether these differ from risk factors for monomorbidity.

STUDY DESIGN

Monomorbidity and multimorbidity of six types of psychiatric disorders were determined by a standardised psychiatric interview. Using univariate and multivariate logistic and ordinal logistic regression, associations of mono- and multimorbidity with prospectively collected early risk factors were examined.

SUBJECTS

Two hundred and eighty-five young adults selected from a prospective birth cohort on the basis of their Obstetric Optimality Scores.

OUTCOME MEASURES

Six types of psychiatric disorder and their co-occurrence.

RESULTS

Monomorbidity was related to isolated early risk factors such as low birth weight or a low Apgar score, and to an accumulation of unfavourable pre- and perinatal events. Multimorbidity on the other hand, was only related to a chain of pre- and perinatal adversities.

CONCLUSION

Research and prevention strategies should not focus solely on isolated early risk factors, but also on the entire pre- and perinatal situation.

Cortisol and adrenocorticotropic hormone responses to naloxone in subjects with high and low neuroticism

BACKGROUND

Neuroticism is a highly heritable personality trait that is a risk factor for certain affective and anxiety disorders. Studies link neuroticism with alterations in the Hypothalamic-Pituitary-Adrenal (HPA) stress response. We interrogated HPA axis dynamics as a function of neuroticism, employing the opioid receptor antagonist, naloxone.

METHODS

Subjects were assigned to either high or low neuroticism groups on the basis of Revised Neuroticism, Extraversion, Openness Personality Inventory (NEO-PI-R) scores and received naloxone hydrochloride (0, 125 microg/kg, and 375 microg/kg). Serum adrenocorticotropic hormone (ACTH) and cortisol levels were monitored.

RESULTS

Significant, dose-dependent differences in cortisol response were observed between neuroticism groups, whereas no differences were observed in ACTH. The low neuroticism group demonstrated a dose-dependent cortisol response with a plateau at the 125 microg/kg dose of naloxone. In contrast, the high neuroticism group demonstrated a graded cortisol response to all doses of naloxone.

CONCLUSIONS

These findings show that neuroticism is associated with altered cortisol responses to opioid receptor blockade, suggesting that alterations in HPA axis function already exist in persons at increased risk for certain depressive and anxiety disorders.

Stepped care vs. matched care for mood and anxiety disorders: a randomized trial in routine practice

OBJECTIVE

The effectiveness of two versions of stepped care [with either brief therapy (BT) or cognitive behavioural therapy (CBT) as a first step] is studied in comparison with the traditional matched care approach (CAU) for patients with mood and anxiety disorders.

METHOD

A randomized trial was performed in routine mental health care in 12 settings, including 702 patients. Patients were interviewed once in 3 months for 18-24 months (response rate 69%).

RESULTS

Overall, patients' health improved significantly over time: 51% had achieved recovery from the DSM-IV disorder(s) after 1 year and 66% at the end of the study. Respectively, 50% and 60% had 'normal' SCL90 and SF36 scores. Cognitive behavioural therapy and BT patients achieved recovery more often than CAU patients (ORs between 1.26 and 1.48), although these results were not statistically significant.

CONCLUSION

Stepped care, with BT or CBT as a first step, is at least as effective as matched care.

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

OBJECTIVE

Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries.

METHOD

Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews.

RESULTS

In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both.

CONCLUSION

High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

High neuroticism and depressive temperament are associated with dysfunctional regulation of the hypothalamic-pituitary-adrenocortical system in healthy volunteers

OBJECTIVE

Elevated neuroticism, depressive temperament and dysfunctional regulation of the hypothalamic-pituitary-adrenocortical (HPA) system are considered as risk factors for unipolar depression. An interaction of these vulnerability factors was suggested, but controversially discussed. In absence of other informative studies we set out for a replication test and for elucidation of the underlying mechanism.

METHOD

Ninety-two subjects recruited in the community-performed assessments of personality and temperament as well as measurement of HPA function with the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test.

RESULTS

Cortisol levels subsequent to Dex/CRH challenge were associated with neuroticism; high-neuroticism subjects revealed a higher HPA activation. This difference was mainly because of male subjects >/=25 years. A similar relationship was observed for depressive temperament.

CONCLUSION

This constellation may propose that HPA dysregulation is the endocrinological basis for neuroticism and depressive temperament; this result supports the view that distinct personality factors and HPA vulnerability interact in mediating depression.