The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature

Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6-1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.

Comorbidity Between Internalising and Externalising Disorders Among Adolescents: Symptom Connectivity Features and Psychosocial Outcome

Internalising disorders are highly prevalent conditions in adolescence and tend to co-occur with externalising disorders. The present study used a symptom network approach to examine the interplay between symptoms of internalising disorders among adolescents with comorbid internalising and externalising disorders. Data comes from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of adolescents aged 13 to 18 years. The most central symptoms across the disorders in the network were poor self-esteem and worry. The comorbidity between anxiety and depression increases the probability of having comorbid externalising disorders. Adolescents with both internalising and externalising disorders had the highest rate of health service utilisation. Comorbidity group, lifestyle factors, deficits in cognitive and academic competence and coping skills were significant covariates of the mental health outcomes. Understanding comorbidity profile of internalising and externalising disorders and central symptoms that bridge these disorders could have important clinical implications.

A Voxel-Based Morphometric Study of Gray Matter in Specific Phobia

The objective of this study was to analyze the neurostructural abnormalities of brain areas responsible for the acquisition and maintenance of fear in small animal phobia by comparing gray matter volume (GMV) in individuals with phobia and non-fearful controls. Structural magnetic resonance imaging was obtained from 62 adults (79% female) assigned to one of two groups: 31 were diagnosed with small animal phobia and 31 were non-fearful controls. To investigate structural alterations, a whole-brain voxel-based morphometry analysis was conducted to compare the GMV of the brain areas involved in fear between both groups. The results indicated that individuals with a small animal specific phobia showed smaller GMV in cortical regions, such as the orbitofrontal (OFC) and medial frontal cortex, and greater GMV in the putamen than non-fearful controls. These brain areas are responsible for avoidant behavior (putamen) and emotional regulation processes or inhibitory control (prefrontal cortex (PFC)), which might suggest a greater vulnerability of phobic individuals to acquiring non-adaptive conditioned responses and emotional dysregulation. The findings provide preliminary support for the involvement of structural deficits in OFC and medial frontal cortex in phobia, contributing to clarify the neurobiological substrates for phobias.

Variations in psychological disorders, suicidality, and help-seeking behaviour among college students from different academic disciplines

BACKGROUND

Elevated levels of suicidality, ADHD, mental ill-health and substance disorders are reported among college students globally, yet few receive treatment. Some faculties and courses appear to have more at-risk students than others. The current study aimed to determine if students commencing college in different academic disciplines were at a heightened risk for psychopathology, substance use disorders and suicidal behaviour, and examined variations in help-seeking behaviour.

MATERIALS AND METHODS

The study utilised data collected from 1,829 first-year undergraduate students as part of the Student Psychological Intervention Trial (SPIT) which commenced in September 2019 across four Ulster University campuses in Northern Ireland and an Institute of Technology, in the North-West of Ireland. The SPIT study is part of the World Mental Health International College Student Initiative (WMH-ICS) which uses the WMH-CIDI to identify 12-month and lifetime disorders.

RESULTS

Students from Life and Health Sciences reported the lowest rates of a range of psychological problems in the year prior to commencing college, while participants studying Arts and Humanities displayed the highest levels (e.g. depression 20.6%; social anxiety 38.8%). However, within faculty variations were found. For example, psychology students reported high rates, while nursing students reported low rates. Variations in help seeking behaviour were also revealed, with male students less likely to seek help.

CONCLUSIONS

Detecting specific cohorts at risk of psychological disorders and suicidality is challenging. This study revealed that some academic disciplines have more vulnerable students than others, with many reluctant to seek help for their problems. It is important for educators to be aware of such issues and for colleges to provide information and support to students at risk. Tailored interventions and prevention strategies may be beneficial to address the needs of students from different disciplines.

Differences in the Prevalence and Profile of DSM-IV and DSM-5 Alcohol Use Disorders-Results from the Singapore Mental Health Study 2016

INTRODUCTION

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for alcohol use disorders (AUD) was a significant shift from the historical DSM-IV Text Revised version. Following this shift in diagnostic criteria, a difference in the prevalence of AUD was expected. The current study aimed to evaluate the consequences of the modification of the diagnostic criteria from DSM-IV to DSM-5 AUD using lifetime diagnosis in Singapore's multi-ethnic population using data from a nationwide epidemiological study.

METHODS

Respondents were assessed for lifetime mental disorders using the Composite International Diagnostic Interview (CIDI) administered through face-to-face interviews. Lifetime DSM-IV AUD diagnoses were compared with DSM-5 AUD diagnoses generated by modifying the criteria and the addition of the craving criterion. Sociodemographic correlates of lifetime DSM-IV/DSM-5 AUD were examined using multiple logistic regression analysis. Associations between DSM-IV/DSM-5 AUD, chronic conditions, and the HRQOL summary scores were examined using logistic and linear regression after controlling for significant sociodemographic factors.

RESULTS

The lifetime prevalence of DSM-IV AUD was 4.6% (0.5% for dependence and 4.1% for abuse) in the adult population, while the lifetime prevalence of DSM-5 AUD was 2.2%. Younger age, male gender, and lower education were associated with higher odds of both DSM-IV and DSM-5 AUD. However, those who were economically inactive (versus employed) (AOR, 0.4; 95% CI 0.2-0.9) and had a higher monthly household income (SGD 4000-5999 versus below SGD 2000) had lower odds of DSM-IV AUD (AOR, 0.4; 95% CI 0.2-0.7), but this was not observed among those with DSM-5 AUD. Both DSM-IV and DSM-5 AUD were associated with significant comorbidities in terms of other mental disorders; however, those diagnosed with lifetime GAD had significantly higher odds of having DSM-5 AUD (AOR, 5; 95% CI 1.9-13.2) but not DSM-IV AUD.

CONCLUSIONS

While using the DSM-5 criteria would result in a lower prevalence of AUD in Singapore, it remains a highly comorbid condition associated with a poor health-related quality of life that is largely untreated, which makes it a significant public health concern.

Interaction of Depression and Unhealthy Diets on the Risk of Cardiovascular Diseases and All-Cause Mortality in the Chinese Population: A PURE Cohort Substudy

This study aimed to identify the interaction of depression and diets on cardiovascular diseases (CVD) incident and death in China and key subpopulations. We included 40,925 participants from the Prospective Urban Rural Epidemiology (PURE)-China cohort which recruited participants aged 35-70 years from 45 urban and 70 rural communities. Depression was measured by the adapted Short-Form (CIDI-SF). The unhealthy diet was considered when the score of Alternative Healthy Eating Index was below the lowest tertile. The primary outcome was a composite outcome of incident CVD and all-cause mortality. Cox frailty models were used to examine the associations. During a median follow-up of 11.9 years (IQR: 9.6-12.6 years), depression significantly increased the risk of the composite outcome (HR = 2.00; 95% CI, 1.16-3.27), major CVD (HR = 1.82; 95% CI, 1.48-2.23), and all-cause mortality (HR = 2.21; 95% CI, 1.51-3.24) for the unhealthy diet group, but not for the healthy diet group. The interaction between depression and diet for the composite outcome was statistically significant (RERI = 1.19; 95% CI, 0.66-1.72; AP = 0.42, 95% CI, 0.27-0.61; SI = 3.30, 95% CI, 1.42-7.66; multiplicative-scale = 1.74 95% CI, 1.27-2.39), even in the subgroup and sensitivity analyses. In addition, the intake of vegetable and polyunsaturated fatty acids contributed most to the interaction of diets and depression. Depressive participants should focus on healthy diets, especially vegetables and polyunsaturated fatty acids, to avoid premature death and CVD.

Self-rated mental health in the transition to adulthood predicts depressive symptoms in midlife

Self-rated mental health (SRMH), a single item asking individuals to evaluate their mental or emotional health, is included in some surveys as an indicator of risk for mental disorders and to monitor population health, yet little longitudinal research examines how well it predicts future outcomes. Following a life course perspective, the current longitudinal study of 502 Canadian high school seniors tracked into midlife examined to what extent SRMH at ages 20, 25, and 32 years predicted depressive symptoms at ages 43 and 50. Hierarchical linear regressions showed that lower SRMH at age 25 and at 32 years was a significant predictor of higher levels of depressive symptoms at ages 43 and 50, even when controlling for sex, participant education, marital/cohabitation status, self-rated physical health, and baseline depressive symptoms. The results provide evidence that SRMH assessed during the transition to adulthood may be useful as a broad and powerful measure of risk for mental health problems decades into the future.

One-year incidence, predictors, and accuracy of prediction of suicidal thoughts and behaviors from the first to second year of university

BACKGROUND

Research is scarce on the prospective predictors of first onset suicidal thoughts and behaviors (STB) and the accuracy of these predictors in university students, particularly in low-and-middle income countries. Therefore, we assessed the 1-year incidence of STB among first-year students, a broad range of prospective predictors of STB incidence, and evaluated the prediction accuracy of a baseline multivariate risk prediction model to identify students at highest risk for STB onset over the subsequent 12 months.

METHODS

Students (n = 3238) from 13 universities in Mexico completed an online survey developed for the World Mental Health International College Student Surveys in their first year and again 12 months after. We ran generalized linear models and receiver operator curves.

RESULTS

The 1-year incidence of suicidal ideation, plan and attempt was 8.53%, 3.75%, and 1.16%, respectively. Predictors in final models were female sex (ideation only), minority sexual orientation (ideation only), depression, eating disorders, ADHD (ideation and plan), ongoing arguments or breakup with a romantic partner (ideation only), emotional abuse (ideation only), parental death (ideation, plan), not Catholic/Christian (ideation, plan), not having someone to rely on, psychotic experiences (plan only), and insufficient sleep (attempt only). Prediction accuracy for ideation, plan and attempt was area under the curve = 0.76, 0.81 and 0.78, respectively. Targeting the top 10% of students at highest risk could reduce STB in the subsequent year up to 36%.

CONCLUSIONS

By assessing these risk/protective factors in incoming students we identified students at greatest risk for developing STB to whom suicide prevention strategies could be targeted.

Trends in medical students' health over 5 years: Does a wellbeing curriculum make a difference?

BACKGROUND

Trends in New Zealand (NZ) medical students' health and the influence of a wellbeing curricula are unknown.

METHODS

The author's collected self-report data from NZ medical students on 'Graduation Day' from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between 'cohorts' of students receiving different exposures to a wellbeing curriculum, and correlations between students' own lifestyle practices and their frequency of talking with patients about those topics.

RESULTS

Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients.

CONCLUSIONS

NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students' self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces

Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions.

The transition to parenthood, opportunity to drink, drinking, and alcohol use disorder

BACKGROUND

This study used life histories from a setting of near universal marriage and childbearing (Nepal) to identify associations between both marital transitions and the transition into parenthood and alcohol use and disorder (AUD).

METHODS

A retrospective, cross-sectional survey using life history calendars documented lifetime marital and childbearing histories of 4876 men and 5742 women aged 15-59 in 2016-18. The clinically validated, Nepal-specific Composite International Diagnostic Interview assessed first alcohol use opportunity, use, and disorder.

RESULTS

Being never married increased the odds of having the opportunity to drink for men (OR=1.30, 95% CI=1.14 - 1.48, p < 0.001) and women (OR=1.24, 95% CI=1.08 - 1.43, p = 0.003) compared to being married. While men were never married, widowed, or divorced they were at a greater risk of developing AUD. The transition to parenthood significantly increased the odds of AUD onset for men (OR=1.71, 95% CI=1.12 - 2.61, p = 0.013), independent of marital transitions. For women in this setting, becoming divorced increased the odds of having their first drink (OR=1.77, 95% CI=1.14 - 2.75, p = 0.011). Giving birth to a first child also increased the odds of first opportunity to drink for women (OR=1.30, 95% CI=1.07 - 1.57, p = 0.008).

CONCLUSIONS

We found associations between marital transitions and AUD that are consistent with findings worldwide. In this setting of near universal childbearing, the transition into fatherhood increased the odds of postpartum AUD among men.

Mental health symptoms 1 year after the COVID-19 outbreak in Spain: The role of pre-existing mental disorders and their type

BACKGROUND

The type of pre-existing disorder might determine changes in mental health symptoms (i.e., anxiety, depression) during the COVID-19 pandemic and influence the effect of psychological factors (e.g., social support, resilience, stress) on such symptoms.

METHODS

Longitudinal data from two assessments (June-2020 and February/March-2021) collected through telephone interviews (Spanish general population) were analysed. Outcome variables included anxiety (GAD-7) and depressive symptoms (PHQ-8). Psychological factors included COVID-perceived stress (adapted COVID-perceived risk scale), social support (OSSS-3), and resilience (CD-RISC). Pre-existing mental conditions (3 groups: mood, anxiety, and comorbid depression+anxiety) were assessed using the CIDI checklist. Changes in anxiety and depressive symptoms between baseline and follow-up were assessed with the paired samples Wilcoxon test. Tobit regression and interaction models were conducted to test associations between psychological factors and these symptoms in follow-up.

RESULTS

Final sample included 1942 participants (mean age 49.6 yrs., ±16.7; 51.7 % females). Anxiety symptoms increased in all groups except for those with pre-existing mood conditions. Depressive symptoms only increased in those without pre-existing mental disorders and in those with pre-existing anxiety. Higher baseline resilience, increases in social support, and decreases in COVID-perceived stress were associated with lower anxiety and depressive symptoms. The type of pre-existing mental disorder did not modify these associations.

LIMITATIONS

Lack of pre-pandemic data and the limited number of pre-existing mental conditions.

CONCLUSIONS

Having pre-pandemic mental disorders is associated with different patterns of anxiety and depressive symptoms during the pandemic. COVID-related stress, social support, and resilience are key factors in improving mental health regardless of the mental diagnosis.

Sleep quality of Singapore residents: findings from the 2016 Singapore mental health study

Given the importance of sleep for physical and mental wellbeing, it is crucial to understand the extent of insomnia among community dwellers. However, there is a paucity of population wide epidemiological studies to estimate the prevalence of poor sleep quality. This present study aimed to 1) characterize the sleep quality of a nationally representative sample (n = 6126) of Singapore residents using Pittsburg Sleep Quality Index (PSQI) and 2) identify the sociodemographic correlates of poor sleep in this population. A total of 27.6% of respondents reported poor sleep quality (PSQI score ≥5). Sociodemographic correlates of poor sleep quality in the Singapore population included, but were not limited to, females (AOR = 1.44, 95% CI = 1.17 to 1.77, p-value = 0.001), Malays (vs Chinese) (AOR = 1.53, 95% CI = 1.23 to 1.9, p-value < 0.001), Indians (vs Chinese) (AOR = 1.22, 95% CI = 1.02 to 1.47, p-value = 0.03), ex-smokers (vs non-smokers) (AOR = 1.43, 95% CI = 1.07 to 1.92, p-value = 0.02), persons with comorbid mental health conditions (vs no mental health conditions) (AOR = 14.11, 95% CI = 6.52 to 30.54, p-value < 0.01), and persons with physical multimorbidity (vs no physical conditions) (AOR = 1.63, 95% CI = 1.24 to 2.15, p-value < 0.001). The prevalence of poor sleep in Singapore is comparable to that of other countries in the Asian region. Targeted public health campaigns to psycho-educate vulnerable groups on the importance of good sleep hygiene may improve the overall wellbeing of residents in Singapore.

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Sleep is important for physical and mental health, however data on population wide prevalence of insomnia is scarce.

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Using the Pittsburgh Sleep Quality Index, we found that 27.6% of this nationally representative sample had poor sleep.

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Sociodemographic correlates of poor sleep quality in our population included females, Malays, Indians, and ex-smokers.

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Persons with comorbid mental health conditions and physical multimorbidity were found to have poor sleep quality.

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Targeted psychoeducation to the relevant subgroups could improve sleep quality of Singapore residents.

Long-term disability in common mental disorders in Chinese community: evidence from a five-year follow-up study

BACKGROUND

Common mental disorders are general term for mental disorders with high disability rates and significant social burden. The purpose of this study was to determine the degree of long-term disability associated with common mental disorders and to interpret the relationship between common mental disorders and long-term disability.

METHODS

Participants in the 2013 China Mental Health Survey were followed up by telephone between April and June 2018. This study evaluated long-term disability over a five-year period using the World Health Organization's Disability Assessment Schedule 2.0. Poisson regression was used to analyze the relationship between common mental disorders and long-term disability.

RESULTS

A total of 6269 patients were followed up by telephone. In patients with common mental disorders, the prevalence of disability ranged from 7.62% to 43.94%. The long-term disabilities were significantly associated with dysthymic disorder (DD, RR:2.40; 95% CI:1.87-3.03), major depressive disorder (MDD, RR:1.63; 95% CI:1.34-1.98), generalized anxiety disorder (GAD, RR:1.95; 95% CI:1.15-3.09), obsessive-compulsive disorder (OCD, RR:1.68; 95% CI:1.24-2.22) and alcohol use disorder (AUD, RR: 1.42; 95% CI:0.99-1.96).

CONCLUSIONS

In China, common mental disorders raise the risk of long-term disability, and there is a critical need for monitoring patients with DD, MDD, GAD, OCD, and AUD. For improved quality of life and reduced disability levels, more resources need to be dedicated to mental health in the future.

Low Resilience Was a Risk Factor of Mental Health Problems during the COVID-19 Pandemic but Not in Individuals Exposed to COVID-19: A Cohort Study in Spanish Adult General Population

BACKGROUND

The aim is to analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults.

METHODS

a longitudinal cohort study was carried out. Resilience was measured with the CD-RISC. Mental health problems that were assessed included: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms.

RESULTS

we found statistically significant differences between groups and resilience scores in MDE [F (3; 48.40) = 19.55], GAD [F (3; 19.63) = 6.45] and STB [F (3; 111.74) = 31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 were not at higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95% CI) = -3.25 (-3.969 to -2.54)], but not for individuals with COVID-19.

CONCLUSIONS

in the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, and not in the population with COVID-19.

How chronic are depressive and anxiety disorders? 9-year general population study using narrow and broad course outcomes

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.

Healthy aging and late-life depression in Europe: Does migration matter?

Background

There is limited research examining the impact of risk and protective factors on late-life depression using large population-based datasets, particularly those examining differences among older migrants and non-migrants in Europe countries. Thus, the first aim was to analyze differences between migrants and non-migrants regarding socioeconomic status, depression, multimorbidity, healthy aging, and lifestyle behaviors. The second aim was to examine the impact of healthy aging on late-life depression in older migrants compared to their counterparts without a history of international migration in extensive and harmonized data from different population-based cohort studies.

Materials and methods

We analyzed cross-sectional, predominantly nationally representative, community-based data from European participants in the Aging Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) cohort. The descriptive analyses included sociodemographic variables, somatic comorbidities, multimorbidity, healthy aging, and lifestyle behaviors according to migration status. The effects of these variables on late-life depression were examined in a multivariate logistic regression model, including migration status and years since migration as predictors.

Results

Data of 122,571 individuals aged ≥ 50 years were analyzed, of which 11,799 (9.60%) were migrants. The descriptive analyses indicated that compared to non-migrants, migrants showed a higher prevalence of diabetes (25.6%), hypertension (38.0%), coronary artery disease (49.4%), stroke (4.9%), and depression (31.1%). Healthy aging was also better in non-migrants (51.7; SD = 9.7) than in migrants (39.6; SD = 18.2). The results of the logistic regression showed that migration status [OR = 1.231 (CIs: 0.914-1.547)] and increased number of years since migration in the host country [OR = 0.003 (CIs: 0.001-0.005)] were associated with greater levels of depressive symptoms. Concerning health variables, multimorbidity was associated with higher levels of depressive symptoms [OR = 0.244 (CIs: 0.211-0.278)], whereas better healthy aging was associated with fewer depressive symptoms [OR = -0.100 (CIs: -0.102 to -0.098)]. The interaction between migration and healthy aging status was also significant [OR. = -0.019 (CIs: -0.025 to -0.014)].

Conclusion

Migrants reported higher risks for worse health outcomes compared to non-migrants. Significantly, worse healthy aging was associated with a greater risk of depressive symptoms in migrants than in non-migrants. Shedding light on migration and aging processes is essential for promoting a cross-cultural understanding of late-life depression in Europe.

Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study

INTRODUCTION

Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs).

METHODS AND ANALYSIS

The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD.

TRIAL REGISTRATION NUMBER

DRKS00025994.

Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys

PURPOSE

Lesbian, gay, and bisexual (LGB) individuals, and LB women specifically, have an increased risk for psychiatric morbidity, theorized to result from stigma-based discrimination. To date, no study has investigated the mental health disparities between LGB and heterosexual AQ1individuals in a large cross-national population-based comparison. The current study addresses this gap by examining differences between LGB and heterosexual participants in 13 cross-national surveys, and by exploring whether these disparities were associated with country-level LGBT acceptance. Since lower social support has been suggested as a mediator of sexual orientation-based differences in psychiatric morbidity, our secondary aim was to examine whether mental health disparities were partially explained by general social support from family and friends.

METHODS

Twelve-month prevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substance disorders was assessed with the WHO Composite International Diagnostic Interview in a general population sample across 13 countries as part of the World Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807 LGB-identified).

RESULTS

Male and female LGB participants were more likely to report any 12-month disorder (OR 2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individual disorders than heterosexual participants. We found no evidence for an association between country-level LGBT acceptance and rates of psychiatric morbidity between LGB and heterosexualAQ2 participants. However, among LB women, the increased risk for mental disorders was partially explained by lower general openness with family, although most of the increased risk remained unexplained.

CONCLUSION

These results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.

The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

OBJECTIVE

Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).

METHOD

A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.

RESULTS

Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.

DISCUSSION

The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.

PUBLIC SIGNIFICANCE STATEMENT

The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

Associations of Social Capital with Mental Disorder Prevalence, Severity, and Comorbidity among U.S. Adolescents

OBJECTIVE

To examine cross-sectional associations between social capital constructs and 1) adolescent lifetime mental disorders, 2) severity of functional impairment, and 3) psychiatric comorbidity.

METHOD

Data were from the National Comorbidity Survey Adolescent Supplement, a nationally representative mental health survey of 6,483 U.S. adolescents aged 13-18 years. Information from fully-structured diagnostic interviews, including adolescent and caregiver reports, was used to measure seven social capital constructs and lifetime DSM-IV mental disorders (mood, anxiety, behavior, substance use and eating disorder classes). Disorder severity was divided into severe vs. mild/moderate. Comorbidity was measured as the number of different classes of lifetime mental disorders.

RESULTS

Adjusted for socio-demographics and caregivers' mental health, the most consistent associations with adolescent mental disorder were for supportive friendships (any disorder OR = 0.95, 95%CI = 0.91-0.99), family cohesion (OR = 0.81, 95%CI = 0.75-0.86), school bonding (OR = 0.76, 95%CI = 0.71-0.81), and extracurricular participation (OR = 0.90, 95%CI = 0.86-0.95), although results differed by disorder class. Caregiver-reported neighborhood trust and reciprocity and caregiver community involvement were less consistently associated with mental disorder. Medium levels of adolescent-reported affiliation with neighbors was associated with lower odds of mood (OR = 0.81, 95%CI = 0.66-0.98) and anxiety (OR = 0.78, 95%CI = 0.64-0.96) disorder, while high levels were associated with higher odds of behavior disorder (OR = 1.47, 95%CI = 1.16-1.87). Several associations were stronger for severe vs. mild/moderate disorder and with increasing comorbidity.

CONCLUSION

Although we cannot infer causality, our findings support the notion that improving actual and/or perceived social capital, especially regarding friendships, family, and school, (e.g., through multimodal interventions) could aid in the prevention and treatment of both individual adolescent mental disorders and psychiatric comorbidity.

Multimorbidity and out-of-pocket expenditure for medicines in China and India

Introduction

Using nationally representative survey data from China and India, this study examined (1) the distribution and patterns of multimorbidity in relation to socioeconomic status and (2) association between multimorbidity and out-of-pocket expenditure (OOPE) for medicines by socioeconomic groups.

Methods

Secondary data analysis of adult population aged 45 years and older from WHO Study on Global Ageing and Adult Health (SAGE) India 2015 (n=7397) and China Health and Retirement Longitudinal Study (CHARLS) 2015 (n=11 570). Log-linear, two-parts, zero-inflated and quantile regression models were performed to assess the association between multimorbidity and OOPE for medicines in both countries. Quantile regression was adopted to assess the observed relationship across OOPE distributions.

Results

Based on 14 (11 self-reported) and 9 (8 self-reported) long-term conditions in the CHARLS and SAGE datasets, respectively, the prevalence of multimorbidity in the adult population aged 45 and older was found to be 63.4% in China and 42.2% in India. Of those with any long-term health condition, 38.6% in China and 20.9% in India had complex multimorbidity. Multimorbidity was significantly associated with higher OOPE for medicines in both countries (p<0.05); an additional physical long-term condition was associated with a 18.8% increase in OOPE for medicine in China (p<0.05) and a 20.9% increase in India (p<0.05). Liver disease was associated with highest increase in OOPE for medicines in China (61.6%) and stroke in India (131.6%). Diabetes had the second largest increase (China: 58.4%, India: 91.6%) in OOPE for medicines in both countries.

Conclusion

Multimorbidity was associated with substantially higher OOPE for medicines in China and India compared with those without multimorbidity. Our findings provide supporting evidence of the need to improve financial protection for populations with an increased burden of chronic diseases in low-income and middle-income countries.

The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys

AIM

Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time.

METHODS

Data come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: "exposure to organised violence"; "participation in organised violence"; "interpersonal violence"; "sexual-relationship violence"; "other life-threatening events"; and those involving loved ones ("network traumas"). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset.

RESULTS

Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years.

CONCLUSION

Sexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.

Social participation and mild cognitive impairment in low- and middle-income countries

Social participation may theoretically decrease risk for mild cognitive impairment (MCI). However, to date, no study has specifically investigated the association between social participation and MCI in LMICs, while the mediating role of loneliness is unknown. Thus, we investigated this association in a sample of adults aged ≥50 years from six low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, South Africa) using nationally representative datasets. We analyzed cross-sectional, community-based data from the Study on Global Ageing and Adult Health. A social participation score (range 0-10 with higher scores corresponding to greater levels of social participation) was created based on nine questions about involvement in community activities in the last 12 months. The National Institute on Ageing-Alzheimer's Association criteria were used to define MCI. Multivariable logistic regression and mediation analysis was performed. The analytical sample consisted of 32,715 individuals aged ≥50 years with preserved functional abilities [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, after adjustment for potential confounders, a one-unit increase in the social participation score was associated with a 13% decrease in odds for MCI (OR = 0.87; 95%CI = 0.82-0.93). Loneliness only explained 3.0% of the association. Greater levels of social participation were associated with a reduced odds for MCI, and this was not largely explained by loneliness. It may be prudent to implement interventions in LMICs to increase levels of social participation to aid in the prevention of MCI and ultimately dementia.

Analysing the role of sleep quality, functional limitation and depressive symptoms in determining life satisfaction among the older Population in India: a moderated mediation approach

Background:

Life satisfaction (LS), a useful construct in the study of psycho-social well-being, is an important indicator of healthy aging. With a view to investigate whether the improved longevity in India is accompanied by commensurate levels of well-being and contentment among the older adults , this study aimed to examine (1) the association between LS and sleep quality among older Indian adults aged 60 years and above (2) the mediating role of depression that accounts for the association and (3) the moderating role of functional limitation in this mediation.

Methods:

Cross-sectional data from the Longitudinal Ageing Study in India (LASI), Wave-1 (2017-18) was used. Pearson’s correlation coefficients were calculated to investigate the pair-wise relationship between sleep quality, depressive symptoms, functional limitation, and LS. Structural Equation Model was employed to analyse the moderated-mediated association between sleep quality and the level of LS.

Results:

Sleep quality had a direct effect (β=-0.12) as well as an indirect effect (β=-0.024) via depressive symptoms on LS, accounting for 83.6 and 16.4 per cent of the total effects, respectively. Also, the interaction term between poor seep quality and functional limitation was positive (β = 0.03, p < 0.001) in determining depressive symptoms, suggesting that higher level of functional limitation aggravated the indirect effect of poor sleep quality on LS.

Conclusion:

The findings of the study suggested that ensuring both the physical as well as the mental well-being of the population during the life course may confer in later life the desired level of life satisfaction.

Adolescent-onset depression is associated with altered social functioning into middle adulthood

Depression during sensitive periods of social development may have consequences that extend well beyond mental health, and far into adulthood. This study compared the social functioning of adults with adolescent-onset depression (ages 10-20) to those with adult-onset depression (ages 21+). Participants were 3,360 adults (67.2% female; ages 42 ± 15) who had experienced major depression. Adult functional outcomes were marital status, divorce, number of children, years of education, employment status, household income, dependency on welfare, and obesity. Participants with depression during adolescence were less likely to get married, have children, and more likely to have lower household incomes. Depression during adolescence may be associated with broader functional outcomes that impact individuals and society, and may be mitigated through intervention and effective policy.

Childhood inhibition predicts adolescent social anxiety: Findings from a longitudinal twin study

An enduring issue in the study of mental health is identifying developmental processes that explain how childhood characteristics progress to maladaptive forms. We examine the role that behavioral inhibition (BI) has on social anxiety (SA) during adolescence in 868 families of twins assessed at ages 8, 13, and 15 years. Multimodal assessments of BI and SA were completed at each phase, with additional measures (e.g., parenting stress) for parents and twins. Analyses were conducted in several steps: first, we used a cross-lagged panel model to demonstrate bidirectional paths between BI and SA; second a biometric Cholesky decomposition showed that both genetic and environmental influences on childhood BI also affect adolescent SA; next, multilevel phenotypic models tested moderation effects between BI and SA. We tested seven potential moderators of the BI to SA prediction in individual models and included only those that emerged as significant in a final conditional model examining predictors of SA. Though several main effects emerged as significant, only parenting stress had a significant interaction with BI to predict SA, highlighting the importance of environmental moderators in models examining temperamental effects on later psychological symptoms. This comprehensive assessment continues to build the prototype for such developmental psychopathology models.

Addictive disorders, psychiatric symptoms, and potentially traumatic events in individuals with disabilities

Background/Objectives

Individuals with disabilities (IWD) have a higher risk of potentially traumatic events (PTEs) either in childhood or adulthood, increasing the risk of suicide attempts, mental disorders, and substance use disorder. The aim of this study was to explore the association between substance use, psychiatric symptoms and suicidal behavior with PTEs. A Multisite cross-sectional study was conducted.

Materials and methods

The sample includes 1,098 participants with any type of disability (motor, intellectual, visual, and mixed) located in Mexico City. Traumatic events, violence, discrimination, addictive disorders, and psychiatric disorders were examined. Multivariate logistic regression models were conducted. Data was collected between September–October 2014.

Results

People with motor or visual disability have a higher prevalence in nicotine use disorder (NUD), generalize anxiety disorder (GAD), mayor depression disorder (MDD), want to be dead, and lifetime suicide attempts. Intellectual disability group only presents GAD and MDD. All disability groups have a high prevalence of PTEs. Verbal violence in childhood, sexual abuse, discrimination and serious accidents had a strong impact in the development of NUD, psychiatric symptoms and suicidal behavior.

Conclusion

These findings show the relevance of develop specific tools for detection, referral and treatment, in order to improve the mental health of people with disabilities.

Assessment of vitamin D levels and adipokines mediated obesity among psychiatric patients on treatment and treatment naïve: A comparative cross-sectional study

Background and aims

Antipsychotic treatment may contribute to low vitamin D levels and have impact on direct anti-inflammatory activity such as adiponectin activity and indirect proinflammatory activity such as leptin and resistin activity. However, vitamin D levels and adipokines mediated effect on weight gain and increased adiposity are not well evaluated. This study, therefore, assessed vitamin D and adipokines-mediated obesity among Ghanaian psychiatric patients.

Methods

This comparative cross-sectional study was conducted at psychiatric unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Anthropometric measurements, sociodemographic and previous medical history were taken from 300 antipsychotics treatment naïve and active patients. Obesity was classified using World Health Organization (WHO) body mass index (BMI)-specific cut-offs. Blood samples were collected for serum vitamin D and adipokines (adiponectin, leptin, and resistin) analysis using enzyme-linked immunosorbent assay. Statistical analyses were done using SPSS version 26.0 and GraphPad Prism version 8.0.

Results

We observed higher prevalence of obesity among treatment active psychiatric patients (40.7%) compared to treatment naïve group (16.8%). Vitamin D insufficiency and deficiency prevalence were significantly higher among the treatment active group (25.3%; 39.5%; p < 0.001) and associated with increased odds of obesity (91.8%; cOR = 91.84, 95% confidence interval [CI]: 24.94-338.13). Moreover, adiponectin (84.2%: cOR = 14.15, 95% CI: 5.52-36.27), leptin (55.6% cOR = 2.20, 95% CI: 1.04-4.67), and resistin (79.4%: cOR = -8.34, 95% CI: 3.39-20.55) were significantly associated with increased odds of obesity among treatment active psychiatric. Furthermore, treatment active psychiatric patients exhibited inverse correlation for adiponectin and leptin with BMI (r = -0.62; -0.24), and WHtR (r = -0.53; -0.24); however, a moderate positive correlation for resistin with BMI (r = 0.80), HC (r = 0.67), and WHtR (r = 0.65).

Conclusion

Obesity is more prevalent in psychiatric patients on antipsychotics such as Olanzapine and Clozapine. Obesity among treatment active psychiatric patients is associated with vitamin D insufficiency and deficiency, low adiponectin and leptin levels but higher resistin level.

The bidirectional relationship between anxiety disorders and alcohol use disorders in adults: Findings from a longitudinal population-based study

BACKGROUND

Anxiety disorders (AD) and alcohol use disorder (AUD) frequently co-occur, but the temporal order of the association is unclear. We have determined the association between AD and the presence and first-onset of AUD, and vice versa.

METHODS

Data were used from n = 6.646 participants and four measurement waves (baseline, 3-, 6- and 9-years) of the Netherlands Mental Health Survey and Incidence Study 2 (NEMESIS-2), a cohort study of the Dutch general population aged 18-64 years. AD and AUD were assessed with the Composite International Diagnostic Interview 3.0. Multilevel logistic autoregressive models were controlled for previous-wave AD or AUD, sociodemographics (Model 1), smoking and clinical factors (Model 2).

RESULTS

People with AUD had a higher risk of present (OR = 1.65, 95 % CI 1.11-2.43; Model 2) and first-onset (OR = 2.03, 95 % CI 1.17-3.51; Model 2) AD in 3-years follow-up intervals than people without AUD. Vice versa, people with AD also had a higher sociodemographics-adjusted risk of present and first-onset AUD over 3-years follow-up intervals, but these associations attenuated into insignificance after adjustment for smoking and clinical variables. Limitations For statistical power reasons we were not able to analyze 9-year follow-up data or distinguish between AD and AUD types.

CONCLUSIONS

Our results indicate a bidirectional relationship between AD and AUD; especially those with severe AD (medication use, comorbid depression) are at risk of developing AUD. Health care professionals should focus on prevention of AD in AUD patients and prevention of AUD in patients with (more severe) AD. Further research should investigate the mechanisms underlying the observed associations.

Association between depression and subjective cognitive complaints in 47 low- and middle-income countries

People with depression and subjective cognitive complaints (SCC) may be at particularly high risk for developing dementia. However, to date, studies on depression and SCC are limited mainly to single high-income countries. Thus, the aim of the present study was to investigate the association between depression and SCC in adults from low- and middle-income countries (LMICs). Cross-sectional, community-based data were analyzed from the World Health Survey. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). ICD-10 Diagnostic Criteria for Research was used for the diagnosis of subsyndromal depression, brief depressive episode, and depressive episode. Multivariable linear regression was conducted to explore the associations. Data on 237,952 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; females 50.8%] were analyzed. After adjustment for potential confounders (age, sex, education, anxiety), compared to no depressive disorder, subsyndromal depression (b-coefficient 7.91; 95%CI = 5.63-10.18), brief depressive episode (b-coefficient 10.37; 95%CI = 8.95-11.78), and depressive episode (b-coefficient 13.57; 95%CI = 12.33-14.81) were significantly associated with higher mean SCC scores. The association was similar in all age groups (i.e., 18-44, 45-64, and ≥65 years), and both males and females. All depression types assessed were associated with worse SCC among adults in 47 LMICs. Future longitudinal studies are needed to investigate whether older people with depression and SCC are at higher risk for dementia onset in LMICs.

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders

OBJECTIVES

Transdiagnostic risk factors-disrupted processes common to psychopathology-link adverse childhood experiences to severe mental disorders (i.e. major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders); however, transdiagnostic protective factors are understudied. The present study investigated the association between a positive mental health framework of protective intra- and interpersonal resources and severe mental disorders in individuals with adverse childhood experiences. We hypothesized that (1) individuals with adverse childhood experiences will experience more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences; (2) intrapersonal (e.g. general coping) and interpersonal resources (e.g. emotional support) will interact to predict severe mental disorders.

METHODS

A total of 1929 adults participated in this population-based study. Participants were assessed for adverse childhood experiences, severe mental disorders, and intra- and interpersonal resources (general coping, general affect, emotional support, interpersonal skills, spirituality, and personal growth and autonomy) via structured interviews and self-reports.

RESULTS

As hypothesized, individuals with adverse childhood experiences (62.6%) experienced more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences. Among those with adverse childhood experiences, emotional support interacted with general coping and general affect to predict severe mental disorders; general coping and general affect were negatively associated with severe mental disorders at high (+1 SD) and low (-1 SD) emotional support, respectively.

CONCLUSIONS

The present study identified interactions between specific intrapersonal (i.e. general coping and general affect) and interpersonal resources (i.e. emotional support); knowing among whom and when to intervene are essential for optimal treatment of adverse childhood experiences and severe mental disorders.

Religious Involvement and DSM-IV Anxiety Disorders Among African-Americans

ABSTRACT

This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.

Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys

PURPOSE

To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample.

METHODS

The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD.

RESULTS

In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders.

CONCLUSIONS

The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

Childhood adversity increases risk of psychotic experiences in patients with substance use disorder

INTRODUCTION

Adverse childhood experiences (ACEs) increase the risk of psychotic experiences (PE), but little is known about heterogeneities of this association in different developmental stages, dimensions, or whether they are affected by substance use disorder (SUD). This study examines the association between different types of ACEs at various developmental stages and lifetime PE in patients with SUD in Chile.

METHODS

We included 399 consenting adults in outpatient or residential SUD treatment programs. Sociodemographic data and information about PE and ACEs were obtained by trained clinical psychologists.

RESULTS

Patients reporting PE experienced more ACEs compared to patients without PE (4.2 versus 3.4). They also experienced more complex adversities (41.8% versus 25.1%), had more psychiatric comorbidities (85% versus 70.4%), and reported using more substances (mean 4.5 versus 3.9). Adjusted association between ACEs and PE showed the highest OR for arrests (1.88), sexual abuse (1.81), alcohol abuse by parents (1.48), school exclusion (1.39), foster or residential care (18.3).

CONCLUSION

Early exposure to ACEs is a risk factor for later PE among patients with SUD. Type of ACE and the period when they occurred is important, suggesting the existence of critical periods where the individual is more susceptible to adverse environmental stimuli.

Do levels of posttraumatic growth vary by type of traumatic event experienced? An analysis of the Nurses' Health Study II

OBJECTIVE

Posttraumatic growth (PTG) has been documented in the aftermath of a range of traumatic events, including bereavement, physical assault, and rape. However, only a handful of studies have examined whether levels of total PTG, as well as the 5 domains of PTG (Appreciation of Life, New Possibilities, Relating to Others, Personal Strength, and Spiritual Change), vary by the type of potentially traumatic event. The current study examined variation in total PTG and PTG domains, as well as posttraumatic stress (PTS), by event type using data from a large epidemiological study.

METHOD

Participants were from a substudy of the Nurses' Health Study 2, an epidemiologic study of female nurses in the United States (N = 1,574).

RESULTS

Controlling for demographic covariates, we found that rape was consistently associated with lower PTG, both total PTG and all five PTG domains, relative to other event types. Other findings were limited to specific PTG domains; for example, intimate partner violence (IPV) was associated with higher Personal Strength and New Possibilities. In contrast, rape and IPV were associated with higher PTS, and the serious illness or injury of someone close with lower PTS, relative to other event types.

CONCLUSION

These results add to the growing literature exploring variation in PTG by event type and suggest that different events could yield markedly different patterns of PTG domains and PTS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts

Social fears arise when fearing to be judged in social events. When these fears are intense, persistent, and debilitating, the individual may suffer from social anxiety disorder (SAD), which has its most frequent onset during adolescence and tends to be chronic. Still, evidence on the prevalence of social fears and SAD in adolescence is scarce. This study analyzed the prevalence of social fears and of SAD in Portuguese adolescents. Of the initial sample (n = 1495), 26% presented with intense self-reported social fears. Of those, 53.9% accepted to be further assessed for diagnosis, resulting in a point-estimate prevalence of adolescent SAD of 9.4%; this is slightly higher than previously found. Social performance was the most feared social event. Of the adolescents with SAD, 12.9% were receiving psychological intervention, 12.1% refused intervention, and 92 (65.7%) accepted intervention. Findings confirm SAD as a highly prevalent mental disorder among adolescents, particularly girls, and additionally, that most of these adolescents did not seek treatment but are willing to receive help if made available. Hence, schools should be invested not only in identifying vulnerable adolescents but also in providing diverse intervention options, tailored to their needs, and directing them to successful developmental trajectories.

Gender Differences in Alcohol Use: a Nationwide Study in a Multiethnic Population

The increase in alcohol consumption, and the greater consequences of chronic alcohol use among females, as well as the convergence of the gender gap warrants investigation. This paper aims to uncover gender differences in individuals with alcohol use disorder (AUD) in Singapore. The SMHS 2016 was a population-based, cross-sectional, epidemiological study. Recruitment spanned from August 2016 to March 2018, where 6126 respondents were recruited. Similarly to global estimates, lifetime prevalence and 12-month prevalence for AUD were higher in males than females. However, females had a higher prevalence of obsessive–compulsive disorder (OCD) co-morbidity than males. Women also had an earlier onset and age of recovery of AUD than men. Alarmingly, male (94.14%) and female (100%) respondents reported low help-seeking for their AUD. Gender differences in individuals with AUD were identified in Singapore population. Future research should direct its effort to identify barriers to help-seeking for individuals with alcohol use disorder.

Pharmacological interventions for the treatment of disordered and problem gambling

BACKGROUND

Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling.

OBJECTIVES

The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other.  SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022).

SELECTION CRITERIA

We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract).

MAIN RESULTS

We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks.  Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%).

AUTHORS' CONCLUSIONS

This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.

Association between sarcopenia and quality of life among adults aged ≥ 65 years from low- and middle-income countries

BACKGROUND

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce.

AIMS

To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs.

METHODS

Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted.

RESULTS

Data on 14,585 people aged ≥ 65 years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant - 3.37 points [95% CI - 5.56, - 1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL.

DISCUSSION

The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia.

CONCLUSIONS

In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

Intergenerational transmission of psychopathology: An examination of symptom severity and directionality

The present study examined the intergenerational transmission of internalizing and externalizing symptom severity, which indexes comorbidity, and symptom directionality, which indicates differentiation toward externalizing versus internalizing problems. Data are from 854 male and female, same-sex adult twin pairs born between 1926 and 1971 (32-60 years old, M = 44.9 years, SD = 4.9 years) from the Twin and Offspring Study in Sweden and their adolescent offspring (11-22 years old, M = 15.7 years, SD = 2.4 years, 52% female). Children-of-twins models revealed additive (9%) and dominant (45%) genetic and nonshared environmental (47%) influences on twins' symptom severity, and additive genetic (39%) and nonshared environmental (61%) influences on twins' symptom directionality. Both comorbid problems and preponderance of symptoms of a particular - internalizing versus externalizing - spectrum were correlated across parent and child generations, although associations were modest especially for directionality (i.e., transmission of specific symptom type). By interpreting findings alongside a recent study of adolescent twins, we demonstrate that the intergenerational transmission of symptom severity and symptom directionality are both unlikely to be attributable to genetic transmission, are both likely to be influenced by direct phenotypic transmission and/or nonpassive rGE, and the intergenerational transmission of symptom severity is also likely to be influenced by passive rGE.

The effect of polluting cooking fuels on depression among older adults in six low- and middle-income countries

BACKGROUND

Little is known about the association between polluting cooking fuel and depression among older adults living in low- and middle-income countries (LMICs).

OBJECTIVE

To evaluate the association between polluting cooking fuel and depression in older population of LMICs.

METHODS

We derived data from WHO Study on global AGEing and adult health (SAGE), which was conducted in six LMICs including China, India, Ghana, South Africa, Mexico and Russia. We applied logistic regression with the propensity score method to examine the relationship of polluting cooking fuel and depression among adults ≥50 years old.

RESULTS

Overall, the odds ratio (OR) of depression was 1.57 [95% confidence intervals (CIs), 1.26-1.93] for older adults relying on polluting cooking fuel in six LMICs. In India and China, polluting cooking fuel was associated with depression with ORs of 2.06 (95%CI, 1.44-2.94) and 1.59 (95%CI, 1.01-2.49), respectively. Positive OR of depression was identified for those polluting cooking fuel users aged over 65 years old (OR, 1.65; 95%CI,1.16-2.36) and those aged 50-65 (OR, 1.50; 95%CI,1.14-1.97). Polluting cooking fuel was associated with depression for females (OR, 1.80; 95%CI, 1.32-2.46), however we did not observe significant association for males. Positive effect of polluting cooking fuel was identified in both rural (OR, 1.72; 95%CI, 1.26-2.34) and urban areas (OR, 1.44; 95%CI, 1.07-1.95). For individuals relying on solid fuel, cooking in a room used for living/sleeping and using open stove/fire was associated with depression with ORs of 1.30 (95%CI, 1.14-1.48) and 1.15 (95%CI, 1.01-1.31), respectively. However, no significant effect was identified for hood.

CONCLUSION

Polluting cooking fuel was related to depressive symptoms among older adults in LMICs. In addition, cooking ventilation could be useful intervention to control health hazard of solid fuel.

“Degrees of Freedom”: Comparing Mental Distress of Populations with Different Levels of Access to Care-Prisoners, Psychiatric Patients and General Population

Objectives: The study presents an analysis of the risk for common mental disorders (CMDs) in populations with different levels of access to mental health care. Methods: We merged and statistically compared the representative data of prisoners to data collected from psychiatric clinics and the general population. Participants across all samples completed the General Health Questionnaire. Results: More than half of the inmates met the criteria for CMDs, while rates were 25% in the general population and 80% among psychiatric patients. The odds of prisoners being five times more likely to meet the criteria for CMDs were five times higher than the odds of the general population while controlling for demographic variables. Conclusions: The study highlights the need for prisoners for mental health services. Prisoners face stressful life conditions before and during incarceration while having limited access to medical and psychological treatment stresses the need for systemic interventions.

ADHD Symptoms as a Stressor Leading to Depressive Symptoms among University Students: The Mediating Role of Perceived Stress between ADHD and Depression

Attention deficit hyperactivity disorder (ADHD) is a condition manifested in childhood and includes symptoms, such as attention deficit, impulsivity, difficulty in concentrating, hyperactivity, and aggressive behavior. Along with the negative effects of ADHD symptoms on individuals, various psychological factors are thought to be associated with these symptoms. However, ADHD in emerging adulthood is not rare and can be conceived as the continuation of discomfort that might emerge during childhood and adolescence. Our mediation study involved 613 undergraduate students in İstanbul. The participants filled out demographic information forms: Adult Attention Deficit and Hyperactivity Disorder Self-Reported Scale (ASRS), Perceived Stress Scale and Beck Depression Inventory (BDI). Our work stressed those positive correlations found among ASRS, Perceived Stress Scale, and BDI scores. Analysis by Model 4 of Hayes Process Macro and Sobel tests showed that ADHD symptoms predicted both perceived stress and depression scores of the participants and dimensions of perceived stress acted as partial mediators in the positive relationship between ADHD and depression scores.

Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative

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.

Early menarche and adult major depressive disorder among Japanese women: The role of childhood traumatic experience and socioeconomic conditions in young adulthood

Aim

The aim of this study is to examine the long-term impact of early menarche with adult depression, and to assess whether this association was explained by childhood traumatic experience and socioeconomic condition in early adulthood.

Methods

The data were derived from World Mental Health Survey Japan Second, a cross-sectional survey conducted among Japanese community residents between 2013 and 2015. We used the data of female respondents aged 20-75 years (N = 1171). Hazard ratio (HR) of the onset of major depression up to 40 years was calculated for an early-menarche group and a non-early-menarche group, respectively. Kaplan-Meier curve and log-rank statistics were used to examine the difference in failure. Cox proportional hazard models were administered for the association of major depression with early-menarche and early-life psychosocial factors.

Results

Risk for major depressive disorders were three to four times higher in an early-menarche group, and the differences in survival functions were significant (p < 0.001). HR of early menarche was 2.79 (95% CI = 1.29-6.02), and was slightly changed when childhood traumatic experience and socioeconomic conditions in young adulthood were added in the model (HR = 2.88, 95% CI = 1.30-6.38; HR = 3.19, 95% CI = 1.41-7.21).

Conclusion

Early menarche was significantly associated with increased risk for depression by the age of 40 years. Childhood trauma and socioeconomic hardship in early adulthood did not account for the association. Both physical and psychosocial risk factors in early life need to be addressed for preventing women's depression.

Psychological distress is independently related to new coronary events at 8 years' follow-up in elderly primary care patients with hypertension

OBJECTIVE

Occurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality.

METHODS

A prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60-85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems.

RESULTS

Among the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04-1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08-1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality.

CONCLUSION

In a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality.

The Mediating Roles of Mental Health and Substance Use on Suicidal Behavior Among Undergraduate Students With ADHD

OBJECTIVE

To evaluate the prevalence of suicidal ideation (SI), plans and attempts, and non-suicidal self-injury (NSSI) among students with attention deficit hyperactivity disorder (ADHD). Furthermore, we explored the mediating effects of depression, anxiety, alcohol and substance use on the association between ADHD and suicidal behaviors and NSSI.

METHOD

Participants were first-year undergraduate students (n = 1,829) recruited as part of the World Mental Health International College Student Initiative. Participants completed validated clinical measures online.

RESULTS

The prevalence of suicide behaviors and NSSI were significantly higher among students with ADHD than those without. Mediation analyses indicated that ADHD directly and indirectly increased suicidal behaviors and NSSI. While ADHD increased suicidal behaviors and NSSI through depression, ADHD and the co-variates age and gender also had indirect effects on suicidal behaviors via substance use.

CONCLUSIONS

Specific predictors of risk were identified for students with ADHD which may inform the development of more targeted mental health and suicide prevention strategies across campuses.

Adverse childhood experiences and positive psychotic symptoms: A nationally representative study in Singapore

BACKGROUND

Epidemiological studies show that adverse childhood experiences (ACE) are associated with positive psychotic symptoms in Western populations; however, there is a lack of population-based data in multi-ethnic, Asian societies.

OBJECTIVE

We investigated the associations between ACE (type and dosage) and positive psychotic symptoms in a nationally representative study in Singapore.

PARTICIPANTS AND SETTING

A total of 4441 adult Singapore residents were recruited via door-to-door surveys; they were assessed for ACE and positive psychotic symptoms (i.e., hallucinations, delusions, thought insertion, thought control, and telepathic powers) on structured interviews.

METHODS

Lifetime experiences of positive psychotic symptoms were regressed on (1) the experience of any ACE; (2) cumulative ACE; and (3) the experience of either no ACE, interpersonal victimization only, dysfunctional home environments only, neglect only or multiple exposures to ACE in weighted and adjusted regression models.

RESULTS

5.2 % of the sample experienced positive psychotic symptoms during their lifetime. Individuals exposed to dysfunctional home environments (OR = 2.84, 95 % CI 1.26 to 6.37) and multiple adverse childhood experiences (OR = 3.31, 95 % CI 2.18 to 5.01) were at an elevated risk of experiencing positive psychotic symptoms. The exposure to three or more ACE was associated with a near five-fold higher risk of experiencing positive psychotic symptoms (OR = 4.51, 95 % CI 2.89 to 7.05).

CONCLUSIONS

Individuals exposed to dysfunctional home environments or multiple adverse childhood experiences are at an elevated risk of experiencing positive psychotic symptoms. Given the intrafamilial nature of these childhood adversities, dual-generation approaches and family-centered interventions are key.