Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health survey

Exploring prevalence and factors associated with postpartum depression among Ukrainian women

INTRODUCTION

Postpartum depression negatively impacts maternal mental health and child development. The high prevalence of postpartum depression (PPD) in low and lower middle-income countries raises questions about its predictors. This study examines the association between PPD and breastfeeding experience, child death, unresolved pregnancy, forced displacement, COVID-19 pandemic lockdown, marital, and financial status among Ukrainian women.

METHODS

This online study recruited 1634 Ukrainian mothers of children aged 0-5 years through non-governmental organizations providing services to them. The Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥13, was used to assess depressive symptoms in the postpartum period. Independent t-tests, chi-squared tests, one-way ANOVA, non-parametric correlations, and logistic regression tests were used to analyze the data.

RESULTS

The prevalence of depressive symptoms was 39.0% (n=1631). There was a positive association between EPDS scores and breastfeeding difficulties, pandemic lockdown, and financial difficulties. We did not find an association between PPD symptoms and unresolved pregnancy, death of a child, being affected by COVID-19, and forced displacement. We found that EPDS scores for women who did not experience forced displacement (n=1528) were significantly higher compared to displaced mothers (n=74).

CONCLUSIONS

The present study of Ukrainian women shows that women experienced depressive symptoms influenced by various factors including breastfeeding difficulties, pandemic lockdown, and financial difficulties. There is a need for additional research into such factors as unresolved pregnancy, the death of a child, being affected by COVID-19, and forced displacement.

Understanding of perinatal mental health and its psychosocial determinants through Ukrainian women's experience

INTRODUCTION

Perinatal mental health defines new mothers, their families, and the social, emotional, and cognitive development of their children. The factors contributing to Ukrainian mothers' mental health are not well-defined in the literature. This study aims to explore how Ukrainian women understand mental health and its psychosocial determinants through their perinatal experience.

METHODS

This qualitative analysis is part of a larger mixed-methods study exploring perinatal mental health in Ukraine. Five online focus groups (n=30) with Ukrainian mothers of children aged 0-5 years were conducted in June-July 2020. The participants were selected from a pool of 1634 women who completed an online questionnaire and agreed to participate in further research. Informed consent was obtained. The data collected from the focus groups were transcribed verbatim and analyzed thematically using Dedoose software.

RESULTS

The study identified two themes. The first theme was: 'Understanding perinatal mental health through women's experience', which covers five subthemes. The second theme was 'Psychosocial determinants of maternal mental health', which includes six subthemes. Overall, women's feelings of guilt, blame, and shame during their perinatal journey are influenced by socio-cultural factors and can lead to mental health problems and reluctance to seek proper help.

CONCLUSIONS

The study has identified some factors that can contribute to the enhancement of mental health and well-being of mothers in Ukraine during their perinatal journey. Negative emotions such as guilt, blame, and shame can have a significant impact on their ability to seek the necessary support, and should be addressed by midwives and other healthcare professionals.

Mental health in Ukraine in 2023

BACKGROUND

Very little is known about the mental health of the adult population of Ukraine following Russia's full-scale invasion in February 2022. In this study, we estimated the prevalence of seven mental health disorders, the proportion of adults screening positive for any disorder, and the sociodemographic factors associated with meeting requirements for each and any disorder.

METHODS

A non-probability quota sample (N = 2,050) of adults living in Ukraine in September 2023 was collected online. Participants completed self-report questionnaires of the seven mental health disorders. Logistic regression was used to determine the predictors of the different disorders.

RESULTS

Prevalence estimates ranged from 1.5% (cannabis use disorder) to 15.2% (generalized anxiety disorder), and 36.3% screened positive for any of the seven disorders. Females were significantly more likely than males (39.0% vs. 33.8%) to screen positive for any disorder. Disruption to life due to Russia's 2014 invasion of Ukraine, greater financial worries, and having fewer positive childhood experiences were consistent risk factors for different mental health disorders and for any or multiple disorders.

CONCLUSION

Our findings show that approximately one in three adults living in Ukraine report problems consistent with meeting diagnostic requirements for a mental health disorder 18 months after Russia's full-scale invasion. Ukraine's mental healthcare system has been severely compromised by the loss of infrastructure and human capital due to the war. These findings may help to identify those most vulnerable so that limited resources can be used most effectively.

Associations between coping strategies and psychological distress among people living in Ukraine, Poland, and Taiwan during the initial stage of the 2022 War in Ukraine

Background: The 2022 War in Ukraine has significantly affected the psychological well-being and daily lives of people in many countries.Objective: Two aims of this transnational study were (1) to compare psychological distress and coping strategies among people living in Ukraine, Poland, and Taiwan, (2) to examine whether the associations between various coping strategies (ie. problem-focused coping, emotion-focused coping, and avoidance) and psychological distress (ie. depression, anxiety, stress, posttraumatic stress disorder symptoms, and hopelessness about the ongoing war) differed among people of various countries during the initial stage of the 2022 War in Ukraine.Method: In total, 1,598 participants (362 from Ukraine, 1,051 from Poland, and 185 from Taiwan) were recruited using an online advertisement to complete online survey questionnaires, including the Brief Coping Orientation to Problems Experienced inventory; the 21-item Depression, Anxiety and Stress Scale; the Impact of Event Scale-Revised; and a questionnaire devised to assess the level of hopelessness about the ongoing war.Results: Psychological distress and adoption of coping strategies differed across people of various countries. Among Taiwanese and Polish respondents, avoidant coping strategies were most strongly associated with all categories of psychological distress compared with problem- and emotion-focused coping strategies. However, the associations of various coping strategies with psychological distress differed to a less extent among Ukrainian respondents. In addition, problem- and emotion-focused coping strategies had comparable associations with psychological distress among the people of Ukraine, Poland, and Taiwan.Conclusions: The 2022 War in Ukraine has affected the psychological well-being of people, especially the Ukrainians. Because of the strong association between the adoption of avoidance coping strategies and psychological distress, despite a less extent among Ukrainian respondents, adaptive coping strategies such as (problem- and emotion-focused) are suggested to help people during times of war.

[Screening for mental distress symptoms among Ukrainian refugees in an initial reception center in Baden-Württemberg]

OBJECTIVE

Millions of people are fleeing the war in Ukraine. Stressors associated with flight can have a massive impact on mental health. The aim of the present study was to perform a low-threshold screening for mental distress symptoms among Ukrainian refugees in an initial reception center in Baden-Württemberg.

METHODS

At the initial reception center in Heidelberg Ukrainian refugees were interviewed about psychological distress during consultations with medical care providers, using four screening questionnaires (PC-PTSD-5, PHQ-9, GAD-7, stress thermometer) in Ukrainian or Russian language, and further sociodemographic data and data about the refugees' background were collected.

RESULTS

More than 90% of the N = 36 respondents reported that they had experienced war, 55.6% reached the cut-off score for post-traumatic stress disorder. One fourth of the participants reached cut-off scores for depression and more than 30% for generalized anxiety disorder. The majority of respondents had relatives living in embattled cities, and in over 36% close relatives were currently deployed in war. In the group comparison there was no significant correlation of symptom burden with the family background situation.

DISCUSSION

In line with the existing literature, many of the participants showed signs of mental distress. Potentially affected persons can be identified using low-threshold screening questionnaires. Adequate care for mentally stressed refugees according to their needs should be established to facilitate integration.

CONCLUSION

Due to the known high prevalence of mental distress, refugees should be screened for mental distress symptoms at a low-threshold level to identify affected individuals. The psychosocial situation of Ukrainian refugees should be considered at an early stage in medical care.

Gender differences in the association between anxiety symptoms and thyroid hormones in young patients with first-episode and drug naïve major depressive disorder

Objective

Gender differences are prevalent in major depressive disorder (MDD), but the gender differences in the relationship between comorbid anxiety and thyroid hormones in young first-episode and drug-naive (FEND) MDD patients are unknown.

Methods

A total of 1,289 young outpatients with FEDN MDD were recruited. Demographic and clinical data were collected for each patient. The patient's blood glucose, blood pressure, thyroid hormone, and thyroid antibody levels were measured. The Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess patients' depression, anxiety, and positive symptoms, respectively.

Results

The prevalence of comorbid anxiety disorders was 80.4 and 79.4% in male and female MDD patients, respectively. Patients with anxiety had higher HAMD and PANSS scores, higher serum thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (A-TG), and thyroid peroxidase antibody (A-TPO) levels, higher blood glucose and blood pressure levels, and more patients with psychotic symptoms and suicide attempts. Male patients were younger and had a younger age of onset. Logistic regression analysis showed that HAMD score and comorbid suicide attempts were significant predictors of anxiety symptoms in both males and females, whereas A-TG predicted anxiety symptoms in female patients only. Limitations: No causal relationship could be drawn due to the cross-sectional design.

Conclusion

This study showed gender differences in factors associated with anxiety symptoms in patients with MDD. Some factors were associated with anxiety symptoms in both male and female patients, while A-TG was only associated with anxiety symptoms in female patients.

Design, implementation and preliminary results of a type-2 hybrid cluster-randomized trial of integrating screening and treatment for major depressive disorder into specialty clinics providing opioid agonist therapies in Ukraine

INTRODUCTION

Ukraine has a high prevalence of co-occurring disorders (COD), defined as having both substance use (SUD) and psychiatric disorders. Major depressive disorder (MDD) is the most prevalent psychiatric disorder among people with SUD. People with COD experience poor health outcomes, and international agencies propose integrated COD care. In Ukraine, treatment for SUD is delivered in specialized substance use clinics, without providing any other medical services for comorbidities, including MDD. Here we present the protocol, along the with the preliminary results of the MEDIUM project, including observations over the first 6 months.

METHODS

A cluster-randomized type-2 hybrid trial was conducted to integrate MDD treatment into specialty clinics providing opioid agonist therapies (OAT) in Ukraine. Twelve clinics in four regions underwent randomization to control (N = 1) vs experimental arms (N = 2) in each region. Clinicians at experimental sites received tele-education through modified project ECHO using a facilitated screening, evaluation, and treatment algorithm of depression, with or without financial incentives. Service-, patient- and provider-level data were collected for the analysis every 6 months for 24 months.

PRELIMINARY RESULTS

For service delivery outcomes, 4421 patients enrolled on OAT across all sites were assessed for MDD for screening (76.7%), evaluation with diagnosis (43.5%) and treatment (30.7%) for MDD; 13.8% continued treatment at least for 6 months. For patient-level outcomes, 1345 patients and 54 providers participated in serial surveys every six months.

CONCLUSION

This study will be the first to explore integrated COD care in Ukraine and generate evidence on effective service integration and delivery strategies for people with COD receiving treatment at substance use clinics with broader implications for Eastern Europe and Central Asia region.

The global movement towards a public health approach to substance use disorders

Drug misuse is a global problem. Markets that supply illegal drugs often span international borders. However, each country has different primary drugs of use, populations that are using and consequences of use. The policy approach of each country to addressing substance use disorders can be characterized along a continuum between purely public health approaches and purely law enforcement approaches. Historically, a law enforcement approach has been the primary strategy in much of the world. However, there is a growing movement towards use of a public health approach. This article provides four case examples, Ukraine, Philippines, Nigeria and Peru, where there is movement to develop addiction public health infrastructure. The work varies by country, but includes regulatory changes, workforce development and resource allocation all of which are supported by the United Nations Office on Drugs and Crime (UNODC) and multi-national organizations that provide training and technical assistance, funded primarily by the European Union and United States governments. All four countries highlighted have barriers to moving towards a more public health approach which may include popularity of the law enforcement approach, turbulent government environments, and economics of being a drug producing nation. However, whether starting from the top down with changed policies, such as Ukraine or from the bottom up with training community members as in the Philippines, each country provides an example of how donor resources can be applied to make the transition towards a more humane and evidence-based approach to addressing substance use disorders.Key MessagesWhile the primary approach to addressing drug use has focussed resources on law enforcement for over 100 years, many countries are adopting elements of a public health approach including prevention and treatment of the harms of drug use including substance use disorders.There is a growing global movement to make policy towards drugs and drug users more humane and evidence-based.Donor nation resources can be applied in a variety of combinations to improve care and outcomes for people who use drugs in low- and middle-income countries.

Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine

OBJECTIVE

Adults <30 years' of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings.

DESIGN

We conducted qualitative individual interviews with CJS-involved YA (18-24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis.

SETTING

Data were collected in three locales, prior to the 2022 Russian-Ukrainian conflict.

PARTICIPANTS

Thirty YA and 20 stakeholders.

RESULTS

Most YA were men, reported recent injection drug use and were M age=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma).

CONCLUSIONS

Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).

Psychosocial and Psychiatric Factors Associated with Expected Fatality during Suicide Attempt in Men and Women

BACKGROUND

Differential factors that influence intention and subjectively perceived fatality during non-fatal suicidal acts amongst men and women have rarely been explored in the extant literature. Exploring these factors may help to understand how they influence medical outcomes and may also be used in a post-crisis counselling. This study aims to assess factors influencing intent in relation to expected fatality during suicidal acts in men and women.

METHOD

In the current study, 433 individuals who attempted suicide (age 24.89±0.98 years, male/female ratio=1.29) were surveyed using the WHO-5 Well-Being Index, Beck Depression Inventory, Beck Suicide Intent Scale, Plutchik Feelings and Acts of Violence Scale, and Spielberger State/Trait Anger Scale. Life stress was evaluated as an accumulation of negative life events, whilst psychiatric disorders were assessed using CIDI 2.1 inventory.

RESULTS

It was found that the higher expected fatality was associated with higher suicide intention scores, whereas the medical severity of attempts and violent/non-violent attempts distribution did not differ between groups. Although there was no difference in suicide intent scores and medical severity between men and women, men demonstrated a 2.4-3.5 times higher proportion of violent attempts, depending on the group. Higher perceived fatality was associated with lower general well-being, higher depression and violence, hopelessness, and total life stress in men, whereas among women higher perceived fatality was only associated with total life stress. Moreover, in men and women, higher intent and expected fatality was associated with a differential set of negative life events that occurred during childhood. The prevalence of mental health disturbances in the entire sample was about 50% and equally distributed among men and women. However, addictions prevailed among men, while neurotic and stress-related disorders were more common among women. Among those who expected more fatality the number of people with diagnoses and comorbidity was higher, especially in men.

CONCLUSION

There is a difference in risk factors for expected fatality and intent in men and women attempting suicide, which may not necessarily result in severe medical outcomes but may help during the post-crisis counseling of suicide attempters. Expected fatality deserves more attention as a component of general intent. An in-depth study of this phenomenon may help to understand motives of men and women attempting suicide and help prevent future suicidal attempts.

HISTORICAL AND CONTEMPORARY CONTEXTS OF ALCOHOL CONSUMPTION IN MODERN UKRAINE

OBJECTIVE

The aim: To identify and to describe the historical and current factors that determine the patterns of alcohol consumption in modern Ukraine.

PATIENTS AND METHODS

Materials and methods: A review and analysis of existing literature focused on historical and contemporary contexts of alcohol use in modern Ukraine. Epidemiological data from general population adolescents survey (N=2038; 2020) and adults survey (N=1200; 2019) conducted in the Lviv region are analyzed from the sociological perspective.

CONCLUSION

Conclusions: Studies results demonstrate the existence of special mechanism that conserves and strengthens the predisposition of positive attitude towards alcohol since early childhood. This information will help to shift the focus of anti-alcohol policy towards a more diverse set of strategies (including administrative intervention and harm reduction strategy).

Estimating the global treatment rates for depression: A systematic review and meta-analysis

BACKGROUND

Depression is considered a global crisis due to its high prevalence and associated disabilities. The burden posed by depression could be reduced by increasing access to timely treatment. Limited information is available on treatment rates of depression, particularly in low- and middle-income countries. This study aimed to estimate the treatment rates for depression in the general adult population by World Bank income classification.

METHODS

We searched PubMed, EMBASE, PsycINFO, and CINAHL, supplemented with hand-search of reference lists to identify community-based studies. The overall treatment rate for depression was estimated from studies that reported any treatment (behavioral or pharmacological treatments) in healthcare or informal non-healthcare settings. Data were pooled using a random-effects meta-analysis model. Subgroup analyses by income classification were completed. Meta-regression was conducted by study characteristics. The protocol was pre-registered at PROSPERO (CRD42020161683).

RESULTS

We included 65 studies comprising 1.1 million participants from 79 countries and territories. The global 12-month/lifetime pooled treatment rate was 34.8% (95% confidence interval: 29.9, 39.9%). The treatment rates were 48.3% (43.0, 53.6%) in high-income countries, 21.4% (15.1, 27.7%) in middle-income countries, and 16.8% (11.3, 23.0%) in low-income countries. Among the treated samples, 12-month minimally adequate treatment was estimated to be 40%.

LIMITATION

We reported a substantial level of between-study heterogeneity, which was partially explained by study characteristics in the meta-regression.

CONCLUSION

Globally, approximately one-third of people with depression receive treatment. Three in five treated people with depression did not receive minimally adequate treatment. Depression treatment rates are considerably lower in low-and middle-income countries.

Mental health care in Eastern Europe and Central Asia: An analysis of needs and a call for greater investment

Over the past decade, there has been increased attention to global mental health, which emphasizes improving access to quality mental health care in order to reduce the worldwide treatment gap. However, Eastern European and Central Asian countries and their specific mental health needs have largely been under-emphasized, evidenced by a dearth in literature and funding. Here, we provide an overview of the mental health needs in Ukraine and its challenges with quality care provision as a key example in highlighting these gaps, then broaden our discussion to include parallels with other countries in the Eastern European and Central Asian region. We describe the unique strengths relative to mental health care provision that are present in Eastern Europe and Central Asia and suggest the importance of post-graduate training, regional collaboration, and capacity building specific to research management as strategies to address the current challenges. We stress that greater investment from funders, government, and the global mental health community are needed to improve the current mental health situation in Ukraine, specifically, and Eastern Europe and Central Asia, broadly. We argue that greater attention to Eastern Europe and Central Asia is needed to fully advance the agenda of the global mental health field.

Partner influence as a factor in maternal alcohol consumption and depressive symptoms, and maternal effects on infant neurodevelopmental outcomes

BACKGROUND

Few studies have investigated the partner's influence on risk factors such as alcohol consumption and depression during pregnancy. Partner substance use and lower relationship satisfaction predict higher maternal alcohol use and depressive symptoms. Because prenatal alcohol use and maternal depression affect infant outcomes, it is imperative to examine how the partner affects these maternal risk factors. The current study examined the effect of a latent construct of partner influence on maternal alcohol use and depressive symptoms, and the effects on infant development of these maternal factors.

METHODS

Participants were 246 pregnant women from 2 sites in Western Ukraine from whom longitudinal data were collected as part of a multisite study. In the first trimester, mothers reported on relationship satisfaction, partner substance use, and socioeconomic status (SES). In the third trimester, they reported on alcohol use and depressive symptoms. Infants were assessed using the Bayley Scale of Infant Development (average age = 6.93 months). A latent construct titled partner influence was formed using partner substance use and measures of relationship satisfaction, including the frequency of quarreling, happiness in the relationship, and the ease of talking with the partner. Using structural equation modeling, a model was specified in which partner influence and SES predicted maternal alcohol use and depressive symptoms, which in turn predicted infant neurodevelopmental outcomes.

RESULTS

Higher partner influence significantly predicted lower prenatal alcohol use and lower depressive symptoms, controlling for the effect of SES. Higher maternal prenatal alcohol use significantly predicted lower infant mental and psychomotor development. Maternal depressive symptoms did not predict infant development over and above the effect of alcohol use.

CONCLUSIONS

Partner influence is an important contributor to prenatal alcohol use and maternal depressive symptoms, over and above the effect of SES. The significant paths from prenatal alcohol exposure to infant neurodevelopmental outcomes underscore the importance of partner influence during pregnancy.

Cross-Cultural Counselling Supervision in Ukraine

Counsellor educators face complex challenges in the advancement of the counselling profession internationally. One way the counselling profession in Ukraine has been developed is through the use of cross-cultural engagement between local supervisees and U.S.-trained international supervisors. This qualitative study examined the phenomenon of the cross-cultural supervisory experiences of twelve participants involved in transnational distance supervision among Ukrainian supervisees, and their U.S.-trained, non-Ukrainian supervisors. Semi-structured interviews were used to elicit participants’ descriptions of their supervisory experiences. Participants identified commitment to the supervisory relationship, the importance of felt supervisor support, shared resources to promote counsellor growth, and in-person meetings in the supervisee’s context prior to the start of the supervisory relationship as the most important aspects of supervision. The researchers highlight implications and propose recommendations for counsellor educators and supervisors desiring to implement cross-cultural or transnational supervision in different cultural contexts.

Association between acoustic speech features and non-severe levels of anxiety and depression symptoms across lifespan

BACKGROUND

Several studies have investigated the acoustic effects of diagnosed anxiety and depression. Anxiety and depression are not characteristics of the typical aging process, but minimal or mild symptoms can appear and evolve with age. However, the knowledge about the association between speech and anxiety or depression is scarce for minimal/mild symptoms, typical of healthy aging. As longevity and aging are still a new phenomenon worldwide, posing also several clinical challenges, it is important to improve our understanding of non-severe mood symptoms' impact on acoustic features across lifetime. The purpose of this study was to determine if variations in acoustic measures of voice are associated with non-severe anxiety or depression symptoms in adult population across lifetime.

METHODS

Two different speech tasks (reading vowels in disyllabic words and describing a picture) were produced by 112 individuals aged 35-97. To assess anxiety and depression symptoms, the Hospital Anxiety Depression Scale (HADS) was used. The association between the segmental and suprasegmental acoustic parameters and HADS scores were analyzed using the linear multiple regression technique.

RESULTS

The number of participants with presence of anxiety or depression symptoms is low (>7: 26.8% and 10.7%, respectively) and non-severe (HADS-A: 5.4 ± 2.9 and HADS-D: 4.2 ± 2.7, respectively). Adults with higher anxiety symptoms did not present significant relationships associated with the acoustic parameters studied. Adults with increased depressive symptoms presented higher vowel duration, longer total pause duration and short total speech duration. Finally, age presented a positive and significant effect only for depressive symptoms, showing that older participants tend to have more depressive symptoms.

CONCLUSIONS

Non-severe depression symptoms can be related to some acoustic parameters and age. Depression symptoms can be explained by acoustic parameters even among individuals without severe symptom levels.

Mental health stigma in Ukraine: cross-sectional survey

BACKGROUND AND STUDY OBJECTIVES

This study aimed to assess among Ukrainian adults: (1) knowledge of mental disorders; (2) attitudes towards people with mental health disorders, and to the delivery of mental health treatment within the community; and (3) behaviours towards people with mental disorders.

METHODOLOGY

A cross-sectional survey of Ukrainian adults aged 18-60 was conducted. Stigma-related mental health knowledge was measured using the mental health knowledge schedule. Attitude towards people with mental health disorders was assessed using the Community Attitudes towards Mental Illness scale. The Reported and Intended Behaviour scale was used to assess past and future intended behaviour towards people with mental health disorders.

RESULTS

Associations between gender, age, and educational level and the knowledge and attitudes measures were identified. There was evidence of a positive association between being male and positive intended behaviours towards people with mental health disorders [mean difference (MD) = 0.509, 95% confidence interval (CI) 0.021-0.998]. Older age was negatively associated with positive intended behaviours towards people with mental health disorders (MD = -0.017, 95% CI 0.0733 to -0.001). Higher education was positively associated with stigma-related mental health knowledge (MD = 0.438, 95% CI 0.090-0.786), and negatively associated with authoritarian (MD = 0.755, 95% CI 0.295-1.215) attitudes towards people with mental health problems.

CONCLUSION

Overall, the findings indicate a degree of awareness of, and compassion towards, people with mental illness among Ukrainian adults, although this differed according to gender, region, and education level. Results indicate a need for the adoption and scaling-up of anti-stigma interventions that have been demonstrated to be effective.

Factors associated with incidence of depressiveness among the middle-aged and older Estonian population

OBJECTIVE

Relatively scant research among older Estonian population describes factors associated with the incidence of depressive symptoms. This study identifies factors associated with the incidence of depressiveness among middle-aged and older Estonians over 2- and 4-year periods.

METHOD

In this cross-sectional analysis, logistic regression models are used to identify the factors associated with the incidence of depressiveness over 2- and 4-year periods. The data were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) 2011-2015 which included Estonian population aged 53 years and older in 2013. After excluding those younger than 53 years, not interviewed 2 years later, those with depressive symptoms at baseline in 2013, and missing values for depressiveness or other variables, our analytical sample comprised 2513 people.

RESULTS

Among those who were not depressive in 2013, 21.9% became depressive within 2 years; 16.1% of non-depressive individuals since 2011 became depressive by 2015. No age differences in incidence remained in adjusted models. Women have almost 50% higher odds of becoming depressive. A previous history of depressiveness and the presence of everyday activity limitations were important factors increasing the incidence of depression.

DISCUSSION

Changes related to the individual's unique ageing experience are important explanatory factors related to the likelihood of developing depressive symptoms, rather than age itself. To diminish the incidence of depressive symptoms among older Estonian population, public health interventions should attempt to address factors which complicate existing health problems and facilitate continued independence and community involvement, both of which contribute to overall satisfaction with life.

Transitioning to community-based mental health service delivery: opportunities for Ukraine

Background and objectives: Ukraine's mental health system has been found to be inadequate and unresponsive to the needs of the population, in view of its emphasis on inpatient service delivery. This study sought to identify potential changes to the organization and financing of mental health services within the Ukrainian health system that would facilitate the delivery of mental health services in a community-based setting. Methodology: A systematic literature review was undertaken to identify organizational and financing features that have been successfully used to enable and incentivize the delivery of community-based mental health services in Central or Eastern European and/or former Soviet Union countries. Results: There was limited literature on the organizational and financing features that facilitate the delivery of community-based care. Key facilitators for transitioning from institution-based to community-based mental health service delivery include; a clear vision for community-based care, investment in the mental health system, and mechanisms that allow health funding to follow the patient through the health system. Conclusions: Ukraine should adopt strategic purchasing mechanisms to address inefficiency in the financing of its mental health system, and prioritize collaborative planning and delivery of mental health services. Ongoing reform of the Ukrainian health system provides momentum for instituting such changes.

Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services

BACKGROUND

There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours.

METHODS

A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours.

RESULTS

Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours.

CONCLUSIONS

AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.

The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys

BACKGROUND

Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities.

METHODS

Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0.

RESULTS

Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence.

CONCLUSIONS

Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns.

Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique

PURPOSE

There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique.

METHODS

Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique.

RESULTS

19% (CI 17-21%) of respondents reported DS in the past year and 17% (CI 15-18%) lifetime SI. Overall, only 10% (CI 8-11%) of respondents ever sought any care for mental illness, though 26% (CI 23-29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability-especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care.

CONCLUSIONS

DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.

Epidemiology of chronic pain in Ukraine: Findings from the World Mental Health Survey

Chronic pain can pose a serious challenge in everyday life for many individuals globally, especially in developing countries, but studies explicitly exploring risk factors of chronic pain beyond demographic characteristics using survey data have been scarce. To address this problem, this study analyzed World Health Organization data on chronic pain in Ukraine to explore demographic, psychological, and treatment perception-related risk factors to chronic pain. We replicated previous reports of older age, female sex, married status, inadequate financial resources, and comorbidity of other physical conditions as significant demographic risk factors for chronic pain diagnosis but not necessarily for severe pain. We also found evidence for psychological risk factors and treatment perceptions as significant predictors for chronic pain diagnosis and its severity. These results provide a first step in examining beyond demographic risk factors for chronic pain diagnosis and severity and, instead, assessing potential psychological risk factors.

Internalizing and Externalizing Behaviors among Ukrainian Children: The Role of Family Communication and Maternal Coping

OBJECTIVES

This study aims to explore the relationship of mother's ways of coping with stress and family communication with the child internalizing and externalizing behaviors in Ukraine.

METHODS

In a cross-sectional sample of 294 mother-and-child (9-16 years of age) Ukrainian dyads, mothers answered questions from the revised Ways of Coping Checklist, FACES Family Communication scale, Child Behavior Checklist, and questions about their sociodemographic characteristics.

RESULTS

Robust regression results suggest increased internalizing behaviors were statistically associated with poor family communication (b = -.19, 95% CI [-.30, -.08], p<.01), maternal coping by accepting responsibility (b = 2.14, 95% CI [.44, 3.84], p<0.05), escape-avoidance (b = 3.79, 95% CI [1.00, 6.58], p<0.01), planful problem solving (b=2.80, 95% CI [.61, 4.99], p<0.05), child female gender (b = -2.53, 95% CI [-4.22, -.83], p<.01) and lower family income (b = -.003, 95% CI [-.006, -.0001], p<.01). Increased child externalizing behaviors were statistically associated with maternal seeking social support (b = 3.25, 95% CI [1.06, 5.43], p<.01), decreased positive reappraisal (b = -1.52, 95% CI [-2.91, -.12], p <.05), maternal unemployment (b = -2.80, 95% CI [-5.30, -.30], p<.05), poor family communication (b = .46, 95% CI [-.59, -.34], p<.001), and child male gender (b = 3.48, 95%CI [1.53, 5.44], p<.01). Poor family communication was linked with significantly higher increase in internalizing behaviors for girls compared to boys (b = .17, 95% CI [.03, .32], p<.05).

CONCLUSIONS

When examining child internalizing and externalizing behaviors it is important to consider the role of family communication and maternal coping.

The factor structure of a Polish language version of the hospital anxiety depression scale (HADS)

The Hospital Anxiety Depression Scale (HADS) is widely used as a screening measure for psychological distress. Nevertheless, there is disagreement among researchers about the extent to which the HADS provides separate measures of anxiety and depression or a single measure of affectively based distress, and the present study was designed to contribute to this discussion. Participants (n = 951) who were psychologically distressed, but not hospitalized, completed a Polish language version of the HADS. A confirmatory factor analysis of participants’ responses confirmed a model with two correlated factors with one cross-loaded item. The estimated correlation between the factors was .68. These results suggest that the Polish version of the HADS consists of two correlated measures of affectively focused distress, depression and anxiety. Nevertheless, analysts and practitioners need to be cautious and take into account the possibility that the discriminant validity of these two scales may be somewhat limited given the correlation between the subscales and the possible cross-loadings of items.

Adaptation and testing of an assessment for mental health and alcohol use problems among conflict-affected adults in Ukraine

Background

In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. Our purpose was to develop reliable and valid instruments to screen for common mental health and alcohol use problems in these populations.

Methods

We used a three-step process of instrument adaptation and testing. The instrument-the Mental Health Assessment Inventory (MHAI)-combines adapted standard screeners with items derived locally in Ukraine. A validity study was conducted using a sample of 153 adults (54% male) ages 18 years and older. All participants in the sample were IDPs or veterans living in or near the major urban areas of Kyiv and Zaporizhia. Reliability testing (internal consistency, test-retest) and validity testing (construct, criterion) of the MHAI were conducted using classical test theory. After initial testing, we used Item Response Theory (IRT) to shorten and further refine the instrument.

Results

The MHAI showed good internal consistency and test-retest reliability for the main outcomes: depression (α = 0.94; r = .84), post-traumatic stress (PTS; α = 0.97; r = 0.87), anxiety (α = 0.90; r = 0.80), and alcohol use (α = 0.86; r = 0.91). There was good evidence of convergent construct validity among the scales for depression, PTS, and anxiety, but not for alcohol use. Item Response Theory (IRT) analysis supported use of shortened versions of the scales for depression, PTS, and anxiety, as they retained comparable psychometric properties to the full scales of the MHAI.

Conclusion

The findings support the reliability and validity of the assessment-the MHAI-for screening of common mental health problems among Ukrainian IDPs and veterans. Use of IRT shortened the instrument to improve practicality and potential sustainability.

The impact of measurement differences on cross-country depression prevalence estimates: A latent transition analysis

BACKGROUND

Depression is currently the second largest contributor to non-fatal disease burden globally. For that reason, economic evaluations are increasingly being conducted using data from depression prevalence estimates to analyze return on investments for services that target mental health. Psychiatric epidemiology studies have reported large cross-national differences in the prevalence of depression. These differences may impact the cost-effectiveness assessments of mental health interventions, thereby affecting decisions regarding government and multi-lateral investment in mental health services. Some portion of the differences in prevalence estimates across countries may be due to true discrepancies in depression prevalence, resulting from differential levels of risk in environmental and demographic factors. However, some portion of those differences may reflect non-invariance in the way standard tools measure depression across countries. This paper attempts to discern the extent to which measurement differences are responsible for reported differences in the prevalence of depression across countries.

METHODS AND FINDINGS

This analysis uses data from the World Mental Health Surveys, a coordinated series of psychiatric epidemiology studies in 27 countries using multistage household probability samples to assess prevalence and correlates of mental disorders. Data in the current study include responses to the depression module of the World Mental Health Composite International Diagnostic Interview (CIDI) in four countries: Two high-income, western countries-the United States (n = 20, 015) and New Zealand (n = 12,992)-an upper-middle income sub-Saharan African country, South Africa (n = 4,351), and a lower-middle income sub-Saharan African country, Nigeria (n = 6,752). Latent class analysis, a type of finite mixture modeling, was used to categorize respondents into underlying categories based on the variation in their responses to questions in each of three sequential parts of the CIDI depression module: 1) The initial screening items, 2) Additional duration and severity exclusion criteria, and 3) The core symptom questions. After each of these parts, exclusion criteria expel respondents from the remainder of the diagnostic interview, rendering a diagnosis of "not depressed". Latent class models were fit to each of the three parts in each of the four countries, and model fit was assessed using overall chi-square values and Pearson standardized residuals. Latent transition analysis was then applied in order to model participants' progression through the CIDI depression module. Proportion of individuals falling into each latent class and probabilities of transitioning into subsequent classes were used to estimate the percentage in each country that ultimately fell into the more symptomatic class, i.e. classified as "depressed". This latent variable design allows for a non-zero probability that individuals were incorrectly excluded from or retained in the diagnostic interview at any of the three exclusion points and therefore incorrectly diagnosed. Prevalence estimates based on the latent transition model reversed the order of depression prevalence across countries. Based on the latent transition model in this analysis, Nigeria has the highest prevalence (21.6%), followed by New Zealand (17.4%), then South Africa (15.0%), and finally the US (12.5%). That is compared to the estimates in the World Mental Health Surveys that do not allow for measurement differences, in which Nigeria had by far the lowest prevalence (3.1%), followed by South Africa (9.8%), then the United States (13.5%) and finally New Zealand (17.8%). Individuals endorsing the screening questions in Nigeria and South Africa were more likely to endorse more severe depression symptomology later in the module (i.e. they had higher transition probabilities), suggesting that individuals in the two Western countries may be more likely to endorse screening questions even when they don't have as severe symptoms. These differences narrow the range of depression prevalence between countries 14 percentage points in the original estimates to 6 percentage points in the estimate taking account of measurement differences.

CONCLUSIONS

These data suggest fewer differences in cross-national prevalence of depression than previous estimates. Given that prevalence data are used to support key decisions regarding resource-allocation for mental health services, more critical attention should be paid to differences in the functioning of measurement across contexts and the impact these differences have on prevalence estimates. Future research should include qualitative methods as well as external measures of disease severity, such as impairment, to assess how the latent classes predict these external variables, to better understand the way that standard tools estimate depression prevalence across contexts. Adjustments could then be made to prevalence estimates used in cost-effectiveness analyses.

Predictors of Parental Use of Corporal Punishment in Ukraine

Despite a great deal of evidence that corporal punishment is harmful, corporal punishment is still very prevalent worldwide. We examine predictors of different types of corporal punishment among Ukrainian mothers in 12 communities across Ukraine. Findings suggest that maternal spirituality, maternal coping styles, family communication, and some demographic characteristics are predictive of mothers' use of corporal punishment.

Alcohol use and addiction services in Ukraine

Ukraine, with a population of 46.2 million, is the second largest country in Europe, with an area of 603 700 km2. It is still recovering from the collapse of the Soviet Union in 1991, following the Soviet stagnation era (since the mid-1960s) and perestroika (from 1986), as well as the 1998 Russian financial crisis and Ukraine's 2004 Orange Revolution. These events have resulted in high levels of socio-economic disparity, political instability and a degraded healthcare infrastructure. These issues, in addition to traditionally high levels of alcohol consumption, have made binge drinking and alcoholism, among other addictions, major problems in Ukrainian society (Voloshin et al, 2003).

Psychiatry in Ukraine

Ukraine, at 603 700 km2, has the second largest landmass in Europe. It has a population of about 47.4 million. Ukraine is a lower-middle-income country with a gross national income per capita of US$1260 (World Bank, 2002).

The Associations between Self-Reported Exposure to the Chernobyl Nuclear Disaster Zone and Mental Health Disorders in Ukraine

BACKGROUND

In 1986, Reactor 4 of the Chernobyl nuclear power plant near Pripyat, Ukraine exploded, releasing highly-radioactive materials into the surrounding environment. Although the physical effects of the disaster have been well-documented, a limited amount of research has been conducted on association of the disaster with long-term, clinically-diagnosable mental health disorders. According to the diathesis-stress model, the stress of potential and unknown exposure to radioactive materials and the ensuing changes to ones life or environment due to the disaster might lead those with previous vulnerabilities to fall into a poor state of mental health. Previous studies of this disaster have found elevated symptoms of stress, substance abuse, anxiety, and depression in exposed populations, though often at a subclinical level.

MATERIALS AND METHODS

With data from The World Mental Health Composite International Diagnostic Interview, a cross-sectional large mental health survey conducted in Ukraine by the World Health Organization, the mental health of Ukrainians was modeled with multivariable logistic regression techniques to determine if any long-term mental health disorders were association with reporting having lived in the zone affected by the Chernobyl nuclear disaster. Common classes of psychiatric disorders were examined as well as self-report ratings of physical and mental health.

RESULTS

Reporting that one lived in the Chernobyl-affected disaster zone was associated with a higher rate of alcohol disorders among men and higher rates of intermittent explosive disorders among women in a prevalence model. Subjects who lived in the disaster zone also had lower ratings of personal physical and mental health when compared to controls.

DISCUSSION

Stress resulting from disaster exposure, whether or not such exposure actually occurred or was merely feared, and ensuing changes in life circumstances is associated with increased rates of mental health disorders. Professionals assisting populations that are coping with the consequences of disaster should be aware of possible increases in psychiatric disorders as well as poorer perceptions regarding personal physical and mental health.

Predictors of Internalizing Behaviors in Ukrainian Children

OBJECTIVE

To (a) estimate the level of child internalizing problems in a sample of Ukrainian school-age children and (b) examine the relationships between child internalizing psychopathology and parenting practices, depression, alcohol use, and sociodemographics.

BACKGROUND

Most research on child internalizing behaviors has used samples from high-income countries, but there is a lack of information about children's behaviors and associated risk and protective factors from low- and middle-income countries such as Ukraine. An ecological-transactional model framework was used in this study to examine maternal and family-level factors associated with child internalizing behavior problems.

METHOD

Data were gathered from a community-based sample of Ukrainian mothers and children between 9 and 16 years of age (n = 251) using face-to-face interviews. Multiple linear regression analysis was used to examine the relationship among the independent variables (e.g., alcohol use, depression, and parenting behaviors) and children's internalizing behaviors.

RESULTS

Older children, especially boys, reported fewer internalizing problems. Increased internalizing symptomatology was associated with mothers' older age, higher level of depression, lower use of positive parenting, and poor child monitoring and supervision.

CONCLUSION

These results raise awareness about the importance of child familial backgrounds while trying to address child mental health problems in Ukraine.

IMPLICATIONS

Family practitioners may want to help mothers learn and apply positive parenting and effective supervision and monitoring skills to help reduce their children's depression and anxiety symptoms. Additionally, helping to decrease maternal depression may have a positive trickle-down effect on their children's internalizing behaviors.

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

INTRODUCTION

The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.

METHODS

We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.

RESULTS AND DISCUSSION

The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.

CONCLUSIONS

Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms

In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms

In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Relationship Between Alcohol Use, Spirituality, and Coping

Authors investigated a relationship between the frequency of alcohol consumption, spirituality, and coping with everyday life events in a cross-sectional, community-based sample of 320 adults in Ukraine, the country with one of the highest alcohol consumption levels in the world. Face-to-face interviews with participants took place in rural and urban locations across Eastern, Southern, and Central Ukraine. Results of the ordinary least-squares regression suggest that a higher frequency of alcohol consumption was related with the lower use of positive reappraisal (β = -.27, p < .001), higher use of escape-avoidance (β = .23, p < .01) and confrontive (β = .15, p < .05) coping strategies, lower spirituality (β = -.20, p < .001), and younger age (β = -.11, p < .05). On the whole, current findings suggest that specific coping behaviors, younger age, and lower spirituality are involved in higher frequency of alcohol consumption among Ukrainian adults.

Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors

Background

Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health.

Methods

Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors.

Results

In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women.

Conclusions

The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.

Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries

Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.

Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

OBJECTIVE

Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-to-female ratios in indicators of alcohol use and related harms.

METHODS

We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.

FINDINGS

There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.

CONCLUSIONS

Findings confirm the closing male-female gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.

Intimate partner violence perpetrated by young adult women against men in Ukraine: Examining individual, familial, and cultural factors

We examined the role of financial strain, parent-to-parent violence, parent-to-child violence, emotional distress, and alcohol use in intimate partner violence perpetrated by young adult women against men in Ukraine. The moderating role of acceptability of intimate partner violence and violence-related laws and regulations was also examined. Four hundred and six full-time female university students from four universities in Ukraine participated in the study. We found that emotional distress, parent-to-parent, and parent-to-child violence mediated the link between financial strain and intimate partner violence perpetrated by women on men. However, we found limited support for the moderating role of acceptability of intimate partner violence and violence-related laws and regulations in the relationship between individual and familial factors on intimate partner violence. The findings from this investigation suggest that there is a distinct need for supporting families and individuals in dealing with issues of intimate partner violence directed by women against men in Ukraine. Aggr. Behav. 42:380-393, 2016. © 2015 Wiley Periodicals, Inc.

Prevalence of DSM-IV intermittent explosive disorder in Black adolescents: Findings from the National Survey of American Life, Adolescent Supplement

Little is known about the epidemiology of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) intermittent explosive disorder (IED) in adolescents, and no information is currently available regarding the relationship between race/ethnicity and IED among Black youth in the United States. Using the World Health Organization World Mental Health Composite International Diagnostic Interview (Adolescent Version), we estimated the prevalence, severity, and disability of IED in a national, probability sample of African American and Caribbean Black youth (ages 13–17) from the National Survey of American Life, Adolescent Supplement. Face-to-face surveys of 810 African American and 360 Caribbean Black youth were conducted between 2001 and 2003. We calculated lifetime and 12-month diagnoses of IED using diagnostic algorithms based on DSM–IV and assessed IED disability using a modified Sheehan Disability Scale. Overall findings indicated lifetime and 12-month IED prevalence rates of 9.2% and 7.0%, respectively. Lifetime prevalence rates of IED were 9.0% for African American and 12.4% for Caribbean Black teens. Within the past 12 months, 6.7% of African American and 11.5% of Caribbean Black adolescents met diagnostic criteria for IED. Lifetime and 12-month IED were associated with anxiety disorders. In addition, few teens with lifetime IED received any treatment. Findings are consistent with recent evidence that intermittent explosive disorder may be more common than previously considered, especially among adolescents. Significant acts of aggression and impairment are associated with IED, and low treatment rates indicate that more research on this disorder and intervention options is warranted.

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

BACKGROUND

Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.

METHODS

Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher's exact test and χ2 test for categorical variables.

RESULTS

A quarter (27% (49/180) antenatally and 25% (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58% (7/12) vs. 25% (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40% (17/43) vs. 23% (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43% (12/28) vs. 23% (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44% (20/45) vs. 21% (18/84) of cohabiting and 19% (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40% (20/45) vs. 18% (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30% (44/146) vs. 14% (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48% (11/23) vs. 27% (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82% (37/45) postnatally but only 31% (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.

CONCLUSIONS

A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review

In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.

Spousal Violence in 5 Transitional Countries: A Population-Based Multilevel Analysis of Individual and Contextual Factors

OBJECTIVES

I examined the individual- and community-level factors associated with spousal violence in post-Soviet countries.

METHODS

I used population-based data from the Demographic and Health Survey conducted between 2005 and 2012. My sample included currently married women of reproductive age (n = 3932 in Azerbaijan, n = 4053 in Moldova, n = 1932 in Ukraine, n = 4361 in Kyrgyzstan, and n = 4093 in Tajikistan). I selected respondents using stratified multistage cluster sampling. Because of the nested structure of the data, multilevel logistic regressions for survey data were fitted to examine factors associated with spousal violence in the last 12 months.

RESULTS

Partner's problem drinking was the strongest risk factor associated with spousal violence in all 5 countries. In Moldova, Ukraine, and Kyrgyzstan, women with greater financial power than their spouses were more likely to experience violence. Effects of community economic deprivation and of empowerment status of women in the community on spousal violence differed across countries. Women living in communities with a high tolerance of violence faced a higher risk of spousal violence in Moldova and Ukraine. In more traditional countries (Azerbaijan, Kyrgyzstan, and Tajikistan), spousal violence was lower in conservative communities with patriarchal gender beliefs or higher financial dependency on husbands.

CONCLUSIONS

My findings underscore the importance of examining individual risk factors in the context of community-level factors and developing individual- and community-level interventions.

Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis

BACKGROUND

Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys.

METHODS

A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted.

RESULTS

There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence.

CONCLUSIONS

This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.

Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study

INTRODUCTION

When evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs.

METHODS

In ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender × age interaction.

RESULTS

Within countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52-2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05-0.35). Any lifetime suicide attempt was found in 0.8-5.4% of women and 0.3-2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77-4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p = 0.01), the Netherlands (p = 0.05), and Spain (p = 0.02).

LIMITATIONS

Mental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality.

CONCLUSIONS

Consistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.