1
|
Berk M, Köhler-Forsberg O, Turner M, Penninx BWJH, Wrobel A, Firth J, Loughman A, Reavley NJ, McGrath JJ, Momen NC, Plana-Ripoll O, O'Neil A, Siskind D, Williams LJ, Carvalho AF, Schmaal L, Walker AJ, Dean O, Walder K, Berk L, Dodd S, Yung AR, Marx W. Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry 2023; 22:366-387. [PMID: 37713568 PMCID: PMC10503929 DOI: 10.1002/wps.21110] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.
Collapse
Affiliation(s)
- Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Megan Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Loughman
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Adam J Walker
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ken Walder
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
2
|
Mansueto G, Faravelli C. Stressful life events and psychosis: Gender differences. Stress Health 2022; 38:19-30. [PMID: 33973342 DOI: 10.1002/smi.3067] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
There is evidence that stressful events are associated with psychosis. This study aimed to explore sex differences in the association between stressful life events occurring during childhood and adulthood and psychosis. A total of 78 psychotic patients and 156 controls were enrolled. Childhood adversities were evaluated using a validated semi-structured interview and the Childhood Experience of Care and Abuse Questionnaire. Recent life events were recorded using a semi-structured interview with a normative and contextual approach. The diagnosis of psychosis was made according to Jablensky's criteria. χ2 and t-test statistical analyses were run. Odds ratios were calculated in logistic regression. People with psychosis reported more exposure to both childhood adversities and recent events than the general population. An excess of childhood physical abuse was found among male psychotic patients, whereas both childhood sexual abuse and recent life events were overrepresented among female patients in comparison with the general population. There was a cumulative effect of stressful life events on psychosis, although it was stronger among females than in males. It is likely that there are gender differences in the association between stressful life events and psychosis.
Collapse
Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Carlo Faravelli
- Department of Health Sciences, University of Florence, Florence, Italy
| |
Collapse
|
3
|
Crespo-Sanmiguel I, Zapater-Fajarí M, Pulopulos MM, Hidalgo V, Salvador A. Loneliness Mediates the Relationship Between Early Life Stress and Perceived Stress but not Hypothalamic-Pituitary-Adrenal Axis Functioning. Front Psychol 2021; 12:647265. [PMID: 34539480 PMCID: PMC8446206 DOI: 10.3389/fpsyg.2021.647265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Many authors have proposed that early life stress (ELS) provokes a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and contributes negatively to the management of stress in adulthood. However, these associations have not always been observed, making it necessary to include new factors that could explain the different results found. In this regard, people with ELS experiences report less social support during adulthood, suggesting that loneliness could be a mediating factor. Thus, our aims were to investigate whether ELS was related to both perceived stress and diurnal HPA axis activity, and whether loneliness mediates these relationships, in a community sample (N=187, 18-55years old). Fourteen cortisol samples were collected on two non-consecutive days to obtain the overall diurnal cortisol, diurnal cortisol slope, and bedtime levels. Additionally, ELS was assessed with the Risky Families Questionnaire (RFQ) and the Recalled Childhood and Adolescence Perceived Stress (ReCAPS) measure. Results revealed that ELS was associated with perceived stress, but not HPA axis functioning, and loneliness mediated the relationship between ELS and perceived stress, but not between ELS and HPA axis functioning. Similar results were found for both ELS questionnaires, suggesting that the ReCAPS is an adequate tool. These results highlight the importance of loneliness in understanding the long-term effects of ELS, and they indicate different effects of ELS on subjective and physiological stress indicators.
Collapse
Affiliation(s)
- Isabel Crespo-Sanmiguel
- Laboratory of Social Cognitive Neuroscience, Psychobiology-IDOCAL, University of Valencia, Valencia, Spain
| | - Mariola Zapater-Fajarí
- Laboratory of Social Cognitive Neuroscience, Psychobiology-IDOCAL, University of Valencia, Valencia, Spain
| | - Matias M Pulopulos
- Department of Psychology and Sociology, Area of Psychobiology, IIS Aragón, University of Zaragoza, Teruel, Spain
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, Area of Psychobiology, IIS Aragón, University of Zaragoza, Teruel, Spain
| | - Alicia Salvador
- Laboratory of Social Cognitive Neuroscience, Psychobiology-IDOCAL, University of Valencia, Valencia, Spain
| |
Collapse
|
4
|
Mansueto G, Cavallo C, Palmieri S, Ruggiero GM, Sassaroli S, Caselli G. Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review. Clin Psychol Psychother 2021; 28:557-568. [PMID: 33861493 DOI: 10.1002/cpp.2590] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'. RESULTS A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression. CONCLUSION Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.
Collapse
Affiliation(s)
- Giovanni Mansueto
- Department of Psychology, Sigmund Freud University, Milan, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Cavallo
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Sara Palmieri
- Department of Psychology, Sigmund Freud University, Milan, Italy.,School of Applied Sciences, London South Bank University, London, UK.,Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy
| | - Giovanni Maria Ruggiero
- Department of Psychology, Sigmund Freud University, Milan, Italy.,Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy
| | - Sandra Sassaroli
- Department of Psychology, Sigmund Freud University, Milan, Italy.,Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy
| | - Gabriele Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy.,Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy
| |
Collapse
|
5
|
Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
Collapse
Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Bhavsar V, Hatch SL, Dean K, McManus S. Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the Adult Psychiatric Morbidity Survey. Eur Psychiatry 2020; 63:e51. [PMID: 32431256 PMCID: PMC7355179 DOI: 10.1192/j.eurpsy.2020.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Symptoms of mental disorder, particularly schizophrenia, predispose to victimization. Much less is known about the relationship between depressive symptoms and later victimization in the general population, the influence of these symptoms on types of subsequent victimization, or the role of symptom severity. We investigated this in nationally representative data from the United Kingdom. Methods: Data were from the Adult Psychiatric Morbidity Survey 2007. Multivariable logistic regressions estimated association between (a) prior depressive symptoms, (b) prior depressive symptoms with suicide attempt, and types of more recent victimization. Gender-specific associations were estimated using multiplicative interactions. Results: Prior depressive symptoms were associated with greater odds of any recent intimate partner violence (IPV), emotional IPV, sexual victimization, workplace victimization, any victimization, and cumulative victimization (adjusted odds ratio [aOR] for increasing types of recent victimization: 1.47, 95% confidence interval [CI]: 1.14, 1.89). Prior depressive symptoms with suicide attempt were associated with any recent IPV, emotional IPV, any victimization, and cumulative victimization (aOR for increasing types of recent victimization: 2.33, 95% CI: 1.22, 4.44). Self reported recalled data on previous depressive symptoms may have limited accuracy. Small numbers of outcomes for some comparisons results in imprecision of these estimates. Conclusions: Aside from severe mental illness such as schizophrenia, previous depressive symptoms in the general population are associated with greater subsequent victimization. Men and women with prior depressive symptoms may be vulnerable to a range of types of victimization, and may benefit from interventions to reduce this vulnerability.
Collapse
Affiliation(s)
- Vishal Bhavsar
- Department of Health Services and Population Research, Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Justice Health & Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Sally McManus
- National Center for Social Research, NatCen, London, United Kingdom
| |
Collapse
|
7
|
Cotter J, Bucci S, Drake RJ, Yung AR, Carney R, Edge D. Exploring functional impairment in young people at ultra-high risk for psychosis: A qualitative study. Early Interv Psychiatry 2019; 13:789-797. [PMID: 29512314 DOI: 10.1111/eip.12560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 11/11/2017] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Abstract
AIM Many young people at ultra-high risk (UHR) of developing psychosis exhibit marked and persistent impairments in social and occupational functioning. We aimed to explore UHR patients' subjective experiences of these difficulties and their causes. METHODS We conducted semi-structured interviews with 20 UHR individuals recruited from Early Detection and Intervention Teams in Northwest England. Topics covered included how participants spent their time, their interpersonal relationships, academic and occupational performance, premorbid functioning and clinical treatment. Thematic analysis was used to examine the prevailing themes. RESULTS The sample included individuals with varying degrees of functional impairment, ranging from mild to severe difficulties in functioning. Analysis of the qualitative data elicited themes around 2 topics: breadth of functional difficulties and subjective reasons for poor functioning. Participants reported a range of impairments in their social and occupational functioning which they attributed to a combination of clinical, cognitive and psychological factors. These included variables previously identified in the quantitative literature such as psychiatric symptoms, adverse life experiences and cognitive deficits. However, our findings also included other factors which have received comparably little attention such as self-stigmatizing attitudes and dysfunctional metacognitive beliefs. CONCLUSIONS We propose a model that attempts to explain how these variables interact to drive and sustain functional impairment in the UHR population. This will assist in the development of clinical interventions aimed at promoting functional recovery among UHR individuals.
Collapse
Affiliation(s)
- Jack Cotter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cambridge Cognition, Cambridge, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Rebekah Carney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Bhavsar V. Do educational interventions stop dating violence? BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYViolence is a critical challenge for society and it disproportionately affects young people. Violence experienced in an intimate relationship is associated with attempted suicide, depression and post-traumatic stress disorder, as well as poorer physical health. Interventions to limit intimate partner violence, especially in adolescents and young people, are a priority. This commentary examines a systematic review and meta-analysis of educational interventions for relationship and dating violence in young people aged 12–25 years. Random-effects meta-analysis revealed a small statistical effect on knowledge, but no statistical associations with reduced violence. None of the included studies assessed health outcomes. The reviewers recommend further investigation of educational interventions in low- and middle-income settings, and studies with longer follow-up.DECLARATION OF INTERESTNone.
Collapse
|
9
|
Exploring the impact of adverse childhood experiences on symptomatic and functional outcomes in adulthood: advances, limitations and considerations. Ir J Psychol Med 2019; 35:5-7. [PMID: 30115206 DOI: 10.1017/ipm.2017.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exposure to traumatic experiences in childhood is a risk (and potentially causal) factor for the development of a range of adverse physical and mental health conditions. In addition to the onset of clinical disorders, there is emerging evidence that childhood trauma may also be associated with other long-term outcomes, such as the persistence and severity of an individual's symptoms, as well as their long-term social and occupational functioning. However, the reasons for this remain poorly understood. A greater understanding both of the mediators that drive these associations, and those variables that enhance resilience against such damaging experiences may help to inform effective therapeutic interventions. In addition to biological and cognitive measures, there is a need to consider social and environmental factors, such as parental bonding and attachment, when investigating these complex relationships.
Collapse
|
10
|
Abstract
UNLABELLED AimsAlthough violence is a vital public health problem, no prospective studies have tested for subsequent vulnerability to violence, as a victim or witness, in members of the general population with a range of psychiatric symptoms, or evaluated the importance of higher symptom burden on this vulnerability. METHODS We used successive waves of a household survey of Southeast London, taken 2 years apart, to test if association exists between psychiatric symptoms (symptoms of psychosis, common mental disorders, post-traumatic stress disorder and personality disorder) and later victimisation, in the form of either witnessing violence or being physically victimised, in weighted logistic regression models. Statistical adjustment was made for prior violence exposure, sociodemographic confounders, substance/alcohol use and violence perpetration. Sensitivity analyses were stratified by violence perpetration, sex and history of mental health service use. RESULTS After adjustments, psychiatric symptoms were prospectively associated with reporting any subsequent victimisation (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.25-2.83), a two times greater odds of reporting witnessed violence (OR 2.24, 95% CI 1.33-3.76) and reporting physical victimisation (OR 1.76, 95% CI 1.01-3.06). One more symptom endorsed was accompanied by 47% greater odds of subsequent victimisation (OR 1.47, 95% CI 1.16-1.86). In stratified analyses, statistical associations remained evident in non-perpetrators, and among those without a history of using mental health services, and were similar in magnitude in both men and women. CONCLUSIONS Psychiatric symptoms increase liability to victimisation compared with those without psychiatric symptoms, independently of a prior history of violence exposure and irrespective of whether they themselves are perpetrators of violence. Clinicians should be mindful of the impact of psychiatric symptoms on vulnerability to victimisation, including among those with common psychiatric symptoms and among those who are not considered at risk of perpetrating violence.
Collapse
|
11
|
Lindgren M, Mäntylä T, Rikandi E, Torniainen-Holm M, Morales-Muñoz I, Kieseppä T, Mantere O, Suvisaari J. Childhood adversities and clinical symptomatology in first-episode psychosis. Psychiatry Res 2017; 258:374-381. [PMID: 28867407 DOI: 10.1016/j.psychres.2017.08.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 11/28/2022]
Abstract
In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with psychotic disorders and have an effect on symptomatology and functioning. We explored eleven negative childhood experiences and their influence on clinical symptoms among young adults with first-episode psychosis (FEP, n = 75) and matched population controls (n = 51). Individuals with FEP reported more adversities than controls. Specifically serious conflicts within the family, bullying at school, maternal mental health problems, and one's own and parents' serious illness during childhood were experienced by the patients more often than by controls. In the FEP group, the severity of adversity was associated with increased anxiety, manic, and obsessive-compulsive symptoms, but not with the severity of positive psychotic symptoms. Adversity produced a more pronounced effect on symptoms in male patients than in female patients. To conclude, in line with earlier studies of more chronic psychosis, a majority of the participants with FEP reported exposure to childhood adversities, with the FEP group reporting more adversities than controls. High levels of mood and anxiety symptoms in patients with FEP may be related to cumulative exposure to childhood adversities. This should be taken into account in the treatment for FEP.
Collapse
Affiliation(s)
- Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Minna Torniainen-Holm
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Isabel Morales-Muñoz
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, McGill University, Montréal, QC, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
12
|
Long-term employment among people at ultra-high risk for psychosis. Schizophr Res 2017; 184:26-31. [PMID: 27903412 DOI: 10.1016/j.schres.2016.11.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultra-high risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. METHOD 268 UHR patients recruited from the Personal Assessment and Crisis Evaluation clinic in Melbourne, Australia were followed-up over 2-14years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. RESULTS A high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses. CONCLUSIONS Nearly a quarter of this UHR sample was unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.
Collapse
|