Psychosozialer Stress und Alkoholkonsum: Wechselwirkungen, Krankheitsprozess und Interventionsmöglichkeiten

Prevalence and correlates of psychological distress among national community-based adult populations in Nauru, Tukelau and Tuvalu

AIMS

The aim of the study was to estimate the prevalence and correlates of psychological distress (PD) in three small Pacific Island countries.

METHOD

National cross-sectional data (pooled sample N = 3,088, 18-69 years) of participants from the STEPS surveys in Nauru (2015/16; N = 1382), Tukelau (2014; N = 554) and Tuvalu (2015; N = 1152) were analysed.

RESULTS

In the pooled sample 30.4% participants had PD (⩾20 scores), 18.1% mild (20-24 scores), 7.8% moderate (25-29 scores) and 4.4% severe (30-50 scores) PD. The prevalence of PD in Nauru was 41.5%, in Tukelau 5.0% and in Tuvalu 22.7%. In the adjusted logistic regression analysis with the pooled sample, younger age (18-39 years), alcohol family problems, heart attack/stroke, current smoking, high salt intake and high sedentary behaviour were positively associated with PD, while male sex and being from Tukelau and Tuvalu were negatively associated with PD.

CONCLUSION

Almost one in three participants reported PD and several associated factors were found that can be targeted in population interventions.

Prevalence and correlates of psychological distress among a national population-based sample of adults in Solomon Islands

BACKGROUND

Psychological distress is an undersearched cause of poorer health in the Pacific island countries.

AIMS

The study aimed to investigate the prevalence and associated factors of psychological distress in a population-based survey among 18-69 year-old persons in Solomon Islands.

METHOD

Cross-sectional nationally representative data of 2,533 18-69 year-old persons (38 years were the median age) from the 2015 Solomon Islands STEPS survey were analysed.

RESULTS

The results indicate that 18.9% of participants had psychological distress (⩾20 scores), 13.4% had mild (20-24 scores), 4.3% moderate (25-29 scores) and 1.1% severe (30-50 scores) psychological distress. In adjusted logistic regression analysis, being divorced, separated, or widowed (AOR: 2.76, 95% CI: 1.60-4.78), having had a heart attack or stroke (AOR: 3.34, 95% CI: 2.23-4.99), alcohol dependence (AOR: 1.72, 95% CI: 1.04-2.84), and sedentary behaviour (AOR: 1.90, 95% CI: 1.28-2.84), were positively and the consumption of 3-4 servings of fruit and vegetables (AOR: 0.62, 95% CI: 0.42-0.92), were negatively associated with psychological distress (⩾20 scores). In addition, in a sex stratified adjusted logistic regression analysis among men, current smokeless tobacco use (AOR: 4.95, 95% CI: 1.66-14.75), was associated with psychological distress. Furthermore, in the overall unadjusted analysis, stop smoking attempts in the past 12 months and consumption of too much salt was associated with psychological distress.

CONCLUSION

Almost one in five participants were reported psychological distress and several factors were detected which could be targeted in intervention activities.

[Alcohol prevention in the workplace: current workplace concepts for addiction prevention and addiction assistance programmes]

Zur Vorbeugung von Alkoholproblemen am Arbeitsplatz und zur Hilfe bei Suchtgefährdung hat sich das Standardmodell der betrieblichen Suchtprävention und Suchthilfe bewährt. Kernelemente sind: 1) Information und Aufklärung, 2) frühzeitige Interventionen, 3) Qualifizierung und Beratung von Personalverantwortlichen und 4) Hilfeangebote für Beschäftigte. In diesem Beitrag wird zunächst die historische Entwicklung der betrieblichen Alkohol- und Suchtprävention kurz beschrieben, Forschungsergebnisse werden dargestellt und danach wird auf Maßnahmen zur Prävention, zur Intervention bei Suchtgefährdung und zur Reduzierung des Alkoholkonsums am Arbeitsplatz eingegangen.

In den 1970er-Jahren wurden betriebliche Suchtpräventionsprogramme nach US-amerikanischem Vorbild in Deutschland etabliert. Im Jahr 2006 veröffentlichte die Deutsche Hauptstelle für Suchtfragen (DHS) erstmals die „Qualitätsstandards in der betrieblichen Suchtprävention und Suchthilfe“ und ermöglichte allen Betrieben den Zugriff auf fachlich abgestimmte und rechtlich aktuelle Materialien. Das ist bedeutsam, um angemessene Maßnahmen zur Regulierung und Reduzierung des Alkoholkonsums am Arbeitsplatz zu treffen. Zum Präventionsauftrag der Führungskräfte gehört die Unterweisung der Beschäftigten zur Vermeidung gesundheitlicher Gefährdungen. Sobald Verstöße gegen die Arbeitssicherheit vorliegen, sind Vorgesetzte zudem verpflichtet einzugreifen. Generell sollten sie bei Auffälligkeiten möglichst frühzeitig intervenieren. Bei riskantem Suchtmittelgebrauch und Suchtgefährdung wird nach einer gestuften Gesprächsfolge verfahren. Unterstützungsangebote von internen oder externen Beratungsstellen werden empfohlen.

Alkohol- und Suchtprävention ist Teil des betrieblichen Gesundheitsmanagements. Besonders nachhaltig wirkt sie dort, wo das Programm in einer Betriebs- oder Dienstvereinbarung festgeschrieben wurde und verbindlich umgesetzt wird.

Kann die Symptombelastung einen regulären oder irregulären Behandlungsabschluss bei Substanzkonsumstörungen vorhersagen?

Ziel der Studie Das Ziel der vorliegenden explorativen Studie war zu untersuchen, ob die subjektive Symptombelastung vor und während der Behandlung von PatientInnen mit einer Substanzkonsumstörung einen Einfluss darauf hat, ob die Behandlung regulär (d. h. in gegenseitigem Einverständnis zwischen Therapeut und Patient) oder irregulär (d. h. Therapeut oder Patient bricht ab) beendet wird.

Methodik In der vorliegenden, retrospektiven Untersuchung wurden 54 PatientInnen einer Drogenentzugs- und Entwöhnungsstation untersucht. Die Informationen zur Art des Behandlungsabschlusses wurden der Basisdokumentation und zur Symptombelastung der Brief-Symptom-Checkliste (BSCL) entnommen.

Ergebnisse Die Ergebnisse der binären logistischen Regressionsanalysen zeigten, dass eine allgemeine Reduktion der Symptombelastung während der Behandlung mit einem regulären statt einem irregulären Behandlungsabschluss einherging. Die Analysen der Subskalen der BSCL ergaben signifikante Effekte für eine Abnahme der Ängstlichkeit und des Paranoiden Denkens während der Therapie zugunsten eines regulären Behandlungsabschlusses. Des Weiteren sagten hohe Werte der Zwanghaftigkeit zu Behandlungsbeginn einen regulären Behandlungsabschluss vorher.

Schlussfolgerung Bei der Behandlung von PatientInnen mit Substanzkonsumstörungen erscheint es sinnvoll, die allgemeine subjektive Symptombelastung während der Behandlung zu erfragen, um Therapieabbrüche zu vermeiden. Insbesondere sollten die Ängstlichkeit und das Paranoide Denken in den Fokus der Behandlung rücken, da diese in der vorliegenden Studie einen regulären Behandlungsabschluss vorhersagten.

Psychiatric Comorbidities among People Who Inject Drugs in Hai Phong, Vietnam: The Need for Screening and Innovative Interventions

The objective of this study is to describe psychiatric comorbidities, associated factors, and access to psychiatric assessment and care in a cohort of people who inject drugs (PWID) in Hai Phong, Vietnam. Mental health was assessed after 12 months' follow-up using the Mini International Neuropsychiatric Interview questionnaire (MINI 5.0.0). PWID medical history, drug use, and sociodemographic and clinical characteristics were also collected. Among 188 PWID who participated in the assessment, 48 (25.5%) had at least one psychiatric disorder and 19 (10.1%) had 2 or more psychiatric disorders. The most common current psychiatric disorders were major depressive episode (12.2%) and psychotic disorder (4.8%), reaching 10.1% for the latter when lifetime prevalence was considered. Females were more likely than males to have at least one psychiatric disorder, a major depressive disorder, or an anxiety disorder. Methamphetamine use was associated with an increased risk of presenting a lifetime psychotic syndrome. Problematic alcohol consumption was associated with an increased risk of having at least one psychiatric disorder. Psychiatric comorbidities are frequent among PWID in Vietnam. These results highlight the need for routine assessment and innovative interventions to address mental health needs among PWID. Community-based interventions targeting mental health prevention and care should be strongly supported.

Psychological Distress Among Methadone Maintenance Patients in Vietnamese Mountainous Areas

We conducted a cross-sectional study in Tuyen Quang Province, a mountainous province in northern Vietnam, to examine rates of psychological distress among 241 patients receiving methadone maintenance treatment (MMT). Using the Kessler psychological distress Scale, we found that approximately one-fourth (26.8%) of respondents suffered from mental health pathologies. Physical health problems, current drug use, and alcohol abuse were found to be associated with mental health problems among the participants. Our findings highlight the high prevalence of psychological distress among MMT patients in northern Vietnam, and the need to integrate mental and physical health care services, as well as behavioral health counseling, into currently existing MMT clinics in this region.

The association between somatic symptoms, anxiety disorders and substance use. A literature review

The aim of this article is to review the association between somatic symptoms, anxiety disorders and substance use. A Pub Med based literature review was conducted using various combinations of keywords related to substance use, somatic symptoms and anxiety. In various studies somatic symptoms were found to be associated with substance use. Anxiety disorders were found to have a high co-morbidity with substance use in most studies. However, several of the reviewed studies also included depressive symptoms which might have confounded the results. None of the studies was specifically aimed to find out if somatic symptoms in substance users represent an underlying primary anxiety disorder. Somatic symptoms and anxiety disorders are commonly noticed in substance users. Further studies are needed to clarify these associations since they may have significant clinical implications.

Moderation and mediation in the relationship between mothers' or fathers' serious psychological distress and adolescent substance use: findings from a national sample

PURPOSE

This study estimated percentages of adolescents living with a mother or father with serious psychological distress (SPD), and examined moderation and mediation of the relationships between mother or father SPD and adolescent substance use.

METHODS

We analyzed data from nationally representative samples of adolescents interviewed with their mothers (n = 4734) and fathers (n = 3176) in the combined 2002 and 2003 National Surveys on Drug Use and Health (NSDUHs).

RESULTS

An estimated 4.1% of adolescents living with their father had a father with SPD during the past year, and 11.5% of adolescents living with their mother had a mother with SPD during this time period. A positive association was found between mothers' SPD and adolescent binge drinking (OR = 1.49, 95% CI = 1.01-2.21), but no association was found between fathers' SPD and adolescent binge drinking. Mothers' SPD was associated with increased risk of binge drinking among adolescents aged 14-15 years (OR = 2.52, 95% CI = 1.38-4.60), and fathers' SPD was associated with lowered risk of binge drinking among black adolescents (OR = .08, 95% CI = .01-.79). A positive association was found between mothers' SPD and adolescent illicit drug use (OR = 1.55, 95% CI = 1.08-2.23), but no association was found between fathers' SPD and adolescent illicit drug use. Mothers' SPD was associated with increased risk of illicit drug use among female adolescents (OR = 2.14, 95% CI = 1.24-3.70) and among adolescents of white ethnicity (OR = 1.78, 95% CI = 1.19, 2.68). Parental involvement partially mediated the relationship between mothers' SPD and daughters' illicit drug use; mothers' SPD was associated with lower levels of parental involvement, which in turn were associated with an increased probability of daughters' illicit drug use.

CONCLUSIONS

Overall, parents' SPD is associated differentially with adolescent substance use depending on the gender of parent and adolescent, adolescent age, race/ethnicity, and substance used. Parental involvement appears to be one mechanism through which mothers' SPD influences daughters' illicit drug use. Future research should further consider the interindividual effects of parents' SPD and associated parenting behaviors on adolescent risk behaviors.