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Zhao W, Xu S, Zhang Y, Li D, Zhu C, Wang K. The Application of Extended Reality in Treating Children with Autism Spectrum Disorder. Neurosci Bull 2024:10.1007/s12264-024-01190-6. [PMID: 38498091 DOI: 10.1007/s12264-024-01190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 03/19/2024] Open
Abstract
Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder in children, characterized by social interaction, communication difficulties, and repetitive and stereotyped behaviors. Existing intervention methods have limitations, such as requiring long treatment periods and needing to be more convenient to implement. Extended Reality (XR) technology offers a virtual environment to enhance children's social, communication, and self-regulation skills. This paper compares XR theoretical models, application examples, and intervention effects. The study reveals that XR intervention therapy is mainly based on cognitive rehabilitation, teaching, and social-emotional learning theories. It utilizes algorithms, models, artificial intelligence (AI), eye-tracking, and other technologies for interaction, achieving diverse intervention outcomes. Participants showed effective improvement in competency barriers using XR-based multimodal interactive platforms. However, Mixed Reality (MR) technology still requires further development. Future research should explore multimsodal interaction technologies combining XR and AI, optimize models, prioritize the development of MR intervention scenarios, and sustain an optimal intervention level.
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Affiliation(s)
- Weijia Zhao
- First Clinical Medical College, Anhui Medical University, Hefei, 230032, China
| | - Song Xu
- School of Biomedical Engineering, Anhui Medical University, Hefei, 230032, China
| | - Yanan Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, China, Hefei, 230032, China
| | - Dandan Li
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230000, China.
| | - Chunyan Zhu
- School of Mental Health and Psychological Sciences, Anhui Medical University, China, Hefei, 230032, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230000, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China
| | - Kai Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, China, Hefei, 230032, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China
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Aljadani A, Alshammari K, Alshammari M, Alshammari S, Alhuwaydi A, AbouZed M, Shabaan I, Elzahab N, Altuhayni A, Alghasab N. Prevalence and Predictive Factors of Panic Disorder among Adults in Saudi Arabia: A Cross-Sectional Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00208-6. [PMID: 38372895 DOI: 10.1007/s44197-024-00208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
Panic disorder (PD) is a severe anxiety disorder characterized by recurrent and unexpected panic attacks that cause intense distress. Despite the high prevalence of panic disorder and its significant impact on life, limited research has been conducted on its prevalence and their associated factors in Saudi Arabia. This study seeks to contribute to the understanding of PD among adults in Saudi Arabia by examining its prevalence and associated factors, using an online survey method. A validated questionnaire-based cross-sectional study was conducted targeting 1276 Saudi adults. Data were collected electronically via Google Forms from the eligible participants. The questionnaire comprised three sections: sociodemographic information, medical history, and a validated diagnostic tool for PD. The prevalence of PD among Saudi adults was 13.1%. Most individuals with PD experienced their first panic attack before the age of 18. Only 38.3% individuals with PD sought medical attention, and approximately one-third of those who sought help did not receive a diagnosis. Multiple logistic regression analysis revealed that significant risk factors for PD included being female; having chronic health problems, a comorbid psychiatric disorder, a high body mass index; and experiencing suicidal ideation (P < 0.05). The highest risk was associated with chronic diseases (adjusted odds ratio = 3.1, 95% confidence interval: 2.1-4.6). This study demonstrates that PD is a prevalent and debilitating mental health condition among Saudi Arabian adults. Non-mental health physicians should be aware of PD, as many cases remain undiagnosed.
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Affiliation(s)
- Ahmed Aljadani
- Internal Medicine Department, Division of Psychiatry, University of Hail, Hail, Saudi Arabia.
| | - Khalid Alshammari
- Internal Medicine Department, Division of Psychiatry, University of Hail, Hail, Saudi Arabia
| | - Mossa Alshammari
- Internal Medicine Department, Division of Psychiatry, University of Hail, Hail, Saudi Arabia
| | - Sulaiman Alshammari
- Internal Medicine Department, Division of Psychiatry, University of Hail, Hail, Saudi Arabia
| | - Ahmed Alhuwaydi
- Internal Medicine Department, Division of Psychiatry, Jouf University, Sakaka, Saudi Arabia
| | - Mohamed AbouZed
- Psychiatry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Psychiatry Department, Eradah Mental Complex, Hail, Saudi Arabia
| | - Islam Shabaan
- Psychiatry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Psychiatry Department, Eradah Mental Complex, Hail, Saudi Arabia
| | - Nasr Elzahab
- Psychiatry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Naif Alghasab
- Internal Medicine Department, University of Hail, Hail, Saudi Arabia
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3
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Vickery A. Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England. J Aging Health 2024:8982643241227251. [PMID: 38235737 DOI: 10.1177/08982643241227251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.
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Affiliation(s)
- Alex Vickery
- Cardiff School of Education and Social Policy, Cardiff Metropolitan University, Bristol, UK
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Single A, Alcolado G, Keough MT, Mota N. Cannabis use and social anxiety disorder in emerging adulthood: Results from a nationally representative sample. J Anxiety Disord 2024; 101:102808. [PMID: 38061325 DOI: 10.1016/j.janxdis.2023.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Cannabis use and social anxiety disorder (SAD) are prevalent during emerging adulthood. Previous work has demonstrated that SAD is related to cannabis use in adults; however, less is known about what correlates relate to this association in emerging adults. A subsample of individuals ages 18-25 years old from the NESARC-III (N = 5194) was used to (a) evaluate the association between cannabis use and SAD and (b) examine what correlates may be associated with cannabis use and SAD in emerging adulthood. Weighted cross-tabulations assessed sociodemographics and lifetime psychiatric disorder prevalence estimates among the emerging adult sample. Multinomial logistic regressions examined associations between sociodemographics and psychiatric disorders and four groups (i.e., no cannabis use or SAD; cannabis use only; SAD only; cannabis use + SAD). The prevalence of co-occurring cannabis use and SAD was 1.10%. Being White, a part-time student, or not a student were associated with increased odds of having co-occurring cannabis use + SAD (OR range: 2.26-3.09). Significant associations also emerged between major depressive disorder, bipolar I disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder and co-occurring cannabis use + SAD (AOR range: 3.03-19.05). Results of this study may have implications for better identifying and screening emerging adults who are at risk of co-occurring cannabis use and SAD.
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Affiliation(s)
- Alanna Single
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Gillian Alcolado
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba R3E 3N4, Canada
| | - Matthew T Keough
- Department of Psychology, York University, 4700 Keele St., North York, Ontario M3J 1P3, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba R3E 3N4, Canada
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Calaprice-Whitty D, Tang A, Tona J. Factors Associated with Symptom Persistence in PANS: Part I-Access to Care. J Child Adolesc Psychopharmacol 2023; 33:356-364. [PMID: 37902790 DOI: 10.1089/cap.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: Pediatric acute-onset neuropsychiatric syndrome (PANS) presents with abrupt neuropsychiatric symptoms, often after an immunologic trigger. A 2017 survey of 698 subjects found diagnostic delays to be associated with recurrences, suggesting that timely care impacts course. This secondary analysis explores the impact of barriers to care on symptom persistence. Methods: A 146-question online survey gathered history, symptomatology, intervention, and outcome data from subjects with PANS. Multivariate analyses examined associations between symptom persistence over the entire reported disease course, measured as % days symptom-free over reporting periods averaging approximately 4 years, and access-to-care history, reflected in availability of medical expertise and affordability of care. The impacts of time from symptom onset to treatment and effectiveness of initial antibiotics were also examined. Results: Among the 646 subjects analyzed, greater symptom persistence was associated with longer intervals between symptom onset and treatment (F = 4.43, p = 0.002). Thirty-four percent of subjects with the least symptom persistence (>75% symptom-free days), versus 13% of those with the most (symptoms every day), had been diagnosed by the first practitioner seen (likelihood ratio [L-R] χ2 = 36.55, p < 0.0001, for comparison across all groups). Diagnosis and treatment had not been impeded by lack of access to expertise for 52% of subjects with the least persistent symptoms, versus 22% of those with the most (L-R χ2 = 22.47, p < 0.0001). Affordability had not impacted diagnosis and treatment for 76% of subjects with the least persistent symptoms, versus 42% of those with the most (L-R χ2 = 27.83, p < 0.0001). The subjects whose PANS symptoms resolved with antibiotic treatment of the inciting infection experienced less symptom persistence than others (χ2 = 23.27, p = 0.0001). More persistently symptomatic subjects were more likely to have discontinued intravenous immunoglobulin (IVIG) treatment for access-to-care reasons. Conclusions: Unimpeded access to care for PANS is associated with more symptom-free days over reporting periods averaging approximately 4 years. Difficulty reaching expert providers, missed opportunities for diagnoses, and financial limitations may worsen outcomes. Practitioners, particularly primary providers, should adhere to published diagnostic and treatment guidelines promptly upon presentation.
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Affiliation(s)
- Denise Calaprice-Whitty
- Division of Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Brain Inflammation Collaborative, Delafield, Wisconsin, USA
| | - Angela Tang
- Division of Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Janice Tona
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
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Geng W, Cao J, Jin L, Wei J. Case report: specific phobia of vaginal penetration in a pregnant patient. Front Psychiatry 2023; 14:1218900. [PMID: 37593448 PMCID: PMC10427344 DOI: 10.3389/fpsyt.2023.1218900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Specific phobia is frequently unrecognized or untreated unless it causes significant impairment. In this report, we documented a rare case of a pregnant patient who had a specific fear related to vaginal penetration. Due to abnormal fetal cardiac development in the second trimester, the patient was admitted for termination of pregnancy. The patient's persistent request for surgical termination via cesarean delivery prompted the obstetrician to seek psychiatric consultation for tokophobia, a labor- and childbirth-related phobia. The consulting psychiatrist discovered that the patient had developed a significant fear of vaginal penetration during adolescence. Throughout the extended period of this specific phobia, the patient established a range of avoidance strategies. Had it not been for the unforeseen need for abortion, her phobia may not have been identified. Psychoeducation on specific phobias, exposure therapy, muscle relaxation techniques, and the administration of anxiolytics were implemented. The pregnancy was terminated through a vaginal labor induction procedure 2 days later. Collaboration across disciplines is necessary to support a thorough assessment of obstetric patients who express hesitancy toward vaginal delivery.
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Affiliation(s)
- Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Jin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Doherty WJ, Harris SM, Hall EL, Hubbard AK. Hoe lang wachten mensen voordat zij hulp zoeken voor relatieproblemen? Een onderzoeksnotitie. GEZINSTHERAPIE WERELDWIJD 2023. [PMCID: PMC9912228 DOI: 10.1007/s12440-023-00190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Een vaak aangehaalde, maar slecht onderbouwde opvatting over relatietherapie is dat koppels gemiddeld zes jaar wachten voordat zij met relatietherapie beginnen voor ernstige relatieproblemen. Deze opvatting gaat vaak hand in hand met het idee dat veel koppels “te laat” komen en dat de vooruitzichten op herstel niet goed zijn. Dit is de eerste studie met een grote steekproef naar de tijd tussen het begin van de relatieproblemen en de start van relatietherapie (N = 270) of individuele therapie (N = 101). We hebben hierin een gemiddelde interval geconstateerd van 2,68 jaar; vanaf het begin van de problemen tot de start van de relatietherapie. De meeste koppels starten binnen twee jaar met de therapie. De bevindingen voor individuele therapie voor relatieproblemen zijn vergelijkbaar. De belangrijkste klinische implicatie is dat therapeuten zich geen zorgen hoeven te maken over het aantal koppels dat zo lang wacht met therapie dat hun problemen niet meer op te lossen zijn.
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Affiliation(s)
- William J. Doherty
- Department of Family Social Science, University of Minnesota, St. Paul, MN Verenigde Staten
| | - Steven M. Harris
- Department of Family Social Science, University of Minnesota, St. Paul, MN Verenigde Staten
| | - Eugene L. Hall
- Postdoctoral Research Associate at the Danielsen Institute, Boston University, Boston, MA Verenigde Staten
| | - Aimee K. Hubbard
- Department of Family Social Science, University of Minnesota, St. Paul, MN Verenigde Staten
- Postdoctoral Research Associate at the Danielsen Institute, Boston University, Boston, MA Verenigde Staten
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8
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Latency to selective serotonin reuptake inhibitor vs benzodiazepine treatment in patients with panic disorder: a naturalistic study. CNS Spectr 2023; 28:46-52. [PMID: 34736545 DOI: 10.1017/s1092852921000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Panic disorder (PD) is a prevalent and impairing anxiety disorder with previous reports suggesting that the longer the condition remains untreated, the greater the likelihood of nonresponse. However, patients with PD may wait for years before receiving a guideline-recommended pharmacological treatment. The widespread prescription of benzodiazepines (BDZ) for managing anxiety symptoms and disorders might delay the administration of pharmacotherapy according to guidelines (eg, selective serotonin reuptake inhibitors, SSRIs). The present study aimed to determine the mean duration of untreated illness (DUI) in a sample of PD patients, to quantify and compare DUI-SSRI to DUI-BDZ, and to compare findings with those from previous investigations. METHODS Three hundred and fourteen patients with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of PD were recruited from an Italian outpatient psychotherapy unit, and epidemiological and clinical variables were retrieved from medical records. Descriptive statistical analyses were undertaken for sociodemographic and clinical variables, Wilcoxon matched-pair signed rank test was applied to compare the distribution of DUI-SSRI vs DUI-BDZ, and Welch's t test was performed to compare findings with those from previous studies. RESULTS The mean DUI-SSRI of the total sample was 64.25 ± 112.74 months, while the mean DUI-BDZ was significantly shorter (35.09 ± 78.62 months; P < 0.0001). A significantly longer DUI-SSRI, compared to findings from previous studies, was also observed. CONCLUSIONS The present results confirm a substantial delay in implementing adequate pharmacological treatments in patients with PD, and highlight the discrepancy between recommendations from international treatment guidelines and common clinical practice in relation to BDZ prescription.
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9
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Dzemaili S, Pasquier J, Oulevey Bachmann A, Mohler-Kuo M. The Effectiveness of Mental Health First Aid Training among Undergraduate Students in Switzerland: A Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1303. [PMID: 36674060 PMCID: PMC9859566 DOI: 10.3390/ijerph20021303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Half to three-fourths of mental disorders appear during adolescence or young adulthood, and the treatment gap is mainly due to lack of knowledge, lack of perceived need, and the stigmatization of mental illness. The aims of this study were to implement and evaluate a Mental Health First Aid (MHFA) training program among undergraduates. Participants were second-year students from two universities in the French-speaking region of Switzerland (N = 107), who were randomly assigned to an intervention group (n = 53) or control group (n = 54). The intervention group received a 12-h MHFA course. Online questionnaires were completed before the intervention (T0), and both 3 months (T1) and 12 months (T2) after the intervention in order to evaluate the participants' mental health knowledge, recognition of schizophrenia, and attitudes and behaviors towards mental illness. We used Generalized Estimating Equations (GEE) to examine the effects of intervention over time. After the MHFA course, the intervention group showed significantly increased basic knowledge and confidence helping others with mental illness and reduced stigmatization at both T1 and T2 compared to their baseline scores and compared to control groups. This suggests that the MHFA training program is effective and has significant short-term and long-term impacts, in terms of enhancing basic knowledge about mental health and improving attitudes towards mental illness among undergraduate students.
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Affiliation(s)
- Shota Dzemaili
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, 1004 Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
| | - Annie Oulevey Bachmann
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, 1004 Lausanne, Switzerland
| | - Meichun Mohler-Kuo
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, 1004 Lausanne, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
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10
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Ten Have M, Tuithof M, van Dorsselaer S, de Beurs D, de Graaf R, Batelaan NM, Penninx BWJH. How chronic are depressive and anxiety disorders? 9-year general population study using narrow and broad course outcomes. J Affect Disord 2022; 317:149-155. [PMID: 36031004 DOI: 10.1016/j.jad.2022.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/24/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Existing studies on disease course usually apply relatively short follow-up periods and narrow definitions of disease course resulting in too optimistic views on disease prognosis. This study explores the relevance of using a longer and broader (cross-disorder) perspective. METHODS Respondents with a 12-month disorder at baseline and available at 3-, 6- and 9-year follow-up were selected (major depressive disorder, MDD: n = 208; anxiety disorder: n = 220) from a general population study (N = 6646). DSM-IV disorders were assessed with the Composite International Diagnostic Interview. Disease course was described using a short and narrow perspective (i.e., 3-year follow-up, and considering presence of the index disorder only) and a long and broad perspective (9-year follow-up, and considering presence of any mood, anxiety or substance use disorder as outcome). RESULTS The recovery rates of both MDD and anxiety disorder reduced by half when the perspective switched from short and narrow (MDD: 74.0 %; anxiety disorder: 79.5 %) to long and broad (35.6 % and 40.0 % respectively). At 9-year follow-up, the rates of a persistent disorder (a disorder at each follow-up assessment) tripled when the perspective switched from narrow to broad (MDD: from 4.8 % to 13.9 %; anxiety disorder: from 4.5 % to 15.5 %). LIMITATIONS The findings are not generalizable to the most severe depressed and anxious patients. CONCLUSIONS Most people with MDD or anxiety disorder in the general population have a rather favourable prognosis when a narrow perspective is applied, but an unfavourable prognosis when a long-term and broad perspective is applied. Consequently, MDD and anxiety disorder should not merely be perceived as episodic disorders, and require longer-term disease monitoring and management.
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Affiliation(s)
- Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | | | - Derek de Beurs
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Neeltje M Batelaan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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11
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Patel TA, Schubert FT, Hom MA, Cougle JR. Correlates of treatment seeking in individuals with social anxiety disorder: Findings from a nationally representative sample. J Anxiety Disord 2022; 91:102616. [PMID: 36007388 DOI: 10.1016/j.janxdis.2022.102616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/23/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Despite the availability of well-established and efficacious treatments for social anxiety disorder, most socially anxious individuals do not seek treatment and those who do often suffer for years before seeking treatment. A more comprehensive understanding of the factors related to treatment seeking for social anxiety disorder is needed. This study utilized the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a large representative U.S. adult sample, to examine the relationships between treatment seeking for social anxiety disorder and demographic characteristics, psychiatric comorbidities, social anxiety disorder symptomatology, and specific feared situations. Socially anxious individuals (n = 1,255) were identified using DSM-V criteria and treatment seeking was measured by either seeking help from a professional or being prescribed medication for social anxiety disorder symptoms. Results indicate key relationships between treatment seeking and age as well as comorbid anxiety disorders. Importantly, this study found that specific feared situations such as fear of small groups (AOR = 1.78) and speaking in social gatherings (AOR = 1.66), and specific social anxiety disorder symptoms such as panic attacks (AOR = 2.92) were significantly and uniquely associated with increased treatment seeking for social anxiety disorder.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Melanie A Hom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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12
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Aluh DO, Azeredo-Lopes S, Cardoso G, Pedrosa B, Grigaitė U, Dias M, Xavier M, Caldas-de-Almeida JM. Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative. Psychiatry Res 2022; 315:114734. [PMID: 35872402 DOI: 10.1016/j.psychres.2022.114734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Sofia Azeredo-Lopes
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Miguel Xavier
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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Doherty WJ, Harris SM, Hall EL, Hubbard AK. How long do people wait before seeking couples therapy? A research note. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:882-890. [PMID: 33411353 DOI: 10.1111/jmft.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
A widely cited but poorly supported idea in the couples therapy field is that the average couple waits six years before starting therapy for serious relationship problems. This figure is often accompanied by the notion that many couples come "too late" and have poor prospects for recovery. This is the first large-sample study on the delay between the onset of serious marital problems and entry into couples therapy (N = 270) and individual therapy (N = 101) for relationship problems. We found an average interval of 2.68 years from onset of problems and entering couples therapy, with the great majority of couples entering therapy within two years. Findings were similar for seeking individual therapy for relationship problems. The main clinical implication is that therapists have little reason to be pessimistic about the majority of couples waiting so long before starting therapy that their problems are not resolvable.
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Affiliation(s)
- William J Doherty
- University of Minnesota, St. Paul, MN, USA
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Steven M Harris
- University of Minnesota, St. Paul, MN, USA
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Eugene L Hall
- Boston University, Boston, MA, USA
- Postdoctoral Research Associate at the Danielsen Institute, Boston University, Boston, MA, USA
| | - Aimee K Hubbard
- University of Minnesota, St. Paul, MN, USA
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
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14
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Tobias MR, Landy LN, Levin ME, Arch JJ. A Randomized Trial of Brief Online Interventions to Facilitate Treatment Seeking for Social Anxiety. Behav Modif 2021; 46:1137-1166. [PMID: 34459271 DOI: 10.1177/01454455211040051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates. Adults (N = 267) reporting significant SA symptoms were recruited online and randomized to a brief, single-session online intervention: Education consisted of brief psychoeducation and treatment resources, or Education+Motivation which added treatment seeking-focused motivational content adapted from Motivational Interviewing and Acceptance and Commitment Therapy. Attitudes, intentions, perceived control, and treatment seeking were assessed at Pre, Post, and 1-month follow-up (FU). Both interventions were feasible (90% completion) and improved all outcomes. At FU, 70% reported engaging in one or more SA treatment-seeking behaviors. Education+Motivation was more effective than Education at improving treatment-seeking attitudes and behaviors. A brief online intervention with educational and motivational content is a promising direction for promoting treatment seeking for adults with SA symptoms.
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15
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Ten Have M, Tuithof M, van Dorsselaer S, Kleinjan M, Penninx BWJH, Batelaan NM, de Graaf R. Duration of anxiety disorder and its associated risk indicators: Results of a longitudinal study of the general population. Depress Anxiety 2021; 38:328-336. [PMID: 33107675 DOI: 10.1002/da.23103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Data on episode duration of anxiety disorders are required for informing patients and for disease management, but such data from population studies are lacking. METHODS Three-year longitudinal data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the general adult population (N = 6646). Respondents with a new (first or recurrent) anxiety disorder were selected (n = 158). DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview; the Life Chart Interview assessed episode duration and recovery rates. RESULTS Among those with anxiety disorder, median episode duration was 7.5 months and mean duration was 15.2 months. 38.8% had not recovered at 12 months and 30.1% not at 36 months. Longer duration was associated with older age, not having a paid job, higher neuroticism, more physical disorders, and worse physical functioning. CONCLUSIONS Also, in the general population, anxiety disorder has a rather chronic course. After 12 months the cumulative recovery rate flattened. To prevent and manage chronicity, timely treatment, and chronic disease management are required. The risk indicators found may help to identify individuals with an anxiety disorder at risk for chronicity.
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Affiliation(s)
- Margreet Ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marloes Kleinjan
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Department of Interdisciplinary Social Sciences, Youth Studies, Utrecht University, Utrecht, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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16
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Thompson CL, Alcover K, Yip SW. Development and Validation of a Prediction Model of Prescription Tranquilizer Misuse Based on a Nationally Representative United States Sample. Drug Alcohol Depend 2021; 218:108344. [PMID: 33109457 DOI: 10.1016/j.drugalcdep.2020.108344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prescription tranquilizer misuse is a risky behavior associated with fatal drug poisonings. Although various predictors have been examined, there is no published prediction model for tranquilizer misuse. This study develops and internally validates a tranquilizer misuse prediction model based primarily on drug histories of participants in a national cross-sectional survey. Predictors also include psychiatric, behavioral and demographic variables. METHODS We analyzed data from 471,097 individuals aged 14-to-29-years in the United States, as sampled by the National Survey of Drug Use and Health, 2004-2018, an annual cross-sectional survey. We encoded 21 predictors with known or likely onset prior to tranquilizer misuse initiation, (e.g., early onset of cannabis use). With this dataset, we trained a neural network and regularized logistic regression model. While the assessment for tranquilizer misuse changed slightly in 2015, by pooling all years of survey data, predictions are robust to this source of variation. RESULTS 1.44% of the pooled sample, 2004-2018, recently initiated tranquilizer misuse (unweighted estimate). On held-out test data (n = 43,714), logistic regression and the neural network performed equally well, with an area under the receiver operating characteristic curve (AUC) of ∼0.83 on the primary model, containing 12 variables known to occur before tranquilizer misuse. CONCLUSION Built for case prediction rather than case detection, this model restricted predictors to those with known timing prior to initiation of tranquilizer misuse. Yet its performance supersedes commonly accepted criteria for clinical prediction models (AUC > 0.80). Future work should incorporate survey analysis weights into the prediction model to minimize possible bias.
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Affiliation(s)
- C L Thompson
- Peds AI, 325 E. Grand River Avenue, East Lansing, MI 48823, United States.
| | - Karl Alcover
- Department of Medical Education and Clinical Sciences, Washington State University, United States.
| | - Sarah W Yip
- Departments of Psychiatry and of Child Study, Yale School of Medicine, United States.
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17
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Goodwin RD, Weinberger AH, Kim JH, Wu M, Galea S. Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults. J Psychiatr Res 2020; 130:441-446. [PMID: 32905958 PMCID: PMC7441973 DOI: 10.1016/j.jpsychires.2020.08.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/09/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In a time of global uncertainty, understanding the psychological health of the American public is imperative. There are no current data on anxiety trends among adults in the United States (US) over time. This study aimed to investigate prevalence of anxiety among US adults from 2008 to 2018. METHODS Data from the National Survey on Drug Use and Health (NSDUH), which is an annual, cross-sectional survey on substance use and mental health in the US, were analyzed in 2020. Prevalence of past-month anxiety was estimated among those ages ≥18, by survey year from 2008 to 2018. Time trends were tested using logistic regression. RESULTS Anxiety increased from 5.12% in 2008 to 6.68% in 2018 (p < 0.0001) among adult Americans. Stratification by age revealed the most notable increase from 7.97% to 14.66% among respondents 18-25 years old (p < 0.001), which was a more rapid increase than among 26-34 and 35-49 year olds (differential time trend p < 0.001). Anxiety did not significantly increase among those ages 50 and older. Anxiety increased more rapidly among those never married and with some college education, relative to their respective counterparts. Apart from age, marital status and education, anxiety increased consistently among sociodemographic groups. CONCLUSIONS Anxiety is increasing among adults under age 50 in the US, with more rapid increase among young adults. To prepare for a healthier adulthood and given direct and indirect (via 24/7 media) exposure to anxiety-provoking world events, prophylactic measures that can bolster healthy coping responses and/or treatment seeking seem warranted on a broad scale.
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Affiliation(s)
- Renee D. Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,Corresponding author. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1030D, New York, NY, 10032, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - June H. Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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18
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Hurtado MM, Villena A, Vega A, Amor G, Gómez C, Morales-Asencio JM. 'I have anxiety, but I have values and preferences' Experiences of users with generalized anxiety disorder: A qualitative study. Int J Ment Health Nurs 2020; 29:521-530. [PMID: 31908140 DOI: 10.1111/inm.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 12/12/2022]
Abstract
To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision-making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision-making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Amelia Villena
- Mental Health Unit, Valle de los Pedroches Hospital, Pozoblanco, Spain
| | - Amanda Vega
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Gisela Amor
- Mental Health Unit, Regional University Hospital, Málaga, Spain
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19
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Duffy ME, Mueller NE, Cougle JR, Joiner TE. Perceived burdensomeness uniquely accounts for suicidal ideation severity in social anxiety disorder. J Affect Disord 2020; 266:43-48. [PMID: 32056911 DOI: 10.1016/j.jad.2020.01.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND High rates of suicidal ideation in those with social anxiety disorder (SAD) have been attributed to feelings of thwarted belongingness and perceived burdensomeness, but most work has been in non-clinical samples. We assessed the contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation severity, over clinical covariates, in individuals diagnosed with SAD. METHODS Participants were 58 adult outpatients (mean age 25.62 years, 69% female) with SAD. Hierarchical linear regression assessed contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation, before and after covarying other potential explanatory variables (depression, agitation, brooding rumination). RESULTS Perceived burdensomeness was significantly positively related to suicidal ideation severity (p < .001) above thwarted belongingness, which was not incremental (p = .791). The same pattern was found after inclusion of additional covariates (perceived burdensomeness p = .006; thwarted belongingness p = .757). Greater agitation also uniquely accounted for more severe suicidal ideation (p = .001). LIMITATIONS This study was cross-sectional, did not assess all potential confounding variables, and utilized a treatment-seeking sample. CONCLUSIONS Results suggest perceived burdensomeness is independently related to suicidal ideation severity in SAD, over thwarted belongingness and other clinical features. Future work should seek to replicate these findings and evaluate causal, longitudinal relationships among perceived burdensomeness, agitation, and severity of suicidal ideation in those with SAD in order to determine whether these may be clinically-relevant mechanisms.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Nora E Mueller
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
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20
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Abstract
AIMS Mental disorders in children are a significant and growing cause of morbidity worldwide. Although interventions to help overcome barriers along the pathway to accessing health care for children with mental disorders exist, there is no overview of randomised controlled trials (RCTs) on these interventions as yet. This study aimed to systematically identify RCTs of interventions to improve access to mental health care for children and synthesise them using a conceptual framework of access to health care. METHODS This systematic review was performed following a predefined protocol registered with PROSPERO (ID: CRD42018081714). We searched the databases MEDLINE, EMBASE, PsycINFO and CENTRAL for RCTs up to 15 May 2019 using terms related to the concepts 'young people,' 'mental disorders' and 'help-seeking interventions' and scanned reference lists from relevant studies. Two reviewers independently screened all identified articles in a two-stage process, extracted results on outcomes of interest (knowledge, attitudes, intentions, help-seeking, accessing care, mental health outcomes and satisfaction), assessed the risk of bias and conducted meta-analyses where deemed appropriate. RESULTS After screening 5641 identified articles, 34 RCTs were eligible for inclusion. Eighty per cent of universal school-based interventions measuring knowledge (n = 5) and 67% measuring attitudes (n = 6) reported significantly better results compared with controls on those outcomes, whereas 20% measuring access to care (n = 5) and none measuring mental health outcomes (n = 7) did. In contrast, 71% of interventions targeting at-risk individuals (n = 21) reported better access to care compared with controls, while just 33% (n = 6) did for mental health outcomes. For satisfaction with care, this proportion was 80% (n = 5). Meta-analyses of interventions measuring initial appointment attendance yielded combined odds ratios of 3.11 (2.07-4.67) for appointment reminder interventions and 3.51 (2.02-6.11) for treatment engagement interventions. The outcomes for universal school-based interventions were heterogeneous and could not be summarised quantitatively through meta-analysis. CONCLUSIONS To have a population-level effect on improving children's access to mental health care, two-stage interventions that identify those in need and then engage them in the health-care system may be necessary. We need more evidence on interventions to target contextual factors such as affordability and infrastructural barriers.
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21
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Maskey M, Rodgers J, Ingham B, Freeston M, Evans G, Labus M, Parr JR. Using Virtual Reality Environments to Augment Cognitive Behavioral Therapy for Fears and Phobias in Autistic Adults. AUTISM IN ADULTHOOD 2019; 1:134-145. [PMID: 31032480 PMCID: PMC6485262 DOI: 10.1089/aut.2018.0019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposure can be too anxiety-provoking to allow treatment to take place, and imaginal exposure can be problematic. To address this, we developed an intervention that combines cognitive behavioral therapy (CBT) with immersive virtual reality (VR) exposure to reduce anxiety. Following successful trials of this intervention with young people on the autism spectrum, we report a pilot study using the same intervention with autistic adults. Eight adults (aged 18–57 years) received one psychoeducation session and then four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant completed all sessions showing that the intervention is feasible and acceptable. Outcomes were monitored at 6 weeks and 6 months postintervention. Five of the eight participants were classified as intervention responders and at 6 months after the end of intervention were experiencing real-life functional improvements. These preliminary findings show that VR-graded exposure alongside CBT may be an effective treatment for autistic people with phobias.
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Affiliation(s)
- Morag Maskey
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barry Ingham
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mark Freeston
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Evans
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Marie Labus
- Business Development and Enterprise, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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22
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Goode TD, Ressler RL, Acca GM, Miles OW, Maren S. Bed nucleus of the stria terminalis regulates fear to unpredictable threat signals. eLife 2019; 8:46525. [PMID: 30946011 PMCID: PMC6456295 DOI: 10.7554/elife.46525] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 12/15/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) has been implicated in conditioned fear and anxiety, but the specific factors that engage the BNST in defensive behaviors are unclear. Here we examined whether the BNST mediates freezing to conditioned stimuli (CSs) that poorly predict the onset of aversive unconditioned stimuli (USs) in rats. Reversible inactivation of the BNST selectively reduced freezing to CSs that poorly signaled US onset (e.g., a backward CS that followed the US), but did not eliminate freezing to forward CSs even when they predicted USs of variable intensity. Additionally, backward (but not forward) CSs selectively increased Fos in the ventral BNST and in BNST-projecting neurons in the infralimbic region of the medial prefrontal cortex (mPFC), but not in the hippocampus or amygdala. These data reveal that BNST circuits regulate fear to unpredictable threats, which may be critical to the etiology and expression of anxiety.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Reed L Ressler
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Gillian M Acca
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Olivia W Miles
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Stephen Maren
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
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23
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Examining predictors of help-seeking behaviours in patients with mood and anxiety symptoms. Psychiatry Res 2018; 265:190-197. [PMID: 29729499 DOI: 10.1016/j.psychres.2018.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
Relatively little is known about individual characteristics that factor into the decision to seek help for mood and anxiety symptoms. The current study was undertaken in order to examine factors that predict the likelihood of seeking help for mood and anxiety symptoms amongst a clinical population. Patients (N = 278) referred to a tertiary care clinic in Toronto, Canada were asked about their help-seeking behaviours (HSB) through initial intake assessments and self-administered questionnaires, including the Beck Anxiety Inventory, Anxiety Sensitivity Index, Intolerance of Uncertainty Scale, and Beck Depression Inventory-II. Correlates of anxiety and depression were examined to determine whether they could predict HSB amongst individuals with Generalized Anxiety Disorder with or without comorbid Major Depressive Disorder, as well as Panic Disorder and Social Anxiety Disorder. Psychiatric diagnoses were then examined to determine whether comorbidity and demographic factors impacted HSB. Results indicated that there were significant differences in anxiety and depression correlating mainly with anxiety sensitivity, as a predictor of HSB, and that there is a complex relationship between disorder type and demographic variables. The implications of these findings and suggested targeted interventions are discussed.
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25
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Font H, Roelandt JL, Behal H, Geoffroy PA, Pignon B, Amad A, Simioni N, Vaiva G, Thomas P, Duhamel A, Benradia I, Rolland B. Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the 'Mental Health in General Population' (MHGP) survey. Soc Psychiatry Psychiatr Epidemiol 2018; 53:567-576. [PMID: 29619580 DOI: 10.1007/s00127-018-1507-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/28/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE No lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France. METHODS In a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor. RESULTS In total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59-1.91)] and practising religion [OR 1.13 (1.02-1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85-0.91)], being single [OR 0.74 (0.66-0.84)], being a French native [OR 0.67 (0.60-0.75)], and experiencing MDs [OR 0.39 (0.36-0.43)], ADs [OR 0.47 (0.43-0.52)], AUDs [OR 0.83 (0.73-0.96)], SUDs [OR 0.77 (0.65-0.91)], or PDs [OR 0.50 (0.43-0.59)]. CONCLUSIONS In France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.
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Affiliation(s)
- Hélène Font
- Centre Collaborateur de l'Organisation Mondiale de la Santé, 211 rue Roger Salengro, 59 260, Hellemmes, France.
| | - Jean-Luc Roelandt
- Centre Collaborateur de l'Organisation Mondiale de la Santé, 211 rue Roger Salengro, 59 260, Hellemmes, France
| | - Hélène Behal
- Département de Biostatistiques, Univ. Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Pierre-Alexis Geoffroy
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Pôle Neurosciences, Paris, France
- Université Paris Diderot, UMR-S 1144, Paris, France
| | - Baptiste Pignon
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri Mondor, Pôle Psychiatrie Addictologie, Créteil, France
- INSERM, U955, équipe 15, Créteil, France
- Fondation FondaMental, Créteil, France
- UPEC, Université Paris-Est, Faculté de médecine, Créteil, France
| | - Ali Amad
- Pôle de Psychiatrie et Addictologie, CHRU de Lille, Lille, France
- UMR9193-PsychiC-SCALab, Department of Psychiatry, Univ. Lille, CNRS, CHU de Lille, Lille, France
| | - Nicolas Simioni
- Fondation Phénix, Centre Phénix Plainpalais, Geneva, Switzerland
| | - Guillaume Vaiva
- Pôle de Psychiatrie et Addictologie, CHRU de Lille, Lille, France
- UMR9193-PsychiC-SCALab, Department of Psychiatry, Univ. Lille, CNRS, CHU de Lille, Lille, France
| | - Pierre Thomas
- Pôle de Psychiatrie et Addictologie, CHRU de Lille, Lille, France
- UMR9193-PsychiC-SCALab, Department of Psychiatry, Univ. Lille, CNRS, CHU de Lille, Lille, France
| | - Alain Duhamel
- Département de Biostatistiques, Univ. Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Imane Benradia
- Centre Collaborateur de l'Organisation Mondiale de la Santé, 211 rue Roger Salengro, 59 260, Hellemmes, France
| | - Benjamin Rolland
- Pôle de Psychiatrie et Addictologie, CHRU de Lille, Lille, France
- INSERM U1171, Univ Lille, Lille, France
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France
- Université de Lyon, UCBL, Lyon, France
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Blanco C, Hoertel N, Franco S, Olfson M, He JP, López S, González-Pinto A, Limosin F, Merikangas KR. Generalizability of Clinical Trial Results for Adolescent Major Depressive Disorder. Pediatrics 2017; 140:e20161701. [PMID: 29097612 PMCID: PMC5703774 DOI: 10.1542/peds.2016-1701] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although there have been a number of clinical trials evaluating treatments for adolescents with major depressive disorder (MDD), the generalizability of those trials to samples of depressed adolescents who present for routine clinical care is unknown. Examining the generalizability of clinical trials of pharmacological and psychotherapy interventions for adolescent depression can help administrators and frontline practitioners determine the relevance of these studies for their patients and may also guide eligibility criteria for future clinical trials in this clinical population. METHODS Data on nationally representative adolescents were derived from the National Comorbidity Survey: Adolescent Supplement. To assess the generalizability of adolescent clinical trials for MDD, we applied a standard set of eligibility criteria representative of clinical trials to all adolescents in the National Comorbidity Survey: Adolescent Supplement with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD (N = 592). RESULTS From the overall MDD sample, 61.9% would have been excluded from a typical pharmacological trial, whereas 42.2% would have been excluded from a psychotherapy trial. Among those who sought treatment (n = 412), the corresponding exclusion rates were 72.7% for a pharmacological trial and 52.2% for a psychotherapy trial. The criterion leading to the largest number of exclusions was "significant risk of suicide" in both pharmacological and psychotherapy trials. CONCLUSIONS Pharmacological and, to a lesser extent, psychotherapy clinical trials likely exclude most adolescents with MDD. Careful consideration should be given to balancing eligibility criteria and internal validity with applicability in routine clinical care while ensuring patient safety.
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Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Nicolas Hoertel
- Paris Descartes University, Pôles de recherche et d'enseignement supérieur Sorbonne Paris Cité, Paris, France;
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Institut national de la santé et de la recherche médicale unité mixte de recherche 894, Psychiatry and Neurosciences Center, Paris, France
| | - Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York; and
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York; and
| | - Jian-Ping He
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Saioa López
- Hospital Universitario de Alava (Santiago), Centre for Biomedical Research in Mental Health Network, Vitoria, Spain
| | - Ana González-Pinto
- Hospital Universitario de Alava (Santiago), Centre for Biomedical Research in Mental Health Network, Vitoria, Spain
| | - Frédéric Limosin
- Paris Descartes University, Pôles de recherche et d'enseignement supérieur Sorbonne Paris Cité, Paris, France
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Institut national de la santé et de la recherche médicale unité mixte de recherche 894, Psychiatry and Neurosciences Center, Paris, France
| | - Kathleen R Merikangas
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Mental disorder comorbidity and treatment utilization. Compr Psychiatry 2017; 79:89-97. [PMID: 28215792 PMCID: PMC5550376 DOI: 10.1016/j.comppsych.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Effective interventions have been developed for myriad common psychological and substance use disorders, though they remain highly underutilized. Previous research has shown that the likelihood of treatment utilization varies across disorder diagnosis. However, studies that focus on individual disorders have resulted in a large, piecemeal literature that neglects the high rates of multivariate comorbidity. The current study investigated the association between treatment utilization and transdiagnostic comorbidity factors. METHODS In a nationally representative sample of the United States adult population (N=34,653), we applied the internalizing-externalizing latent comorbidity model to examine its association with lifetime utilization of various treatments for mood, anxiety, and substance use disorders. RESULTS Both internalizing and externalizing transdiagnostic factors were positively associated with all forms of treatment utilization. Stronger within-domain domain (e.g., internalizing's association with mood or anxiety treatment) than between-domain (e.g., internalizing's association with substance use disorder treatment) associations were found. Significant antagonistic internalizing-by-externalizing interactions were also observed. CONCLUSIONS These results underscore the importance of applying a nuanced approach to modeling comorbidity when predicting treatment utilization. Clinical implications are discussed.
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Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther 2017; 88:49-64. [PMID: 28110676 DOI: 10.1016/j.brat.2016.09.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 01/27/2023]
Abstract
Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders.
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Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, Bunting B, de Girolamo G, Demyttenaere K, Florescu SE, Gureje O, Hisateru T, Hu C, Huang Y, Karam E, Kiejna A, Lepine JP, Navarro-Mateu F, Browne MO, Piazza M, Posada-Villa J, ten Have ML, Torres Y, Xavier M, Zarkov Z, Kessler RC, Scott KM, de Jonge P. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47:1744-1760. [PMID: 28222820 PMCID: PMC5674525 DOI: 10.1017/s0033291717000174] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. METHOD Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. RESULTS The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. CONCLUSIONS Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
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Affiliation(s)
- Klaas J. Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Carmen C.W. Lim
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jordi Alonso
- Health Services Research Unit, Instituto Hospital del Mar de Investigaciones Médicas, Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Laura H. Andrade
- Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Brendan Bunting
- Psychology Research Institute, Ulster University, Londonderry, United Kingdom
| | | | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Tachi Hisateru
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Japan
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - Elie Karam
- St George Hospital University Medical Center, Balamand University, Institute for Development, Research, Advocacy, Beirut, Lebanon
| | - Andrzej Kiejna
- Department of Psychiatry Wroclaw Medical University, Wroclaw, Poland
| | - Jean Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes Paris, France
| | - Fernando Navarro-Mateu
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca. Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP)-Murcia. Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | | | - Maria Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, St Martin de Porres, Peru
| | | | - Margreet L. ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Miguel Xavier
- Nova faculdade ciencias medicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Zahari Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | | | - Kate M. Scott
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
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Boulos D, Zamorski MA. Delay to mental healthcare in a cohort of Canadian Armed Forces personnel with deployment-related mental disorders, 2002-2011: a retrospective cohort study. BMJ Open 2016; 6:e012384. [PMID: 27609855 PMCID: PMC5020680 DOI: 10.1136/bmjopen-2016-012384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess whether the delay to care among Canadian Armed Forces (CAF) personnel who sought care for a mental disorder changed over time and in association with CAF mental health system augmentations. DESIGN A stratified, random sample (n=2014) was selected for study from an Afghanistan-deployed cohort (N=30 513) and the 415 (weighted N=4108) individuals diagnosed with an Afghanistan service-related mental disorder were further assessed. Diagnosis-related data were abstracted from medical records (22 June 2010 to 30 May 2011). Other data were extracted from administrative databases. Delay to care was assessed across five mental health system eras: 2002/2004, 2005/2006, 2007, 2008 and 2009/2010. Weighted Cox proportional hazards regression assessed the association between era, handled as a time-dependent covariate, and the outcome while controlling for a broad range of potential confounders (ie, sociodemographic, military and clinical characteristics). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. PRIMARY OUTCOME The outcome was the delay to mental healthcare, defined as the latency from most recent Afghanistan deployment return date to diagnosis date, among individuals with an Afghanistan service-related mental disorder diagnosis. RESULTS Mean delay to care was 551 days (95% CI 501 to 602); the median was 400 days. Delay to care decreased in subsequent eras relative to 2002/2004; however, only the most recent era (2009/2010) was statistically significant (adjusted HR (aHR): 3.01 (95% CI 1.91 to 4.73)). Men, operations support occupations, higher ranks, non-musculoskeletal comorbidities and fewer years of military service were also independently associated with longer delays to care. CONCLUSIONS CAF mental health system changes were associated with reduced delays to mental healthcare. Further evaluation research is needed to identify the key system changes that were most impactful.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa,Ottawa, Ontario, Canada
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. J Adolesc Health 2015; 57:144-9. [PMID: 25937471 PMCID: PMC4545276 DOI: 10.1016/j.jadohealth.2015.03.003] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/28/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students. METHODS Data came from 289,024 students from 223 U.S. universities participating in the American College Health Association-National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates. RESULTS Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95% confidence interval [CI], 3.41-6.26) and past-month use of diet pills (OR, 2.05; 95% CI, 1.48-2.83) and vomiting or laxatives (OR, 2.46; 95% CI, 1.83-3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40-1.54). CONCLUSIONS Transgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.
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Affiliation(s)
| | - Julia D. Grant
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110
| | - Melissa A. Munn-Chernoff
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110
| | - David A. Patterson
- George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130
| | - Alexis E. Duncan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110,George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130
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Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend 2015; 149:136-44. [PMID: 25725934 PMCID: PMC4789763 DOI: 10.1016/j.drugalcdep.2015.01.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence. METHODS The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment. RESULTS In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment. CONCLUSIONS Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.
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Affiliation(s)
- Carlos Blanco
- New York State Psychiatric Institute, New York, NY, USA.
| | - Miren Iza
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | | | - Enrique Baca-García
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY, USA
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