The CZEch Mental health Study (CZEMS): Study rationale, design, and methods

Population mental health, help-seeking and associated barriers following the COVID-19 pandemic: Analysis of repeated nationally representative cross-sectional surveys in Czechia

This study investigated the Czech adults' mental health following the COVID-19 pandemic and the potential influence of data collection methodology on prevalence estimates. Separately, it investigated changes in help-seeking and associated barriers. Data from representative surveys on Czech adults, conducted in November 2017 (n = 3,306), in May (n = 3,021) and November 2020 (n = 3,000), and in November and December 2022 (n = 7,311), were used. Current mental disorders were assessed by the Mini International Neuropsychiatric Interview, and the treatment gap was established in individuals scoring positively. In help-seeking individuals, encountering barriers was investigated. In 2017 and 2022, 20.02 % and 27.22 % of individuals had at least one mental disorder, respectively. The 2022 panel sampling and online and telephone interviewing estimates (34.29 % and 26.7 %) were substantially higher than those from household sampling and personal interviewing (19.9 %). Prevalence rates based on household sampling and personal interviewing were broadly consistent in 2017 and 2022. The treatment gap was around 80 % from 2017 to 2022. More than 50 % of individuals encountered structural barriers in help-seeking in 2022. This study showed that prevalence rates were still elevated in 2022, but suggests that data collection methodology influenced the estimates. Separately, the treatment gap remained consistently very high, and encountering structural barriers in help-seeking was common.

Depression in healthcare workers during COVID-19 pandemic: results from Czech arm of HEROES Study

The pandemic due to COVID-19 brought new risks for depression of health care workers, which may have differently influenced men and women. We aimed to investigate (1) whether health care workers in Czechia experienced an increase in depression during the COVID-19 pandemic, (2) which factors contributed the most to this change, and (3) whether the magnitude of the associations differed by gender. We studied 2564 participants of the Czech arm of the international COVID-19 HEalth caRe wOrkErS (HEROES) Study. Online questionnaire was administered to health care workers in summer 2020 (wave 0) and spring 2021 (wave 1). Depression was defined by reaching 10 or more points on the Patient Health Questionnaire. Logistic regression investigated the association of participant´s characteristics with depression and multivariable decomposition for non-linear models assessed, to what extent the characteristic explained the change in depression occurrence. The prevalence of depression increased twice during the pandemic (11% in wave 0 and 22% in wave 1). Stress accounted for 50% of the difference, experience of death due to COVID-19 for 15% and contact with COVID-19 patients for 14%. Greater resilience and sufficient personal protective equipment were strongly associated with lower occurrence of depression. The protective association of resilience with depression was stronger in men than in women. We conclude that interventions to promote mental health of health care workers in future health crisis should aim at decreasing stress and enhancing resilience. They should be delivered especially to individuals who have contact with the affected patients and may face their death.

Suicide Risk in Individuals With and Without Mental Disorders Before and During the COVID-19 Pandemic: An Analysis of Three Nationwide Cross-Sectional Surveys in Czechia

OBJECTIVE

The impact of the coronavirus disease 2019 (COVID-19) pandemic on suicidal thoughts and behavior has been widely hypothesized but remains largely unexplored at the population-level. We aimed to assess changes in suicide risk (SR) in people with and without mental disorders, before and during the COVID-19 pandemic in Czechia.

METHODS

We analyzed data from three nationwide cross-sectional surveys of Czech adults (November 2017, May and November 2020). For the 2017 data collection, we employed paper and pencil interviewing, while for the two 2020 data collections, we used a mixed computer-assisted web interviewing and computer-assisted telephone interviewing approach. All samples were representative in terms of age, gender, education, and area of residence for the Czech adult population (18+). We used the Mini International Neuropsychiatric Interview to screen for mental disorders and SR. We calculated weighted prevalence rates with 95% confidence intervals (95% CI).

RESULTS

When compared to baseline, we found a 4% and 6% increase in SR in individuals without mental disorders in pandemic surveys (1.95% (1.45%; 2.44%) vs. 6.29% (5.28%; 7.30%) and 8.42% (7.19%; 9.65%)). Relative to baseline, SR in people with major depressive episode or anxiety disorders was elevated in May and November 2020 (22.35% (17.64%; 27.06%) vs. 36.68% (32.45%; 40.91%) and 38.88% (34.51%; 43.25%)).

CONCLUSIONS

We found substantially increased SR in both people with and without mental disorders, however, these changes could be partially related to differing data collection methods used in the baseline and subsequent surveys. Ongoing prevention, monitoring and evaluation of nationwide suicidality is warranted.HIGHLIGHTSWe found that suicide risk substantially increased during the pandemicSuicide risk was elevated in both individuals with and without mental disordersOur findings support increased suicide monitoring and prevention.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis

Background

Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period.

Methods

We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels.

Findings

Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings.

Interpretation

Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries.

Funding

Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Prevalence of current mental disorders before and during the second wave of COVID-19 pandemic: An analysis of repeated nationwide cross-sectional surveys

OBJECTIVES

To assess the prevalence of mental disorders during the second wave of COVID-19 pandemic in comparison with both, baseline and the first wave of the pandemic, and to identify disproportionally affected non-clinical subgroups.

MATERIAL AND METHODS

We used data from three nationally representative cross-sectional studies and compared the prevalence of current mood and anxiety disorders, and alcohol-use disorders at baseline (November 2017, n = 3306), immediately after the first peak (May 2020, n = 3021), and during the second peak (November 2020, n = 3000) of COVID-19 in Czechia. We used the Mini International Neuropsychiatric Interview (M.I.N.I.) as a screening instrument, and calculated weighted prevalence (%) with 95% weighted confidence intervals (95% CIs). Additionally, we examined the prevalence of these disorders across different non-clinical population sub-groups during the second wave of the pandemic.

RESULTS

The proportion of individuals experiencing at least one mental disorder was highest during the second wave of the pandemic (32.94%, 95% CI = 31.14%; 34.77%), when compared to both the baseline in November 2017 (20.02%, 95% CI = 18.64%; 21.39%), and the first wave in May 2020 (29.63%, 95% CI = 27.9%; 31.37%). Younger adults, students, those having lost a job or on forced leave, and those with only elementary education displayed disproportionally high prevalence of mental disorders.

CONCLUSIONS

Our findings suggest that population mental health has not returned to pre-COVID-19 levels. It seems that mental health of some population subgroups, such as young adults or those worse off economically, might have been affected disproportionately by the COVID-19 situation, and future studies identifying high-risk groups are warranted.

Sex differences in the association of childhood socioeconomic position and later-life depressive symptoms in Europe: the mediating effect of education

PURPOSE

We aimed to study sex differences in the association of childhood socioeconomic position (SEP) with later-life depressive symptoms, the mediating effect of education and explore regional differences across Europe.

METHODS

The study included 58,851 participants (55% women, mean age 65 years) from the multicentre, population-based Survey on Health, Ageing and Retirement in Europe. Interviews were conducted in six waves and included measurements of childhood SEP (household characteristics at the age of 10) and depressive symptoms (EURO-D scale). Linear regression was used to study the association of childhood SEP with depressive symptoms, adjusting for covariates, and structural equation modelling assessed the mediating effect of education.

RESULTS

In the fully adjusted model, higher childhood SEP was associated with lower depressive symptoms with a greater magnitude in women (B = - 0.07; 95% CI - 0.08, - 0.05) than in men (B = - 0.02; 95% CI - 0.03, - 0.00). Relative to men, childhood SEP had 3 times greater direct effect on depressive symptoms in women, and education had 3.7 times stronger mediating effect against childhood SEP. These associations and the sex differences were particularly pronounced in Southern, Central and Eastern Europe.

CONCLUSION

Growing up in poor socioeconomic conditions is a stronger risk factor for the development of depressive symptoms for women than for men. Education may have a stronger preventive potential for women in reducing the adverse effects of childhood socioeconomic hardship. Central and Eastern European populations experience disproportionately higher risk of later-life depression due to lower SEP and greater sex differences.

Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers

BACKGROUND

Facing an increasing prevalence of dementia, the Czech Republic is developing a new nationwide strategy for the management and prevention of dementia. Lack of evidence about characteristics of individuals with dementia in the country is a major obstacle.

OBJECTIVE

The study aimed to 1) characterize individuals with dementia, 2) compare their mortality with the general population, and 3) analyze differences in survival between different dementia disorders.

METHODS

The study capitalizes on two nationwide registers in the Czech Republic, from which information about individuals who were hospitalized with dementia or died from it between 1994 and 2014 was retrieved. Standardized intensity of hospitalizations was calculated for each year, mortality was studied using standardized mortality ratio, life-tables, Kaplan-Mayer curves, and Cox proportional hazard models.

RESULTS

Standardized intensity of hospitalizations for dementia increased more than 3 times from 1994 to 2014. Standardized mortality ratio was 3.03 (95% confidence interval 2.97-3.08). One-year survival rate was 45% and five-year survival rate 16%. Vascular dementia was the most common type of dementia disorders and was associated with higher hazard of death than Alzheimer's disease, even after adjusting for sociodemographic and clinical covariates (hazard ratio 1.04; 95% confidence interval 1.02-1.05).

CONCLUSION

The study provides estimates on demographic characteristics and mortality of the Czech hospitalized dementia population, which have not been so far available and which are unique also in the context of the entire region of Central and Eastern Europe.

Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS)

PURPOSE

We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic.

METHODS

Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics.

RESULTS

We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates.

CONCLUSIONS

Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.

Prevalence of mental disorders and treatment gap among Czech women during paid maternity or parental leave

We performed a secondary analysis of the data from Czech epidemiological study on mental health to determine the prevalence of mental disorders among Czech women on maternity or parental leave and to assess the present treatment gap. Any mental disorder was present in 17.6% (n = 21) of the total sample of 119 women. The treatment gap was present among 76% (n = 16) of them. In conclusion, most women on maternity or parental leave facing a mental disorder were not receiving treatment. The present study is the first of its kind in the region of Central and Eastern Europe.

Role of sex in the association between childhood socioeconomic position and cognitive ageing in later life

We aimed to explore sex differences in the association of childhood socioeconomic position (SEP) with the level of cognitive performance and the rate of cognitive decline. We studied 84,059 individuals (55% women; mean age 64 years) from the Survey on Health, Ageing and Retirement in Europe. Sex differences in the association of childhood SEP (household characteristics at age 10) with the level of cognitive performance (verbal fluency, immediate recall, delayed recall) were analysed using multilevel linear regression. Structural equation modelling tested education, depressive symptoms and physical state as mediators. The relationship between childhood socioeconomic advantage and disadvantage and the rate of cognitive decline was assessed using linear mixed-effects models. Higher childhood SEP was associated with a higher level of cognitive performance to a greater extent in women (B = 0.122; 95% CI 0.092–0.151) than in men (B = 0.109; 95% CI 0.084–0.135). The strongest mediator was education. Childhood socioeconomic disadvantage was related to a higher rate of decline in delayed recall in both sexes, with a greater association in women. Strategies to prevent impaired late-life cognitive functioning, such as reducing childhood socioeconomic disadvantages and improving education, might have a greater benefit for women.

Changes in Cognitive Impairment in the Czech Republic

BACKGROUND

Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts.

OBJECTIVE

We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic.

METHODS

The study used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out.

RESULTS

The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education.

CONCLUSION

Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.

Trajectories of depressive symptoms and associated patterns of cognitive decline

The aim was to investigate the pattern and rate of cognitive decline across distinctive trajectories of depressive symptoms in older adults. In this prospective multinational cohort study on 69,066 participants (on average 64 years at baseline, 55% women), assessments of cognitive functions (immediate recall, delayed recall, verbal fluency) and depressive symptoms (EURO-D scale) were conducted at 2-year intervals. The trajectories of depressive symptoms were obtained using latent growth mixture modelling, cognitive decline was assessed using smoothing splines and linear mixed effects models. Four distinct trajectories of depressive symptoms were identified: constantly low (n = 49,660), constantly high (n = 2999), increasing (n = 6828) and decreasing (n = 9579). Individuals with increasing and constantly high depressive symptoms showed linear cognitive decline, while those with constantly low and decreasing depressive symptoms had fluctuating cognition. Participants with increasing depressive symptoms had the fastest decline, while those with decreasing symptoms were spared from decline in cognition. This study suggests that the pattern as well as the rate of cognitive decline co-occurs with specific patterns of changes in depressive symptoms over time. The most pronounced cognitive decline is present in individuals, in whom depressive symptoms increase late in life. Unique mechanisms of cognitive decline may exist for subgroups of the population, and are associated with the trajectory of depressive symptoms.

Educational attainment inequalities in depressive symptoms in more than 100,000 individuals in Europe

Background

Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions.

Methods

We studied 108,315 Europeans (54% women, median age 63 years old) from the Survey on Health, Ageing and Retirement in Europe assessing EA (seven educational levels based on International Standard Classification of Education [ISCED] classification) and depressive symptoms (≥4 points on EURO-D scale). Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors, testing for sex/age/region and education interactions.

Results

Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% confidence interval [CI] 0.55–0.65; p < 0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33–0.40; p < 0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60–0.80; p < 0.001). The association was strongest among younger individuals. There was a sex and education interaction only within Central and Eastern Europe.

Conclusions

Level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to decreased burden of depression across the life course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.

Education as inefficient resource against depressive symptoms in the Czech Republic: cross-sectional analysis of the HAPIEE study

BACKGROUND

Increasing educational level of the population could be a strategy to prevent depression. We investigated whether education may offer a greater benefit for mental health to women and to individuals living in socioeconomically disadvantaged areas.

METHODS

We performed a cross-sectional study using data on 6964 Czech participants of the Health, Alcohol and Psychosocial factors in Eastern Europe study (on average 58 years old; 53% women). Binary logistic regression was used to examine the association of education with depressive symptoms, adjusting for several groups of covariates. Interactions were tested between education and sex as well as between education and socioeconomic advantage of the area of residence.

RESULTS

Higher education was strongly associated with lower odds of depressive symptoms, independently of sociodemographic characteristics, health behavior and somatic diseases. This association was attenuated after adjusting for other markers of individual socioeconomic position (work activity, material deprivation and household items). There were no interactions between education and either sex or socioeconomic advantage of the area of residence.

CONCLUSIONS

We did not find an independent association between education and depressive symptoms after controlling for other socioeconomic markers in a sample with a formative history of communistic ideologies. Women or individuals from socioeconomically disadvantaged areas do not seem to gain a larger mental health benefit from education.

Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys

AIMS

The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic.

METHODS

We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders.

RESULTS

The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively).

CONCLUSIONS

This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.

Perceived stress and depression in 45 low- and middle-income countries

BACKGROUND

There is limited research examining the association between perceived stress and depression using large population-based datasets, particularly from low- and middle-income countries (LMICs). Thus, the aim of the study was to assess the association between perceived stress and depression in 45 LMICs.

METHODS

We analyzed cross-sectional, predominantly nationally representative data from the World Health Survey. A perceived stress score [range 2 (lowest stress) -10 (highest stress)] was computed based on two questions from the Perceived Stress Scale. DSM-IV depression was based on past 12-month symptoms. Multivariable logistic regression analysis (adjusting for sex and age) and meta-analysis were used to examine the associations.

RESULTS

Data on 232,243 adults aged ≥18 years were analyzed. The overall mean (SD) perceived stress score was 4.8 (2.2), while the prevalence of depression was 6.2% (95%CI=5.9%-6.5%). Overall, there was a linear increase in the prevalence of depression with increasing perceived stress scores [i.e., score 2 (1.9%) to score 10 (22.0%)]. Country-wise analysis showed that higher perceived stress levels were significantly associated with increased odds for depression in all countries with the exception of Georgia and Vietnam. The results of the meta-analysis showed that a one-unit increase in the perceived stress score was associated with a 1.40 (95%CI=1.35-1.44) times higher odds for depression.

LIMITATIONS

The cross-sectional nature of the study limits interpretations about causation.

CONCLUSION

Perceived stress is positively associated with depression across the globe. Future longitudinal and intervention studies from LMICs are warranted to elucidate the potential impact of addressing stress on depression in this setting.

Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic

BACKGROUND

Depression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country.

METHODS

We analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies - Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors.

RESULTS

The analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82).

LIMITATIONS

Individuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately.

CONCLUSIONS

Socioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.

Changes in depressive symptoms of older adults in the Czech Republic

BACKGROUND

It is unclear whether the rising burden of depression is due to its increasing prevalence or better detection. We aimed to study trends in depressive symptoms in older individuals from the Czech Republic.

METHODS

We used data from the Survey on Health, Aging and Retirement in Europe. Depressive symptoms, defined by 4 or more points on the EURO-D scale, alone or in combination with pharmacological treatment, were compared between participants in 2006/2007 (cohort 1) and in 2015 (cohort 2). Binary logistic regression assessed the association of cohort 2 with depressive symptoms, step-wise adjusting for sociodemographic and clinical covariates.

RESULTS

The prevalence of depressive symptoms (defined by EURO-D) was 28% in cohort 1 and 22% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for all covariates (OR 0.77; 95% CI 0.63-0.94). Defined by EURO-D scale or pharmacological treatment, the prevalence was 30% in cohort 1 and 26% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for age and sex, but not in the fully adjusted model (OR 0.88; 95% CI 0.73-1.07). The difference in depressive symptoms between cohorts was associated in particular with increased length of education and higher household net worth.

LIMITATIONS

Information about pharmacological treatment has been reported inaccurately.

CONCLUSIONS

The prevalence of depressive symptoms has decreased in older adults in the Czech Republic. Additional increase in education and socioeconomic resources of the population could further reduce the depressive symptoms in the population.

Prevalence of mental disorders and associated disability: Results from the cross-sectional CZEch mental health Study (CZEMS)

INTRODUCTION

We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability.

METHODS

We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability.

RESULTS

In our sample of 3 306 participants, 21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%, 2.9%, and 1.5% respectively. Alcohol dependence was identified in 6.6%, and major depression in 4.0% of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non-alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4).

CONCLUSIONS

People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.

The treatment gap for mental disorders and associated factors in the Czech Republic

OBJECTIVES

To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care.

METHODS

Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied.

RESULTS

The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02-1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97-5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12-3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03-1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist.

CONCLUSIONS

The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.

Differences in cognitive performance and cognitive decline across European regions: a population-based prospective cohort study

BACKGROUND

A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline.

METHODS

We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline.

RESULTS

Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%).

DISCUSSION

There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.

Prevalence of late-life depression and gap in mental health service use across European regions

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

Socioeconomic position in childhood and cognitive aging in Europe

OBJECTIVES

We aimed to investigate whether socioeconomic position (SEP) in childhood has an effect on the level of cognitive performance and the rate of cognitive decline in older adults.

METHODS

We performed a prospective cohort study of individuals enrolled in a multicenter population-based study, SHARE (Survey of Health, Ageing and Retirement in Europe). Interviews were conducted in 6 waves at approximately 2-year intervals and included examinations of cognitive performance (memory, verbal fluency, delayed recall) and measurements of childhood SEP (participants' household characteristics at the age of 10 years). We estimated the associations of SEP with the level of cognitive performance using linear regression and the relation to the rate of cognitive decline with mixed-effects models.

RESULTS

This study included 20,244 participants from 16 European countries (median age at baseline 71 years, 54% women). Adverse childhood SEP was associated with a lower level of baseline cognitive performance. This association was attenuated after adjustment for clinical and social risk factors but remained statistically significant. Childhood SEP was not related to the rate of cognitive decline.

CONCLUSIONS

Variation in childhood SEP helps to explain differences in cognitive performance between older people, but not the rate of decline from their previous level of cognition. Strategies to protect cognitive aging should be applied early in life.

The CZEch Mental health Study (CZEMS): Study rationale, design, and methods

OBJECTIVES

The CZEch Mental health Study (CZEMS) was launched to inform the ongoing mental health care reform. This paper describes rationale, methods, and the plan for the future analyses of this project.

METHODS

A cross-sectional survey on a representative sample of the general adult noninstitutionalized population of the Czech Republic was conducted. Two-stage sampling was utilized and respondents were interviewed by centrally trained staff using a paper and pencil interviewing. The presence of mental disorders was assessed by The Mini-International Neuropsychiatric Interview. The study also collected information about disability, self-identification of having a mental illness, medical history, and help-seeking behaviour.

RESULTS

This survey had a 75% response rate, and the final sample consisted of 3,306 persons aged from 18 to 96 years (mean age 49 years old, 54% women) that were interviewed in their homes. The final sample is representative for the Czech Republic in terms of age, gender, education, and region.

CONCLUSIONS

CZEMS will provide up-to-date evidence about a prevalence of mental disorders in the Czech Republic, associated disability, and treatment gap. This will help informed decision-making about the current mental health care reform and future mental health care development in the Czech Republic.