Socio-economic status, standard of living, and neurotic disorder

Phantom shocks in implantable cardioverter-defibrillator recipients: impact of education level, anxiety, and depression

BACKGROUND

Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks in the event of ventricular arrhythmias. Some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock, PS).

OBJECTIVES

The aim of this study was to evaluate the incidence, predictors, and consequences of PS in ICD recipients.

MATERIALS AND METHODS

Consecutive ICD recipients were examined during a routine outpatient follow-up (FU) visit. Subjects completed a written survey; their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire.

RESULTS

Of 434 patients invited to the study, 423 (97.5%) ICD recipients agreed to and completed the survey; 349 (83%) had a primary prevention indication and 339 (80%) ischemic cardiomyopathy. A total of 27 patients (6.4%) reported a PS during a mean FU of 64 ± 44 months (5.4% in the primary prevention group and 10.8% in the secondary prevention group; p = 0.11). PS were related to higher education (≥bachelor's degree 41% versus 20%; p = 0.03), and more frequent in patients receiving adequate shocks during FU (34% versus 0.5%; p < 0.001). HADS score levels were higher following PS (15 ± 6 versus 8.8 ± 7.4; p < 0.001). The majority of patients reporting PS felt that the information provided to them prior to ICD placement was insufficient (22.2% versus 5.0%), that they needed psychological support after ICD implantation (26% versus 3%), and considered ICD deactivation in near end-of-life situations (59% versus 29%; p < 0.001 for all).

CONCLUSIONS

PS occur in 6.4% of all ICD recipients and are related to higher education and to patients that experienced adequate shocks during FU.

Mental health problems and socioeconomic disadvantage: a controlled household study in rural Ethiopia

Background

There is a lack of high quality population-based studies from low- and middle-income countries examining the relative economic status of households with and without a member with a mental health problem. The aim of the study was to explore the socio-economic status of households with a person with severe mental disorder (SMD; psychosis or bipolar disorder) or depression compared to households without an affected person.

Methods

A population-based, comparative, cross-sectional household survey was conducted in Sodo district, south Ethiopia, between January and November 2015. Two samples were recruited, each with its own comparison group. Sample (1): households of 290 community-ascertained persons with a clinician-confirmed diagnosis of SMD and a comparison group of 289 households without a person with SMD. Sample (2): households of 128 people who attended the primary health care centre and who were identified by primary care staff as having a probable diagnosis of depressive disorder; and comparison households of 129 patients who attended for other reasons and who did not receive a diagnosis of depression. Household socioeconomic status (household income, consumption and asset-based wealth) was assessed using a contextualized version of theWorld Health Organization (WHO) Study on global Ageing and adult health (SAGE) questionnaire. Each disorder group (SMD and depression) was further divided into higher and lower disability groups on the basis of median score on the WHO Disability Assessment Schedule.

Results

Households of a person with SMD who had higher disability were more likely to have a poorer living standard (no toilet facility; p < 0.001). Having a reliable source of regular income was significantly lower in households of a person with SMD (p = 0.008) or depression (p = 0.046) with higher disability than the comparison group. Households of persons with SMD with higher disability earned less (p = 0.005) and owned significantly fewer assets (p < 0.001) than households without SMD. Households including persons with depression who had higher disability had lower income (p = 0.042) and reduced consumption (p = 0.048).

Conclusions

Households with a member who had either SMD or depression were socioeconomically disadvantaged compared to the general population. Moreover, higher disability was associated with worse socio-economic disadvantage. Prospective studies are needed to determine the direction of association. This study indicates a need to consider households of people with SMD or depression as a vulnerable group requiring economic support alongside access to evidence-based mental healthcare.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-1020-4) contains supplementary material, which is available to authorized users.

Incidence of Major Depressive Disorder: Variation by Age and Sex in Low-Income Individuals: A Population-Based 10-Year Follow-Up Study

Major depressive disorder (MDD), the most prevalent mental disorder is a global public health issue. The aim of this study was to assess the association between low income and major depressive disorder (MDD) by age and sex. The National Health Insurance Research Database (NHIRD) of Taiwan was used to retrieve data. A total of 1,743,948 participants were eligible for the study. Low-income individuals were identified from 2001 and 2003 (specifically, Group Insurance Applicants, ie, category"51" or "52") and followed from 2004 to 2010. MDD was identified using the ICD-9-CM 296.2 and 296.3 codes. Among non-low-income individuals, the MDD incidence rates increased with age in both males and females, that is, 0.35, 0.93, 0.97, 1.40 per 10,000 person-months for males and 0.41, 1.60, 1.89, 1.95 per 10,000 person-months for females aged 0 to 17, 18 to 44, 45 to 64, and ≥65 years, respectively. Low-income females (18-44 years) and males (45-64 years) had the highest incidence of MDD, which was 3.90 and 3.04, respectively, per 10,000 person-months. Among low and non-low-income individuals, the MDD incidence rates were higher in the females than males in all age groups. Males aged 45 to 64 and 0 to 17 years had highest hazard ratios (HR) of 2.789 (95% confidence interval [CI], 1.937-4.014) and 2.446 (95% CI, 1.603-3.732), respectively. The highest HRs for females were 2.663 (95% CI, 1.878-3.775) and 2.219 (CI, 1.821-2.705) in the 0 to 17 and 18- to 44-year age groups. Low income was not found to serve as a risk factor for the development of MDD in males and females aged ≥65 years. Among the non-low-income males and females, the incidence rates of MDD were found to increase with age. Low income was found to serve as a significant risk factor for MDD only in individuals under age 65.

Construct and Incremental Validity of the Rotter Incomplete Sentences Blank in Adult Psychiatric Outpatients

The expression of positive vs negative attitudes in response to the 40 stems of the Rotter Incomplete Sentences Blank (RISB) can be scored and summed to an Overall Adjustment Score (OAS). By extending the validation of the OAS to adult psychiatric outpatients, this study demonstrates for the first time the incremental validity of a personality test over a simple self-rating. The RISB and six tests of adjustment were administered to 41 recent admissions to psychotherapy in two rural clinics. The tests of adjustment were selected to cover the two domains of symptoms vs function and the three methods of interview schedule vs objective inventory vs therapist ratings. Their scores were combined into an adjustment composite. The OAS related strongly to the composite in univariate regression, and moderately in hierarchical regression after covarying demographics, intelligence, social desirability, and self-ratings of adjustment. Construct validity was good, and incremental validity at least fair.

Risk factors for psychological distress in Northern Ireland

BACKGROUND

Stress-related mental ill health and its disorders are considered by the World Health Organization (WHO) to be the new world epidemic and their prevalence rates seem to be increasing worldwide.

AIMS

To examine and identify sub-populations at risk for psychological discomfort in Northern Ireland and map the relative impact of potential predictors.

METHODS

A sample of 4,638 respondents to the NIHSW-2001 survey was analysed with latent class analysis and latent class factorial analysis. Latent class multinomial logistic regression assessed the impact of a range of predictors on class membership.

RESULTS

Five sub-populations were differentiated. All subgroups at risk for anxiety and depression were characterized as being younger and female. Disability and adverse life events were strong predictors of risk. Long-standing illness and housing worries were predictors of medium and high risk membership. The effect of civil unrest was significant only for the medium-risk subgroup; marital status and income did not affect group membership.

CONCLUSIONS

Because all five subgroups showed a different probability, but a similar profile of endorsing GHQ-12 items, it could be hypothesized that an underlying continuum dimension of anxiety and depression is present in the Northern Irish population.

Major depression in the era of economic crisis: a replication of a cross-sectional study across Greece

BACKGROUND

The study endeavoured to gauge the impact of the current economic crisis on the mental health of the Greek population. Particularly, it explored changes in the prevalence rates of major depression between 2008 and 2011, and its link to financial hardship. Furthermore, the study also identified potential predictors of major depression in 2011.

METHODS

Two nationwide cross-sectional teleophone surveys were conducted in 2008 and 2011 following the same methodology. A random and representative sample of 2.197 and 2.256 people, respectively, participated in the studies. Major depression was assessed with the Structural Clinical Interview, whereas financial strain with the Index of Personal Economic Distress (IPED), an original scale with good psychometric properties.

RESULTS

In 2011, one-month prevalence rate of major depression was found to be 8.2%, as compared to the corresponding rate in 2008, which was 3.3%. Significant increases in prevalence rates were observed for the majority of the population subgroups. A significant association was recorded between major depression and economic hardship. Young people, married persons, individuals with financial distress and people who use medication displayed increased odds of suffering from major depression in 2011.

LIMITATIONS

Participants' responses concerning financial difficulties were not confirmed from collateral accounts. Moreover, the direction of causality between financial hardship and major depression is unclear.

CONCLUSIONS

The impact of the economic crisis on the mental health of the population is pervasive. Services and clinicians should focus on the primary prevention of major depression as well as on its timely recognition and treatment.

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

PURPOSE

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

METHODS

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

RESULTS

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

CONCLUSIONS

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens' mental health.

Symptoms of depression during pregnancy are associated with increased systolic blood pressure responses towards infant distress

A mother's response towards her infant's distress is important for the mother-infant relationship and infant development. There is evidence that maternal responses are impaired in depressed mothers. Further understanding of how depression disrupts maternal responses is important to direct treatment strategies. There is evidence that maternal responses develop during pregnancy. Further understanding of the relationship between depression and maternal responses during pregnancy is therefore important. We have previously found that depression during pregnancy is associated with reduced attentional engagement with infant distress but is unclear whether this is an insensitive or avoidance response. In the current study, we investigated the impact of anhedonic symptoms of depression on pregnant women's autonomic response towards infant distress. We found that women experiencing anhedonic depressive symptoms during pregnancy had significantly larger systolic blood pressure responses towards infant distress (β, 1.6 mmHg, 95 % CI 0.5 to 2.6, p = 0.004) than non-depressed pregnant women. These results suggest that anhedonic symptoms during pregnancy may be associated with increased sympathetic sensitivity. This suggests that depression is not, at a sympathetic level at least, associated with insensitivity to infant distress and rather depression may be associated with an abnormally sensitive response.

Income-related inequalities in common mental disorders among ethnic minorities in England

PURPOSE

The relative prevalence of common mental health problems among different ethnic groups in Britain is one of the least researched topics in health variations research. We calculate and compare income-related inequalities in common mental disorders among ethnic groups in Britain.

METHOD

Data from a nationally representative survey of ethnic minorities (the EMPIRIC survey) were used to calculate concentration index values to indicate the extent of income-related inequalities within and across ethnic groups.

RESULTS

Looking at income-related inequalities in common mental disorders within each of the ethnic groups, it was found that the burden of these disorders were greater for the lower income groups among the Irish, White and African Caribbean communities. Within-group inequality was less clearly defined for each of the three Asian communities: Indian, Bangladeshi and Pakistani. However, when the data were pooled and individuals were assigned income ranks in the pooled set (not within their own ethnic group), the relative position of those in lower income groups among the different groups was striking. The poor among the Bangladeshi, Pakistani and the African Caribbean groups clearly suffered both from low income and a greater burden of mental health morbidity than the other three groups. The effect of lower income is thus worse for the mental health of populations if they are African Caribbean, Pakistani or Bangladeshi than if they are White, Irish or Indian.

CONCLUSION

Inequality in mental health morbidity between and within ethnic groups is at least partly linked to income, and thus to employment and education. Tackling disadvantage and discrimination in these areas could help to tackle the challenge of mental ill-health.

Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys

BACKGROUND

Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s.

METHODS

Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics.

RESULTS

This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally.

CONCLUSION

The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.

Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide

PURPOSE

In many western countries during the recent years, people have witnessed the deterioration of their economies and the emergence of related phenomena such as loss of property, unemployment and social disruption. These phenomena have also been associated with increasing levels of demoralization and the developing of major depressive episodes (MDE). Greece in the years 2008 and mainly in 2009 started facing a sharp economic decline. The purpose of this study was to explore the consequences of this condition and the ways are reflected in the prevalence of MDE during these two critical years.

METHOD

Two nationwide cross-sectional telephone surveys were carried out in 2008 and 2009 with representative samples of 2,197 and 2,192 respondents, respectively. The interview comprised the SCID I module of MDE and an Index of Personal Economic Distress (IPED).

RESULTS

The 1-month prevalence of MDE in 2009 was found to be 6.8%, compared to corresponding rates of 3.3% in 2008. Respondents facing serious economic hardship (with higher scores in IPED) were mostly at risk for developing an MDE.

CONCLUSIONS

The findings of both studies underline the significance of the risk involved in developing MDE when individuals have been exposed in extreme and stressful economic situations.

Equity in mental health

Aim– The aim of this paper is to discuss the study of equity in mental health contexts.Methods– We review major principles and theories of distributive justice, covering various disciplines such as ethics, philosophy, economics, medicine and sociology. Recent literature on empirical analysis of inequalities in the mental health field is also reviewed.Results– The review of literature reveals a general lack of debate on equity principles in relation to mental health. Robust empirical evidence on inequalities in the field is also scarce.Conclusions– There is need for better exposition of the relevance of different equity principles for mental health policy and practice. There is also a need for developing standardised methods for the empirical analysis of equity, to examine the distribution of psychiatric morbidity and use of services by income, socioeconomic group, ethnicity, gender and place of residence, and, of course, to examine how equity can be promoted.

Declaration of Interest: This work was funded by the Department of Health programme grant to the PSSRU.

Repeated exposure to socioeconomic disadvantage and health selection as life course pathways to mid-life depressive and anxiety disorders

BACKGROUND

Socioeconomic position (SEP) in childhood and adulthood influences the risk of adult psychiatric disorder. This paper investigates first how cumulative childhood manual SEP influences the risk for mid-life depressive and anxiety disorders and secondly the effects of health selection based on psychological disorder in childhood and psychological distress in early adulthood on mid-life social position.

METHODS

9,377 participants of the 1958 Birth Cohort were followed up at 45 years with the Revised Clinical Interview Schedule to measure depressive and anxiety disorders. SEP was measured by Registrar General Social Class in childhood (ages 7, 11 and 16 years) and adulthood (ages 23, 33 and 42 years). Internalising and externalising disorders were also measured in childhood.

RESULTS

Cumulative manual SEP in childhood was weakly associated with increased risk of mid-life disorder. Childhood internalising and externalising disorders were associated with less upward social mobility and manual adult social position. Psychological disorder on three occasions in childhood was associated with manual adult occupational status (OR = 3.33, 95% CI 2.63-4.21) even after adjusting for childhood SEP and malaise score at 42 years.

CONCLUSIONS

Both social causation and health selection contribute to the association of childhood socioeconomic disadvantage and mid-life depressive and anxiety disorders. Tackling accumulation of disadvantage and understanding and treating childhood psychological disorders and their educational and occupational consequences could reduce the risk of mid-life psychiatric disorders.

Epidemiology and symptomatology of depression in Sri Lanka: a cross-sectional population-based survey in Colombo District

BACKGROUND

It is important to understand the nature of depression in non-Western and lower-income countries, but little such research exists. This study aimed to examine the characteristic features of depression in Sri Lanka, and to identify environmental risk factors.

METHODS

Depression diagnoses, symptoms and impairment were measured using the Composite International Diagnostic Interview, in a population-based sample of 6014 twins and non-twins in the Colombo region of Sri Lanka (the CoTASS sample). Socio-demographic factors and environments were assessed via questionnaires.

RESULTS

Lifetime-ever depression was reported in 6.6% of participants, rising to 11.2% if the functional impairment criterion was excluded. The symptom profile of depression and its socio-demographic associations were very comparable to those in Western and more economically developed countries, whether functional impairment was included in the definition or not. Standard of living was independently associated with depression, especially among men at the more deprived end of the distribution. Specific associations were found with both financial wellbeing and material characteristics of the home environment.

LIMITATIONS

The observational associations identified are cross-sectional, so do not necessarily imply causal links.

CONCLUSIONS

Aside from a lower prevalence, depression is very similar in this predominantly urban Sri Lankan sample to higher-income, Western countries, and may be under-identified due to a relatively low cultural appropriateness of the assessment of impairment. Under Sri Lanka's cultural and environmental context, certain aspects of the material environment are associated with depression among certain segments of society, perhaps because of their particular link to social status and social networks.

Depressive symptoms in early pregnancy disrupt attentional processing of infant emotion

BACKGROUND

Growing evidence suggests that perinatal depression is associated with disrupted mother-infant interactions and poor infant outcomes. Antenatal depression may play a key role in this cycle by disrupting the development of a maternal response to infant stimuli. The current study therefore investigated the impact of depressive symptoms on the basic cognitive processing of infant stimuli at the beginning of pregnancy.

METHOD

A total of 101 women were recruited by community midwives and tested at an average gestation of 11 weeks. An established computerized paradigm measured women's ability to disengage attention from infant and adult faces displaying negative positive and neutral emotions. Depressive symptoms were measured using a computerized interview (the Clinical Interview Schedule).

RESULTS

The effect of infant emotion on women's ability to disengage from infant faces was found to be influenced by depressive symptoms. Non-depressed pregnant women took longer to disengage attention from distressed compared with non-distressed infant faces. This bias was not, however, seen in women experiencing depressive symptoms. There was a difference of -53 (s.d.=0.7) ms (95% confidence interval -90 to -14, p=0.007) between those with and without depressive symptoms in this measure of attentional bias towards distressed infant faces.

CONCLUSIONS

Our results suggest that depressive symptoms are already associated with differential attentional processing of infant emotion at the very beginning of childbearing. The findings have potential implications for our understanding of the impact of depressive symptoms during pregnancy on the developing mother-infant relationship.

Mental health in a gendered context: Gendered community effect on depression and problem drinking

Socio-economic features of a community influence people's health. However, not all inhabitants are affected similarly. The present study explores gendered contextual effects on problem drinking and depression with the differential exposure, vulnerability and expression hypotheses of the social stress model in mind. Analyses are based on the pooled data of the Belgian Health Interview Survey 2001 and 2004 (N=21.367 respondents, N=589 municipalities). Results reveal that living in an area with high unemployment is more detrimental for women in terms of depression, but has the same impact on men and women when problem drinking is the outcome.

Estimating population prevalence of psychiatric conditions by small area with applications to analysing outcome and referral variations

This paper considers the development of estimates of mental illness prevalence for small areas and applications in explaining psychiatric outcomes and in assessing service provision. Estimates of prevalence are based on a logistic regression analysis of two national studies that provides model based estimates of relative morbidity risk by demographic, socio-economic and ethnic group for major psychiatric conditions; household/marital and area status also figure in the regression. Relative risk estimates are used, along with suitably disaggregated census populations, to make prevalence estimates for 354 English local authorities (LAs). Two applications are considered: the first involves analysis of variations in schizophrenia referrals and suicide mortality over English LAs that takes account of prevalence differences, and the second involves assessing hospital referral and bed use in relation to prevalence (for ages 16-74) for a case study area, Waltham Forest in NE London.

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000

BACKGROUND

Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK.

METHODS

A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder.

RESULTS

The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD.

CONCLUSIONS

Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.