Mental distress--gender aspects of symptoms and coping

Polypharmacy and Psychological Distress May Be Associated in African American Adults

Background: Compared to Whites, African Americans are at a higher risk of multiple chronic conditions, which places them at a higher risk of polypharmacy. Few national studies, however, have tested whether polypharmacy is associated with psychological distress—the net of socioeconomic status, health status, and stress—in African Americans. Aims: In a national sample of African Americans in the US, this study investigated the association between polypharmacy and psychological distress. Methods: The National Survey of American Life (NSAL, 2003) included 3570 African American adults who were 18 years or over. This number was composed of 2299 women and 1271 men. Polypharmacy (using ≥ 5 medications) and hyper-polypharmacy (using ≥ 10 medications) were the independent variables. Psychological distress was the dependent variable. Age, gender, socioeconomic status (education attainment, income, employment, and marital status), health care access (insurance status and usual place of care), and health status (multimorbidity and psychiatric disorders) were the covariates. Linear multivariable regression was applied to perform the data analysis. Results: Both polypharmacy and hyper-polypharmacy were associated with psychological distress. This association was significant after controlling for all the covariates. Conclusions: African Americans with polypharmacy, particularly those with hyper-polypharmacy, are experiencing higher levels of psychological distress, which itself is a known risk factor for poor adherence to medications. There is a need for a comprehensive evaluation of medications as well as screening for psychopathology in African Americans with multiple medical conditions.

Employment status and mental health care use in times of economic contraction: a repeated cross-sectional study in Europe, using a three-level model

INTRODUCTION

Framed within the recent economic crisis, in this study we investigate the medical mental health care use of the unemployed compared with that of the employed in Europe, and whether the relationship between employment status and mental health care use varies across macro-economic conditions. We examine whether the macro-economic context and changes therein are related to mental health care use, via their impact on mental health, or more directly, irrespective of mental health.

METHODS

We use data from three waves of the Eurobarometer (2002, 2005/2006, and 2010), which has a repeated cross-sectional and cross-national design. Linear and logistic multilevel regression analyses are performed with mental health, contacting a general practitioner, and contacting a psychiatrist for mental health problems as dependent variables. The multilevel design has three levels (the individual, the period-country, and the country), which allows us to estimate both longitudinal and cross-sectional macro-effects. The macro-economic context and changes therein are assessed using national unemployment rates and growth rates in Gross Domestic Product (GDP).

RESULTS

The mean unemployment rate is negatively related to mental health, although for women, this effect only applies to the employed. Among women, no relationship is found between changes in the macro-economic context and mental health. The unemployment rate, and changes in both the unemployment rate and the real GDP growth rate, are associated with men's care use, regardless of their mental health, whereas this does not hold for women. In countries with an increase in the unemployment rate, both unemployed and employed men tend to medicalize their problems more by contacting a general practitioner, irrespective of their mental health, while the likelihood of contacting a psychiatrist is lower among employed men.

CONCLUSIONS

Our findings stress the importance of taking the macro-economic context and changes therein into account when studying the mental health care use of unemployed people compared with the employed, in particular among men. Moreover, it is important to make the distinction between primary and specialized medical care use, as the impact of macro-economic conditions is dependent on the type of care, which also applies when controlling for mental health.

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences

PURPOSE

This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.

METHODS

Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed.

RESULTS

Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use.

CONCLUSIONS

Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.

Item response theory analyses of DSM-IV and DSM-5 stimulant use disorder criteria in an American Indian community sample

BACKGROUND

Native Americans experience some of the highest rates of DSM-IV stimulant dependence (SD) of all U.S. ethnic groups. This report compares DSM-IV and DSM-5 stimulant use disorder (SUD) diagnostic criteria in an American Indian community sample.

METHODS

Demographic information, stimulant (methamphetamine or cocaine) use, and lifetime DSM-IV and DSM-5 diagnoses were assessed in 858 adult American Indians. Item Response Theory (IRT) analyses were used to assess SUD criteria in both DSM-IV and DSM-5 criteria sets along an underlying latent trait severity continuum and the effect of demographic variables on differential item functioning (DIF) in those criteria.

RESULTS

The overall rate of DSM-IV SD was 33%, of DSM-IV SUD was 38%, and of DSM-5 SUD was 36% with no gender differences. All SUD symptoms in both the DSM-IV and DSM-5 datasets functioned on the moderate portion of the underlying severity continuum. "Craving" discriminated better than any other criterion at its level of severity in indicating the presence or absence of SUD. There was little DIF in groups defined by gender or any other demographic variable in either the DSM-IV or DSM-5 datasets.

CONCLUSIONS

These findings indicate that in this American Indian sample, diagnostic criteria for DSM-IV and DSM-5 SUD function similarly in terms of severity and DIF and that the abolition of the DSM-IV distinction between stimulant abuse and dependence in DSM-5 is warranted.

Understanding how men experience, express and cope with mental distress: where next?

In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about men's subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?

Why do patients with chronic illnesses fail to keep their appointments? A telephone interview

Missed appointments affect patients' health in addition to reducing practice efficiency. This study explored the rate and reasons of non-attendance among patients with chronic illnesses. It was a cross-sectional descriptive study carried out in a family practice clinic over a one-month period in 2004. Those who failed turn up for scheduled appointments were interviewed by telephone based on a structured questionnaire. Out of 671 patients, the non-attendance rate was 16.7%. Sixty-seven percent of non-attenders were successfully interviewed. Males (p = 0.01), Indians (p = 0.015), patients with coronary artery disease (p = 0.017), multiple diseases (> 4) (p = 0.036) and shorter appointment intervals (p = 0.001) were more likely to default. The main reasons for non-attendance were: forgot the appointment dates (32.9%), not feeling well (12.3%), administrative errors (19.1%) and work or family commitments (8.2%). The majority would prefer a reminder through telephone (71.4%), followed by letters (41.3%). In conclusion, appropriate intervention could be taken based on the reasons identified in this study.

Establishing priorities for reducing suicide and its antecedents in the United States

There is now a substantial literature on risk factors for suicide across the life course. Therefore, it is essential to extend this knowledge by considering more fully which age- and gender-specific groups bear the greatest public health burden owing to suicide and its antecedents. With this in mind, suicide mortality rates alone may not sufficiently inform U.S. policy makers who must distribute scarce suicide prevention resources. We compared age- and gender-specific mortality rates, age- and gender-specific estimates of years of potential life lost, and age- and gender-specific present value of lost earnings that individuals would have contributed to society had they lived to their full life expectancies. Men in the middle years of life contribute disproportionately to the public health burden because of completed suicide. The substantial burden evident in this group has not translated into a public health priority.

Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients

OBJECTIVES

This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, and levels of cortisol, dehydroepiandrosterone-sulfate (DHEAS) and melatonin.

METHODS

Fifty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week Mindfulness-Based Stress Reduction (MBSR) program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life, mood, stress, and the hormone measures of salivary cortisol (assessed three times/day), plasma DHEAS, and salivary melatonin were assessed pre- and post-intervention.

RESULTS

Fifty-eight and 42 patients were assessed pre- and post-intervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality, but these improvements were not significantly correlated with the degree of program attendance or minutes of home practice. No significant improvements were seen in mood disturbance. Improvements in quality of life were associated with decreases in afternoon cortisol levels, but not with morning or evening levels. Changes in stress symptoms or mood were not related to changes in hormone levels. Approximately 40% of the sample demonstrated abnormal cortisol secretion patterns both pre- and post-intervention, but within that group patterns shifted from "inverted-V-shaped" patterns towards more "V-shaped" patterns of secretion. No overall changes in DHEAS or melatonin were found, but nonsignificant shifts in DHEAS patterns were consistent with healthier profiles for both men and women.

CONCLUSIONS

MBSR program enrollment was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients, and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal (HPA) axis functioning. These pilot data represent a preliminary investigation of the relationships between MBSR program participation and hormone levels, highlighting the need for better-controlled studies in this area.

Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients

OBJECTIVES

This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production.

METHODS

Forty-nine patients with breast cancer and 10 with prostate cancer participated in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C-30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-gamma, IL-4, and IL-10 were assessed pre- and postintervention.

RESULTS

Fifty-nine and 42 patients were assessed pre- and postintervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL-4 increased and IFN-gamma decreased, whereas NK cell production of IL-10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile.

CONCLUSIONS

MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer-related cytokine production associated with program participation.

Psychostimulant dependence in a community sample

OBJECTIVE

To examine the prevalence of psychostimulant dependence and the characteristics associated with nonmedical users' development of dependence.

METHODS

The study sample was drawn from the 1995 to 1998 National Household Surveys on Drug Abuse. Statistical analysis was conducted on a total of 1047 individuals aged 12 or older who reported nonmedical use of stimulants in the past year. Multiple multinomial logistic regression identified factors related to stimulant dependence and dependence problems.

RESULTS

Among all past year stimulant users, 19% met criteria for stimulant dependence in the past year, and an additional 16% reported having one to two dependence problems. Adjusting for demographics and drug use characteristics, female stimulant users were an estimated 2.6 times more likely than male users to develop dependence. Not only did the Western region of the United States have more recent stimulant users than other regions, its users also were more likely to meet criteria for dependence or experience dependence problems. Stimulant users who had increased odds of progressing into dependence were characterized by an early onset of stimulant use, coexisting multiple illicit drug use, and an onset of daily cigarette smoking between the ages of 13 and 17 years.

CONCLUSIONS

Gender differences in initial stimulant use and progression to dependence require further investigation, including contextual, cultural, or perceptual factors related specifically to the choice of drugs by females.

Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression

Consultation rates and help-seeking patterns in men are consistently lower than in women, especially in the case of emotional problems and depressive symptoms. Empirical evidence shows that low treatment rates for men cannot be explained by better health, but must be attributed to a discrepancy between perception of need and help-seeking behavior. It is argued that social norms of traditional masculinity make help-seeking more difficult because of the inhibition of emotional expressiveness influencing symptom perception of depression. Other medical and social factors which produce further barriers to help-seeking are also examined. Lines of future research are proposed to investigate the links between changing masculinity and its impact on expressiveness and on the occurrence and presentation of depressive symptoms in men.