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

Smoking and suicidal behaviors in the National Comorbidity Survey: Replication

Controversy exists about the role of mental disorders in the consistently documented association between smoking and suicidal behavior. This controversy is addressed here with data from the nationally representative National Comorbidity Survey-Replication (NCS-R). Assessments were made of 12-month smoking, suicidal behaviors (ideation, plans, attempts), and DSM-IV disorders (anxiety, mood, impulse-control, and substance use disorders). Statistically significant odds ratios (2.9-3.1) were found between 12-month smoking and 12-month suicidal behaviors. However, the associations of smoking with the outcomes became insignificant with controls for DSM-IV mental disorders. Although clear adjudication among contending hypotheses about causal mechanisms cannot be made from the cross-sectional NCS-R data, the results make it clear that future research on smoking and suicidal behaviors should focus more centrally than previous research on mental disorders either as common causes, markers, or mediators.

Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder

BACKGROUND

Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).

AIMS

To estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.

METHOD

An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.

RESULTS

Estimates of ADHD prevalence averaged 3.4% (range 1.2-7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.

CONCLUSIONS

Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication

CONTEXT

There is growing recognition that bipolar disorder (BPD) has a spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys.

OBJECTIVE

To estimate the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the US population.

DESIGN

Direct interviews.

SETTING

Households in the continental United States.

PARTICIPANTS

A nationally representative sample of 9282 English-speaking adults (aged >or=18 years).

MAIN OUTCOME MEASURES

Version 3.0 of the World Health Organization's Composite International Diagnostic Interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-IV lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, comorbidity, and treatment.

RESULTS

Lifetime (and 12-month) prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings.

CONCLUSIONS

This study presents the first prevalence estimates of the BPD spectrum in a probability sample of the United States. Subthreshold BPD is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the US population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes.

Mental health treatment dropout and its correlates in a general population sample

BACKGROUND

Dropping out of mental health treatment prematurely may affect treatment outcome. However, we have limited knowledge about the epidemiology of mental health treatment dropout. The objectives of this analysis were to estimate the rates of dropout in individuals who had received mental health treatment provided by different health professionals and to identify factors associated with mental health treatment dropout.

METHODS

Data from the Canadian Community Health Survey-Mental Health-Well-being were used. Participants who had used mental health services in the past 12 months were included in the analysis (n=3556). The percentages dropping out of mental health treatment provided by various health professionals were estimated. Logistic regression was used to identify factors associated with treatment dropout.

RESULTS

The overall rate of dropout from mental health treatment in the past 12 months was 22.3%. Participants who had used services provided by family doctors/general practitioners had the lowest rate of dropout (11.8%). The dropout rate was 22.7% in those who were treated by psychiatrists and was 21.9% in participants who had seen psychologists. Young (15-25 years), nonwhite and individuals who reported having had a mood disorder or having had substance dependence were more likely to terminate treatment prematurely.

CONCLUSIONS

In Canada, a large percentage of individuals who use mental health services prematurely terminate their treatment. Clinical factors may play important roles in treatment dropout. Patients with substance dependence and those with mood disorders have a high risk of treatment dropout.

Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use

OBJECTIVE

The Bergen Child Study is a longitudinal study of child mental health from the city of Bergen, Norway. We present methods and results from the first wave of the study, focusing on prevalence of disorders, associations with risk factors, and the use of services.

METHOD

The target population included all 9,430 children attending grades 2 to 4 in Bergen schools during the academic year 2002/2003. The main screening instrument was the Strengths and Difficulties Questionnaire, whereas diagnoses were based on the Development and Well-Being Assessment. Information about child and family risk factors and service use was also obtained in this second stage.

RESULTS

In the first phase, the teacher Strengths and Difficulties Questionnaire was obtained for 9,155 (97%) of the target children and the matching parent Strengths and Difficulties Questionnaire for 6,297 (67%); 1,011 children (11%) were assessed with the Development and Well-Being Assessment in the second phase. The weighted prevalence for any DSM-IV psychiatric disorder was 7.0% (95% confidence interval 5.6%-8.5%). Disorders were associated with age, gender, learning difficulties, family type, and poverty. Although 75% of children with attention-deficit/hyperactivity disorder had been in contact with specialist mental health services, this was true for only 13% of those with pure emotional disorders.

CONCLUSIONS

The overall prevalence of psychiatric disorders in children is relatively low in this Norwegian sample, when assessed with the Development and Well-Being Assessment. Children with emotional disorders have limited access to specialist services.

The sensitivity of the K6 as a screen for any disorder in community mental health surveys: a cautionary note

OBJECTIVE

Short screening instruments, which exclude respondents unlikely to have psychiatric disorders, can make epidemiologic surveys shorter and more cost-effective. The Kessler 6-Item Psychological Distress Scale (K6), a measure of generalized distress, has been proposed for this role and has shown good agreement with the Composite International Diagnostic Interview (CIDI). However, performance of the K6 may vary for individual disorders or combinations of disorders. In this report, we examine the ability of the K6 to detect disorders among respondents in different diagnostic categories.

METHOD

We used data from Cycle 1.2 of the Canadian Community Health Survey to assemble 5 groups of respondents with different 12-month psychiatric disorders (n = 4481). A sixth group comprised those with 2 or more disorders. We examined the sensitivity of the K6 among respondents with an individual disorder as well as those with multiple disorders.

RESULTS

The sensitivity of the K6 varies significantly by disorder; it is highest among respondents with multiple disorders and lowest among those with agoraphobia only.

CONCLUSIONS

Use of the K6 as a screen for the CIDI is likely to result in biased prevalence estimates. However, both instruments should be compared with a third standard to fully assess the benefits and drawbacks of their combination.

Prevalence and correlates of lifetime suicidal ideation and suicide attempts among Latino subgroups in the United States

OBJECTIVE

Limited data are available to understand the prevalence and correlates of suicidal behavior among U.S. Latino subgroups. This article compares the prevalence of lifetime suicidal ideation and suicide attempts among major U.S. Latino ethnic subgroups and identifies psycho-sociocultural factors associated with suicidal behaviors.

METHOD

The National Latino and Asian American Study includes Spanish- and English-speaking Mexicans, Puerto Ricans, Cubans, and other Latinos. A total of 2554 interviews were conducted in both English and Spanish by trained interviewers between May 2002 and November 2003. Lifetime psychiatric disorders were measured using the World Health Organization-Composite International Diagnostic Interview. Descriptive statistics and logistic models were used to determine demographic, clinical, cultural, and social correlates of lifetime suicidal ideation and suicide attempts.

RESULTS

The lifetime prevalence of suicidal ideation and suicide attempts among Latinos was 10.1% and 4.4%, respectively. Puerto Ricans were more likely to report ideation as compared with other Latino subgroups, but this difference was eliminated after adjustments for demographic, psychiatric, and sociocultural factors. Most lifetime suicide attempts described by Latinos were reported as occurring when they were under the age of 18 years. Any lifetime DSM-IV diagnoses, including dual diagnoses, were associated with an increased risk of lifetime suicidal ideation and suicide attempts among Latinos. In addition, female gender, acculturation (born in the United States and English speaking), and high levels of family conflict were independently and positively correlated with suicide attempts among Latinos, even among those without any psychiatric disorder.

CONCLUSIONS

These findings reinforce the importance of understanding the process of acculturation, the role of family, and the sociocultural context for suicide risk among Latinos. These should be considered in addition to psychiatric diagnoses and symptoms in Latino suicide research, treatment, and prevention, especially among young individuals.

Population level of unmet need for mental healthcare in Europe

BACKGROUND

The high prevalence of mental disorders has fuelled controversy about the need for mental health services.

AIMS

To estimate unmet need for mental healthcare at the population level in Europe.

METHOD

As part of the European Study of Epidemiology of Mental Disorders (ESEMeD) project, a cross-sectional survey was conducted of representative samples of the adult general population of Belgium, France, Germany, Italy, The Netherlands and Spain (n=8796). Mental disorders were assessed with the Composite International Diagnostic Interview 3.0. Individuals with a 12-month mental disorder that was disabling or that had led to use of services in the previous 12 months were considered in need of care.

RESULTS

About six per cent of the sample was defined as being in need of mental healthcare. Nearly half (48%) of these participants reported no formal healthcare use. In contrast, only 8% of the people with diabetes had reported no use of services for their physical condition. In total, 3.1% of the adult population had an unmet need for mental healthcare. About 13% of visits to formal health services were made by individuals without any mental morbidity.

CONCLUSIONS

There is a high unmet need for mental care in Europe, which may not be eliminated simply by reallocating existing healthcare resources.

Eating disorders in diverse lesbian, gay, and bisexual populations

OBJECTIVE

This study estimates the prevalence of eating disorders in lesbian, gay, and bisexual (LGB) men and women, and examines the association between participation in the gay community and eating disorder prevalence in gay and bisexual men.

METHOD

One hundred and twenty six white heterosexuals and 388 white, black, Latino LGB men and women were sampled from community venues. DSM-IV diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Gay and bisexual men had significantly higher prevalence estimates of eating disorders than heterosexual men. There were no differences in eating disorder prevalence between lesbian and bisexual women and heterosexual women, or across gender or racial groups. Attending a gay recreational group was significantly related to eating disorder prevalence in gay and bisexual men.

CONCLUSION

Researchers should study the causes of the high prevalence of eating disorders among gay and bisexual men.

Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys

This paper reports cross-national data concerning back or neck pain comorbidity with mental disorders. We assessed (a) the prevalence of chronic back/neck pain, (b) the prevalence of mental disorders among people with chronic back/neck pain, (c) which mental disorder had strongest associations with chronic back/neck pain, and (d) whether these associations are consistent across countries. Population surveys of community-dwelling adults were carried out in 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (N=85,088). Mental disorders were assessed with the Composite International Diagnostic Interview, third version (CIDI 3.0): anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social anxiety disorder), mood disorders (major depression and dysthymia), and alcohol abuse or dependence. Back/neck pain was ascertained by self-report. Between 10% and 42% reported chronic back/neck pain in the previous 12 months. After adjusting for age and sex, mental disorders were more common among persons with back/neck pain than among persons without. The pooled odds ratios were 2.3 [95% CI=2.1-2.5] for mood disorders, 2.2 [95% CI=2.1-2.4] for anxiety disorders, and 1.6 [95% CI=1.4-1.9] for alcohol abuse/dependence in people with versus without chronic back/neck pain. Although prevalence rates of back/neck pain were generally lower than in previous reports, mental disorders were associated with chronic back/neck pain. The strength of association was stronger for mood and anxiety disorders than for alcohol abuse/dependence. The association of mental disorders with back/neck pain showed a consistent pattern across both developed and developing countries.

Lack of psychological resilience: an important correlate for urinary incontinence

Our study evaluated medical conditions, level of physical functioning, and psychological health as correlates of urinary continence (UI) for four different age groups of women. Survey questions from the 1996 MIDUS survey were used in three domains of health: medical conditions, physical functioning, and psychological health. Mean questionnaire scores or prevalence percentages for individual and total medical conditions, physical functioning, and psychological health were computed. Two-sample independent t tests or chi-square tests were used to compare women with UI to those without. Prevalence of UI was as follows: 25-39 years: 13.3%, 40-49 years: 24.0%, 50-59 years: 32.7%, and 60-74 years: 32.8%. Lower psychological resilience scores were significantly associated with UI in all age groups. Significant correlates (p<0.02) for women 25-39 years were hysterectomy, weak core muscles, and lack of psychological resilience. In older women, more chronic conditions and parity were significantly (p<0.01) associated with UI. Although each age group had specific medical associations with UI, lack of resilience and poor core muscle strength are particularly correlated with UI in young women.

Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults

The objective was to estimate the prevalence and correlates of psychiatric disorders in a nationwide sample of Korean adults. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview 2.1/DSM-IV (N = 6275, response rate 79.8%). The lifetime and 12-month prevalences for all types of DSM-IV disorders were 33.5% and 20.6%, respectively. Those of specific disorders were as follows: 17.2% and 7.1% for alcohol use disorder, 11.2% and 7.4% for nicotine use disorder, 5.2% and 4.2% for specific phobia, 4.3% and 1.7% for major depressive disorder, and 2.3% and 1.0% for generalized anxiety disorder. Among the sociodemographic variables, widowed status, higher income, and rural residence were the risk factors for both lifetime major depressive disorder and alcohol use disorder after controlling for gender, age, and education. The prevalence of psychiatric disorders was higher than those observed in other East-Asian countries and most European countries, but lower than that in the United States. Alcohol use disorder was particularly high in Korea.

Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey Replication

Although previous research has consistently documented that immigrants to the United States have better mental health than US natives, little is known about why this difference occurs. DSM-IV anxiety, mood, impulse control, and substance use disorders were assessed in a nationally representative survey of the US household population, the National Comorbidity Survey Replication. Differences in risk for disorder between immigrants (N = 299) and 5124 natives (N = 5124) were examined using discrete time survival models. Differences were estimated by generation, age of immigration, and duration of residence in the United States. Immigrants had lower lifetime risk of disorder than natives (OR = 0.7; 95% CI, 0.5-0.9). Risk was equally large for natives who were children of immigrants as for natives of subsequent generations. For mood and impulse control disorders, risk equal to that of natives was also found among immigrants who arrived in the United States as children (12 years of age or younger). Immigrants had lower risk than natives prior to arrival in the United States, but there was a trend toward equalization of risk with longer duration of residence in the United States. Differences in risk for disorder emerge within a single generation following immigration, consistent with a strong effect of environmental factors on changes in risk among immigrant populations. This pattern is consistent with either of two causal processes, one involving early socialization in the United States and the other involving postmigration experiences among immigrants who arrive in the United States as adults.

Treatment adequacy for anxiety and depressive disorders in six European countries

The aims of this study are to describe the adequacy of treatment for anxiety and depressive disorders in Europe and how itdiffers between providers, using data from the ESEMeD study. The overall proportion of adequate treatment was 45.8% (57.4% in the specialised sector and 23.3% in the general medical care sector). Between-country differences were found in treatment adequacy in the specialised setting. Organisational and political aspects may explain these findings.

The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication

BACKGROUND

Little population-based data exist on the prevalence or correlates of eating disorders.

METHODS

Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview.

RESULTS

Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index > or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment.

CONCLUSIONS

Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.

Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong

BACKGROUND

The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago. The lifetime prevalence rates of DSM-III major depressive disorder (females 2.44% and males 1.29%) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong.

METHODS

Each of 5004 adults randomly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode (MDE), sociodemography, help-seeking, and other epidemiological data.

RESULTS

Twelve-month prevalence of MDE was 8.4%. The female-to-male ratio was low but typical of surveys in Chinese communities. Female sex and unemployment were associated with increased risk. 32.5% of respondents with MDE reported frequent thoughts of suicide. Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low.

LIMITATIONS

Response rate was low though cooperation rate was moderately high. Detailed demography, comorbidity, and clinical reappraisal interviews were not covered.

CONCLUSIONS

Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people. Although longitudinal studies are needed to confirm a genuine increase in prevalence, depression is likely to be more common in Hong Kong than previously suggested. High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment.

The World Health Organization World Mental Health Survey Initiative

To present an overview of the World Health Organization World Mental Health (WMH) Survey Initiative. The discussion draws on knowledge gleaned from the authors' participation as principals in WMH. WMH has carried out community epidemiological surveys in more than two dozen countries with more than 200,000 completed interviews. Additional surveys are in progress. Clinical reappraisal studies embedded in WMH surveys have been used to develop imputation rules to adjust prevalence estimates for within- and between-country variation in accuracy. WMH interviews include detailed information about sub-threshold manifestations to address the problem of rigid categorical diagnoses not applying equally to all countries. Investigations are now underway of targeted substantive issues. Despite inevitable limitations imposed by existing diagnostic systems and variable expertise in participating countries, WMH has produced an unprecedented amount of high-quality data on the general population cross-national epidemiology of mental disorders. WMH collaborators are in thoughtful and subtle investigations of cross-national variation in validity of diagnostic assessments and a wide range of important substantive topics. Recognizing that WMH is not definitive, finally, insights from this round of surveys are being used to carry out methodological studies aimed at improving the quality of future investigations.

Mental disorders among adults with asthma: results from the World Mental Health Survey

OBJECTIVE

Our objectives were (a) to determine which common mental disorders are associated with asthma in the general population after controlling for age and sex, and (b) to assess whether the associations of mental disorders with asthma are consistent across diverse countries.

METHOD

Eighteen population surveys of household-residing adults were carried out in 17 countries (N=85,088). Mental disorders were assessed with the Composite International Diagnostic Interview 3.0, a fully structured diagnostic interview. The disorders considered here are 12-month anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder and social phobia), depressive disorders (dysthymia and major depressive disorder) and alcohol use disorders (abuse and dependence). Asthma was ascertained by self-reports of lifetime diagnosis among a subsample (n=42,697).

RESULTS

Pooled estimates of age-adjusted and sex-adjusted odds of mental disorders among persons with asthma relative to those without asthma were 1.6 [95% confidence interval (95% CI)=1.4, 1.8] for depressive disorders, 1.5 (95% CI=1.4, 1.7) for anxiety disorders and 1.7 (95% CI=1.4, 2.1) for alcohol use disorders.

CONCLUSION

This first cross-national study of the relationship between asthma and mental disorders confirms that a range of common mental disorders occurs with greater frequency among persons with asthma. These results attest to the importance of clinicians in diverse settings being alert to the co-occurrence of these conditions.

Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members

The validity of the six-question World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was assessed in a sample of subscribers to a large health plan in the US. A convenience subsample of 668 subscribers was administered the ASRS Screener twice to assess test-retest reliability and then a third time in conjunction with a clinical interviewer for DSM-IV adult ADHD. The data were weighted to adjust for discrepancies between the sample and the population on socio-demographics and past medical claims. Internal consistency reliability of the continuous ASRS Screener was in the range 0.63-0.72 and test-retest reliability (Pearson correlations) in the range 0.58-0.77. A four-category version The ASRS Screener had strong concordance with clinician diagnoses, with an area under the receiver operating characteristic curve (AUC) of 0.90. The brevity and ability to discriminate DSM-IV cases from non-cases make the six-question ASRS Screener attractive for use both in community epidemiological surveys and in clinical outreach and case-finding initiatives.

Psychotropic drug use in Israel: results from the national health survey

BACKGROUND

Despite increasing psychotropic drug prescriptions worldwide, little is known about utilization of these medications in the general population in Israel. We examined psychotropic drug use in the general population of Israel and the patterns of use among individuals with different DSM-IV diagnoses of 12-month mental disorders.

METHOD

A representative sample was derived from the National Population Register of noninstitutionalized residents aged 21 and older. Face-to-face interviews were conducted from May 2003 to April 2004. Individuals were asked about any psychotropic drug use in the past 12 months. DSM-IV disorders were assessed using a revised version of the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Psychotropic drug utilization was observed in 6.9% of the general population and in 19.6% of individuals with any 12-month psychiatric disorder. The extent of use varied according to sociodemographic variables and the specific DSM-IV diagnostic categories. Among individuals with a 12-month diagnosis of pure major depression, only 13.6% received any antidepressants within the same period; exclusive use of antidepressants was 5.7%, while 3.3% of the individuals used only anxiolytics.

CONCLUSION

Similar to findings in other European countries, our findings suggest that the majority of individuals diagnosed with a common mental disorder are not being treated with psychotropic drugs or are being inappropriately treated.

Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study

OBJECTIVES

We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos.

RESULTS

Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos.

CONCLUSIONS

Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Prevalence of psychiatric disorders across Latino subgroups in the United States

OBJECTIVES

We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups.

RESULTS

Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos.

CONCLUSIONS

Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.

Parental bonding and suicidality in adulthood

OBJECTIVE

The short-term effect of an adverse parental child rearing style on suicidality in adolescence has been extensively discussed. Nevertheless, little is known about the long-term effect of adverse parental child rearing on lifetime suicidality in adulthood. So the present study aims to examine the relation between parental bonding on the one hand and suicidality in adulthood on the other.

METHOD

We used data from 7740 respondents of the European Study of Epidemiology of Mental Disorders project, a cross-sectional household survey carried out in six European countries. The data were assessed with the World Mental Health Composite International Diagnostic Interview, a comprehensive, fully structured psychiatric diagnostic interview. Suicidality was categorized as follows: 'no ideation', 'ideation', 'attempt'. Parental bonding was assessed by means of a three-factor ('care', 'overprotection', 'authoritarianism') short form of the Parental Bonding Instrument. Using a multinomial-logistic regression model to investigate the association between these two constructs, we also adjusted for mood disorders, anxiety disorders, alcohol abuse/dependence and possible country effects.

RESULTS

We found associations between low maternal and paternal care on the one hand and suicidality on the other. Country-specific differences proved negligible.

CONCLUSIONS

Prevention programs can help better equip parents in their child-rearing role to create a more caring parenting environment. This can be a protective factor for suicidality in adulthood. Nevertheless, more efforts are necessary to better describe the paths that lead from child-rearing behaviour to suicidality in adulthood.

Mental disorders among persons with heart disease - results from World Mental Health surveys

OBJECTIVES

While depression and heart disease often co-occur in Western countries, less is known about the association of anxiety and alcohol use disorders with heart disease and about the cross-cultural consistency of this association. Consistency across emotional disorders and cultures would suggest that relatively universal mechanisms underlie the association.

METHODS

Surveys with 18 random population samples of household-residing adults in 17 countries in Europe, the Americas, the Middle East, Africa, Asia and the South Pacific were carried out. Medically recognized heart disease was ascertained by self-report. Mental disorders were assessed with the World Mental Health Composite International Diagnostic Interview, a fully structured diagnostic interview.

RESULTS

Specific mood and anxiety disorders occurred among persons with heart disease at rates higher than those among persons without heart disease. Adjusted for sex and age, the pooled odds ratios (95% confidence interval) were 2.1 (1.9-2.5) for mood disorders, 2.2 (1.9-2.5) for anxiety disorders and 1.4 (1.0-1.9) for alcohol abuse/dependence among persons with versus those without heart disease. These patterns were similar across countries.

CONCLUSIONS

An excess of anxiety disorders and that of mood disorders are found among persons with heart disease. These associations hold true across countries despite substantial between-country differences in culture and mental disorder prevalence rates. These results suggest that similar mechanisms underlie the association and that a broad spectrum of mood-anxiety disorders should be considered in research on the comorbidity of mental disorders and heart disease.

Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China

BACKGROUND

This is the first study to examine variation across cohorts in lifetime risk of DSM-IV mental disorders in metropolitan China.

METHOD

Face-to-face household interviews of 2633 adults in Beijing and 2568 adults in Shanghai were conducted from November 2001 to February 2002 using a multi-stage household probability sampling method. The Chinese World Mental Health (WMH) Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used for assessment.

RESULTS

Lifetime prevalence of any disorder was 13.2%. Alcohol abuse (4.7%), major depressive disorder (3.5%), and specific phobia (2.6%) were the most common disorders. The median age of onset was later for mood (43 years) than anxiety (17 years) and substance use (25 years) disorders. Compared to observed lifetime prevalence, the projected lifetime risk as of age 75 years increased by 106% for major depressive disorder (7.2%), and was uniformly higher for all disorders. Relative odds of any lifetime disorder were 4.7 in the most recent cohorts (ages 18-34) compared to the eldest cohorts (ages > or =65).

CONCLUSIONS

The findings of this cross-sectional study tally with the view that rapid socioeconomic changes may bring about increasing incidence of mental disorders in China. However, prospective longitudinal studies are needed to confirm if the increase is real. Because of the huge size of the Chinese population, any increase in projected lifetime risk of mental disorders represents an enormous increase in the number of affected individuals.

The global burden of anxiety and mood disorders: putting the European Study of the Epidemiology of Mental Disorders (ESEMeD) findings into perspective

This article compares the preliminary, descriptive European Study of The Epidemiology of Mental Disorders (ESEMeD) findings reported in this supplement with 8 broad patterns of results found in previous psychiatric epidemiologic surveys. It is a systematic review of the literature on community epidemiologic surveys of anxiety and mood disorders. It concludes that the ESEMeD findings are broadly consistent with the patterns found in previous surveys but faults the preliminary ESEMeD analyses for failing to distinguish cases by severity and to consider the effects of severity on need for treatment. The fact that the ESEMeD surveys collected much richer data than previous psychiatric epidemiologic surveys on role impairment, symptom severity, and episode duration makes it possible to develop more useful classifications of clinical severity in future analyses. Elaborations that feature such distinctions have the potential to substantially increase the relevance of the ESEMeD findings for European health care policy.

Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

Concerns have been raised that the DSM-IV requirements of 6-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD.

Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication

BACKGROUND

Little is known about the population prevalence of sleep problems or whether the associations of sleep problems with role impairment are due to comorbid mental disorders.

METHODS

The associations of four 12-month sleep problems (difficulty initiating or maintaining sleep, early morning awakening, nonrestorative sleep) with role impairment were analyzed in the National Comorbidity Survey Replication controlling 12-month DSM-IV anxiety, mood, impulse-control, and substance disorders. The WHO Composite International Diagnostic Interview was used to assess sleep problems and DSM-IV disorders. The WHO Disability Schedule-II (WHO-DAS) was used to assess role impairment.

RESULTS

Prevalence estimates of the separate sleep problems were in the range 16.4-25.0%, with 36.3% reporting at least one of the four. Mean 12-month duration was 24.4 weeks. All four problems were significantly comorbid with all the 12-month DMS-IV disorders assessed in the survey (median OR: 3.4; 25(th)-75(th) percentile: 2.8-3.9) and significantly related to role impairment. Relationships with role impairment generally remained significant after controlling comorbid mental disorders. Nonrestorative sleep was more strongly and consistently related to role impairment than were the other sleep problems.

CONCLUSIONS

The four sleep problems considered here are of public health significance because of their high prevalence and significant associations with role impairment.

Measurement of psychological distress in palliative care

Research investigating the psychological distress of palliative care patients has contributed to our understanding of the needs and experiences of individuals approaching death. This paper aims to provide a brief review of such measurement of psychological distress in palliative care, focusing on established psychiatric and psychological research tools, and quantitative research methods. This includes clinical screening and diagnostic assessment instruments used to identify key distress-related symptoms and the presence of common clinical syndromes, such as depression, anxiety, delirium, as well as the broader psychological dimensions of suffering, such as existential concerns, spirituality, hope and demoralisation. There are important considerations in undertaking psychological research in palliative care, such as maintaining a balance between the methods and measurements that will address key research questions, and sensitivity to the range of physical and emotional demands facing individuals at the point of receiving palliative care. The clinical application of psychological and psychiatric research tools and methods can aid the detection of psychological distress, aid the thorough assessment of the psychological dimension of the patients' illness and care, aid the identification of individuals who would benefit from specific psychotherapeutic or pharmacologic interventions, and the evaluation of response to treatments.

Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0

OBJECTIVE

Although growing interest exists in the bipolar spectrum, fully structured diagnostic interviews might not accurately assess bipolar spectrum disorders. A validity study was carried out for diagnoses of threshold and sub-threshold bipolar disorders (BPD) based on the WHO Composite International Diagnostic Interview (CIDI) in the National Comorbidity Survey Replication (NCS-R). CIDI BPD screening scales were also evaluated.

METHOD

The NCS-R is a nationally representative US household population survey (n=9282 using CIDI to assess DSM-IV disorders. CIDI diagnoses were evaluated in blinded clinical reappraisal interviews using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID).

RESULTS

Excellent CIDI-SCID concordance was found for lifetime BP-I (AUC=.99 kappa=.88, PPV=.79, NPV=1.0), either BP-II or sub-threshold BPD (AUC=.96, kappa=.88, PPV=.85, NPV=.99), and overall bipolar spectrum disorders (i.e., BP-I/II or sub-threshold BPD; AUC=.99, kappa=.94, PPV=.88, NPV=1.0). Concordance was lower for BP-II (AUC=.83, kappa=.50, PPV=.41, NPV=.99) and sub-threshold BPD (AUC=.73, kappa=.51, PPV=.58, NPV=.99). The CIDI was unbiased compared to the SCID, yielding a lifetime bipolar spectrum disorders prevalence estimate of 4.4%. Brief CIDI-based screening scales detected 67-96% of true cases with positive predictive value of 31-52%.

LIMITATION

CIDI prevalence estimates are still probably conservative, though, but might be improved with future CIDI revisions based on new methodological studies with a clinical assessment more sensitive than the SCID to sub-threshold BPD.

CONCLUSIONS

Bipolar spectrum disorders are much more prevalent than previously realized. The CIDI is capable of generating conservative diagnoses of both threshold and sub-threshold BPD. Short CIDI-based scales are useful screens for BPD.

Co-occurrence of mental and physical illness in US Latinos

BACKGROUND

This study describes the prevalence of comorbid physical and mental health problems in a national sample of US Latinos. We examined the co-occurrence of anxiety and depression with prevalent physical chronic illnesses in a representative sample of Latinos with national origins from Mexico, Cuba, Puerto Rico, and other Latin American countries.

METHOD

We used data on 2,554 Latinos (75.5% response rate) ages 18 years and older from the National Latino and Asian American Study (NLAAS). The NLAAS was based on a stratified area probability sample design, and the sample came from the 50 states and Washington, DC. Survey questionnaires were delivered both in person and over the telephone in English and Spanish. Psychiatric disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI). Physical chronic illness was assessed by self-reported history.

RESULTS

Puerto Ricans had the highest prevalence of meeting criteria for any comorbid psychiatric disorder (more than one disorder). Puerto Ricans had the highest prevalence (22%) of subject-reported asthma history, while Cubans had the highest prevalence (33%) of cardiovascular disease. After accounting for age, sex, household income, number of years in the US, immigrant status, and anxiety or depression, anxiety was associated with diabetes and cardiovascular disease, in the entire sample. Depression and co-occurring anxiety and depression were positively associated with having a history of asthma but not with other physical diseases, in the entire sample. Interestingly, Puerto Ricans with a depressive disorder had a lower odds of having a history of cardiovascular disease than Puerto Ricans without a depressive disorder. The relationship between chronic physical and mental illness was not confounded by immigration status or number of years in the US.

DISCUSSION

Despite previous findings that link acculturation with both chronic physical and mental illness, this study does not find that number of years in the US nor nativity explain the prevalence of psychiatric-medical comorbidities. This study demonstrates the importance of considering psychiatric and medical comorbidity among specific ethnic groups, as different patterns emerge than when using aggregate ethnic measures. Research is needed on both the pathways and the mechanisms of comorbidity for the specific Latino groups.

A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

BACKGROUND

Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators.

METHOD

The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders.

RESULTS

Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.6, 0.7 and 0.4% respectively. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0.88]. The distribution (conditional probability of attempt) of the risk index is: 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high-risk category.

CONCLUSIONS

A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.

Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study

OBJECTIVES

We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors.

METHODS

Data were derived from the National Latino and Asian American Study (2002-2003).

RESULTS

About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months.

CONCLUSIONS

Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study

OBJECTIVES

We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos.

RESULTS

Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos.

CONCLUSIONS

Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Prevalence of psychiatric disorders across Latino subgroups in the United States

OBJECTIVES

We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States.

METHODS

We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups.

RESULTS

Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos.

CONCLUSIONS

Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.

Hypnotic use in a population-based sample of over thirty-five thousand interviewed Canadians

Background

As with most medications, benzodiazepine and similar sedative hypnotics (BDZ/SSH) can produce both beneficial and adverse effects. Pharmacoepidemiological studies have been limited in their capacity to evaluate the relationship between these medications and psychiatric diagnoses in non-clinical populations. The objective of this study was to provide a description of the pattern of use of BDZ/SSH medications in relation to both demographic and diagnostic data in a community population.

Methods

The source of data for this study was the Canadian Community Health Survey (CCHS 1.2), also known as the Canadian National Study of Mental Health and Well-being. This study was based on a nationally representative sample that included over 35 thousand subjects with a response rate of 77%. The survey interview included the latest version of the Composite International Diagnostic Interview (CIDI), which was developed for the World Health Organization's WHO Mental Health 2000 project. Current medication use was also recorded.

Results

As expected, BDZ/SSH use was more common in women than in men (4.2%, 95% CI 3.9 to 4.6 vs. 2.5%, 95% CI 2.2 to 2.8) and its frequency increased with age, 8.5% (95% CI 7.7 to 9.4) of those over the age of 65 compared to 2.4% (95% CI 2.2 to 2.7) of those aged 18 to 64 years. These medications were more frequently used in subjects with low levels of education (4.8%, 95% CI% 4.3 to 5.2) vs. high levels of education (2.4%, 95% CI 2.1 to 2.6) and low personal incomes (5.7%, 95% CI 5.2 to 6.3) vs. high personal incomes (2.3%, 95% CI 2.0 to 2.6). BDZ/SSH use was strongly associated with the presence of mood or anxiety disorders, but not with substance use disorders. Demographic differences persisted after statistical adjustment for diagnosis.

Conclusion

The observation that benzodiazepine use is more frequent in women, increases with age and is higher in low income and education groups supports previous findings. These results help to confirm that these differences are not accounted for by psychiatric diagnoses.

Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)

OBJECTIVE

To present 1-month, 12-month and lifetime prevalence estimates of mood, anxiety and alcohol disorders in Italy; and the socio-demographic correlates and comorbidity patterns of these estimated disorders.

METHOD

A representative random sample of non-institutionalised citizens of Italy aged 18 or older (N=4,712) was interviewed between January 2001 and July 2003, with a weighted response rate of 71.3%. DSM-IV disorders were assessed by lay interviewers using Version 3.0 of the Composite International Diagnostic Interview (CIDI).

RESULTS

A total of 11% of respondents reported a lifetime history of any mood disorder, 10.3% any anxiety disorder and 1.3% any alcohol disorder. About 5% reported having an anxiety disorder in the past 12 months compared to 3.3% for any mood disorder and 0.2% for any alcohol disorder. Major depression and specific phobia were the most common mental disorders. Women were twice as likely as men to report a mood disorder and four times as likely as men to report an anxiety disorder, while men were twice as likely as women to report an alcohol disorder. High comorbidity of mood and anxiety disorders was observed. Prevalence estimates were generally lower than in parallel surveys carried out in other Western European countries.

CONCLUSION

A high proportion of adults in Italy have a history of mood, anxiety or alcohol disorders. The lower than expected prevalence estimate of alcohol use disorder may be due to under-reporting or to low social harm from alcohol consumption.

Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States

CONTEXT

Lack of data on the lifetime prevalence and age at onset of suicide ideation, plans, and attempts among blacks in the United States limits the creation and evaluation of interventions to reduce suicide among black Americans.

OBJECTIVE

To examine the prevalence and correlates of suicide ideation, planning, and attempts across 2 ethnic classifications of blacks in a nationally representative sample.

DESIGN, SETTING, AND PARTICIPANTS

Data are from the National Survey of American Life, a national household probability sample of 5181 black respondents aged 18 years and older, conducted between February 2001 and June 2003, using a slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Bivariate and survival analyses were used to delineate patterns and correlates of nonfatal suicidal behavior.

MAIN OUTCOME MEASURES

Self-reports of lifetime suicide ideation, planning, and attempts.

RESULTS

Survey respondents, categorized as African Americans and Caribbean Americans, reported lifetime prevalence of 11.7% for suicide ideation and 4.1% for attempts. Among the respondents who reported ideation, 34.6% transitioned to making a plan and only 21% made an unplanned attempt. Among 4 ethnic-sex groups, the 7.5% lifetime prevalence for attempts among Caribbean black men was the highest among black Americans. The greatest risk of progressing to suicide planning or attempt among ideators occurred within the first year after ideation onset. Blacks at higher risk for suicide attempts were in younger birth cohorts, less educated, Midwest residents, and had 1 or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders.

CONCLUSIONS

This study documents the burden of nonfatal suicidality among US blacks, notably Caribbean black men, and individuals making planned attempts. Advancing research on the transition from suicide planning to attempt is vital to the efficacy of health care professionals' ability to screen blacks at risk for suicide.

Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain

BACKGROUND

Literature suggests that a high proportion of the population with mental disorders remains either untreated or poorly treated. This study aimed to describe the adequacy of treatment for Anxiety and Depressive disorders in Spain, how this differs between providers (primary versus specialised care) and which factors are associated with appropriate care.

METHOD

Data were derived from the Spanish sample (N=5473) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross sectional study in a representative sample of adults. The subsample analyzed was composed by the 133 subjects with a mental disorder in the year prior to the interview who received treatment. Treatment adequacy was evaluated in two different ways: (1) considering definitions of minimally adequate treatment evidence based guidelines and criteria used in other epidemiological studies; (2) considering experts rating of treatment appropriateness based on the information contained in the case vignettes created from the CIDI answers. Generalised Estimating Equation (GEE) models and simple logistic regression were conducted to assess the correlates of adequate treatment.

RESULTS

Similar proportions of patients in specialty and general medical treatment received a minimally adequate treatment (31.8% and 30.5%, respectively). Associated factors to appropriateness were living in a large city, having a high educational level, and having a good self rated health state.

LIMITATIONS

Treatment adequacy was based on simple information and criteria.

CONCLUSIONS

Only one third of the mental health treatment in Spain met minimal adequacy criteria. More research is needed in order to find out reasons for these low rates.

Functional disability in elderly Nigerians: Results from the Ibadan Study of Aging

Functional disability is a common reason for loss of independence and need for informal care by elderly persons. There is little information on the profile of disability and the level of unmet need for care in elderly persons living in sub-Saharan Africa. Using a multistage clustered sampling of households conducted in the Yoruba-speaking area of Nigeria (representing 22% of the national population), persons aged 65 and older (N = 2,152) were assessed for disability in activities of daily living and instrumental activities of daily living. Respondents were assessed for self-reports of physical health, for major depressive disorder, and for availability of informal care. The prevalence of any functional disability (defined as inability to independently perform any function) was 9.2% (standard error 0.6). In logistic regression analysis, high risks of disability were associated with female sex, older age, and urban dwelling. Risks were also high for persons with chronic pain, those with poor self-reported overall health, and those with evidence of undernutrition. Disabled persons had poorer quality of life and were more likely to suffer from major depressive disorder; 19.8% of disabled elderly persons lacked any informal care, and this unmet need for care increased the likelihood of having depression. The findings suggest a high burden of unmet need for care in a large section of disabled elderly persons in this African community undergoing demographic and social changes. Social factors relating to urbanization and poverty may be associated with the occurrence of disability and inability to access informal care.

Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers

OBJECTIVE

Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania.

METHOD

The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders.

RESULTS

A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression.

CONCLUSIONS

Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To estimate the lifetime prevalence and projected lifetime risk at age 75 years of DSM-IV disorders in New Zealand.

METHOD

A nationwide face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0), was used. There were 12,992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are lifetime prevalence and projected lifetime risk at age 75 years.

RESULTS

The lifetime prevalence of any disorder was 39.5%. The lifetime prevalences for disorder groups were: anxiety disorders, 24.9%; mood disorders, 20.2%; substance use disorders, 12.3%; and eating disorders, 1.7%. The prevalences for all disorders were higher in the younger age groups. Females had higher prevalences of anxiety, mood and eating disorders compared with males; males had higher prevalences of substance use disorders. The estimated projected lifetime risk of any disorder at age 75 years was 46.6% with the median age of onset being 18 years. Adjustment for age, sex, education and household income did not remove all differences between Māori and the composite other ethnic group in the risk of disorder (hazard ratio = 1.1-1.4). After adjustment, hazard ratios for Pacific people ranged from 0.8 to 2.5.

CONCLUSIONS

These results confirm those of other studies: mental disorders are relatively common and tend to have early onset. Females are more likely to experience anxiety, mood and eating disorders than males, who experience more substance use disorders. Adjustment for socioeconomic factors and demography does not explain all ethnic differences, although remaining differences are small relative to cohort and even sex differences.

Mental-physical comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To estimate the prevalence of chronic physical conditions, and the risk factors for those conditions, among those with 12 month mental disorder; to estimate the prevalence of 12 month mental disorder among those with chronic physical conditions.

METHOD

A nationally representative face-to-face household survey was carried out in October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health version of the Composite International Diagnostic Interview (CIDI 3.0). Physical conditions were self-reported. All associations are reported adjusted for age and sex.

RESULTS

People with (any) mental disorder, relative to those without mental disorder, had higher prevalences of several chronic physical conditions (chronic pain, cardiovascular disease, high blood pressure and respiratory conditions) and chronic condition risk factors (smoking, overweight/obesity, hazardous alcohol use). Around a quarter of people with chronic physical conditions had a comorbid mental disorder compared with 15% of the population without chronic conditions. Significant relationships occurred between some mental disorders and obesity, cardiovascular disease and diabetes for females, but not for males.

CONCLUSIONS

This paper provides evidence of substantial comorbidity between mental disorders and chronic physical conditions in New Zealand. This should be borne in mind by clinicians working in both mental health and medical services.

Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To estimate the 12 month prevalence of DSM-IV disorders in New Zealand, and associated interference with life and severity.

METHOD

A nationally representative face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12,992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper the outcomes reported are 12 month prevalence, interference with life and severity for individual disorders.

RESULTS

The prevalence of any disorder in the past 12 months was 20.7%. The prevalences for disorder groups were: anxiety disorders 14.8%, mood disorders 7.9%, substance use disorders 3.5%, eating disorders 0.5%. The highest prevalences for individual disorders were for specific phobia (7.3%), major depressive disorder (5.7%) and social phobia (5.1%). Interference with life was higher for mood disorders than for anxiety disorders. Drug dependence, bipolar disorder and dysthymia had the highest proportion of severe cases (over 50%), when severity was assessed over the disorder itself and all comorbid disorders. Overall, only 31.7% of cases were classified as mild with 45.6% moderate and 22.7% serious.

CONCLUSIONS

Compared with other World Mental Health survey sites New Zealand has relatively high prevalences, although almost always a little lower than for the US. For all disorders, except specific phobia, interference with life was reported to be moderate, on average, which has lead to less than a third of cases being classified as mild. Most people who have ever met full DSM-IV criteria, including the impairment criterion, and who experience symptoms or an episode in the past 12 months find that their disorders impact on their lives to a non-trivial extent.

Mental disorder comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To show the extent and patterning of 12 month mental disorder comorbidity in the New Zealand population, and its association with case severity, suicidality and health service utilization.

METHOD

A nationwide face-to-face household survey was carried out in October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. The measurement of mental disorder was with the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Comorbidity was analysed with hierarchy, consistent with a clinical approach to disorder count.

RESULTS

Comorbidity occurred among 37% of 12 month cases. Anxiety and mood disorders were most frequently comorbid. Strong bivariate associations occurred between alcohol and drug use disorders and, to a lesser extent, between substance use disorders and some anxiety and mood disorders. Comorbidity was associated with case severity, with suicidal behaviour (especially suicide attempts) and with health sector use (especially mental health service use).

CONCLUSION

The widespread nature of mental disorder comorbidity has implications for the configuration of mental health services and for clinical practice.

Disability in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To show the disability associated with 1 month mental disorders and chronic physical conditions for the New Zealand population, controlling for comorbidity, age and sex.

METHOD

A nationally representative face-to-face household survey was carried out from October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health (WMH) Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Disability was measured with the WMH Survey Initiative version of the World Health Organization Disability Assessment Schedule (WMH WHO-DAS) in the long-form subsample (n = 7435). Outcomes include five WMH WHO-DAS domain scores for those with 1 month mental disorders and with chronic physical conditions.

RESULTS

Mood disorders were associated with more disability than anxiety or substance use disorders. Experiencing multiple mental disorders was associated with substantial role impairment. Mental disorders and chronic physical conditions were associated with similar degrees of disability on average. The combination of mental and physical disorders had additive effects on associated disability.

CONCLUSIONS

Mood disorders are disabling. The investigation of disability in relation to 1 month rather than 12 month disorders is likely to provide a clearer indication of the disability associated with mood disorders. Although some researchers have queried whether negative mood can lead to 'over-reporting' of disability, recent conceptualizations of disability provide a perspective which may ease such concerns. Comorbidity, of mental disorders or of mental and physical disorders, is disabling.

Ethnic comparisons of the 12 month prevalence of mental disorders and treatment contact in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To compare ethnic groups for the 12 month prevalence of mental disorders and 12 month treatment contact in Te Rau Hinengaro: The New Zealand Mental Health Survey.

METHOD

Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over, including Māori (n = 2595), Pacific people (n = 2236) and a composite Other ethnic group (predominantly European) (n = 8161). Ethnicity was measured using the 2001 census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used to measure disorder. The overall response rate was 73.3%.

RESULTS

The 12 month prevalence of any mental disorder was highest in Māori (29.5%; 26.6, 32.4), followed by Pacific people (24.4%; 21.2, 27.6) and Others (19.3%; 18.0, 20.6). Adjustment for age, sex, education and household income reduced differences: Māori (23.9%; 21.3, 26.4), Pacific (19.2%; 16.4, 22.1) and Other (20.3%; 18.9, 21.6). A similar pattern was seen for serious disorder and most individual disorders or disorder groups. After adjustment, Māori were most different from Pacific people and Others for substance use disorder. Both Māori and Pacific people had a higher prevalence of bipolar disorder than Others. Pacific people had the lowest prevalence of major depressive disorder. Among those with disorder, the proportion with a visit for mental health problems to any service was highest among Others (41.1%; 38.1, 44.1), with Māori (32.5%; 28.3, 36.7) intermediate and Pacific (25.4%, 19.4, 31.4) lowest. Adjustment did not alter ethnic differences in service contact.

CONCLUSION

Māori, and to a lesser extent Pacific people, have a higher prevalence of 12 month mental disorders than Others. Differences are reduced after adjusting for sociodemographic correlates. Relative to need, Pacific people in particular and Māori are less likely than Others to have contact with services (health or non-health), regardless of sociodemographic circumstances.

Prevalence of mental disorders among Māori in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To describe the prevalence of mental disorders (period prevalence across aggregated disorders, 12 month and lifetime prevalence) among Māori in Te Rau Hinengaro: The New Zealand Mental Health Survey.

METHOD

Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken between 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over, including 2,595 Māori. Ethnicity was measured using the 2001 New Zealand census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorder. The overall response rate was 73.3%. This paper presents selected findings for the level and pattern of mental disorder prevalence among Māori.

RESULTS

Māori lifetime prevalence of any disorder was 50.7%, 12 month prevalence 29.5% and 1 month prevalence 18.3%. The most common 12 month disorders were anxiety (19.4%), mood (11.4%) and substance (8.6%) disorders and the most common lifetime disorders were anxiety (31.3%), substance (26.5%) and mood (24.3%) disorders. Levels of lifetime comorbidity were high with 12 month prevalence showing 16.4% of Māori with one disorder, 7.6% with two disorders and 5.5% with three or more disorders. Twelve-month disorders were more common in Māori females than in males (33.6%vs 24.8%) and in younger age groups: 16-24 years, 33.2%; 25-44 years, 32.9%; 45-64 years, 23.7%; and 65 years and over, 7.9%. Disorder prevalence was greatest among Māori with the lowest equivalized household income and least education. However, differences by urbanicity and region were not significant. Of Māori with any 12 month disorder, 29.6% had serious, 42.6% had moderate and 27.8% had mild disorders.

CONCLUSION

Mental disorders overall and specific disorder groups (anxiety, mood and substance) are common among Māori and measures of severity indicate that disorders have considerable health impact. Findings provide a platform for informing public health policy and health sector responses to meeting mental health needs of Māori.

Suicidal behaviour in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE

To describe prevalence and correlates of suicidal behaviour in the New Zealand population aged 16 years and over.

METHOD

Data are from Te Rau Hinengaro: The New Zealand Mental Health Survey, a nationally representative household survey conducted from October 2003 to December 2004 in a sample of 12,992 participants aged 16 years and over to study prevalences and correlates of mental disorders assessed using the World Mental Health Composite International Diagnostic Interview. Lifetime and 12 month prevalences and onset distributions for suicidal ideation, plans and attempts, and sociodemographic and mental disorder correlates of these behaviours were examined.

RESULTS

Lifetime prevalences were 15.7% for suicidal ideation, 5.5% for suicide plan and 4.5% for suicide attempt, and were consistently significantly higher in females than in males. Twelve-month prevalences were 3.2% for ideation, 1.0% for plan and 0.4% for attempt. Risk of ideation in the past 12 months was higher in females, younger people, people with lower educational qualifications, and people with low household income. Risk of making a plan or attempt was higher in younger people and in people with low household income. After adjustment for sociodemographic factors, there were no ethnic differences in ideation, although Māori and Pacific people had elevated risks of plans and attempts compared with non-Māori non-Pacific people. Individuals with a mental disorder had elevated risks of ideation (11.8%), plan (4.1%) and attempt (1.6%) compared with those without mental disorder. Risks of suicidal ideation, plan and attempt were associated with mood disorder, substance use disorder and anxiety disorder. Major depression was the specific disorder most strongly associated with suicidal ideation, plan and attempt. Less than half of those who reported suicidal behaviours within the past 12 months had made visits to health professionals within that period. Less than one-third of those who had made attempts had received treatment from a psychiatrist.

CONCLUSIONS

Risks of making a suicide plan or attempt were associated with mental disorder and sociodemographic disadvantage. Most people with suicidal behaviours had not seen a health professional for mental health problems during the time that they were suicidal.

Twelve-month and lifetime health service use in Te Rau Hinengaro: The New Zealand Mental Health Survey

OBJECTIVE

To estimate the 12 month and lifetime use of health services for mental health problems.

METHOD

A nationwide face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are 12 month and lifetime health service use for mental health and substance use problems.

RESULTS

Of the population, 13.4% had a visit for a mental health reason in the 12 months before interview. Of all 12 month cases of mental disorder, 38.9% had a mental health visit to a health or non-health-care provider in the past 12 months. Of these 12 month cases, 16.4% had contact with a mental health specialist, 28.3% with a general medical provider, 4.8% within the human services sector and 6.9% with a complementary or alternative medicine practitioner. Most people with lifetime disorders eventually made contact if their disorder continued. However, the percentages seeking help at the age of onset were small for most disorders and several disorders had large percentages who never sought help. The median duration of delay until contact varies from 1 year for major depressive disorder to 38 years for specific phobias.

CONCLUSIONS

A significant unmet need for treatment for people with mental disorder exists in the New Zealand community, as in other comparable countries.