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Abstract
Alcohol dependence and major depression commonly occur together; however, few studies have assessed prospectively the magnitude of the risk that one disorder imparts on the subsequent occurrence of the other. We used data from the first two waves of the Epidemiologic Catchment Area community survey (n=14480) to estimate the odds of either major depression or alcohol dependence being followed by the other disorder after 1 year of follow-up. The odds of developing major depression associated with low, medium, and high levels of alcoholic symptoms at baseline were 1.66, 3.98, and 4.32 for females (P<0.001), and 1.19, 2.49, and 2.12 for males (P=0.026). Conversely, odds ratios indicating the 1-year follow-up risk of incident alcohol dependence within low, medium, and high categories of baseline depressive symptomatology were 2.75, 3.52, and 7.88 for females (P<0.001) and 1.50, 1.41, and 1.05 for males (P=0.091). Individuals with alcohol dependence appeared more likely to meet lifetime diagnostic criteria for both disorders after 1 year than individuals with depression. These results suggest that both alcohol dependence and major depression pose a significant risk for the development of the other disorder at 1 year.
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Affiliation(s)
- S E Gilman
- Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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202
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Goldney RD, Fisher LJ, Wilson DH. Mental health literacy: an impediment to the optimum treatment of major depression in the community. J Affect Disord 2001; 64:277-84. [PMID: 11313096 DOI: 10.1016/s0165-0327(00)00227-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mental health literacy refers to the knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This study examined the mental health literacy and experience of depression in a random and representative community population. METHODS The experience of depression and mental health literacy of 3010 subjects from a random and representative population were determined on the basis of responses to the mood module of the PRIME-MD and questions about a vignette of a person with features of major depression. RESULTS Those with major depression had significantly more personal experience of depression than those with other depressions and those who were not depressed, but there were few significant differences between the groups in terms of mental health literacy. Of those with major depression, 40% considered anti-depressants helpful, but 40% also considered they were harmful. CONCLUSIONS There is a considerable impediment to the recognition and management of major depression and a need for further community education programs.
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Affiliation(s)
- R D Goldney
- Department of Psychiatry, University of Adelaide, The Adelaide Clinic, 33 Park Terrace, SA 5081, Gilberton, Australia.
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203
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Snowdon J, Lane F. The prevalence and outcome of depression and dementia in Botany's elderly population. Int J Geriatr Psychiatry 2001; 16:293-9. [PMID: 11288164 DOI: 10.1002/gps.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Large epidemiological studies of adult populations have reported depression to be less prevalent in old age than among younger adults, whereas studies limited to older persons have reported rates that vary considerably, some showing high rates of depression. There was, therefore, reason to check data from a study that reported high rates, and to review evidence in relation to diagnosis and outcome. METHOD Re-examination of data from a 1985 survey of elderly people living at home (n = 146). Depression and cognitive impairment were also assessed in a local hostel (n = 42) and nursing home (n = 74). DSM diagnoses were made by an old age psychiatrist. In the nursing home, 23 other residents could not respond to interview questions but were considered to have severe dementia. Subjects in all three settings were followed up after 4 years. RESULTS Seven community subjects (4.5%; confidence interval 1.3-8.3%) and three in residential care fulfilled criteria for major depression. The estimated total prevalence of depressive disorders among elderly in Botany was between 13.0 and 13.6% (4.6% major depression, 3.6% dementia with depression, 5.4% other depressive disorders). In 1985, the prevalence of dementia among those living at home was 11%. Four-year mortality in the dementia cases was 60%. CONCLUSIONS Botany has a high prevalence of dementia and depression among elderly people. The recent cross-age. Australian study of mental health and well-being provided an inaccurate report concerning the pattern of mental disorders in old age.
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Affiliation(s)
- J Snowdon
- Central Sydney Psychogeriatric Service and Department of Psychological Medicine, University of Sydney, NSW, Australia.
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204
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Abstract
BACKGROUND Despite a growing number of studies of patients' health values (utilities), little is known about health values of patients with mental illness, particularly bipolar (manic-depressive) disorder. METHODS We administered a computerized rating scale, time tradeoff, and standard gamble to 53 patients. Patients were asked to rate or value their current state of health overall and then their current mental health. In addition, we administered the SF-36; Inventory of Depressive Symptoms (IDS-C); Positive and Negative Syndrome Scale (PANSS); Young Mania Rating Scale (YMRS); and Global Assessment of Functioning Scale. RESULTS The patients' median (25th, 75th percentile) age was 43 (37, 50); 62% were female. Mean (+/- SD) health ratings for current overall health were 68.0 (+/- 20.3) vs. 61.0 (+/- 25.7) for current mental health (p-value for difference = 0.02). On the time tradeoff, scores for current overall health averaged 0.71 (+/- 0.37) vs. 0.61 (+/- 0.39) for current mental health (p = 0.02); on the standard gamble, mean scores were 0.77 (+/- 0.32) for current overall health vs. 0.70 (+/- 0.35) for current mental health (p = 0.11). In univariate analyses, rating scale, time-tradeoff, and standard gamble scores for both current overall health and for current mental health were correlated with the SF-36 and all psychiatric scale (magnitude of r = 0.22-0.76) except the YMRS (magnitude of r < or = 0.13). In multivariable analyses, health values for current overall health were related to factors different from those that were related to health values for current mental health (R2 = 0.38-0.65), and none of the health value measures was related to the YMRS. CONCLUSION Health values of patients with bipolar disorder are higher for their current health overall than for their current state of mental health. Health values are related to certain health status attributes and to level of depression but perhaps not to level of mania.
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Affiliation(s)
- J Tsevat
- Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
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205
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Cochran SD, Keenan C, Schober C, Mays VM. Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population. J Consult Clin Psychol 2001. [PMID: 11142540 DOI: 10.1037//0022-006x.68.6.1062] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.
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Affiliation(s)
- S D Cochran
- Department of Epidemiology, University of California, School of Public Health, Los Angeles 90095-1772, USA.
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206
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Goldney RD, Fisher LJ, Wilson DH, Cheok F. Major depression and its associated morbidity and quality of life in a random, representative Australian community sample. Aust N Z J Psychiatry 2000; 34:1022-9. [PMID: 11127612 DOI: 10.1080/000486700279] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study is to describe health services utilisation and morbidity, including health-related quality of life, in those with major depression in a random and representative sample of the population. METHOD Data were gathered in a Health Omnibus Survey of the South Australian population. Major depression was delineated on the basis of responses to the Primary Care Evaluation of Mental Disorders. Information about use of health services and absence from usual functioning was collated, and two measures of health-related quality of life, the Short-form Health Status Questionnaire and the Assessment of Quality of Life were also administered. Results of those with major depression were compared with those who had other depressive syndromes and those who had no depression. RESULTS Those with major depression reported significantly greater use of all health services and poorer functioning in terms of carrying out their normal duties. Similarly, their health-related quality of life was significantly poorer than those with other depressive syndromes, which in turn was significantly poorer than those who were not depressed. Only one-fifth of those with major depression were currently taking antidepressants. CONCLUSIONS These results are consistent with international studies. In addition to the potential for alleviating the depressive symptomatology of individuals, it is evident that even a modest improvement in functioning with appropriate treatment would have the potential to benefit the Australian community by one billion dollars a year.
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Affiliation(s)
- R D Goldney
- Department of Psychiatry, The University of Adelaide, The Adelaide Clinic, Gilberton, South Australia, Australia.
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207
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Civic D, Holt VL. Maternal depressive symptoms and child behavior problems in a nationally representative normal birthweight sample. Matern Child Health J 2000; 4:215-21. [PMID: 11272341 DOI: 10.1023/a:1026667720478] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the association between maternal depressive symptoms and child behavior problems in a nationally representative sample of U.S. mothers of normal birthweight babies. METHODS We analyzed data from the 1988 National Maternal and Infant Health Survey (NMIHS) and a 1991 follow-up survey. Depressive symptoms were measured at both surveys using the CES-D, and child behavior problems were assessed by maternal self-report at follow-up. RESULTS Approximately 28% of the 5303 mothers reported depressive symptoms at a mean of 17 months after delivery, as did 20% at 36 months. In multivariate analyses, women with depressive symptoms at either or both surveys were significantly more likely than women without depressive symptoms to report that their children had frequent temper tantrums or difficulty getting along with other children, and were difficult to manage, unhappy, or fearful. Compared to women without depressive symptoms, the risks of reporting three out of the five child behavior problems for women with depressive symptoms were OR = 1.6 (CI = 1.1-2.1), 1988 only; OR = 2.3 (CI = 1.6-3.3), 1991 only; and OR = 3.6 (2.6-5.0), both 1988 and 1991. CONCLUSIONS Study findings indicate that a substantial proportion of mothers of young children in the United States experience depressive symptoms and that their children are at significantly increased risk of maternally reported behavior problems. Our results suggest that efforts to identify and treat depression in new mothers should be increased and that mothers whose children are found to have behavior problems should be assessed for depression.
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Affiliation(s)
- D Civic
- School of Social Work. University of Washington, Seattle, USA
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208
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Cochran SD, Keenan C, Schober C, Mays VM. Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population. J Consult Clin Psychol 2000; 68:1062-71. [PMID: 11142540 PMCID: PMC4197972 DOI: 10.1037/0022-006x.68.6.1062] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.
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Affiliation(s)
- S D Cochran
- Department of Epidemiology, University of California, School of Public Health, Los Angeles 90095-1772, USA.
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209
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King RD, Gaines LS, Lambert EW, Summerfelt WT, Bickman L. The co-occurrence of psychiatric and substance use diagnoses in adolescents in different service systems: frequency, recognition, cost, and outcomes. J Behav Health Serv Res 2000; 27:417-30. [PMID: 11070635 DOI: 10.1007/bf02287823] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The frequency, severity, recognition, cost, and outcomes of adolescent substance use comorbidity were analyzed in the Fort Bragg Demonstration Project. Comorbidity was defined as the co-occurrence of substance use disorder (SUD) with other psychiatric diagnosis. The sample consisted of 428 adolescent clients whose providers' diagnoses were compared with research diagnoses. The project identified 59 clients (13.8%) with SUD, all with additional psychiatric diagnoses. Providers recognized only 21 of these 59 comorbid cases. The frequency and severity of comorbidity did not differ between service system samples, although recognition did. Comorbid clients had more behavior problems and more functioning impairment, and their average treatment cost ($29,057) was more than twice as high as that of noncomorbid clients ($13,067). Mental health outcomes were not influenced by type of service system, comorbid diagnosis, or treatment. Screening for and prevention of SUD are discussed as a potential cost-savings opportunity in mental health services.
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Affiliation(s)
- R D King
- Vanderbilt Institute for Public Policy Studies, Nashville, TN 37212, USA.
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210
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Iwamasa GY, Larrabee AL, Merritt RD. Are personality disorder criteria ethnically biased? A card-sort analysis. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2000; 6:284-296. [PMID: 10938636 DOI: 10.1037/1099-9809.6.3.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
On the basis of methodology used in previous research on sex criterion bias, this study examined ethnicity criterion bias of personality disorders (PDs) defined in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Rev.) and included examination of sex as well as ethnicity. A card-sort analysis using undergraduate college students as sorters indicated that criteria for all of the PDs were applied disproportionately by ethnicity, resulting in particular ethnic groups receiving diagnoses for specific PDs. Criteria were sorted systematically such that diagnoses of antisocial and paranoid PDs were assigned to African Americans, schizoid PD was assigned to Asian Americans, and schizotypal PD was assigned to Native Americans. All other PDs were assigned to European Americans, whereas none of the criteria were sorted resulting in any PD diagnosis being applied to Latinos. Implications for clinicians, methodological considerations, and recommendations for future research are discussed.
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Affiliation(s)
- G Y Iwamasa
- Department of Psychology, Oklahoma State University, USA.
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211
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Greenberg BD, Li Q, Lucas FR, Hu S, Sirota LA, Benjamin J, Lesch KP, Hamer D, Murphy DL. Association between the serotonin transporter promoter polymorphism and personality traits in a primarily female population sample. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 96:202-16. [PMID: 10893498 DOI: 10.1002/(sici)1096-8628(20000403)96:2<202::aid-ajmg16>3.0.co;2-j] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The serotonin transporter (5-HTT) regulates serotonergic neurotransmission and is thought to influence emotion. A 5-HTT-linked polymorphic region (5-HTTLPR) has two common variants, short (s) and long (l). We previously found population and within-family associations between the lower-expressing s allele and neuroticism, a trait related to anxiety, hostility, and depression, on a standard measure (the NEO Personality Inventory, Revised [NEO-PI-R]) in a primarily male population (n=505), and that the s allele was dominant. We investigated this association in a new sample (n=397, 84% female, primarily sib-pairs). The results robustly replicated the 5-HTTLPR neuroticism association, and the dominance of the s allele. Combined data from the two studies (n=902) showed a highly significant association between the s allele and higher NEO Neuroticism both across individuals and within families. Association between genotype and a related measure, Anxiety on the 16PF inventory, was replicated in the new population and within families in the combined sample. Association to another trait, estimated TPQ Harm Avoidance, was not replicated in the new sample but found only within the combined sibship group. Another association found in our original study, between the s allele and lower scores on NEO-PI-R Agreeableness, was also replicated and was more robust in the current and the combined samples. Associations between the functional 5-HTTLPR polymorphism were similar in women and men. These results help to define specific personality features reproducibly associated with 5-HTTLPR genotype. Such associations were strongest for traits defined by the NEO, enhancing the attractiveness of the five-factor personality model in genetic research on complex behavioral dimensions. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:202-216, 2000. Published 2000 Wiley-Liss, Inc.
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Affiliation(s)
- B D Greenberg
- Laboratory of Clinical Science, National Institutes of Mental Health, Bethesda, Maryland 20892-1264, USA.
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212
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Cochran SD, Mays VM. Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. Am J Epidemiol 2000; 151:516-23. [PMID: 10707921 PMCID: PMC3698226 DOI: 10.1093/oxfordjournals.aje.a010238] [Citation(s) in RCA: 255] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services.
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Affiliation(s)
- S D Cochran
- Department of Epidemiology, School of Public Health, University of California, Los Angeles 90095-1772, USA
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213
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Abstract
The common mental disorders, mainly anxiety and depression, constitute a major public health problem, incurring considerable costs in terms of use of health services and time lost from work. Risk factors include low socioeconomic status, poverty and poor housing, as well as stressful life events and difficulties such as demanding child care, separation or divorce, bereavement, loss of employment and caring for a dependant relative. Population approaches are probably necessary to reduce significantly the burden of such mental health problems, but health care measures are far from negligible. Primary care professionals have regular opportunities to identify people at risk of mental health problems and refer them to welfare and social support services (primary prevention). A number of interventions among high-risk groups have been shown to be effective, including problem-solving training and cognitive-behavioural approaches. The most important tasks in primary care are to identify people with depression, alcohol and drug misuse and eating disorders as early as possible in the course of their illness and to institute effective treatment (secondary prevention). Primary care teams should also join in shared care arrangements for patients with chronic disabling mental illnesses, in order to prevent recurrences and relapses (tertiary prevention).
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214
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Pasacreta JV, Minarik PA, Cataldo J, Muller B, Scahill L. Role diversification in the education of advanced practice psychiatric nurses. Arch Psychiatr Nurs 1999; 13:248-60. [PMID: 10565058 DOI: 10.1016/s0883-9417(99)80035-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The mode, location, and focus of health care services are changing rapidly, especially delivery of psychiatric services. The high prevalence of psychiatric and medical comorbidity, the national shift in health care to a managed care arrangement with one professional designated as principle provider, and problems with access to comprehensive services for individuals with psychiatric problems interact to create a compelling need for a clear definition of advanced psychiatric-mental health nursing practice. This article is, in part, a response to the national dialogue and debate sparked by the beginning development of a psychiatric nurse practitioner certification exam. However, this debate will be used merely as a starting point to articulate and document the need for a flexible, diverse, and evolving definition of advanced psychiatric-mental health nursing practice that can inform and shape educational programs in the discipline.
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Affiliation(s)
- J V Pasacreta
- Yale University School of Nursing, Yale University, New Haven, CT, 06536 USA
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215
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Goeree R, O'Brien BJ, Goering P, Blackhouse G, Agro K, Rhodes A, Watson J. The economic burden of schizophrenia in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1999; 44:464-72. [PMID: 10389607 DOI: 10.1177/070674379904400506] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the financial burden of schizophrenia in Canada in 1996. METHOD Using a prevalence-based approach, all direct health care costs, administrative costs of income assistance plans, and costs of incarceration attributable to schizophrenia were determined. Also included was the value of lost productivity associated with premature mortality and morbidity. In addition to using published papers and documents, direct contact was made with representatives from various provincial and federal programs for estimates of the direct health care and non-health care costs. RESULTS The estimated number of persons with schizophrenia in Canada in 1996 was 221,000, with equal distribution between males and females. The direct health care and non-health care cost was estimated to be $1.12 billion in 1996. In addition, another $1.23 billion in lost productivity associated with morbidity and premature mortality was attributable to schizophrenia. CONCLUSIONS The total financial burden of schizophrenia in Canada was estimated to be $2.35 billion in 1996. The largest category of cost was morbidity (52%), followed by acute care and psychiatric hospital admissions (14% and 10% respectively). Given the magnitude of these cost estimates, there are large potential cost savings with more effective management and control of this debilitating disease.
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Affiliation(s)
- R Goeree
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
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216
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Rhodes A, Goering P. Gender differences in the use of outpatient mental health services. JOURNAL OF MENTAL HEALTH ADMINISTRATION 1999; 21:338-46. [PMID: 10138008 DOI: 10.1007/bf02521353] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Current economic constraints necessitate careful planning and evaluation of mental health services. Gender differences in need and use of outpatient mental health services are synthesized based on current epidemiological research. Although overall prevalence rates of mental disorder are similar, women use more outpatient mental health services than do men. This disparity exists largely within the primary care sector. The study of social roles and behavior may help explain these gender differences. Implications for planning and organizing outpatient mental health services are discussed.
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Affiliation(s)
- A Rhodes
- Clarke Institute of Psychiatry, University of Toronto, Ontario
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217
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Abstract
OBJECTIVE Most older people with psychiatric disorders are never treated by mental health specialists, although they visit their primary care physicians regularly. There are no published studies describing the broad array of psychiatric disorders in such patients using validated diagnostic instruments. We therefore characterized Axis I psychiatric diagnoses among older patients seen in primary care. DESIGN Survey of psychopathology using standardized diagnostic methods. SETTING The private practices of three board-certified general internists, and a free-standing family medicine clinic. PARTICIPANTS All patients aged 60 years or older who gave informed consent were eligible. MEASUREMENTS AND MAIN RESULTS For the 224 subjects completing the study, psychiatric diagnoses were based on the Structured Clinical Interview for DSM-III-R. Point prevalence estimates used weighted averages based on the stratified sampling method. For the combined sites, 31.7% of the patients had at least one active psychiatric diagnosis. Prevalent current disorders included major depression (6.5%), minor depression (5.2%), dementia (5.0%), alcohol abuse or dependence (2. 3%), and psychotic disorders (2.0%). Dysthymic disorder and primary anxiety and somatoform disorders were less common and frequently comorbid with major depression. CONCLUSIONS Mental disorders, particularly depression, are common among older persons seen in these primary care settings. Clinicians should be particularly vigilant about depression when evaluating older patients with anxiety or putative somatoform symptoms, given the relatively low prevalences of primary anxiety and somatoform disorders.
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Affiliation(s)
- J M Lyness
- Program in Geriatrics and Neuropsychiatry, Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
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218
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219
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Weich S, Lewis G. Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain. J Epidemiol Community Health 1998; 52:8-14. [PMID: 9604035 PMCID: PMC1756605 DOI: 10.1136/jech.52.1.8] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To test the hypothesis that poor material standard of living is independently associated with the prevalence of the common mental disorders after adjusting for occupational social class, and to estimate the population impact of poor material standard of living on the prevalence of these disorders. DESIGN Cross sectional survey. Prevalence of the common mental disorders was assessed using the General Health Questionnaire, a self administered measure of psychiatric morbidity. PARTICIPANTS 9064 adults aged 16-75 living in private households in England, Wales, and Scotland. MAIN RESULTS The common mental disorders were significantly associated with poor material standard of living, including low household income (OR 1.24, 95% CI 1.00, 1.54) and not saving from income (OR 1.29, 95% CI 1.15, 1.45), after adjusting for occupational social class and other potential confounders. An independent association was also found with occupational social class of the head of household among women, but not men, after adjusting for material standard of living. The adjusted population attributable fraction for poor material standard of living (using a five item index) was 24.0%. CONCLUSIONS Like mortality and physical morbidity, common mental disorders are associated with a poor material standard of living, independent of occupational social class. These findings support the view that recent widening of inequalities in material standards of living in the United Kingdom pose a substantial threat to health.
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Affiliation(s)
- S Weich
- Department of Psychiatry, Royal Free Hospital, School of Medicine, London
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220
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Reijneveld SA, Schene AH. Higher prevalence of mental disorders in socioeconomically deprived urban areas in The Netherlands: community or personal disadvantage? J Epidemiol Community Health 1998; 52:2-7. [PMID: 9604034 PMCID: PMC1756606 DOI: 10.1136/jech.52.1.2] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Major mental disorders occur more frequently in deprived urban areas. This study examines whether this occurs for all mental disorders, including less serious ones. It further assesses whether such a concentration can be explained by the socioeconomic status (SES) of the residents concerned or that a cumulation of problems in deprived areas reinforces their occurrence. DESIGN Mental disorders were assessed by means of the General Health Questionnaire (GHQ) among 4892 residents. Additional data were obtained on area deprivation, and on individual SES. Multilevel logistic regression models were used to take the hierarchical structure of the data into account, residents being nested in boroughs. SETTING General population of the city of Amsterdam, the Netherlands. MAIN OUTCOME MEASURE Prevalence of an increased (> or = 2) score on the GHQ, 12 item version. RESULTS Mental disorders occur more frequently in deprived areas but this can be explained by the lower SES of the residents concerned. CONCLUSIONS The cumulation of mental disorders in deprived urban areas is mainly a result of a concentration of low SES people in these areas. Contextual factors of deprived urban areas give hardly any additional risk above that resulting from a low individual SES.
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Affiliation(s)
- S A Reijneveld
- Amsterdam Municipal Health Service, Department of Epidemiology, University of Amsterdam, The Netherlands
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221
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Rozzini R, Frisoni GB, Ferrucci L, Trabucchi M. Co-occurrence of disadvantage conditions in elderly subjects with depressive symptoms. J Affect Disord 1997; 46:247-54. [PMID: 9547121 DOI: 10.1016/s0165-0327(96)01415-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this survey study is to describe the association of symptomatic depression with the co-occurrence of psycho-social, functional, and somatic disadvantage conditions in 390 over 70 subjects living at home. The most disadvantaged tertile of various conditions (age, social support, cognition, social interactions, self evaluation of health, disability, number of diseases, and somatic symptoms) was associated with greater risk of symptomatic depression. A subset of conditions that might be causally related to depression (age, social support, financial welfare, diseases, and disability) was used to divide subjects into five levels of increasing multiple disadvantage conditions (MDC). Increasing severity of MDC level was associated with greater risk of symptomatic depression even after adjustment for gender and all five conditions used to define MDC levels (odds ratios ranging from 2.7 to 11.3).
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Affiliation(s)
- R Rozzini
- Geriatric Evaluation and Management Unit, P. Richiedei Hospital, Gussago and Geriatric Research Group, Brescia, Italy
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222
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Steketee G. Disability and family burden in obsessive-compulsive disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:919-28. [PMID: 9429061 DOI: 10.1177/070674379704200902] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This paper reviews 2 aspects of obsessive-compulsive disorder (OCD): impairment in functioning and family burden associated with OCD. Impairment is evident from epidemiological and clinical studies in several areas, particularly in occupational and social maladjustment. Clinic outpatients show a range of impairment associated with OCD, while hospitalized patients exhibit consistently severe disabilities that rival those of patients with schizophrenia. Although behaviourally and medication-treated patients improve in adjustment levels, there is some evidence of persistent impairment, particularly in social and work functioning. Several studies support extensive family involvement and accommodation of OCD symptoms, as well as the considerable burden placed on families who reduce their social activities and increase their isolation and distress. Findings are equivocal regarding OCD and marital distress. Predictors of treatment outcome do not include marital dissatisfaction, but may include expressed anger and criticism. With regard to treatment, family support groups are popular but untested interventions, and family-assisted individual and group behaviour therapy have demonstrated good outcomes in limited trials.
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Affiliation(s)
- G Steketee
- Boston University School of Social Work, Massachusetts, USA
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223
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Dekker J, Peen J, Goris A, Heijnen H, Kwakman H. Social deprivation and psychiatric admission rates in Amsterdam. Soc Psychiatry Psychiatr Epidemiol 1997; 32:485-92. [PMID: 9409165 DOI: 10.1007/bf00789144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The main subject of this study was the link between social indicators and the (re)admission rates for, and length of stay in, in-patient mental health care in Amsterdam. In a factor analysis of 15 sociodemographic variables, two principal components analysis factors were distinguished: housing quality and socioeconomic deprivation. The census variables and the factors almost all had high correlations with the crude admission rates as well as the rates standardised for age and sex. In general, the correlations with rates that were also standardised for marital status were significantly lower. This shows that many correlations between indicators and crude rates are determined to a significant extent by the marital status profile of an area. Socioeconomic deprivation is positively correlated with the proportion of readmissions and inversely correlated with average length of stay.
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Affiliation(s)
- J Dekker
- Department of Research, Training and Development, Psychiatric Hospital Amsterdam, The Netherlands
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224
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Canals J, Domènech E, Carbajo G, Bladé J. Prevalence of DSM-III-R and ICD-10 psychiatric disorders in a Spanish population of 18-year-olds. Acta Psychiatr Scand 1997; 96:287-94. [PMID: 9350958 DOI: 10.1111/j.1600-0447.1997.tb10165.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to estimate the current prevalence of DSM-III-R and ICD-10 psychiatric disorders in Spanish 18-year-old members of the general population. Subjects were assessed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Nearly 30% of the study subjects reported at least one current disorder according to ICD-10 criteria, and almost 21% reported at least one current disorder according to DSM-III-R criteria. Women had a significantly higher probability of suffering from any psychiatric disorder than men. The most common disorders were insomnia, dysthymia, major depression and simple phobia. Nearly 40% of the diagnosed subjects had one or more comorbid disorders. Comorbidity was found to be higher among female subjects. Consistent with previous risk factor research, it was found that women had higher rates of mood, anxiety and sleep disorders than men. Good communication between parents and their offspring was found to be a protecting factor for all disorders.
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Affiliation(s)
- J Canals
- Department of Psychology, Rovira i Virgili University, Tarragona, Spain
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225
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Abstract
This tenth anniversary review/update of fluoxetine concentrates on the past 5 years of its clinical application. The mechanism of action of fluoxetine; its metabolism; its efficacy in patients with various diagnostic subgroups of depression, patients with coincident medical disease, children and adolescents with depression, patients with eating disorders, and patients with obsessive-compulsive disorder (OCD); its long-term (maintenance) efficacy; its side effects and toxicity; and pharmacoeconomic considerations are reviewed. Pharmacotherapy is currently the only proven method for treating major depressive disorder that is applicable to all levels of severity of major depressive illness. Since its introduction 10 years ago, fluoxetine has been available to psychiatrists, primary care physicians, and other nonpsychiatric physicians as full-dose effective pharmacotherapy for patients with depression. Fluoxetine has been widely prescribed by physicians knowledgeable in pharmacology and in the treatment of depression because of its proven efficacy (ie, equal to that of tricyclic antidepressants [TCAs]), its ease of administration (with full therapeutic dosing usually starting from day 1), its generally benign side-effect profile, its remarkable safety in over-dose, and its proven effectiveness in the most common depressed patient population--anxious, agitated, depressed patients--as well as in patients with various subtypes and severities of depression. In more recent years it has also proved effective in the treatment of bulimia, an entity for which only limited or inadequate treatment options had been previously available. In OCD, fluoxetine, with its more acceptable side-effect profile and greater ease of dosing, presents a favorable alternative to previous drug therapy and is useful in treating both obsessions and compulsions. Fluoxetine is currently recognized among clinicians as efficacious in treating anxiety disorders and is being used successfully in special depressed populations such as patients with medical comorbidity, elderly patients, adolescents, and children. Rapid discontinuation or missed doses of short-half-life selective serotonin reuptake inhibitors, TCAs, and heterocyclic antidepressants are associated with withdrawal symptoms of a somatic and psychological nature, which cannot only be disruptive, but can also be suggestive of relapse or recurrence of depression. In striking contrast to these short-half-life antidepressants, fluoxetine is rarely associated with such sequelae on sudden discontinuation or missed doses. This preventive effect against withdrawal symptoms on discontinuation of fluoxetine is attributed to the unique extended half-life of this antidepressant. Current studies show that the overall increased effectiveness of fluoxetine in treating depression compensates for its higher cost, compared with older drugs, by reducing the need for physician contact because of increased compliance and less need of titration, and by reducing premature patient discontinuation, thereby yielding fewer relapses, less recurrence, and less reutilization of mental health services.
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Affiliation(s)
- P E Stokes
- Payne Whitney Clinic, New York Hospital-Cornell University Medical Center, New York, USA
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226
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Abstract
We examined the prevalence of depressive disorders and associated factors in the general population in Finland using the Computer-Assisted Telephone Interview (CATI) method. A total of 2293 (71%) of 3250 individuals randomly drawn from the population registry and representing the adult population of Finland in the age group 25-79 years were interviewed by telephone in autumn 1994. The interview included a short form of the University of Michigan version of the Composite International Diagnostic Interview (UM-CIDI) generating probability diagnoses of DSM-III-R major depressive episode and dysthymia. The age-adjusted 6-month prevalence was 4.1% for major depressive episode and 1.7% for current dysthymia; depressive mood during the preceding month was reported in 17% of cases. Major depressive episodes and depressive mood were significantly more prevalent among females than males. In the logistic regression analyses, factors associated with the depressive disorders were found to vary somewhat depending on sex and type of disorder. Only about 50% of those with major depressive episode or dysthymia reported a self-perceived need for mental health services.
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Affiliation(s)
- E Isometsä
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
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227
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228
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Norquist GS, Regier DA. The epidemiology of psychiatric disorders and the de facto mental health care system. Annu Rev Med 1996; 47:473-9. [PMID: 8712797 DOI: 10.1146/annurev.med.47.1.473] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent national epidemiologic studies have provided data on the number of people in the United States with mental and addictive disorders. Many of these people receive their care in the general medical care sector. This has important implications for diagnosis and treatment of mental and addictive disorders.
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Affiliation(s)
- G S Norquist
- Division of Epidemiology and Services Research, National Institute of Mental Health, Rockville, Maryland 20857, USA
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229
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Piccinelli M, Pini S, Bellantuono C, Wilkinson G. Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review. Br J Psychiatry 1995; 166:424-43. [PMID: 7795913 DOI: 10.1192/bjp.166.4.424] [Citation(s) in RCA: 183] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach. METHOD Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms. RESULTS Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties. CONCLUSION Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.
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Affiliation(s)
- M Piccinelli
- Servizio di Psicologia Medica, Università di Verona, Italy
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230
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Abstract
The National Mental Health Policy has brought about a realisation that data on the mental health of Australians are sparse. This applies to the three levels of morbidity in the general population, the mental health component in general practice and the use of specialist services. This paper considers what epidemiological information is now needed to guide policy. There has probably never been a more opportune time to make a useful contribution to the nation's mental health services through well-planned epidemiological research.
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Affiliation(s)
- A S Henderson
- NH & MRC Social Psychiatry Research Unit, Australian National University, Canberra
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231
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232
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Stefánsson JG, Líndal E, Björnsson JK, Guthmundsdóttir A. Period prevalence rates of specific mental disorders in an Icelandic cohort. Soc Psychiatry Psychiatr Epidemiol 1994; 29:119-25. [PMID: 8085180 DOI: 10.1007/bf00796491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper presents the 1-month, 6-month and 1-year prevalence rates for mental disorders in a random sample of people born in Iceland in 1931 and interviewed at the age of 55-57 years. The diagnoses were made according to DSM-III, on the basis of the National Institute of Mental Health's Diagnostic Interview Schedule (DIS) used by trained lay interviewers. The period prevalence rates were found to be similar to those obtained by other studies using the DIS as a survey instrument. The highest rates were among the widowed, separated or divorced. The 1-year symptom-free rates were high for alcohol abuse and alcohol dependence, 74% and 71%, respectively. For depressive disorders, the 1-year symptom-free rate was only 50% and for the anxiety disorders, 50%-65%. The most common psychiatric disorders had a chronic course.
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Affiliation(s)
- J G Stefánsson
- Department of Psychiatry, National University Hospital, Reykjavík, Iceland
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