Enduring mental health: Prevalence and prediction

Reexamining developmental continuity and discontinuity in the 21st century: Better aligning behaviors, functions, and mechanisms

Developmental science aims to explain development across the lifespan. Jerome Kagan observed that the same behavior can occur for different reasons, and differing behaviors can occur for the same reason. To help account for persistence, desistence, and transformation of behavior across development, Kagan introduced various types of continuity and discontinuity of forms and functions of behavior. This framework provides opportunities for identifying explanatory mechanisms in behavior development. However, misconceptions remain in applying the concepts that Kagan introduced. Much of the literature assumes developmental continuity in constructs without examining whether assumptions are supported, leading to faulty developmental inferences. For instance, the use of the same measure across time to assess development assumes that the behavior occurs for the same reason across time (homotypic continuity). In addition, just because one behavior predicts a different behavior at a later time does not necessarily indicate that age-differing behaviors occur for the same reason (heterotypic continuity). This review aims to advance conceptualizations of continuity and discontinuity from a contemporary perspective with aims to improve mechanistic understanding of behavior development across the lifespan. To better align behaviors, functions, and mechanisms, research should (a) examine (dis)continuity of individual behaviors rather than merely syndromes, (b) identify the function(s) of the given behavior(s), and (c) identify the cognitive and biological processes that underlie the behavior-function pairs. Incorporating examples from research on development of humans and nonhuman animals, I discuss challenges from work that has followed Kagan's ideas and ways to advance understanding of continuity and discontinuity across development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"I felt so powerful to have this love in me": A grounded theory analysis of the experiences of people living with and recovering from eating disorders while in diverse romantic relationships

Romantic partners have the potential to influence attitudes and behaviors related to body image and disordered eating. However, the role that romantic relationships can play in eating disorder (ED) recovery has not been comprehensively investigated. The present study aimed to explore the ways that people living with and recovering from EDs experience their romantic relationships, with the specific objective of developing a novel theoretical framework, grounded in the experiences of people in diverse romantic relationships, to guide future research on the topic. Semi-structured individual interviews were conducted with 66 people (45 cisgender women, 11 cisgender men, 9 nonbinary people, and 1 transgender man) living with and recovering from EDs while in romantic relationships. Our grounded theory analysis yielded a theoretical model of ED management in romantic relationships, revealing that Individual and Relationship Characteristics intersected with Relationship-Related Stressors and were navigated using Eating Disorder and Relationship Management Strategies. Combined with Partner Support and Tensions, these management strategies were related to Relationship and Mental Health Outcomes, which affected and were affected by Future Concerns. Future researchers should continue to build on, expand, and modify this model and further explore the role of romantic relationships in the experience of people living with EDs.

Internet-based cognitive behavioural therapy in the real world: Naturalistic use and effectiveness of an evidence-based platform in New Zealand

OBJECTIVE

Internet-based cognitive behavioural therapy (iCBT) is an efficacious, scalable intervention that could help meet the significant demand for psychological treatment. Yet, there is limited real-world evidence for its effectiveness. This study investigated the use and effectiveness of a free iCBT programme ('Just a Thought') in New Zealand.

METHODS

We analysed 18 months of user data from the Just a Thought website to understand the characteristics of those who used the Depression and Generalised Anxiety Disorder courses, how many lessons they completed, how mental distress changed across each course and the factors associated with adherence and improvement in mental health.

RESULTS

The results for both courses followed very similar patterns. Course adherence was low overall. There were small differences in adherence by age, gender and ethnicity, and larger differences for those who were 'prescribed' Just a Thought by a healthcare worker. Mixed models showed significant reductions in mental distress, with some tapering of improvement across latter lessons. Those most likely to show clinically meaningful reductions in mental distress had completed more lessons, were older and had a higher baseline level of distress.

CONCLUSION

Alongside previous efficacy research, this real-world data indicate that iCBT is most likely to be effective at the population level and across different subgroups if users complete as much of the course as possible. Strategies to increase course adherence and maximise the public health benefits of iCBT include healthcare workers 'prescribing' iCBT and tailored solutions to meet the needs of young people, Māori and Pasifika.

Associations between healthy lifestyle behavioral patterns and mental health problems: A latent class analysis of 161,744 Chinese young adults

BACKGROUND

Youth mental health problems are a public health priority. Multiple healthy lifestyle behaviors may cluster into healthy lifestyle behavioral patterns (HLBPs) that increase mental health risks in adolescents and older adults, but little is known regarding young adults. This study aimed to explore the associations between cluster HLBPs and mental health problems in young adults.

METHODS

We selected 161,744 young adults aged 20-39 as participants from the database of a Chinese general hospital health management center for the years 2015-2020. The latent class analysis was used to identify HLBPs.

RESULTS

A total of 15.0 % of young adults have at least one mental health problem. Five clusters of HLBPs were identified, characterized as low-risk class (1.6 %), moderate-risk class 1 (12.0 %), moderate-risk class 2 (2.1 %), moderate-risk class 3 (56.8 %), and high-risk class (27.4 %). The odds ratios (ORs) for young adults with two mental health problems increased with the risk grade of HLBPs, while the ORs for young adults with one or three mental health problems ranged from high to low according to the risk grade of HLBPs: high-risk class, moderate-risk class 2, moderate-risk class 3, moderate-risk class 1.

LIMITATIONS

Cross-sectional design and no causal conclusions could be drawn.

CONCLUSION

Young adults demonstrated a cluster phenomenon of healthy lifestyle behaviors and significant associations between HLBPs and mental health problems. Young adults with a higher risk grade for HLBPs were more likely to have mental health problems. Different HLBPs should be taken into account when implementing mental health interventions.

The Positive Approach to the Psychiatric Assessment: A Randomized Trial of a Novel Interviewing Technique

OBJECTIVE

This pilot study compared a novel communication strategy, the positive approach to the psychiatric interview, with the traditional approach to see if the positive approach can be taught to psychiatric residents; reproduced with standardized patients; measured with a structured scale, the "Positive Approach Outcome Measure," by blinded raters; and used to improve rapport (assessed with the Bond score), a key driver of engagement.

METHODS

Thirty psychiatric residents were randomly assigned to conduct two psychiatric interviews with standardized patients. The standardized patients completed the Working Alliance Inventory-Short Revised, an assessment of the therapeutic alliance. T tests and linear regression examined the effect of the training on the outcome of interest, the Bond score.

RESULTS

The Bond scores for the positive approach group (M = 19.27, SD = 2.87) and the traditional approach group (M = 16.90, SD = 3.44) were statistically significantly different (p = 0.05). All residents trained in the positive approach received a positive score on the Positive Approach Outcome Measure while none of the traditional approach-trained residents attained the threshold. The inter-rater reliability for the blinded raters was high (0.857), as was the intra-rater reliability (1.0).

CONCLUSIONS

The positive approach can be taught to residents and reproduced consistently and was associated with improvement in a key driver of treatment engagement: rapport. The positive approach may be an important, inexpensive intervention to improve treatment engagement and ultimately treatment outcomes.

Promoting mental health through collaboration between workplaces and occupational health services - Preliminary findings from a survey and workshop in Finland

Disability due to mental health problems places a significant burden on both society and the individual. Occupational health professionals play a key role in promoting mental health in collaboration with workplaces. Our study focused on the joint preventive mental health practices of workplaces and occupational health services (OHS). We used a multiple method approach. We gathered data in parallel from September to October 2021 through an online survey and a workshop of 102 participants. The survey was sent to 25 workplaces and their OHS (N = 25), and assessed employee perceptions of collaboration in mental health practices. We set no exclusion criteria and included all responses. We used Fisher's Exact Test in the statistical analysis. We studied 140 comments on the means of the mental health support obtained in the workshop, using content analysis. The survey response rate was 78 % (N = 39). The OHS providers (N = 15) claimed that mental health support was being provided through collaboration, and 74 % (N = 24) of the workplaces agreed. Content analysis streamlined collaboration methods into six upper categories: by (1) Planning measures together, (2) Strengthening employees' resources, (3) Discussing work ability, (4) Providing supervisors/managers with support, (5) Discussing and collaborating, and (6) Clarifying responsibilities and roles in the support of mental health. We found 55 different practices for streamlining collaboration between workplaces and OHS. We conclude that the practices to promote mental health through collaboration between workplaces and OHS require joint planning.

Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden

BACKGROUND

Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors.

METHODS

Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories.

RESULTS

Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector.

LIMITATIONS

Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available.

CONCLUSIONS

Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.

Socioeconomic status and social anxiety: attentional control as a key missing variable?

BACKGROUND AND OBJECTIVES

The aim was to examine the role of attentional control as a psychological factor involved in socioeconomic status-related mental health differences, and specifically in social anxiety. Based on the literature on socioeconomic status differences in cognitive abilities and attentional control theory, we hypothesized that attentional control would account for the relation between socioeconomic status and social anxiety. We tested this hypothesis in an integrative model also including trait anxiety and subjective socioeconomic status.

DESIGN

Cross-sectional.

METHOD

Online, 439 French adults were recruited via social media. They completed self-reported measures of attentional control, objective socioeconomic status, subjective socioeconomic status, social anxiety, and trait anxiety.

RESULTS

Using Structural Equation Modelling, findings showed a positive association between objective (but not subjective) socioeconomic status and attentional control, which in turn was related to social anxiety. Exploratory analyses showed that only income, as objective socioeconomic status indicator, was associated with attentional control.

CONCLUSIONS

The current study is the first to support that low socioeconomic status individuals report less attentional control and more social anxiety symptoms. This suggests that attentional control is a psychological factor involved in social anxiety inequalities.

Theories of psychopathology: Introduction to a special section

This special section on theories of psychopathology provides an opportunity to collect the emergent, cross-cutting scholarship that is challenging traditional approaches to understanding mental illness. Here, we appraise the state of theory in the field and emphasize the pitfalls of working in the context of overly flexible, unchallenged, and essentially unchallengeable theoretic models, such as the biopsychosocial model, which we argue has become the de facto theoretic model for our field. We further posit that theoretic shortcomings are contributing to the often-referenced pessimism regarding our progress in understanding and treating mental illness, and introduce the charge of the authors of the papers in this section to articulate novel, falsifiable theories of psychopathology. We briefly touch on the intertwined issue of how to define psychopathology and discuss a key issue raised by the array of papers comprising the section, namely how to conceptualize the spatiotemporal boundaries of complex causal systems. We then use this schematic for understanding how these theories relate to each other and to the vanilla biopsychosocial model they are vying to replace. Ultimately, it is our belief and hope that progress in theoretic thinking will catalyze faster progress in research and improvements to and novel developments in clinical prevention and intervention efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between polygenic risk of substance use and use disorder and alcohol, cannabis, and nicotine use in adolescence and young adulthood in a longitudinal twin study

BACKGROUND

Recent well-powered genome-wide association studies have enhanced prediction of substance use outcomes via polygenic scores (PGSs). Here, we test (1) whether these scores contribute to prediction over-and-above family history, (2) the extent to which PGS prediction reflects inherited genetic variation v. demography (population stratification and assortative mating) and indirect genetic effects of parents (genetic nurture), and (3) whether PGS prediction is mediated by behavioral disinhibition prior to substance use onset.

METHODS

PGSs for alcohol, cannabis, and nicotine use/use disorder were calculated for Minnesota Twin Family Study participants (N = 2483, 1565 monozygotic/918 dizygotic). Twins' parents were assessed for histories of substance use disorder. Twins were assessed for behavioral disinhibition at age 11 and substance use from ages 14 to 24. PGS prediction of substance use was examined using linear mixed-effects, within-twin pair, and structural equation models.

RESULTS

Nearly all PGS measures were associated with multiple types of substance use independently of family history. However, most within-pair PGS prediction estimates were substantially smaller than the corresponding between-pair estimates, suggesting that prediction is driven in part by demography and indirect genetic effects of parents. Path analyses indicated the effects of both PGSs and family history on substance use were mediated via disinhibition in preadolescence.

CONCLUSIONS

PGSs capturing risk of substance use and use disorder can be combined with family history measures to augment prediction of substance use outcomes. Results highlight indirect sources of genetic associations and preadolescent elevations in behavioral disinhibition as two routes through which these scores may relate to substance use.

Differentiating Abnormal, Normal, and Ideal Personality Profiles in Multidimensional Spaces

Abstract: Current dimensional taxonomies of personality disorder (PD) establish that intense traits do not suffice to diagnose a disorder, and additional constructs reflecting dysfunction are required. However, traits appear able to predict maladaptation by themselves, which might avoid duplications and simplify diagnosis. On the other hand, if trait-based diagnoses are feasible, it is the whole personality profile that should be considered, rather than individual traits. This takes us into multidimensional spaces, which have their own particular – but poorly understood – logic. The present study examines how profile-level differences between normal and disordered subjects can be used for diagnosis. The Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ) and the Personality Inventory for DSM-5 (PID-5) were administered to a community and a clinical sample each (total n = 1,925 and 3,543 respectively). Intense traits proved to be common in the general population, so empirically-based thresholds are indispensable not to take as abnormal what is at most unideal. Profile-level parameters such as Euclidean and Mahalanobis distances outperformed individual traits in predicting mental problems and equaled the performance of published measures of dysfunction or severity. Personality profiles can play a more central role in identifying disorders than is currently acknowledged, provided that adequate metrics are used.

Bottom-up transdiagnostic personality subtypes are associated with state psychopathology: A latent profile analysis

Introduction

Personality-based profiling helps elucidate associations between psychopathology symptoms and address shortcomings of current nosologies. The objective of this study was to bracket the assumption of a priori diagnostic class borders and apply the profiling approach to a transdiagnostic sample. Profiles resembling high-functioning, undercontrolled, and overcontrolled phenotypes were expected to emerge.

Methods

We used latent profile analysis on data from a sample of women with mental disorders (n = 313) and healthy controls (n = 114). 3-5 profile solutions were compared based on impulsivity, perfectionism, anxiety, stress susceptibility, mistrust, detachment, irritability, and embitterment. The best-fitting solution was then related to measures of depression, state anxiety, disordered eating, and emotion regulation difficulties to establish clinical significance.

Results

A 5-profile solution proved best-fitting. Extracted profiles included a high-functioning, a well-adapted, an impulsive and interpersonally dysregulated, an anxious and perfectionistic, and an emotionally and behaviorally dysregulated class. Significant differences were found in all outcome state measures, with the emotionally and behaviorally dysregulated class exhibiting the most severe psychopathology.

Discussion

These results serve as preliminary evidence of the predictive nature and clinical utility of personality-based profiles. Selected personality traits should be considered in case formulation and treatment planning. Further research is warranted to replicate the profiles and assess classification stability and profiles' association with treatment outcome longitudinally.

Sensitive periods in development and risk for psychiatric disorders and related endpoints: a systematic review of child maltreatment findings

Variation in the mental health of people who have experienced childhood maltreatment is substantial. One hypothesis is that this variation is attributable, in part, to the timing of maltreatment-specifically, whether maltreatment occurs during sensitive periods in development when the brain is maximally sensitive to particular types of environmental input. To determine whether there is scientific consensus around when periods of peak sensitivity occur, we did a systematic review of human observational studies. Although 89 (75%) of the 118 unique cross-sectional or longitudinal cohort studies we identified reported timing effects, no consistent sensitive periods were identified for any of the most studied outcomes. Thus, observational research on childhood maltreatment has yet to converge on a single period (or set of periods) of increased vulnerability. We identified study characteristics that might contribute to these between-study differences and used observations from our Review to suggest a comprehensive set of recommendations for future research.

Seven reasons why binary diagnostic categories should be replaced with empirically sounder and less stigmatizing dimensions

Background

An ongoing positive revolution advocates a new approach to the individual differences in human emotions, cognitions, and behavior that cause distress and impair functioning. This revolution endorses the long-proposed, but still unrealized rejection of the medical model, which attributes psychological problems to a sick brain or mind. In addition, it advocates replacing the binary diagnoses used in ICD and DSM, which assume a clear discontinuity between "normal" and "abnormal" functioning, with continuous dimensions of psychological problems.

Method

Selective literature review.

Results and Discussion

Seven strong reasons are provided for adopting a dimensional approach.

Effect of Reading Activities on Children's Mental Health under the Environment of Artificial Intelligence and Deep Learning

The illustrations in picture books are lovely and emotional; pictures and text work together to express a theme and weave into one another to create a seamless and comprehensive visual image in picture books. Reading helps children improve for life and is an unending source of wealth in one's life. Picture book reading has a positive effect on children's psychological well-being since it allows them to develop different intelligences and their spiritual worlds in addition to reading stories and learning facts. This thesis investigates, against the backdrop of artificial intelligence (AI) and deep learning, the impact of reading activities on children's psychological health. Deep learning and AI are the tools used where students can engage in a more in-depth conversation with the article and comprehend the author's mindset and background after completing the basic reading. This can help students' analytical, thinking, writing, and other application skills, as well as give them the opportunity to learn from and build upon their first reading accumulation. Research has shown that this method produces impressive results, and it is suited for widespread use because its reasonable strength has improved by 17.24% when compared to the conventional method.

The Relationship among College Students' Physical Exercise, Self-Efficacy, Emotional Intelligence, and Subjective Well-Being

PURPOSE

To deeply analyze the influencing factors on college students' subjective well-being and the path mechanism between each factor.

METHOD

The physical activity rating scale (PARS-3), the emotional intelligence scale (EIS), the self-efficacy scale (GSES), and the subjective well-being scale (SWS) were used for 826 students from two comprehensive universities in southwest China. College students conducted a questionnaire survey, and used SPSS22.0 and AMOS21.0 statistical software to process and analyze the obtained data.

RESULTS

(1) Physical exercise was significantly positively correlated with self-efficacy, emotional intelligence, and subjective well-being; self-efficacy was significantly positively correlated with emotional intelligence and subjective well-being; emotional intelligence was significantly positively correlated with subjective well-being; (2) Physical exercise has a direct positive predictive effect on subjective well-being (ES = 0.16); (3) Self-efficacy (ES = 0.057) and emotional intelligence (ES = 0.077) play a part in mediating the role between physical exercise and subjective well-being, respectively. Meanwhile, the chain mediation effect (ES = 0.026) of self-efficacy and emotional intelligence also achieved a significant level, among them, only others' emotional management and emotional application were involved in the regulation of emotional intelligence.

CONCLUSIONS

Actively participating in physical exercise could not only directly improve the level of subjective well-being of college students but also indirectly affect their subjective well-being by improving their self-efficacy, as well as their emotional management and emotional application abilities, thereby improving college students' life satisfaction feelings of happiness, such as degree, positive emotion, and negative emotion.

The Dunedin study after half a century: reflections on the past, and course for the future

Over the last 50 years Dunedin Study researchers have published more than 1400 peer-reviewed journal articles, books, and reports on many aspects of human health and development. In this 50th anniversary piece we reflect on (i) our historical roots and necessary re-invention through time; (ii) the underpinning principles that have contributed to our success; (iii) some selected examples of high-impact work from the behavioural, oral health, and respiratory domains; (iv) some of the challenges we have encountered over time and how to overcome these; and (vi) review where we see the Study going in the future. We aim to present some of the 'back story', which is typically undocumented and oft lost to memory, and thus focus on 'know-how'. Our hope is to humanise our research, share insights, and to acknowledge the real heroes of the Study - the 1037 Study members, their families and their friends, who have collectively given so much, for so long, in the hope of helping others.

Impact of early intervention on the population prevalence of common mental disorders: 20-year prospective study

BACKGROUND

The potential for early interventions to reduce the later prevalence of common mental disorders (CMD) first experienced in adolescence is unclear.

AIMS

To examine the course of CMD and evaluate the extent to which the prevalence of CMD could be reduced by preventing adolescent CMD, or by intervening to change four young adult processes, between the ages of 20 and 29 years, that could be mediating the link between adolescent and adult disorder.

METHOD

This was a prospective cohort study of 1923 Australian participants assessed repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). Causal mediation analysis was undertaken to evaluate the extent to which the prevalence of CMD at age 35 years in those with adolescent CMD could be reduced by either preventing adolescent CMD, or by intervening on four young adult mediating processes: the occurrence of young adult CMD, frequent cannabis use, parenting a child by age 24 years, and engagement in higher education and employment.

RESULTS

At age 35, 19.2% of participants reported CMD; a quarter of these participants experienced CMD during both adolescence and young adulthood. In total, 49% of those with CMD during both adolescence and young adulthood went on to report CMD at age 35 years. Preventing adolescent CMD reduced the population prevalence at age 35 years by 3.9%. Intervening on all four young adult processes among those with adolescent CMD, reduced this prevalence by 1.6%.

CONCLUSIONS

In this Australian cohort, a large proportion of adolescent CMD resolved by adulthood, and by age 35 years, the largest proportion of CMD emerged among individuals without prior CMD. Time-limited, early intervention in those with earlier adolescent disorder is unlikely to substantially reduce the prevalence of CMD in midlife.

The Use of Balanced Scorecards in Mental Health Services: an Integrative Review and Thematic Analysis

Performance management of mental health services (MHS) through quality reporting of strategic indicators and goals is essential to improve efficiency and quality of care. One such method is the balanced scorecard (BSC). This integrative review of peer-reviewed and industry implemented BSCs in MHS aims to inform future development of a more comprehensive mental health–focused benchmarking tool. A two-part systematic literature search consisted of peer-reviewed published literature on MHS specific BSCs utilising the PRISMA guidelines in addition to industry published BSCs available online. A total of 17 unique BSCs were identified. A total of 434 indicators were subject to thematic analysis identifying 11 key themes: prevalence, accessibility, services provided, clinical outcomes, client satisfaction, client involvement, staff motivation, staffing levels, governance and compliance, development, and costs and revenue. These themes represented the measures that MHS believed measured key performance criteria in alignment with their organisational objectives.

State of Ireland's mental health: findings from a nationally representative survey

AIMS

Current information about the prevalence of various mental health disorders in the general adult population of the Republic of Ireland is lacking. In this study, we examined the prevalence of 12 common mental disorders, the proportion of adults who screened positive for any disorder, the sociodemographic factors associated with meeting criteria for a disorder and the associations between each disorder and history of attempted suicide.

METHODS

A non-probability nationally representative sample (N = 1110) of adults living in Ireland completed self-report measures of 12 mental health disorders. Effect sizes were calculated using odds ratios from logistic regression models, and population attributable risk fractions (PAFs) were estimated to quantify the associations between each disorder and attempted suicide.

RESULTS

Prevalence rates ranged from 15.0% (insomnia disorder) to 1.7% (histrionic personality disorder). Overall, 42.5% of the sample met criteria for a mental health disorder, and 11.1% had a lifetime history of attempted suicide. Younger age, being a shift worker and trauma exposure were independently associated with a higher likelihood of having a mental health disorder, while being in university was associated with a lower likelihood of having a disorder. ICD-11 complex posttraumatic stress disorder, borderline personality disorder and insomnia disorder had the highest PAFs for attempted suicide.

CONCLUSIONS

Mental health disorder prevalence in Ireland is relatively high compared to international estimates. The findings are discussed in relation to important mental health policy implications.

Prevalence and comorbidity of psychiatric disorders among treatment-seeking elite athletes and high-performance coaches

Objectives

Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric outpatient settings.

Methods

Descriptive overview of EA and HPC with psychiatric disorders at two publicly funded psychiatric outpatient treatment clinics in Stockholm and Malmö, Sweden. Co-occurring psychiatric disorders were illustrated using Venn diagrams for EA and HPC, and male and female EA separately, among patients from the Stockholm clinic (SC) that used standardised diagnostic interviews.

Results

Overall, most patients were EA (n=221) compared with HPC (n=34). The mean age was 23.5 (±5.9) years for EA and 42.8 (±8.8) for HPC. Anxiety disorders were most common at the SC in EA and HPC (69% vs 91%, respectively). Stress-related disorders were found in 72% of HPC compared with 25% of EA. Affective disorders were found in 51% of EA and 52% of HPC. Eating disorders were common among EA (26%), especially females (37%). Substance use disorders were found in 17% of HPC. Comorbidity was generally common between affective and anxiety disorders.

Conclusion

Stress and adjustment disorders were found in nearly three of the four HPC compared with one in four EA. Eating disorders were prevalent in around one in four athletes and about one in six HPC had a substance use disorder.

An Ecological Momentary Intervention Study of Emotional Responses to Smartphone-Prompted CBT Skills Practice and the Relationship to Clinical Outcomes

The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients' emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants (n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.

The Interplay of Environmental Exposures and Mental Health: Setting an Agenda

BACKGROUND

To date, health-effects research on environmental stressors has rarely focused on behavioral and mental health outcomes. That lack of research is beginning to change. Science and policy experts in the environmental and behavioral health sciences are coming together to explore converging evidence on the relationship-harmful or beneficial-between environmental factors and mental health.

OBJECTIVES

To organize evidence and catalyze new findings, the National Academy of Sciences, Engineering, and Medicine (NASEM) hosted a workshop 2-3 February 2021 on the interplay of environmental exposures and mental health outcomes.

METHODS

This commentary provides a nonsystematic, expert-guided conceptual review and interdisciplinary perspective on the convergence of environmental and mental health, drawing from hypotheses, findings, and research gaps presented and discussed at the workshop. Featured is an overview of what is known about the intersection of the environment and mental health, focusing on the effects of neurotoxic pollutants, threats related to climate change, and the importance of health promoting environments, such as urban green spaces.

DISCUSSION

We describe what can be gained by bridging environmental and psychological research disciplines and present a synthesis of what is needed to advance interdisciplinary investigations. We also consider the implications of the current evidence for a) foundational knowledge of the etiology of mental health and illness, b) toxicant policy and regulation, c) definitions of climate adaptation and community resilience, d) interventions targeting marginalized communities, and e) the future of research training and funding. We include a call to action for environmental and mental health researchers, focusing on the environmental contributions to mental health to unlock primary prevention strategies at the population level and open equitable paths for preventing mental disorders and achieving optimal mental health for all. https://doi.org/10.1289/EHP9889.

Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) primary total knee arthroplasty (pTKA), (2) septic revision total knee arthroplasty (rTKA), and (3) aseptic revision total knee arthroplasty (TKA). The State Inpatient Databases were queried for all TKAs from 2005 to 2014 yielding 563,144 patients. Patients were separated into the following cohorts: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition and the following specific conditions were compared between the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention deficit hyperactivity disorder/conduct/impulse control, alcohol abuse, and drug abuse. Throughout the study period, an increase in the prevalence of mental health conditions was observed in septic and aseptic revision patients. Overall, there was a significantly higher prevalence of mental health conditions in the septic revision cohort (22.7%) compared with the primary (17.8%, p < 0.001) and aseptic revision (20.0%, p < 0.001) cohorts. Specifically, septic revision TKA patients had a higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), drug abuse (p < 0.001), schizophrenia (p = 0.0007), and bipolar disorder (p < 0.001), compared with primary TKA patients. Additionally, there was a significantly higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), and drug abuse (p < 0.001) among septic revision patients compared with aseptic revision patients. Mental health conditions were significantly higher among septic revision patients. Alcohol and drug abuse were approximately twice as prevalent in septic revision patients compared with primary and aseptic revision patients. These findings should serve as a call to action for mental health support for patients suffering from PJI.

Mental health and well-being from childhood to adulthood: design, methods and results of the 11-year follow-up of the BELLA study

Mental health and well-being are of great interest in health policy and research. Longitudinal surveys are needed to provide solid population-based data. We describe the design and methods of an 11-year follow-up of the German BELLA study in children, adolescents and young adults, and we report on age- and gender-specific courses of general health and well-being, long-term health-related outcomes of mental health problems, and mental health care use. The BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Standardised measures were used at each of the five measurement points of the BELLA study. In the 11-year follow-up, young people aged 7-31 years participated (n = 3492). Individual growth modelling, linear regression and descriptive analyses were conducted. Self-reported general health and well-being were both better in younger (vs. older) and in male (vs. female) participants according to the data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) predicted impaired health outcomes at 6-year and 11-year follow-ups. Approximately one out of four children with a diagnosed mental disorder was not undergoing mental health treatment. With its 11-year follow-up, the prospective longitudinal BELLA study provides new and solid data on mental health and well-being from childhood to adulthood in Germany, and these data are important for health promotion and prevention practices. These results are consistent with previous findings. Promising future analyses are planned.

Editorial: Enduring Mental Health: The High Lifetime Prevalence of Psychiatric Disorder and Emerging Science of Persistent Mental Wellness

Just how common are "common" mental health problems? For much of the 20^th century, psychiatric research and the US health care system seemed to proceed under the assumption that the answer is "not very." It was not until the early 1990s that the United States conducted its first nation-wide survey of mental health problems, the National Comorbidity Survey, which revealed that about half of all adult participants had experienced at least one diagnosable psychiatric disorder in their lifetime, and close to 1 in 3 participants had met criteria for a psychiatric diagnosis in the past 12 months.¹ Subsequent longitudinal studies showed that these estimates-although initially surprising-were still too low, and that, with repeated assessments over long follow-up periods, the proportion of people who report at least 1 diagnosable brush with a psychiatric disorder can exceed 80%.².

Replicability of structural brain alterations associated with general psychopathology: evidence from a population-representative birth cohort

Transdiagnostic research has identified a general psychopathology factor-often called the 'p' factor-that accounts for shared variation across internalizing, externalizing, and thought disorders in diverse samples. It has been argued that the p factor may reflect dysfunctional thinking present in serious mental illness. In support of this, we previously used a theory-free, data-driven multimodal neuroimaging approach to find that higher p factor scores are associated with structural alterations within a cerebello-thalamo-cortical circuit (CTCC) and visual association cortex, both of which are important for monitoring and coordinating information processing in the service of executive control. Here we attempt to replicate these associations by conducting region-of-interest analyses using data from 875 members of the Dunedin Longitudinal Study, a five-decade study of a population-representative birth cohort, collected when they were 45 years old. We further sought to replicate a more recent report that p factor scores can be predicted by patterns of distributed cerebellar morphology as estimated through independent component analysis. We successfully replicated associations between higher p factor scores and both reduced gray matter volume of the visual association cortex and fractional anisotropy of pontine white matter pathways within the CTCC. In contrast, we failed to replicate prior associations between cerebellar structure and p factor scores. Collectively, our findings encourage further focus on the CTCC and visual association cortex as core neural substrates and potential biomarkers of general psychopathology.

Enduring Mental Health in Childhood and Adolescence: Learning From the Millennium Cohort Study

OBJECTIVE

Enduring mental health (EMH) is a relatively new concept, which refers to a long-term state of not experiencing a mental illness (ie, enduring mental wellness). No analysis using this concept has been undertaken on United Kingdom data nor specifically in the childhood years. The present study seeks to consider the extent and predictors of EMH in children aged 9 months to 14 years who were part of the UK-wide Millennium Cohort Study.

METHOD

Data derived from 13,310 children (49.4% girls) at ages 9 months and 3, 5, 7, 11, and 14 years were pooled into 3 categories: EMH, some instances of mental health problems (SIMHP), and many instances of mental health problems (MIMHP).

RESULTS

Fewer than half of the children (41%) fell into the category of EMH; the rest had at least some periods of mental health problems. Factors associated with EMH relative to those with SIMHP or MIMHP included cognitive ability, lack of special educational needs, good emotion regulation, cooperation, and enjoyment of school. Parenting and maternal mental health were also associated with EMH but only compared with those with MIMHP.

CONCLUSION

Findings suggests that EMH is not the norm during childhood. Identification of the high association between both educational well-being and emotional regulation with EMH offer the opportunity for a potentially powerful combination of community and individual initiatives. These might include supporting positive mental health of the primary care giver, systems to support early recognition, supporting positive parenting in the early years, enhancing school engagement, and strengthening the child's social and emotional skills (including cooperation) and self-regulation to prevent later mental health problems.

Associations of musculoskeletal disorders with occupational stress and mental health among coal miners in Xinjiang, China: a cross-sectional study

BACKGROUND

Musculoskeletal disorders (MSDs), a common type of occupational diseases, have become the main cause of absenteeism and early retirement in the occupational population, as well as a major risk factor for occupational disability. The purpose of this study was to investigate the effects of occupational stress and mental health on MSDs in coal miners in Xinjiang, China, to provide a theoretical basis for reducing the incidence of MSDs in coal miners and improving their physical and mental health.

METHODS

In this study, stratified cluster random sampling was used to randomly select six coal mining companies in Xinjiang, and 1675 coal miners were surveyed by questionnaire. The status of occupational stress, mental health and MSDs among coal miners was investigated by means of the Effort-Reward Imbalance questionnaire (ERI), Symptom Checklist-90(SCL-90), and Musculoskeletal disorders scale (MSDs) questionnaire.

RESULTS

The prevalence of MSDs among coal miners was higher, and there were statistical differences among different sexes, ages, working years, shifts, types of work, educational level and monthly income (P < 0.001). The prevalence of MSDs in different body parts in the occupational stress group and mental disorder group was higher than that in the normal group. The results of multivariate logistic regression analysis showed that females had an increased risk of developing MSDs (OR = 2.23, 95% CI.:1.50,3.33). The risk of MSDs was higher with age < 30 years (30-39 years,OR = 2.39, 95% CI.,1.68,3.40; 40-49 years,OR = 2.15, 95% CI.:1.52,3.04; 50-60 years:OR = 3.25, 95% CI.:2.09,5.07), and the longer the working years, the higher the risk of MSDs (OR = 1.90, 95% CI.:1.38,2.62). The two shifts group (OR = 2.18, 95% CI.:1.59,2.98) had an increased risk of developing MSDs compared with the fixed day shift group. The risk of MSDs was lower in heading drivers (OR = 0.41, 95% CI.:0.29,0.60,) and transport workers (OR = 0.30, 95% CI.:0.20,0.43). The higher the education level, the lower the risk of MSDs (high school: OR = 0.46, 95% CI.:0.34,0.62, junior college and above: OR = 0.12, 95% CI.:0.08,0.17), and the higher the monthly income, the lower the risk of MSDs (OR = 0.50, 95% CI.:0.34,0.74). Occupational stress (OR = 1.32, 95% CI.:1.05,1.67) and mental disorder(OR = 2.94, 95% CI.:2.25,3.84) increased the risk of MSDs. A Bayesian network diagram showed that occupational stress and MSDs have direct effects on mental disorders, and occupational stress can have indirect effects on mental disorders through MSDs.

CONCLUSION

Our research shows that MSDs are common among coal miners. Occupational stress and psychological disorders can increase the incidence of MSDs.

Integrating and differentiating personality and psychopathology: A psychodynamic perspective

Several strands of research converge to suggest that personality and psychopathology can be integrated in the form of a hierarchical model of individual differences. The notion that personality and psychopathology are intrinsically linked has a long tradition within psychodynamic approaches. In this article, we first summarize empirical evidence supporting two related key assumptions of psychodynamic approaches to personality and psychology: that a developmental, person-centered approach is needed to complement a static, disorder-centered approach in the conceptualization and treatment of psychopathology; and that personality and psychopathology are best conceptualized as dynamic attempts at adaptation. Research in each of these areas supports the notion that personality and psychopathology are difficult to separate and may be moderated by severity (i.e., general psychopathology) such that increasing levels of severity result in increased intrinsic coupling between the two. We then discuss these findings in the context of a newly emerging social-communicative approach to human development that suggests that personality and psychopathology are better conceptualized in terms of a disorder of social communication, and that the purported rigidity and stability typically attributed to them are largely explained by the stability of the environmental mechanisms that underpin them, rather than by stable intrapersonal traits. The implications of these new views for the future of the science of personality and psychopathology, and for treatment strategies, are discussed.

Caregiver-mediated interventions to support self-regulation among infants and young children (0-5 years): a protocol for a realist review

INTRODUCTION

Self-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services.

METHODS AND ANALYSIS

Realist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations.

REVIEW REGISTRATION NUMBER

The protocol is registered with Open Science Framework https://osf.io/5ce2z/registrations.

The Influence of Selective Serotonin Reuptake Inhibitors on Lumbar Arthrodesis

STUDY DESIGN

Retrospective analysis using the PearlDiver national insurance claims database.

OBJECTIVE

To investigate the relationship between chronic preoperative selective serotonin reuptake inhibitor (SSRI) prescriptions and nonunion following spine fusion surgery.

SUMMARY OF BACKGROUND DATA

Contemporary literature has linked SSRIs to decreased bone mineral density and increased rates of future bone fracture. Furthermore, a recent murine model has suggested a potential role in the quality of fracture healing itself.

METHODS

All single-level lumbar fusion patients were identified. The rate of nonunion diagnosis between 6 and 24 months following surgery was assessed. A stratified analysis of chronic SSRI use and a number of comorbidities was conducted, followed by a multiple logistic regression analysis of nonunion accounting for qualifying risk factors. Finally, subanalyses of individual procedure codes were carried out.

RESULTS

In total, 7905 single-level lumbar fusion patients were included. In the multivariate analysis, chronic SSRI [odds ratio (OR): 1.558, P=0.004] and tobacco use (OR: 1.500, P=0.011) were identified as independent risk factors for nonunion, whereas patient age over 60 years (OR: 0.468, P<0.001) was observed to be negatively associated with nonunion. In the individual procedure subanalyses, SSRIs were significantly associated with nonunion in 2 of 3 univariate analyses and observed to be an independent risk factor for nonunion in 2 of the 3 procedure populations.

CONCLUSIONS

These data suggest that patients treated concomitantly for mental health disorders with SSRIs before arthrodesis may be at an increased risk of postoperative nonunion. Closer follow-up may be indicated in this patient population.

Association of History of Psychopathology With Accelerated Aging at Midlife

IMPORTANCE

Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease.

OBJECTIVE

To test the hypothesis that a history of psychopathology is associated with indicators of accelerated aging at midlife.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study was based on the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort of 1037 individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. Members were followed up to age 45 years (until April 2019). Data were analyzed from January 6 to December 7, 2020.

EXPOSURES

Mental disorders were assessed in 6 diagnostic assessments from ages 18 to 45 years and transformed through confirmatory factor analysis into continuous measures of general psychopathology (p-factor) and dimensions of internalizing, externalizing, and thought disorders (all standardized to a mean [SD] of 100 [15]).

MAIN OUTCOMES AND MEASURES

Signs of aging (biological pace of aging; declines in sensory, motor, and cognitive functioning; and facial age) were assessed up to age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports.

RESULTS

Of the original 1037 cohort participants, 997 were still alive at age 45 years, of whom 938 (94%) were assessed (474 men [50.5%]). Participants who had experienced more psychopathology exhibited a faster pace of biological aging (β, 0.27; 95% CI, 0.21-0.33; P < .01); experienced more difficulties with hearing (β, 0.18; 95% CI, 0.12-0.24; P < .01), vision (β, 0.08; 95% CI, 0.01-0.14; P < .05), balance (β, 0.20; 95% CI, 0.14-0.26; P < .01), and motor functioning (β, 0.19; 95% CI, 0.12-0.25; P < .01); experienced more cognitive difficulties (β, 0.24; 95% CI, 0.18-0.31; P < .01); and were rated as looking older (β, 0.20; 95% CI, 0.14-0.26; P < .01). Associations persisted after controlling for sex, childhood health indicators, maltreatment, and socioeconomic status and after taking into account being overweight, smoking, use of antipsychotic medication, and the presence of physical disease. Tests of diagnostic specificity revealed that associations were generalizable across externalizing, internalizing, and thought disorders.

CONCLUSIONS AND RELEVANCE

In this cohort study, a history of psychopathology was associated with accelerated aging at midlife, years before the typical onset of age-related diseases. This link is not specific to any particular disorder family but generalizes across disorders. Prevention of psychopathology and monitoring of individuals with mental disorders for signs of accelerated aging may have the potential to reduce health inequalities and extend healthy lives.

Phenotypic and genetic markers of psychopathology in a population-based sample of older adults

Although psychiatric phenotypes are hypothesized to organize into a two-factor internalizing-externalizing structure, few studies have evaluated the structure of psychopathology in older adults, nor explored whether genome-wide polygenic scores (PGSs) are associated with psychopathology in a domain-specific manner. We used data from 6003 individuals of European ancestry from the Health and Retirement Study, a large population-based sample of older adults in the United States. Confirmatory factor analyses were applied to validated measures of psychopathology and PGSs were derived from well-powered genome-wide association studies (GWAS). Genomic SEM was implemented to construct latent PGSs for internalizing, externalizing, and general psychopathology. Phenotypically, the data were best characterized by a single general factor of psychopathology, a factor structure that was replicated across genders and age groups. Although externalizing PGSs (cannabis use, antisocial behavior, alcohol dependence, attention deficit hyperactivity disorder) were not associated with any phenotypes, PGSs for major depressive disorder, neuroticism, and anxiety disorders were associated with both internalizing and externalizing phenotypes. Moreover, the variance explained in the general factor of psychopathology increased by twofold (from 1% to 2%) using the latent internalizing or latent one-factor PGSs, derived using weights from Genomic Structural Equation Modeling (SEM), compared with any of the individual PGSs. Collectively, results suggest that genetic risk factors for and phenotypic markers of psychiatric disorders are transdiagnostic in older adults of European ancestry. Alternative explanations are discussed, including methodological limitations of GWAS and phenotypic measurement of psychiatric outcome in large-scale population-based studies.

Culture and psychopathology: An attempt at reconsidering the role of social learning

This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology.

[How do Adolescents see their Parents? Prevalences, Predictors and Relationships in Longitudinal and Cross-Section Research]

How do Adolescents see their Parents? Prevalences, Predictors and Relationships in Longitudinal and Cross-Section Research The parent-child relationship has a significant influence on the psychological and social development of a young person in adolescence. The parental image from the perspective of the adolescent has rarely been examined. The aim of this study is to examine the parental images of adolescents in terms of family cohesion, conflicts and overprotection for differences between the paternal and the maternal images and between girls and boys. Furthermore, a cross-section examines the relationship between the parental images and psychological disorders, and, in a longitudinal 10-year study, whether the parental images can be predicted through risk factors in childhood. The sample includes 343 young people with an average age of 14 years, 46 % are girls. The parental images were recorded with the "Elternbildfragebogen" (Parental Image Questionnaire; EBF-KJ; Titze u. Lehmkuhl, 2010). Compared to fathers, mothers are assessed more positively in terms of their cohesion, but at the same time they also show more conflictual and higher overprotection behavior. Very few differences were found between girls and boys. There were consistently significant correlations between the parental images and internalizing and externalizing symptomatology, such that cohesion is a protective factor and conflicts and overprotection are risk factors for the development of psychological disorders. Some aspects of the images of the mother and father can be significantly predicted by the parents' education and by psychological disorders in childhood. Future research should examine the influence of possible mediators and moderators.

Pervasively Thinner Neocortex as a Transdiagnostic Feature of General Psychopathology

OBJECTIVE

Neuroimaging research has revealed that structural brain alterations are common across broad diagnostic families of disorders rather than specific to a single psychiatric disorder. Such overlap in the structural brain correlates of mental disorders mirrors already well-documented phenotypic comorbidity of psychiatric symptoms and diagnoses, which can be indexed by a general psychopathology or p factor. The authors hypothesized that if general psychopathology drives the convergence of structural alterations common across disorders, then 1) there should be few associations unique to any one diagnostic family of disorders, and 2) associations with the p factor should overlap with those for the broader diagnostic families.

METHODS

Analyses were conducted on structural MRI and psychopathology data collected from 861 members of the population-representative Dunedin Multidisciplinary Health and Development Study at age 45.

RESULTS

Study members with high scores across three broad diagnostic families of disorders (externalizing, internalizing, thought disorder) exhibited highly overlapping patterns of reduced global and widely distributed parcel-wise neocortical thickness. Study members with high p factor scores exhibited patterns of reduced global and parcel-wise neocortical thickness nearly identical to those associated with the three broad diagnostic families.

CONCLUSIONS

A pattern of pervasively reduced neocortical thickness appears to be common across all forms of mental disorders and may represent a transdiagnostic feature of general psychopathology. As has been documented with regard to symptoms and diagnoses, the underlying brain structural correlates of mental disorders may not exhibit specificity, and the continued pursuit of such specific correlates may limit progress toward more effective strategies for etiological understanding, prevention, and intervention.

Profiles of psychosocial and clinical functioning in adolescence and risk for later depression and other outcomes

BACKGROUND

Most studies examining predictors of the onset of depression focus on variable centered regression methods that focus on the effects of multiple predictors. In contrast, person-centered approaches develop profiles of factors and these profiles can be examined as predictors of onset. Here, we developed profiles of adolescent psychosocial and clinical functioning among adolescents without a history of major depression.

METHODS

Data come from a subsample of participants from the Oregon Adolescent Depression Project who completed self-report measures of functioning in adolescence and completed diagnostic and self-report measures at follow-up assessments up to approximately 15 years after baseline.

RESULTS

We identified four profiles of psychosocial and clinical functioning: Thriving; Average Functioning; Externalizing Vulnerability and Family Stress and Internalizing Vulnerability at the baseline assessment of participants without a history of depression at the initial assessment in mid-adolescence. Classes differed in the likelihood of onset and course of depressive disorders, experience of later anxiety and substance use disorders, and psychosocial functioning in adulthood. Moreover, the predictive utility of these classes was maintained when controlling for multiple other established risk factors for depressive disorders.

CONCLUSIONS

This work highlights the utility of examining multiple factors simultaneously to understand risk for depression.

Role of optimism in adolescent mental health: a protocol for a systematic review

INTRODUCTION

Adolescence is a critical period of human development, where adaptive or maladaptive experiences can happen. These experiences are associated with psychological, social, biological and health factors. Previous empirical evidence suggests that mental health is associated with individual assets and positive states, whose presence may become a factor of protection and resistance to mental disorders. Among these, optimism could play a fundamental role in sustaining physical and mental well-being and in dealing with threats potentially harmful to health. Given the rise of research on optimism and its importance in the various health outcomes, it is necessary to initiate processes of compilation and synthesis of this evidence to facilitate the understanding of the importance of this variable on the mental health of adolescents.

METHODS AND ANALYSIS

The included studies will be experimental, observational, cross-sectional and longitudinal focussed on the role of optimism on mental health in adolescents, regardless of whether they belong to clinical or non-clinical populations. This systematic review protocol will be carried out following the Cochrane Manual for systematic reviews and will follow the statement on systematic reviews and meta-analysis of PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Searches will run from October 2019 to March 2020, and will be carried out from the following electronic databases: APA PsycNet, BVS (Biblioteca Virtual em Saúde), Web of Science, PubMed Central and Scopus. Two reviewers will obtain the eligible articles, published from January 2009 onward, to assess the quality of each study and extract the data. For the presentation of the results, a narrative and quantitative synthesis will be carried out that groups the data found.

ETHICS AND DISSEMINATION

The approval of an ethics committee is not required for a systematic review protocol. The results will be presented at congresses in social sciences and psychology and will be published in a peer-reviewed social or health science journal.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42019142616.

Normal Versus Pathological Mood: Implications for Diagnosis

Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.

Longitudinal Assessment of Mental Health Disorders and Comorbidities Across 4 Decades Among Participants in the Dunedin Birth Cohort Study

IMPORTANCE

Mental health professionals typically encounter patients at 1 point in patients' lives. This cross-sectional window understandably fosters focus on the current presenting diagnosis. Research programs, treatment protocols, specialist clinics, and specialist journals are oriented to presenting diagnoses, on the assumption that diagnosis informs about causes and prognosis. This study tests an alternative hypothesis: people with mental disorders experience many different kinds of disorders across diagnostic families, when followed for 4 decades.

OBJECTIVE

To describe mental disorder life histories across the first half of the life course.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved participants born in New Zealand from 1972 to 1973 who were enrolled in the population-representative Dunedin Study. Participants were observed from birth to age 45 years (until April 2019). Data were analyzed from May 2019 to January 2020.

MAIN OUTCOMES AND MEASURES

Diagnosed impairing disorders were assessed 9 times from ages 11 to 45 years. Brain function was assessed through neurocognitive examinations conducted at age 3 years, neuropsychological testing during childhood and adulthood, and midlife neuroimaging-based brain age.

RESULTS

Of 1037 original participants (535 male [51.6%]), 1013 had mental health data available. The proportions of participants meeting the criteria for a mental disorder were as follows: 35% (346 of 975) at ages 11 to 15 years, 50% (473 of 941) at age 18 years, 51% (489 of 961) at age 21 years, 48% (472 of 977) at age 26 years, 46% (444 of 969) at age 32 years, 45% (429 of 955) at age 38 years, and 44% (407 of 927) at age 45 years. The onset of the disorder occurred by adolescence for 59% of participants (600 of 1013), eventually affecting 86% of the cohort (869 of 1013) by midlife. By age 45 years, 85% of participants (737 of 869) with a disorder had accumulated comorbid diagnoses. Participants with adolescent-onset disorders subsequently presented with disorders at more past-year assessments (r = 0.71; 95% CI, 0.68 to 0.74; P < .001) and met the criteria for more diverse disorders (r = 0.64; 95% CI, 0.60 to 0.67; P < .001). Confirmatory factor analysis summarizing mental disorder life histories across 4 decades identified a general factor of psychopathology, the p-factor. Longitudinal analyses showed that high p-factor scores (indicating extensive mental disorder life histories) were antedated by poor neurocognitive functioning at age 3 years (r = -0.18; 95% CI, -0.24 to -0.12; P < .001), were accompanied by childhood-to-adulthood cognitive decline (r = -0.11; 95% CI, -0.17 to -0.04; P < .001), and were associated with older brain age at midlife (r = 0.14; 95% CI, 0.07 to 0.20; P < .001).

CONCLUSIONS AND RELEVANCE

These findings suggest that mental disorder life histories shift among different successive disorders. Data from the present study, alongside nationwide data from Danish health registers, inform a life-course perspective on mental disorders. This perspective cautions against overreliance on diagnosis-specific research and clinical protocols.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.

Enduring mental health in the Baltimore epidemiologic catchment area follow-up study

PURPOSE

To estimate the prevalence of enduring mental health (EMH) and examine important correlates of EMH 23 years later in the Baltimore Epidemiologic Catchment Area Follow-Up study.

METHODS

We estimated the prevalence of EMH among 964 adults with diagnostic data at all four study waves (1981-2004). Those with EMH were compared to those with any mental or behavioral disorder by demographic, psychosocial, and health characteristics. We used forward selection models to identify the most important predictors of EMH.

RESULTS

Twenty-six percent of participants met criteria for enduring mental health across the four waves. Neuroticism, GHQ-20 score, childhood conduct problems, female sex, maternal depression, and poor self-rated health were negatively associated with EMH.

CONCLUSIONS

We identified several malleable factors associated with a decreased likelihood of enduring mental health. Interventions that target high neuroticism, childhood conduct problems, or maternal depression may increase the likelihood that children achieve EMH later in life. Identifying and treating other factors such as poor self-reported health and greater psychological distress may also keep sub-clinical symptoms from developing into a full mental or behavioral disorder.