One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study

Anxiety and Depression Among US Nursing Home Residents with Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is highly prevalent among nursing home residents; however, few studies have focused on the psychological impact of this clinically significant condition on nursing home residents.

Objective

We examine the prevalence of, and factors associated with, anxiety and depression in nursing home residents with COPD.

Methods

Using the US 2018 Minimum Dataset (MDS), we conducted a cross-sectional study among 239,615 residents aged ≥50 years old in US Medicare/Medicaid certified nursing homes with COPD. Anxiety and depression were diagnosed based on clinical diagnoses, physical examination findings, and treatment orders. Multivariable adjusted Poisson models with a generalized estimating equations approach account for the clustering among residents within nursing homes.

Results

The average age of the study population was 79 years (SD: 10.6), 62.0% were women, and 43.7% had five or more comorbid conditions. In this population, 37.2% had anxiety, 57.6% had depression, and 27.5% had both mental health conditions. Women, current tobacco users, persons 50-64 years old, those who reported having moderate or severe pain, and nursing home residents with multimorbidity were more likely to have anxiety or depression than respective comparison groups.

Conclusion

Anxiety and depression are common among US nursing home residents with COPD. Women, medically complex patients, and those who report having moderate-to-severe pain appear to be more likely to have anxiety and depression. Clinical teams should be aware of these findings when managing nursing home residents with COPD and use various nonpharmacological and medical interventions for the effective management of anxiety and depression. Longitudinal studies evaluating how anxiety and depression affect the management of COPD and related outcomes, and how best to improve the quality of life of nursing home residents with COPD, are warranted.

The influence of excessive stress on medical students in the Czech Republic - national sample

PURPOSE

The Czech Republic has been dealing with a long-term shortage of doctors, which, according to demographic forecasts, will continue to worsen due to the retirement of stronger generations of doctors in contrast to the gradual aging of the population, which will require more health care over time. The country´s political set is trying to respond to this shortage and demographic forecasts by gradually increasing financial funding of medical faculties with the aim of increasing the number of graduates of the program in the field of general medicine.

METHODS

Anonymous questionnaire survey was conducted among students and graduates of general medicine at all eight Czech medical faculties. A total of 3183 respondents participated in the survey. There were 2843 medical students, which represents approximately 28% of all medical students in the Czech Republic. The distribution of respondents within the study years was approximately even and approximately corresponded to the real distribution of students between individual faculties in country, which makes survey a national sample. The statistical processing was performed in the statistical software R. Apart from the basic comparison using percentage relative frequencies and Pearson´s chi-squared test, in this study we used Odds ratios (OR) with CI 0,95 from logistic regression model for a better interpretation of some outputs.

RESULTS

The results show that the vast majority of Czech medical students experience excessive stress during their studies, which increases the risk of students´ somatic problems (OR = 4.89, CI 0.95 = (4.11;5.83), p < 0.001)., targeted alcohol use (OR = 2.29, CI 0.95 = (1.73;3.04), p < 0,001) and the use of anxiolytic or antidepressant medication to reduce it (OR = 2.99, CI 0.95 = (2.24;4.01), p < 0.001). Students experiencing higher levels of excessive stress are more likely to leave their studies based on their own decision (4.20 (CI 0.95 (3.39;5.19), p < 0.001) and not to enter clinical practice after graduation (OR = 2.62, CI 0.95 = (2.06;3.33), p < 0.001).

CONCLUSIONS

The survey shows the need for an open discussion at the highest level about the possibilities of reasonable reduction of unnecessary stress during medical studies. Medical students in the Czech Republic are exposed to excessive stress with all the consequences described above. All that remains is to state the existence of unnecessary components of stress, which represent an opportunity to reduce it, thereby achieving better conditions for studying, improvement in the staff situation in the Czech healthcare system and a reduction in inefficiently spent financial resources for the education of young doctors.

TRIAL REGISTRATION

No registration.

Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use

BACKGROUND

While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia.

METHODS

Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors.

RESULTS

Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment.

CONCLUSION

Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.

Gene expression signatures differentiating major depressive disorder from subsyndromal symptomatic depression

Subsyndromal symptomatic depression (SSD) and major depressive disorder (MDD) have been classified as distinct diseases, due to their dissimilar gene expression profiles and responses to venlafaxine. To identify specific biomarkers of these two diseases, we conducted a secondary analysis of the gene expression signatures of SSD patients, MDD patients and healthy controls (n=8/group) from the study of Yi et al. Global, individual, specific, enrichment and co-expression analyses were used to compare the transcriptomic profiles of peripheral blood lymphocytes from the three groups. The global and individual analyses revealed that different genes were up- and downregulated in the SSD and MDD groups. Through our specific analysis, we identified 1719 and 3278 differentially expressed genes specifically associated with MDD and SSD, respectively. Enrichment and co-expression analyses demonstrated that the genes specific to MDD were enriched in pathways associated with hormone levels and immune responses, while those specific to SSD were associated with immune function. The specific hub gene for the MDD co-expression network was transmembrane protein 132B (TMEM132B), while the hub genes for SSD were actin-related protein 2/3 complex (ARPC2) and solute carrier family 5 member 5 (SLC5A5). This bioinformatic analysis has provided potential biomarkers that can distinguish SSD from MDD.

Stigma and attitudes towards restrictive practices in psychiatry among psychology students: a network and path analysis study in an Italian sample

Background: People suffering from mental disorders are affected by public stigma in many areas of daily life, including mental health services. Stigma among mental health professionals needs to be addressed.Aims: This study explores the path leading to attitudes toward seclusion and restraint practices among future mental health professionals, considering the complex interplay among demographic variables, personality, stigma, and experience in psychiatric services.Method: Network analysis and Structural Equation Modeling were used to explore 1512 Psychology students. The survey instrument included a form for demographic and academic variables, the Attribution Questionnaire-9, the Ten Items Personality Inventory, and few questions exploring attitudes toward open-door and restraint-free policies in Psychiatry.Results: The personality trait of Openness and previous experience with psychiatric patients resulted to play a positive effect on stigma. Openness was also associated with a better disposition towards restraint-free policies. Conversely, higher levels of stigma predicted a negative attitude toward no restraint, decreasing the positive effect of Openness.Conclusions: In conclusion, some personality traits may be associated with lower levels of stigma and a more open view about treatment policies in Psychiatry. Direct educational or professional experience with patients suffering from mental disorders may be a crucial factor in reducing the risk of stigmatizing attitudes in future professionals.

Mental Distress in the United States at the Beginning of the COVID-19 Pandemic

Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults.Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10-16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire.Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress.Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms.

Emotional support as a mechanism linking childhood maltreatment and adult's depressive and social anxiety symptoms

BACKGROUND

Research has well-established that childhood maltreatment is associated with depressive and social anxiety symptoms in adults. Emotional support has been proposed as a mediator, yet research investigating the unique contributions of emotional support from friends, family members, and romantic partners in adulthood is sparse.

OBJECTIVE

The current study tested emotional support from family, friends, and romantic partners as mechanisms linking childhood maltreatment to depressive and social anxiety symptoms in adults.

PARTICIPANTS AND SETTING

Participants for the current study (N = 798) included adults in a committed romantic relationship and completed both the second wave of the National Survey of Midlife Development in the United States (MIDUS 2) as well as the MIDUS 2 biomarker follow-up project. Emotional support from family, friends, and romantic partners was measured at MIDUS 2 and mental health symptoms were reported at the MIDUS 2 biomarker follow up.

RESULTS

Emotional support from friends was identified as a mechanism from maltreatment to social anxiety symptoms (ß = .04, 95 % CI [.019, .066]), emotional support from family members was a mechanism to depressive symptoms (ß = .09, 95 % CI [.045, .146]), and emotional support from romantic partners was a mechanism for both depressive (ß = .02, 95 % CI [.005, .048]) and social anxiety symptoms (ß = .03, 95 % CI [.008, .048]).

CONCLUSIONS

The current study documents that emotional support may be a mechanism linking childhood maltreatment to mental health symptoms. Emotional support from different sources appear to be of significant importance in understanding adult mental health. Clinical implications are discussed.

Mental distress during the COVID-19 pandemic among US adults without a pre-existing mental health condition: Findings from American trend panel survey

Most individuals in the United States have no history of a mental health condition yet are at risk for psychological distress due to the COVID-19 pandemic. The objective of this study was to assess the frequency and risk and protective factors of psychological distress, during the beginning of the COVID-19 pandemic, in this group. Data comes from the Pew Research Center's American Trends Panel (ATP), a probability-based online survey panel representative of the US adult population. The analytic sample consisted of 9687 individuals with no prior history of a mental health condition who completed the survey between March 19-24, 2020. Explanatory variables included sociodemographic factors and items related to behavior, perceptions, and experiences surrounding the pandemic. The outcome was psychological distress, measured by five items on symptoms of anxiety, depression, loneliness, sleep difficulties, and hyperarousal. A multivariable linear regression model was used to identify risk and protective factors for psychological distress. Fifteen percent of the sample experienced 2 psychological distress symptoms for at least 3 days over the past week; 13% had three or more symptoms. Risk factors for higher distress included searching online or using social media to post about coronavirus, reporting that the outbreak caused major changes to personal life, and perception that the virus was a threat to the US economy, the individual's personal health or finances. This has important implications for mental health service delivery.

Urban environment and mental health: the NAMED project, protocol for a mixed-method study

INTRODUCTION

Mental health issues appear as a growing problem in modern societies and tend to be more frequent in big cities. Where increased evidence exists for positive links between nature and mental health, associations between urban environment characteristics and mental health are still not well understood. These associations are highly complex and require an interdisciplinary and integrated research approach to cover the broad range of mitigating factors. This article presents the study protocol of a project called Nature Impact on Mental Health Distribution that aims to generate a comprehensive understanding of associations between mental health and the urban residential environment.

METHODS AND ANALYSIS

Following a mixed-method approach, this project combines quantitative and qualitative research. In the quantitative part, we analyse among the Brussels urban population associations between the urban residential environment and mental health, taking respondents' socioeconomic status and physical health into account. Mental health is determined by the mental health indicators in the national Health Interview Survey (HIS). The urban residential environment is described by subjective indicators for the participant's dwelling and neighbourhood present in the HIS and objective indicators for buildings, network infrastructure and green environment developed for the purpose of this project. We assess the mediating role of physical activity, social life, noise and air pollution. In the qualitative part, we conduct walking interviews with Brussels residents to record their subjective well-being in association with their neighbourhood. In the validation part, results from these two approaches are triangulated and evaluated through interviews and focus groups with stakeholders of healthcare and urban planning sectors.

ETHICS AND DISSEMINATION

The Privacy Commission of Belgium and ethical committee from University Hospital of Antwerp respectively approved quantitative database merging and qualitative interviewing. We will share project results with a wide audience including the scientific community, policy authorities and civil society through scientific and non-expert communication.

Predictors of stigma in a sample of mental health professionals: Network and moderator analysis on gender, years of experience, personality traits, and levels of burnout

Background.

Stigma is one of the most important barriers to help-seeking and to personal recovery for people suffering from mental disorders. Stigmatizing attitudes are present among mental health professionals with negative effects on the quality of health care.

Methods.

Network and moderator analysis were used to identify what path determines stigma, considering demographic and professional variables, personality traits, and burnout dimensions in a sample of mental health professionals (n = 318) from six Community Mental Health Services. The survey included the Attribution Questionnaire-9, the Maslach Burnout Inventory, and the Ten-Item Personality Inventory.

Results.

The personality trait of openness to new experiences resulted to determine lower levels of stigma. Burnout (personal accomplishment) interacted with emotional stability in predicting stigma, and specifically, for subjects with lower emotional stability lower levels of personal accomplishment were associated with higher levels of stigma.

Conclusions.

Some personality traits may be accompanied by better empathic and communication skills, and may have a protective role against stigma. Moreover, burnout can increase stigma, in particular in subjects with specific personality traits. Assessing personality and burnout levels could help in identifying mental health professionals at higher risk of developing stigma. Future studies should determine whether targeted interventions in mental health professionals at risk of developing stigma may be effective in stigma prevention.

Ethnicity, educational attainment, and physical health of older adults in the United States

OBJECTIVE

Minorities' diminished returns theory suggests that socioeconomic status (SES) resources generate fewer health benefits for racial and ethnic minority groups, compared to the majority group. The current study aimed to compare Hispanic and non-Hispanic white older adults for the association between educational attainment and poor physical self-rated health (SRH).

METHODS

The first wave of the University of Michigan National Poll on Healthy Aging (UM-NPHA) included 1820 older adults who were 50-80 years old and were either non-Hispanic white (n = 1618) or Hispanic white (n = 202). The main independent variable of interest was educational attainment. The main dependent variable of interest was poor physical SRH. Gender, age, marital status, and employment status were covariates. Ethnicity was the focal effect modifier.

RESULTS

Overall, higher level of educational attainment was associated with better physical SRH. A significant interaction was found between ethnicity and level of educational attainment, which was indicative of a smaller physical SRH gain due to high educational attainment for Hispanic white compared to non-Hispanic white older adults. In ethnic-specific models, we found evidence suggesting that high educational attainment reduced the odds of poor physical SRH for non-Hispanic whites but not for Hispanic whites.

CONCLUSION

Compared to non-Hispanic whites, Hispanic whites gain less physical SRH benefits from their educational attainment.

Prevalence of major depressive disorder and its socio-demographic correlates in the general adult population in Hebei province, China

BACKGROUND

Major depressive disorder (MDD) is a common psychiatric disorder which is associated with significant disability and psychosocial factors. There are only few epidemiological studies of MDD in economically underdeveloped regions of China. This study examined the 1-month and lifetime prevalence of MDD and their sociodemographic correlates in Hebei province, China.

METHODS

Using multistage, stratified and random sampling, the study was conducted between April and August 2016. The diagnosis of MDD was established using the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition.

RESULTS

The weighted 1-month and lifetime prevalence of MDD were 0.9% (95%CI: 0.8-1.1%) and 1.6% (95%CI: 1.4-1.8%), respectively in the sample of 14,654 adult participants. Multiple logistic regression analysis revealed that the age group of 45-59 years (P < 0.001, OR=3.206, 95%CI:1.693-6.072), female gender (P < 0.001, OR=2.171, 95%CI: 1.522-3.097), married marital status (P < 0.001, OR=0.328, 95%CI: 0.198-0.545), college educational level or higher (P = 0.006, OR=0.145, 95%CI: 0.037-0.573), employment (P = 0.010, OR=2.305, 95%CI: 1.220-4.353), major medical conditions (P < 0.001, OR=3.758, 95%CI: 2.607-5.418) and family history of psychiatric disorders (P < 0.001, OR=3.947, 95%CI: 2.203-7.071) were significantly associated with MDD.

CONCLUSION

The prevalence of MDD in Hebei province was found to be lower than in most areas of China and other countries. Further studies are warranted to confirm the low prevalence of MDD in other economically underdeveloped regions of China.

Gender, Personality Traits and Experience With Psychiatric Patients as Predictors of Stigma in Italian Psychology Students

A sample of undergraduate Psychology students (n = 1005), prevalently females (82.4%), mean age 20.5 (sd 2.5), was examined regarding their attitudes toward people suffering from mental illness. The survey instrument included a brief form for demographic variables, the Attribution Questionnaire-9 (AQ-9), the Ten Items Personality Inventory (TIPI), and two questions exploring attitudes toward open-door and restraint-free policies in Psychiatry. Higher levels of stigmatizing attitudes were found in males (Pity, Blame, Help, and Avoidance) and in those (76.5%) who had never had any experience with psychiatric patients (Danger, Fear, Blame, Segregation, Help, Avoidance and Coercion). A similar trend was also found in those who don't share the policy of no seclusion/restraint, while subjects who are favorable to open-door policies reported higher Coercion scores. No correlations were found between dimensions of stigma and personality traits. A machine learning approach was then used to explore the role of demographic, academic and personality variables as predictors of stigmatizing attitudes. Agreeableness and Extraversion emerged as the most relevant predictors for blaming attitudes, while Emotional Stability and Openness appeared to be the most effective contributors to Anger. Our results confirmed that a training experience in Psychiatry might successfully reduce stigma in Psychology students. Further research, with increased generalizability of samples and more reliable instruments, should address the role of personality traits and gender on attitudes toward people suffering from mental illness.

Blacks' Diminished Return of Education Attainment on Subjective Health; Mediating Effect of Income

Background: Minorities' Diminished Return (MDR) can be defined as smaller health gains from socioeconomic status (SES) indicators, such as education attainment among ethnic minorities compared to the majority group. The current study tested whether income explains why Black and White adults differ in the association between education attainment and self-rated health (SRH). Methods: With a cross-sectional design, this study used data from Cycle 5 of the Health Information National Trends Survey (HINTS), 2017. With a nationally representative sample, the HINTS study generates results that are generalizable to US adults. This study included 2277 adults who were either non-Hispanic White (n = 1868; 82%) or non-Hispanic Black (n = 409; 18%). The independent variable was education attainment. The dependent variable was SRH, measured using a standard single item. Age, gender, and health insurance status were covariates. Ethnicity was the focal moderator. Income was the mediator. A structural equation model (SEM) was applied for data analysis. Results: Overall, higher education attainment was associated with better SRH, net of covariates. However, a significant interaction between ethnicity and education attainment suggested a smaller SRH gain from education for Blacks compared to Whites. This interaction could be explained by Black⁻White differences in income. Conclusion: Our study results suggests that labor market preferences may explain smaller effects of education attainment on SRH for Blacks relative to Whites. Given this finding and other studies documenting MDR, policies should reduce labor market discrimination, increasing job opportunities and reducing the racial pay gap for Blacks. Programs should help Blacks compete for prestigious and high-paying jobs.

Alexithymia and autistic traits as possible predictors for traits related to depression, anxiety, and stress: A multivariate statistical approach

RATIONALE, AIMS, AND OBJECTIVES

Our study focused on the general population and explored the relationships between autistic traits and alexithymia, on the one hand, and traits related to depression, anxiety, and stress, on the other, using a multivariate statistical approach. In previous research, autistic traits and alexithymia have been linked to these traits both in clinical populations and in the general population. We also investigated a possible multiplicative effect of autistic traits and alexithymia and attempted to determine which of these two variables is the better predictor for health outcomes.

METHODS

An online survey was conducted, and 302 participants were included in the statistical analysis. A structural equation modelling approach was chosen, and a model based on prior findings was designed and tested by using IBM SPSS AMOS 21.

RESULTS

The results showed significant, medium-sized effects of alexithymia on depression, anxiety, and stress. Additionally, a medium-sized significant effect of autistic traits on depression, a small significant effect on stress, and a small nonsignificant effect on anxiety were found. The interaction term of alexithymia and autistic traits had no significant effects on any of the endogenous variables.

CONCLUSIONS

Alexithymia can be considered the better predictor for anxiety in this sample, and it is unlikely that a multiplicative effect of alexithymia and autistic traits exists. The use of multivariate statistical methods provided additional information for understanding the investigated constructs and their interdependence.

Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans

Background: The minorities' diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black⁻White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities' diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.

Male views on help-seeking for depression: A Q methodology study

OBJECTIVES

To identify viewpoints among men with depression about depression and its treatment, consider how these might influence help-seeking behaviour, and generate ideas for interventions and future research.

DESIGN

Q methodology.

METHODS

Twenty-nine men with depression completed a Q sort by ranking a set of statements about depression and help-seeking according to their relative agreement with each statement. Factor analysis was used to identify viewpoints relating to male understandings of depression and help-seeking, which were interpreted in the context of participant characteristics and additional information from post-sorting interviews.

RESULTS

A two-factor solution accounting for 45% of the total variance was considered the best fit for the data. The 2 factors were: (1) Help is available if you can get to the point of asking for it (34% of the variance) and (2) depression should be dealt with in private; help-seeking makes you vulnerable (11% of the variance). Participants who were significantly associated with both factors described a sense of shame, relating to their own or others' views that being depressed and help-seeking are in conflict with socially constructed 'masculine' values, such as strength and self-sufficiency. In the viewpoint represented by Factor 1, however, the benefits of help-seeking outweigh the negatives. In contrast, the viewpoint represented in Factor 2 holds that depression should remain a private struggle and that help-seeking is too risky a move to make.

CONCLUSIONS

In order to access treatment, men must first recognize depression, then overcome considerable perceived and internalized stigma to ask for help. Improving public knowledge about the nature of depression; positive messages about the act of help-seeking, types of treatment available, and effectiveness of treatments; and work to overcome the challenges posed by long waiting times and other service constraints may increase rates of help-seeking, and represent areas for future research.

PRACTITIONER POINTS

Interventions to improve recognition of depression symptoms, particularly in the absence of recent negative life events or suicidal ideation, might help to improve help-seeking rates among men. Media campaigns should consider focusing on the positive elements of help-seeking and potential for recovery, and the impact of such campaigns should be evaluated. Improving public knowledge of the types of non-medical intervention that are available for depression may help to increase help-seeking rates. Clinical services and commissioners should be aware of the impact of long waiting times and strict discharge policies on service users, especially those who have difficulty asking for help.

The prevalence, age-of-onset and the correlates of DSM-IV psychiatric disorders in the Tianjin Mental Health Survey (TJMHS)

BACKGROUND

To effectively shape mental healthcare policy in modern-day China, up-to-date epidemiological data on mental disorders is needed. The objective was to estimate the prevalence, age-of-onset (AOO) and sociodemographic correlates of mental disorders in a representative household sample of the general population (age ⩾ 18) in the Tianjin Municipality in China.

METHODS

Data came from the Tianjin Mental health Survey (TJMHS), which was conducted between July 2011 and March 2012 using a two-phase design. 11 748 individuals were screened with an expanded version of the General Health Questionnaire and 4438 subjects were selected for a diagnostic interview by a psychiatrist, using the Structured Clinical Interview for the Diagnostic and Statistical Manual - fourth edition (SCID).

RESULTS

The lifetime and 1-month prevalence of any mental disorder were 23.6% and 12.8%, respectively. Mood disorders (lifetime: 9.3%; 1-month: 3.9%), anxiety disorders (lifetime: 4.5% 1-month: 3.1%) and substance-use disorders (lifetime: 8.8%; 1-month: 3.5%) were most prevalent. The median AOO ranged from 25 years [interquartile range (IQR): 23-32] for substance-use disorders to 36 years (IQR: 24-50) for mood disorders. Not being married, non-immigrant status (i.e. local 'Hukou'), being a farmer, having <6 years of education and male gender were associated with a higher lifetime prevalence of any mental disorder.

CONCLUSION

Results from the current survey indicate that mental disorders are steadily reported more commonly in rapidly-developing urban China. Several interesting sociodemographic correlates were observed (e.g. male gender and non-immigrant status) that warrant further investigation and could be used to profile persons in need of preventive intervention.

Systemic autoimmune diseases are associated with an increased risk of bipolar disorder: A nationwide population-based cohort study

BACKGROUND

Studies suggested autoimmunity plays a role in the etiology of bipolar disorder (BD). This study aimed to investigate the association between systemic autoimmune diseases (SADs) and the subsequent development of BD, and examine the potential risk factors for developing BD.

METHODS

Patients with SADs were identified in the Taiwan National Health Insurance Program (NHIP). A comparison cohort was created by matching patients without SADs with age. The SADs cohort consisted of 65,498 while the comparison cohort consisted of 261,992 patients. The incidence of BD was evaluated in both cohorts.

RESULTS

The major finding was the discovery of a higher incidence of subsequent BD among patients with SADs (adjusted hazard ratio: 1.98). Specifically, the risk of BD was observed to be significant increase in systemic lupus erythematosus, rheumatoid arthritis, autoimmune vasculitis, Sicca syndrome and Crohn's disease. Furthermore, our study revealed some potential risk factors for developing BD including female, younger age and patients who lived in eastern Taiwan. Also, some comorbidities including dyslipidemia, chronic obstructive pulmonary disease, diabetes mellitus, asthma, cerebrovascular disease, alcohol used disorder, liver cirrhosis, and malignancies were potential risk factors for incident BD.

LIMITATIONS

The diagnosis of SADs was based on the catastrophic illness certificate defined by Taiwanese NHIP. Thus, not every form of SADs was explored for subsequent developing BD.

CONCLUSION

This study confirms that SADs are associated with higher incidence of BD, suggesting that abnormal autoimmune process is associated with increased expression of psychiatric disturbances.

Neurosurgery for mental disorder

The authors review contemporary indications for neurosurgical interventions in the management of chronic and refractory mental disorder, the procedures involved, their efficacy and known adverse effects. These data are presented within the context of a brief historical overview of the use of neurosurgery for mental disorder. In addition to a consideration of neurosurgical procedures that rely on the creation of putative therapeutic lesions, we also review two novel, non-destructive neurosurgical electrostimulation treatments that may represent viable alternatives to conventional ablative neurosurgery: vagus nerve stimulation and deep brain stimulation.

Epidemiology of severe mental illness in Hunan province in central China during 2014-2015: A multistage cross-sectional study

Objective

Severe mental illness (SMI) represents major social and public health problem in China, especially in low- or middle-income regions. We aim to assess the prevalence and distribution of SMI in Hunan province in central China.

Methods

Multistage stratified random sampling methods were used to select qualified subjects in 123 districts and counties in Hunan province. 89465 individuals were randomly identified, and 72999 (81.6%) completed the supplemental 12-Item General Health Questionnaire (GHQ-12) and Cue questionnaire of psychiatric abnormal behaviors. 6082 suspected individuals having high or moderate risk, or psychiatric cues, were administered the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) by psychiatrists.

Results

720 respondents were definitely diagnosed as SMI. The 1-month and lifetime prevalence was 9.35‰ and 10.10‰, respectively. The most frequent SMI was schizophrenia, followed by bipolar disorder, intellectual disability, epileptic mental disorder, paranoid psychosis and schizoaffective disorders, with 1-month prevalence ranging from 0.11‰ to 6.50‰ and lifetime prevalence ranging from 0.24‰ to 6.86‰. Multivariate logistic regression analysis revealed that lower education, farmer occupation, retirees or jobless/unemployed, unmarried or divorced and age of 30–64 years old were major factors that associated with the increased risk of SMI. In addition, only 33.3% of 528 patients who completed questionnaire sought help in psychiatric institutions, and up to 51.7% of 720 patients were not referred to the SMI management system in Hunan province.

Conclusions

These findings provided a large-scale prevalence data of SMI in a provincial sample of China. The psychiatric disorders brought economical and psychological burden for family and society, which may shed light on the significance of scaling up province-wide mental health service and strengthening the SMI management.

Do racial patterns in psychological distress shed light on the Black-White depression paradox? A systematic review

PURPOSE

Major epidemiologic studies in the US reveal a consistent "paradox" by which psychiatric outcomes such as major depressive disorder (MDD) are less prevalent among Blacks relative to Whites, despite greater exposure to social and economic stressors and worse physical health outcomes. A second paradox, which has received less attention and has never been systematically documented, is the discrepancy between these patterns and Black-White comparisons in psychological distress, which reveal consistently higher levels among Blacks. By systematically documenting the latter paradox, this paper seeks to inform efforts to explain the first paradox.

METHODS

We conduct a systematic review of the literature estimating the prevalence of MDD and levels of psychological distress in Blacks and Whites in the US.

RESULTS

The literature review yielded 34 articles reporting 54 relevant outcomes overall. Blacks have a lower prevalence of MDD in 8 of the 9 comparisons observed. In contrast, Blacks have higher levels of psychological distress (in terms of "high distress" and mean scores) than Whites in 42 of the 45 comparisons observed. Tests of statistical significance, where available, confirm this discrepant pattern.

CONCLUSIONS

A systematic review of the epidemiologic evidence supports the existence of a "double paradox" by which Blacks' lower prevalence of MDD relative to Whites' is inconsistent with both the expectations of social stress theory and with the empirical evidence regarding psychological distress. Efforts to resolve the Black-White depression paradox should account for the discordant distress results, which seem to favor artifactual explanations.

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines

BACKGROUND

This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity.

METHODS

The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines.

RESULTS

The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option.

CONCLUSION

The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.

Maternal mental health symptoms are positively related to emotional and restrained eating attitudes in a statewide sample of mothers participating in a supplemental nutrition program for women, infants and young children

Postpartum, low-income mothers are at risk for mental health symptoms and obesity, and disordered eating attitudes may be associated with both mental health and obesity in this vulnerable population. The study objective is to determine whether higher levels of mental health symptoms are associated with increased odds of emotional and restrained eating attitudes in this sample of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. Data on 711 mothers of infants <13 months from a statewide sample of Maryland WIC participants were collected via telephone survey. Maternal mental health symptoms were measured on continuous scales for depression (PRIME-MD), stress (Perceived Stress Scale) and anxiety (Spielberger State-Trait Anxiety Inventory). Emotional and restrained eating attitudes were measured with questions adapted from the Dutch Eating Behavior Questionnaire. Multivariate logistic regression analysis was used. Obesity [body mass index (BMI) ≥ 30] was explored as a moderating variable. Mothers reporting higher levels of depression symptoms [odds ratio (OR) = 3.93, 95%CI: 2.71-5.69], anxiety symptoms (OR = 1.96, 95%CI: 1.47-2.65), stress symptoms (OR = 2.09, 95%CI: 1.67-2.61) and high overall mental health symptomatology (OR = 3.51, 95%CI: 2.43-5.3) had increased odds of emotional eating attitudes. There were significant associations between symptoms of depression (OR = 1.59, 95% CI: 1.12-2.25) and increased odds of restrained eating attitudes. Obesity did not moderate the association. Mothers with mental health symptoms are at risk for disordered eating attitudes, which may increase risk of poor diet. These findings underscore the need for greater focus on addressing maternal mental health status and eating attitudes in the postpartum period.

Does neuropsychological performance impact on real-life functional achievements in obsessive-compulsive disorder? A preliminary study

OBJECTIVE

We investigated the association between neuropsychological performance and real-life functioning in obsessive-compulsive disorder (OCD). As a secondary aim, we investigated the association between neuropsychological performance and self-reported quality of life (QoL).

METHODS

We retrospectively selected 68 of 240 inpatients with OCD, who had been hospitalised for a 4-week psychiatric rehabilitation programme. We used clinical information recorded in the patients' electronic medical records. We considered the following variables: neuropsychological performance (verbal/visual memory, sustained attention, visual-constructive ability, and language fluency; in a sub-sample of 37 subjects, divided attention, working memory, and attentional shifting were also available); real-life functional achievements (social/vocational outcomes and independent living); subjectively reported QoL (WHOQOL-BREF); obsessive-compulsive (OC) symptoms severity (DY-BOCS).

RESULTS

We found significant associations between poorer neuropsychological performance and poorer achievements in independent living and vocational outcomes. Among the different neuropsychological tests, we found significant associations between language fluency/executive processing and independent living, and between divided attention, attentional shifting, working memory and vocational outcome. We found no significant associations between neuropsychological performance and subjectively reported QoL. OC symptoms severity was not associated with real-life functional achievements.

CONCLUSIONS

Our preliminary results suggest that poorer neuropsychological performance may be associated with impaired real-life functioning in subjects with OCD.

Anxiety and Shame as Risk Factors for Depression, Suicidality, and Functional Impairment in Body Dysmorphic Disorder and Obsessive Compulsive Disorder

Body dysmorphic disorder (BDD) and obsessive compulsive disorder (OCD) are associated with elevated depression, suicidality, functional impairment, and days housebound, yet little research has identified risk factors for these outcomes. Using path analysis, the present study examined anxiety and shame as risk factors for these outcomes across Internet-recruited self-report groups (BDD [n = 114], OCD [n = 114], and healthy control [HC; n = 133]). Paths from anxiety and shame to outcomes were similar and mostly significant across BDD and OCD, compared to non-significant paths for HCs, with one exception: the path from shame to depression was significant in the BDD group (b = 0.32) but non-significant in the OCD group (b = 0.07). Findings underscore similarities in BDD and OCD, supporting their reclassification into the same Obsessive Compulsive Related Disorders category. Results emphasize the importance of targeting shame, in addition to anxiety, in treatments for BDD and OCD.

Mental Health, Disabilities, and Women

Ongoing development and reform of health care systems worldwide are directing the attention of policymakers to the significance of mental disorders and ensuing disabilities. While this awareness has encouraged empirical work and scientific literature on disabilities associated with mental disorders, insufficient attention has been paid to issues of gender in the context of mental disorder and disability. This paper draws on four data sets-the 1994-96 Disability Survey; the 1992 National Health Interview Survey (NHIS); Social Security Disability Programs; and the recent international measure of Disability-Adjusted Life Years-to explore relationships among gender, mental disorders, and disability in the United States and to consider the special needs presented by women disabled by mental disorders for service development and service configuration. Generally younger than women disabled by physical disorders, women with mental disorders tend to be in their prime child-bearing years. While in the United States private sector managed care programs increasingly are perceived as the most reasonable way to provide health services in a fiscally responsible way, there appears to exist an implicit notion that managed care is intended exclusively for provision of acute care and preventive services. There is little discussion or exploration of the use of managed care systems for rehabilitation generally, or of the particular rehabilitation needs of young women. The implications for the additional “burden” of disabilities along with the potential risk factor of traditional female roles require serious consideration and enlightened policies. Mental

Few middle-aged women with severe mental symptoms use psychotropic drugs: The Women's Health in Lund Area (WHILA) Study

Aims: In a population of middle-aged women a survey was carried out to ascertain the prevalence of mental symptoms and psychotropic drug use, and further to investigate whether severe mental symptoms are associated with social situation, alcohol consumption, smoking, and physical health. Methods: All women (n=10,766) aged 50—59 years and living in the Lund area were invited to the WHILA study, a health survey including laboratory examinations and a self-administered questionnaire; 6,917 (64.2%) participated. This study is based on the questionnaire only. Results: During the past three months 25.4% (n=1,709) had been troubled by none or 1 mental symptom (labelled ``absent/slight''), 52.8% (n=3,555) by 2—6 mental symptoms (``moderate'') and 21.8% (n=1,471) by 7—10 mental symptoms (``severe''). Among women with severe mental symptoms 15.4% regularly used psychotropic drugs, mainly antidepressants. A multiple logistic regression analysis showed that women with severe mental symptoms had higher odds for living alone (OR 1.7; CI 1.3—2.2) or as single parents (OR 2.1; CI 1.2—3.6), being university-educated (OR 1.5; CI 1.1—2.0), being on long-term sick-leave (OR 8.8; CI 3.0—25.5), using hormone replacement therapy (OR 1.3; CI 1.1—1.6), and having severe physical symptoms (136.8; CI 89.2—209.7) compared with women with absent/slight mental symptoms. Conclusion: Mental symptoms were common among the participating women. The presence of severe mental symptoms was strongly associated with severe physical symptoms. Few women with severe mental symptoms used psychotropic drugs. Middle-aged women with severe mental symptoms need to be identified and provided with appropriate psychopharmacological, hormonal, and/or psychosocial treatment.

Social correlates of mental, neurological, and substance use disorders in China and India: a review

Understanding the epidemiological profiles of mental, neurological, and substance use disorders provides opportunities for the identification of high-risk population subgroups and for the development of effective country-specific prevention and intervention strategies. Guided by the Conceptual Framework for Action on the Social Determinants of Health by WHO we reviewed the literature to examine the association between a range of social correlates (eg, sex, age, education, income, urbanicity, marital status, and regional differences) and mental, neurological, and substance use disorders in China and India, the most populous countries in the world. We looked for papers on mental, neurological, and substance use disorders with location identifiers and socioeconomic correlates published between 1990 and 2015 and our search found 65 relevant studies from China and 29 from India. Several association patterns between social correlates and mental, neurological, and substance use disorders were not consistent with those reported in high-income countries, including a high concentration of middle-aged men with alcohol use disorders in China and to a lesser extent in India, and a positive association between being married and depression among women in India. Consistent with previous global reports, low education and poverty were associated with higher occurrence of dementia in both China and India, although there is evidence of an interaction between education and income in the risk for dementia in China. Large variations across regions and ethnic groups were consistently documented in China. These unique correlation patterns for mental, neurological, and substance use disorders identified in China and India emphasise the importance of understanding the local social context when planning targeted strategies to reduce the burden of these disorders. High-quality, up-to-date information about the constantly changing pattern of societal factors correlated with mental, neurological, and substance use disorders is urgently needed to help reduce the large and increasing negative social and economic effects that these conditions are having in China, India, and other low-income and middle-income countries.

A Gender and Racial Epidemiological Profile of Public Psychiatric Hospitals in the Western Cape

The aim of this archival epidemiological study was to identify gender and racial patterns of psychiatric diagnosis and management in admissions to mental hospitals. The hospital records of a random, stratified sample ( N =2110) of all patients admitted to the three public psychiatric hospitals in the Western Cape for a calendar year were studied for gender and racial differences regarding demographics, admission-related variables, diagnosis and management, both during hospitalisation and on discharge. Analysis was done for race groups within females and males and differ-ences between groups were tested by chi-square tests. Consistently significant differences in psychiatric diagnosis and management across race and gender were found, many in line with other international and African studies. Anomalies of diagnosis and treatment reflect past inequities of South African society and suggest the role of both social factors and bias in psychiatric hospital practice. Implications for future mental health research, training and practice are raised.

Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21-100 Years

OBJECTIVE

Studies of aging usually focus on trajectories of physical and cognitive function, with far less emphasis on overall mental health, despite its impact on general health and mortality. This study examined linear and nonlinear trends of physical, cognitive, and mental health over the entire adult lifespan.

METHODS

Cross-sectional data were obtained from 1,546 individuals aged 21-100 years, selected using random digit dialing for the Successful AGing Evaluation (SAGE) study, a structured multicohort investigation that included telephone interviews and in-home surveys of community-based adults without dementia. Data were collected from 1/26/2010 to 10/07/2011 targeting participants aged 50-100 years and from 6/25/2012 to 7/15/2013 targeting participants aged 21-100 years with an emphasis on adding younger individuals. Data included self-report measures of physical health, measures of both positive and negative attributes of mental health, and a phone interview-based measure of cognition.

RESULTS

Comparison of age cohorts using polynomial regression suggested a possible accelerated deterioration in physical and cognitive functioning, averaging 1.5 to 2 standard deviations over the adult lifespan. In contrast, there appeared to be a linear improvement of about 1 standard deviation in various attributes of mental health over the same life period.

CONCLUSIONS

These cross-sectional findings suggest the possibility of a linear improvement in mental health beginning in young adulthood rather than a U-shaped curve reported in some prior studies. Lifespan research combining psychosocial and biological markers may improve our understanding of resilience to mental disability in older age and lead to broad-based interventions promoting mental health in all age groups.

Social Inequalities in Mental Health: A Review of Concepts and Underlying Assumptions

We provide an overview of two major theoretical subjects in the study of the relation between social inequalities and mental health in the last 50 years: the conceptualization of social inequalities, and assumptions about their causes. The two conceptual approaches to the conceptualization of social inequalities are: 1) ‘social stratification’ or the ordering of individuals according to economic, political, or cultural rankings; and 2) ‘social class’ relations that yield a set of class positions for individuals according to their control over different types of assets (economic, political, cultural). The two major assumptions underlying these conceptual choices in studies of social inequalities and mental health are: 1) whether effects on mental health originate at the individual or at the group level (i.e. the ‘levels-of-analysis’ issue); and 2) whether mental health is the consequence of environmental determination or the individual’s capacity for making independent decisions (the ‘agency’ issue). We propose a typology of models of social inequalities in mental health that relates these levels-of-analysis and agency issues. The typology provides an efficient conceptual reorganization that uncovers the assumptions and policy implications of research on social inequalities in mental health.

Assessing Adolescents' Understanding of and Reactions to Stress in Different Cultures

This article expands on an emerging mixed-method approach for validating culturally-specific constructs (see Hitchcock et al., 2005). Previous work established an approach for dealing with cultural impacts when assessing psychological constructs and the current article extends these efforts into studying stress reactions among adolescents in Sri Lanka. Ethnographic data collection and analysis techniques were used to construct scenarios that are stressful to Sri Lankan youth, along with survey items that assess their related coping mechanisms. The data were factor analysed, results were triangulated with qualitative findings, and reliability estimates of resulting scales were obtained. This in turn generated a pilot assessment approach that can be used to measure stress and coping reactions in a distinct culture. Use of the procedures described here could be replicated to generate culturally-specific instruments in international contexts, or when working with ethnic minorities within a given nation. This should in turn generate information needed to develop culturally relevant intervention work.

Psychological Distress and Hypertension: Results from the National Health Interview Survey for 2004-2013

BACKGROUND/AIMS

Psychological conditions are increasingly linked with cardiovascular disorders. We aimed to examine the association between psychological distress and hypertension.

METHODS

We used data from the National Health Interview Survey for 2004-2013. Hypertension was self-reported and the 6-item Kessler Psychological Distress Scale was used to assess psychological distress (a score ≥13 indicated distress). We used a logistic regression model to test the assumption that hypertension was associated with psychological distress.

RESULTS

Among the study participants completing the survey (n = 288,784), 51% were female; the overall mean age (±SEM) was 35.3 ± 0.02 years and the mean body mass index was 27.5 ± 0.01. In the entire sample, the prevalence of psychological distress was 3.2%. The adjusted odds of reporting hypertension in psychologically distressed individuals was 1.53 (95% CI = 1.31-1.80, p = 0.01).

CONCLUSION

The findings suggest that psychological distress is associated with higher odds of hypertension after adjusting for other risk factors for high blood pressure. Further studies are needed to confirm these findings and to elucidate the mechanisms by which stress increases hypertension risk.

Is major depression associated with serum levels of tumor necrosis factor-alpha in patients with rheumatoid arthritis?

OBJECTIVE

This study presents the serum tumor necrosis factor-alpha (TNF-α) levels in rheumatoid arthritis (RA) patients with major depression and without any psychiatric disorder.

METHODS

The study sample included 61 patients with a diagnosis of RA. Major depression and other psychiatric disorders were screened with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Blood sample for the determination of serum TNF-α level was obtained before the psychiatric interview.

RESULTS

The prevalence rates of any depressive disorder and any anxiety disorder were 40.3% (n=25) and 22.6% (n=14), respectively. Fifteen (24.2%) patients had major depression alone, whereas 27 (43.5%) patients were not diagnosed with any psychiatric disorder. We could not determine any significant differences between the patients with major depression alone and patients without any psychiatric diagnosis with regard to the serum levels of TNF-α.

CONCLUSIONS

The existence of major depression in RA patients does not seem to be associated with serum levels of TNF-α.

Prevalence of psychotic disorders in an urban area of France

BACKGROUND

Most data on the prevalence of psychotic disorders is limited to global estimates or restricted to schizophrenia. Consequently, there is limited information available about the prevalence of psychotic disorders more widely and outwith age and sex - specific prevalence values. The objective of this study is to provide period prevalence estimates, detailed by gender and age groups, for treated psychotic disorders in an adult population (aged 18 years and over) from an urban area in France.

METHODS

Prospective reporting of cases treated over an 8-week period complemented by several methods estimating the number of potentially missed cases, including a leakage study. The study took place in an urban, well defined catchment area, with a population of 67 430 at risk subjects living in the east of a Paris suburb.

RESULTS

The observed prevalence was of 3.72 per 1000 subjects at risk; after adjustment for potentially lost cases the estimate was of 4.60 per 1000 subjects at risk. Observed prevalence was higher in men (4.71 per 1000, Relative Risk = 1.68) and in the 35-45 age-band (6.05 per 1000, Relative Risk = 1.93).

CONCLUSION

Global prevalence estimates of psychotic disorders in this study are in line with expected values based on studies conducted in other countries. Careful consideration of the causes of missed cases and gathering of complementary data are essential and could result in significant changes in prevalence estimates. Detailed estimates (by age) suggest that treated psychosis might not be a lifelong condition.

Comparison of Demographic and Diagnostic Characteristics of Iranian Inpatients With Bipolar I Disorder to Western Counterparts

Background:

Patients’ characteristics influence the disorders outcome, so it is valuable to compare mood disorders and inpatients’ attributes in different large samples.

Objectives:

This study was designed to assess demographic and diagnostic characteristics of 3000 Iranian inpatient with bipolar disorders.

Patients and Methods:

We collected the information of demographic, clinical, and therapeutic characteristics of the patients who were hospitalized in Iran Hospital of Psychiatry, a university affiliated hospital in Tehran, during the 5 years from 2006 to 2011.

Results:

About 66.1% of the subjects were males and 33.9% were females. Iranian patients are characterized by a higher rate of unemployment, being more single, having health insurance and lower rate of divorce and education compared to the other clinical samples. In the majority of the patients, the disorder had begun with manic phase.

Conclusions:

Clinical and therapeutic features of Iranian patients are different from patients in western countries.

The natural course of anxiety disorders in the elderly: a systematic review of longitudinal trials

BACKGROUND

The anxiety disorders are a prevalent mental health problem in older age with a considerable impact on quality of life. Until recently there have been few longitudinal studies on anxiety in this age group, consequently most of the evidence to date has been cross-sectional in nature.

METHODS

We undertook a literature search of Medline, PsycINFO, the Cochrane trials database and the TRIP medical database to identify longitudinal studies which would help elucidate natural history and prognosis of anxiety disorders in the elderly.

RESULTS

We identified 12 papers of 10 longitudinal studies in our Review. This represented 34,691 older age participants with 5,199 with anxiety disorders including anxious depression and 3,532 individuals with depression without anxiety. Relapse rates of anxiety disorders are high over 6 year follow-up with considerable migration to mixed anxiety-depression and pure depressive mood episodes. Mixed anxiety-depression appears to be a poorer prognostic state than pure anxiety or pure depression with higher relapse rates across studies. In community settings treatment rates are low with 7-44% of the anxious elderly treated on antidepressant medications.

CONCLUSIONS

To our knowledge this is the first Systematic Review of longitudinal trials of anxiety disorders in older people. Major longitudinal studies of the anxious elderly are establishing the high risk of relapse and persistence alongside the progression to depression and anxiety depression states. There remains considerable under-treatment in community studies. Specialist assessment and treatment and major public health awareness of the challenges of anxiety disorders in the elderly are required.

A pharmacological approach to panic disorder during pregnancy

Anxiety disorders and pregnancy may occur concurrently in some women. Although, several epidemiological or clinical studies about anxiety disorders in pregnancy exist, data on their treatment are very limited. Similar to other anxiety disorders, specific pharmacological treatment approaches in pregnant women with panic disorder (PD) have not been discussed in the literature. An important issue in the treatment of pregnant women with any psychiatric diagnosis is the risk-benefit profile of pharmacotherapy. Therefore, the treatment should be individualized. Untreated PD seems to be associated with several negative outcomes in the pregnancy. When the results of current study regarding the safety of pharmacological agents on the fetus and their efficacy in PD were gathered, sertraline, citalopram, imipramine and clomipramine at low doses for pure PD, and venlafaxine appeared to be more favorable than the other potential drugs. However, controlled studies examining optimum dosing, efficacy of antipanic medications and risk-benefit profile of intrauterine exposure to treated or untreated PD are urgently needed.

Depressive symptoms and suicidal ideation in adolescents accompanying a parent in recyclable trash collection

The relationship between mental health and poverty has been well documented in adults. However, few studies have addressed how low socioeconomic status and psychosocial vulnerabilities may influence depressive symptoms in adolescents. The current study was carried out in a non-randomly selected sample of 239 adolescents whose parents work as ragpickers (waste collectors for recycling) in Brazil. In-person interviews were conducted, and the presence of depressive symptoms and suicidal ideation were assessed using the Children's Depression Inventory (CDI). We observed that 23% (CI ± 5.34) of the adolescents presented with depressive symptoms and 35% (CI ± 6.05) had suicidal ideation. Fatigue or loss of energy (p = .012) and irritable mood (p = .013) were significantly higher among boys than girls according to DSM-IV criteria. However, we found no gender differences in DSM-IV criteria for Major Depressive Disorders (MDD) or Dysthymic Disorder (DD) in diminished interest or pleasure, weight loss or weight gain, decreased appetite, sleep problems, feelings of worthlessness, diminished concentration or ability to think, recurrent thoughts of death, suicidal ideation, or low self-esteem. There were no significant gender differences in total CDI score, however a greater percentage of girls presented with depressed mood than boys (29.9% vs. 17.1%, p < .05).

Depression levels in patients with hyperemesis gravidarum: a prospective case-control study

Hyperemesis gravidarum (HG) is a condition characterized by severe, intractable nausea and vomiting in early pregnancy. It affects about 0.3–2% of all pregnancies and is thought that HG is a multifactorial disease resulting from the combination of various unrelated conditions such as genetic, hormonal and psychiatric. Although there are studies investigating the relationship between anxiety, depression and HG; however, none have sufficiently clarified this link. The aim of this prospective case–control study was to investigate the possible relationship between depression and HG and compare the prevalence of depression disorders in pregnant women with and without HG.

A prospective case–control study was performed at our tertiary referral centre between December 2013 and July 2014. The study group consisted of 78 pregnant women with HG and the control group consisted of 82 healthy pregnant women who never had experienced any nausea and vomiting. No study participants had any pre-pregnancy history of any psychiatric disorder including depression. Structured Clinical Interview for Diagnostic (SCID-I) and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) was used to evaluate symptoms of depression. Beck Depression Inventory (BDI) was administered to patients during the psychiatric interview and was evaluated by the same psychiatrist.

The mean BDI scores in HG study and healthy control groups were 18.97 ± 9.85 and 6.36 ± 5.61, respectively (p < 0.001). Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression.

In conclusion, the findings of this study indicated that psychological distress associated with HG was a direct consequence rather than a cause of HG. Therefore, patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions.

DSM-IV alcohol dependence and marital dissolution: evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

The purpose of this study was to examine the cross-sectional and longitudinal associations among alcohol use disorder (AUD), stressful life events, and marital dissolution in a probability sample of adults.

METHOD

The National Epidemiologic Survey on Alcohol and Related Conditions is a prospective, longitudinal study of a probability sample of 43,083 adults 18 years of age and older living in the United States. The interval between Wave 1 (W1) and Wave 2 (W2) was approximately 3 years. Cross-sectional analyses included 32,359 adults ages 18 and older who were ever married at W1, and longitudinal analyses included 17,192 adults who were currently married at W1 and who completed relevant W2 measures. Participants completed inhome surveys conducted with computer-assisted personal interviewing.

RESULTS

Rates of lifetime marital dissolution were significantly higher among those with lifetime AUD (48.3%) than in those with no lifetime AUD (30.1%). The incidence of marital dissolution from W1 to W2 was 15.5% for those with a past-12-month AUD at W1, compared to 4.8% among those with no AUD. Proportional hazards regression analyses showed that past-12-month AUD, tobacco use disorder, other substance use disorder, stressful life events, older age at marriage, being married more than once, and being married to an alcoholic at W1 predicted greater hazards of marital dissolution at W2. These associations were not moderated by gender.

CONCLUSIONS

AUD and stressful life events predict subsequent marital dissolution independently of other substance use disorders, mood and anxiety disorders, and personality disorders. Results were discussed within the framework of the Vulnerability-Stress-Adaptation model of marriage.

Mortality among people with severe mental disorders who reach old age: a longitudinal study of a community-representative sample of 37,892 men

Background

Severe mental illnesses are leading causes of disability worldwide. Their prevalence declines with age, possibly due to premature death. It is unclear, however, if people with severe mental disorders who reach older age still have lower life expectancy compared with their peers and if their causes of death differ.

Methods and Findings

Cohort study of a community-representative sample of 37892 Australian men aged 65–85 years in 1996–1998. Follow up was censored on the 31st December 2010. Lifetime prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorder was established through record linkage. A subsample of 12136 consented to a face-to-face assessment of sociodemographic, lifestyle and clinical variables. Information about causes of death was retrieved from the Australian Death Registry. The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders was 1.2%, 0.3%, 2.5% and 1.8%. The mortality hazard for men with a severe mental disorder was 2.3 and their life expectancy was reduced by 3 years. Mortality rates increased with age, but the gap between men with and without severe mental disorders was not attenuated by age. Cardiovascular diseases and cancer were the most frequent causes of death. The excess mortality associated with severe mental disorders could not be explained by measured sociodemographic, lifestyle or clinical variables.

Conclusions

The excess mortality associated with severe mental disorders persists in later life, and the causes of death of younger and older people with severe mental disorders are similar. Hazardous lifestyle choices, suboptimal access to health care, poor compliance with treatments, and greater severity of medical comorbidities may all contribute to this increased mortality. Unlike young adults, most older people will visit their primary care physician at least once a year, offering health professionals an opportunity to intervene in order to minimise the harms associated with severe mental disorders.

Depression in older adults: screening and referral

Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.

Construct and Incremental Validity of the Rotter Incomplete Sentences Blank in Adult Psychiatric Outpatients

The expression of positive vs negative attitudes in response to the 40 stems of the Rotter Incomplete Sentences Blank (RISB) can be scored and summed to an Overall Adjustment Score (OAS). By extending the validation of the OAS to adult psychiatric outpatients, this study demonstrates for the first time the incremental validity of a personality test over a simple self-rating. The RISB and six tests of adjustment were administered to 41 recent admissions to psychotherapy in two rural clinics. The tests of adjustment were selected to cover the two domains of symptoms vs function and the three methods of interview schedule vs objective inventory vs therapist ratings. Their scores were combined into an adjustment composite. The OAS related strongly to the composite in univariate regression, and moderately in hierarchical regression after covarying demographics, intelligence, social desirability, and self-ratings of adjustment. Construct validity was good, and incremental validity at least fair.

Health-related quality of life in the Cambridge City over-75s Cohort (CC75C): development of a dementia-specific scale and descriptive analyses

BACKGROUND

The assessment of Health Related Quality of Life (HRQL) is important in people with dementia as it could influence their care and support plan. Many studies on dementia do not specifically set out to measure dementia-specific HRQL but do include related items. The aim of this study is to explore the distribution of HRQL by functional and socio-demographic variables in a population-based setting.

METHODS

Domains of DEMQOL's conceptual framework were mapped in the Cambridge City over 75's Cohort (CC75C) Study. HRQL was estimated in 110 participants aged 80+ years with a confirmed diagnosis of dementia with mild/moderate severity. Acceptability (missing values and normality of the total score), internal consistency (Cronbach's alpha), convergent, discriminant and known group differences validity (Spearman correlations, Wilcoxon Mann-Whitney and Kruskal-Wallis tests) were assessed. The distribution of HRQL by socio-demographic and functional descriptors was explored.

RESULTS

The HRQL score ranged from 0 to 16 and showed an internal consistency Alpha of 0.74. Validity of the instrument was found to be acceptable. Men had higher HRQL than women. Marital status had a greater effect on HRQL for men than it did for women. The HRQL of those with good self-reported health was higher than those with fair/poor self-reported health. HRQL was not associated with dementia severity.

CONCLUSIONS

To our knowledge this is the first study to examine the distribution of dementia-specific HRQL in a population sample of the very old. We have mapped an existing conceptual framework of dementia specific HRQL onto an existing study and demonstrated the feasibility of this approach. Findings in this study suggest that whereas there is big emphasis in dementia severity, characteristics such as gender should be taken into account when assessing and implementing programmes to improve HRQL.

Test anxiety and academic performance in chiropractic students

Objective : We assessed the level of students' test anxiety, and the relationship between test anxiety and academic performance. Methods : We recruited 166 third-quarter students. The Test Anxiety Inventory (TAI) was administered to all participants. Total scores from written examinations and objective structured clinical examinations (OSCEs) were used as response variables. Results : Multiple regression analysis shows that there was a modest, but statistically significant negative correlation between TAI scores and written exam scores, but not OSCE scores. Worry and emotionality were the best predictive models for written exam scores. Mean total anxiety and emotionality scores for females were significantly higher than those for males, but not worry scores. Conclusion : Moderate-to-high test anxiety was observed in 85% of the chiropractic students examined. However, total test anxiety, as measured by the TAI score, was a very weak predictive model for written exam performance. Multiple regression analysis demonstrated that replacing total anxiety (TAI) with worry and emotionality (TAI subscales) produces a much more effective predictive model of written exam performance. Sex, age, highest current academic degree, and ethnicity contributed little additional predictive power in either regression model. Moreover, TAI scores were not found to be statistically significant predictors of physical exam skill performance, as measured by OSCEs.