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Scott J, Morton E, Michalak EE, Murray G. An epidemiological study of externally determined and self-identified mental and physical disability across the spectrum of bipolar disorders. J Affect Disord 2021; 294:597-604. [PMID: 34332361 DOI: 10.1016/j.jad.2021.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Studies exploring disability in bipolar disorder (BD) have primarily assessed clinical samples of full-threshold BD-I and BD-II alongside so-called objective criteria such as unemployment or receipt of government disability payments. This study extends research on disability by examining externally determined and self-identified disability in a community sample and by including subthreshold BD (BDS). METHODS Data were extracted from the USA Collaborative Psychiatric Epidemiology Surveys about individuals who met recognized criteria for BD-I, BD-II and BDS who had completed self-ratings of physical and mental disability, comorbidities, and health risk factors (e.g., obesity). Rates of disability were estimated, and logistic regression analyses were used to determine demographic and clinical variables associated with externally determined and self-identified of disability. RESULTS Of 408 individuals who met eligibility criteria (BD-I = 100; BD-II=104; BDS=204), 35% met criteria for externally determined disability, about 40% self-reported mental disability and about 23% self-reported physical disability. The odds were three-fold (Odds Ratio (OR): 3.05; 95% Confidence Intervals (CI): 1.69, 5.53) that someone with self-identified physical disability would meet criteria for externally determined disability, but associations with mental disability were non-significant (OR: 1.06; 95% CI: 0.63, 1.80). Regression analyses demonstrated that mental disability was associated with being a current or past smoker and physical disability was associated with BD-I. LIMITATIONS the adequacy of the assessments of disability and definition of BDS can be questioned. CONCLUSIONS Future clinical and community studies need to consider both externally determined and self-identified disability across the entire Bd spectrum.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle, UK.
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Victoria, Australia.
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Noteboom A, Have MT, de Graaf R, Beekman ATF, Penninx BWJH, Lamers F. The long-lasting impact of childhood trauma on adult chronic physical disorders. J Psychiatr Res 2021; 136:87-94. [PMID: 33581460 DOI: 10.1016/j.jpsychires.2021.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 11/25/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is unclear if childhood trauma (CT) is an independent risk factor of adult chronic physical disorders or whether its impact is (also) due to underlying poorer mental health. METHODS Data were obtained from baseline measurements among 13,489 respondents of the Netherlands Mental Health Survey and Incidence Study-1 and -2, cohort studies of the Dutch general population aged 18-64 years. We used a childhood trauma questionnaire measuring emotional, psychological, physical or sexual trauma before the age of 16. Lifetime mood, anxiety and substance use disorders were assessed with the Composite International Diagnostic Interview version 1.1 and 3.0. A standard self-report checklist was used to assess a broad range of chronic physical disorders treated by a medical doctor in the previous 12 months. RESULTS Respondents with a history of CT (N = 4054) suffered significantly more often from digestive (OR: 1.89-2.95), musculoskeletal (OR: 1.21-1.75) and respiratory disorders (OR: 1.39-1.91) and migraine (OR: 1.42-1.66). We found indirect associations between CT and digestive, musculoskeletal and respiratory disorders through lifetime mood (54%, 52% and 48% respectively), anxiety (44%, 55% and 44% respectively) and substance use disorders (33%, 23% and 38% respectively). Mood (69%) and anxiety disorders (67%) also impacted the relationship with migraine. CONCLUSIONS CT predicts the development of adult physical disorders, even after controlling for sociodemographic and lifestyle factors. This association is substantially influenced by mental health disorders. Treatment programs for CT should include interventions aimed at enhancing both mental and physical health.
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Affiliation(s)
- Annemieke Noteboom
- GGZinGeest, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Arkin, NPI, Berkenweg 7 3818 LA, Amersfoort, the Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521, VS, Utrecht, the Netherlands.
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521, VS, Utrecht, the Netherlands.
| | - Aartjan T F Beekman
- GGZinGeest, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1105, 1081, HV, the Netherlands.
| | - Brenda W J H Penninx
- GGZinGeest, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1105, 1081, HV, the Netherlands.
| | - Femke Lamers
- GGZinGeest, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1105, 1081, HV, the Netherlands.
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Silva M, Antunes A, Azeredo-Lopes S, Cardoso G, Xavier M, Saraceno B, Caldas-de-Almeida JM. Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey. J Ment Health 2020; 31:453-461. [PMID: 32202450 DOI: 10.1080/09638237.2020.1739249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap.Aims: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal.Method: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal).Results: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92).Conclusions: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Ana Antunes
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | | | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Miguel Xavier
- Chronic Diseases Research Centre (CEDOC), Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Benedetto Saraceno
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Verma S, Luo N, Tan KB, James L, Heng D, Subramaniam M. Impact of mental disorders and chronic physical conditions on quality-adjusted life years in Singapore. Sci Rep 2020; 10:2695. [PMID: 32060390 PMCID: PMC7021810 DOI: 10.1038/s41598-020-59604-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/31/2020] [Indexed: 11/24/2022] Open
Abstract
The current study aims to evaluate the burden of disease in Singapore by estimating the quality-adjusted life years (QALYs) lost due to mental disorders and chronic physical conditions. The second Singapore Mental Health Study (SMHS-2016) was conducted in 2016 among 6126 respondents aged 18 years and above. The World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0) and a modified version of the CIDI chronic medical disorders checklist were used to assess the 12-month diagnoses of mental and chronic physical disorders while the SF-6D scores derived from the 12-item Short Form Health Survey instrument was used to estimate the QALYs lost. The mean SF-6D score in this population was 0.87. The largest reduction in SF-6D scores among people with mental disorders was observed in Generalized Anxiety Disorder (GAD), followed by Major Depressive Disorder (MDD), alcohol abuse, bipolar disorder and Obsessive Compulsive Disorder (OCD) while the largest reduction in SF-6D score among people with chronic physical conditions was observed in ulcer, followed by lung disease, chronic pain and cardiovascular disease. At the population level, chronic pain was associated with the greatest QALY loss followed by MDD (14,204 and 6,889 respectively). Lung disease was associated with the smallest QALY loss (376). These findings highlight chronic pain, MDD, OCD, cardiovascular disease and GAD as the five leading contributors of QALYs lost in the general population which deserve prioritisation in public health prevention programmes.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental health, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Lyn James
- Ministry of Health, Singapore, Singapore
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Disability and common mental disorders: Results from the World Mental Health Survey Initiative Portugal. Eur Psychiatry 2020; 49:56-61. [DOI: 10.1016/j.eurpsy.2017.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 02/05/2023] Open
Abstract
AbstractBackgroundCommon mental disorders are highly prevalent and disabling, leading to substantial individual and societal costs. This study aims to characterize the association between disability and common mental disorders in Portugal, using epidemiological data from the World Mental Health Survey Initiative.MethodsTwelve-month common mental disorders were assessed with the CIDI 3.0. Disability was evaluated with the modified WMHS WHODAS-II. Logistic regression models were used to assess the association between disability and each disorder or diagnostic category (mood or anxiety disorders).ResultsAmong people with a common mental disorder, 14.6% reported disability. The specific diagnoses significantly associated with disability were post-traumatic stress disorder (OR: 6.69; 95% CI: 3.20, 14.01), major depressive disorder (OR: 3.49; 95% CI: 2.13, 5.72), bipolar disorder (OR: 3.41; 95% CI: 1.04, 11.12) and generalized anxiety disorder (OR: 3.14; 95% CI: 1.43, 6.90). Both categories of anxiety and mood disorders were significantly associated with disability (OR: 1.88; 95% CI: 1.23, 2.86 and OR: 3.94; 95% CI: 2.45, 6.34 respectively).ConclusionsThe results of this study add to the current knowledge in this area by assessing the disability associated with common mental disorders using a multi-dimensional instrument, which may contribute to mental health policy efforts in the development of interventions to reduce the burden of disability associated with common mental disorders.
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Changes in socioeconomic position among individuals with mental disorders during the economic recession in Portugal: a follow-up of the National Mental Health Survey. Epidemiol Psychiatr Sci 2019; 28:638-643. [PMID: 30078385 PMCID: PMC6998866 DOI: 10.1017/s2045796018000392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Portugal was one of the European countries most affected by the period of economic recession initiated in 2008. Social inequalities are likely to widen during such periods and disproportionately affect people with mental disorders. The present study aims to compare self-reported changes in indicators of socioeconomic position during the economic recession in Portugal among people with and without mental disorders in the beginning of this period. Three dimensions were assessed, namely employment situation, experiences of financial hardship and subjective social status. METHODS Data from the World Mental Health Survey Initiative Portugal (2008/2009) and from the National Mental Health Survey Follow-up (2015/2016) were used (n = 911). Multinomial and logistic recession models were performed to examine the association between the presence of any 12-month mood or anxiety mental disorder in 2008/2009 and indicators of socioeconomic position in 2015/2016. All analyses were adjusted for gender, age, presence of any physical disorder and education at the baseline. RESULTS Participants that had any mental disorder in the beginning of the economic recession reported 2.20 (95% CI 1.31-3.71; P < 0.01) higher odds of financial hardship related to daily life in 2015/2016, when compared with those without any mental disorder, after adjusting for age, gender, education and presence of any physical disorder. The results may also suggest a pattern of increased socioeconomic disadvantage among people with prior mental disorder, despite not reaching statistical significance. CONCLUSIONS The results of this study suggest that the economic recession may have contributed to wider social inequalities between people with and without mental disorders. Policies to support these individuals, such as access to treatment and alleviation of financial hardship, should be a priority in times of economic downturn.
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Fajardo-Bullón F, Esnaola I, Anderson I, Benjaminsen L. Homelessness and self-rated health: evidence from a national survey of homeless people in Spain. BMC Public Health 2019; 19:1081. [PMID: 31399028 PMCID: PMC6688283 DOI: 10.1186/s12889-019-7380-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. Method The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. Results Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. Conclusions These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.
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Affiliation(s)
- Fernando Fajardo-Bullón
- Department of Development and Educational Psychology. Faculty of Education, University of Extremadura, Badajoz, Spain
| | - Igor Esnaola
- Department of Development and Educational Psychology. Faculty of Education (Avenida de Tolosa, 20018, San Sebastián), University of the Basque Country, UPV/EHU, Leioa, Spain.
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Lars Benjaminsen
- The Danish Center for Social Science Research, København, Denmark
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8
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Qadeer RA, Georgiades K, Boyle MH, Ferro MA. An Epidemiological Study of Substance Use Disorders Among Emerging and Young Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:313-322. [PMID: 30071752 PMCID: PMC6591883 DOI: 10.1177/0706743718792189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We investigated the prevalence of substance use disorders (SUDs) among emerging adults and quantified the extent to which emerging adults, compared with young adults, have increased odds for SUDs. METHODS Data were from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Respondents were 15 to 39 y of age ( n = 9228) and were categorized as: early emerging adults (15 to 22 y); late emerging adults (23 to 29 y); and, young adults (30 to 39 y). SUDs [alcohol or drug abuse/dependence (AAD or DAD)] were measured using the WHO Composite International Diagnostic Interview 3.0. The prevalence of SUDs was compared across age groups, and odds ratios (OR) and 95% confidence intervals (CI) were computed from logistic regression models adjusting for sociodemographic and health covariates. Analyses were weighted to maintain representativeness to the Canadian population. RESULTS The prevalence of AAD was 8.0%, 6.6%, and 2.7% for early emerging adults, late emerging adults, and young adults, respectively. For DAD, the prevalence was 6.4%, 3.6%, and 1.3%. After covariate adjustment, early and late emerging adults had greater odds of reporting AAD (OR = 3.2, 95% CI = 2.2 to 4.9 and OR = 2.4, 95% CI = 1.6 to 3.4, respectively) or DAD (OR = 4.2, 95% CI = 2.5 to 7.0 and OR = 2.5, 95% CI = 1.6 to 4.1, respectively) compared with young adults. Differences between early and late emerging adults were not significant. CONCLUSION Emerging adults are at increased odds for SUDs. Lack of differences between early and late emerging adults provide evidence of the extension of emerging adulthood into the late 20s. Findings have implications for the provision of screening and treatment of SUDs during this developmental period.
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Affiliation(s)
- Rana A Qadeer
- 1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Georgiades
- 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Boyle
- 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Ferro
- 3 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Absenteeism and Presenteeism Associated With Common Health Conditions in Brazilian Workers. J Occup Environ Med 2019; 61:303-313. [DOI: 10.1097/jom.0000000000001538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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10
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Wang YP, Nunes BP, Coêlho BM, Santana GL, do Nascimento CF, Viana MC, Benseñor IM, Andrade LH, Chiavegatto Filho ADP. Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil. Sci Rep 2019; 9:2390. [PMID: 30787376 PMCID: PMC6382818 DOI: 10.1038/s41598-019-39326-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
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Affiliation(s)
- Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Bruno P Nunes
- Nursing Department, Federal University of, Pelotas, RS, Brazil
| | - Bruno M Coêlho
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Geilson L Santana
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carla F do Nascimento
- Department of Epidemiology, School of Public Health, University of São Paulo, Sao Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitario HU USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Laura H Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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11
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Disability and Health Consequences of Traumatic Brain Injury: National Prevalence. Am J Phys Med Rehabil 2019; 97:323-331. [PMID: 29016402 DOI: 10.1097/phm.0000000000000848] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to measure the prevalence of traumatic brain injury (TBI)-related disability and health status in the general population. DESIGN The French National Survey, conducted in households and institutions, assessed 33,896 adults. Data included sequelae from TBI, impairments, current health conditions, and uses of health services. Analyses, adjusted for age and sex, compared subjects who declared sequelae from TBI (n = 479) with the remaining survey population (n = 33,287). Use of weighting factors ensured that results were representative of the national population. RESULTS Prevalence of persistent sequelae from TBI in France was 704/100,000. Median time since injury was 14 yrs. For all Core Set items of the International Classification of Functioning, subjects with TBI reported more impairments than the control population: adjusted odds ratios from 1.7 (behavioral difficulties) to 8.6 (motor difficulties). Rates of cardiovascular, respiratory, musculoskeletal, digestive, urological, neurological, and psychiatric conditions were higher in the TBI population. Use of health services was greater, and women with TBI had higher rates of unmet health needs. CONCLUSIONS Persistent sequelae from TBI significantly affect health in the general population. Planning of post-TBI care should address the chronic needs of these persons.
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12
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Antunes A, Frasquilho D, Azeredo-Lopes S, Silva M, Cardoso G, Caldas-de-Almeida JM. The effect of socioeconomic position in the experience of disability among people with mental disorders: findings from the World Mental Health Survey Initiative Portugal. Int J Equity Health 2018; 17:113. [PMID: 30086758 PMCID: PMC6081835 DOI: 10.1186/s12939-018-0821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders are a major cause of disability with impacts on daily functioning and quality of life, which has been associated with socioeconomic disadvantage. The present study aims to assess how socioeconomic position is related to the disability reported by people with mental disorders, using data from the World Mental Health Survey (WMHS) Initiative Portugal. METHODS Using data from the Portuguese Mental Health Survey, a nationally representative cross-sectional study (n = 3849), several logistic regression models with interaction terms were performed to evaluate the effect of different indicators of socioeconomic position on the disability reported by people with any mental disorder (any 12-month mood or anxiety disorder). Odds ratios were estimated at the specific values of the main effects and interaction terms between the presence of any mental disorder and education, employment status, self-perceived financial deprivation and subjective social status. RESULTS The prevalence rate of any mood or anxiety disorder was 21.0% (n = 788), among which 14.7% (n = 115) reported disability. The results show that among people with any 12-month mental disorder, those in the employment category of "retired or others" had two times higher odds of reporting disability (OR = 2.19; 95%CI: 1.06-4.48) when compared to participants categorized as "working". Likewise, individuals with financial deprivation had two times higher odds of reporting disability when compared to those non-financially deprived (OR = 2.36; 95%CI: 1.31-4.24). The odds ratios obtained for the specific years of education evaluated were not statistically significant but seem to suggest an educational gradient. CONCLUSIONS The findings of this study indicate that the disability reported by people with mental disorders varies according to socioeconomic position and draw attention to the need to develop policies to address these inequalities.
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Affiliation(s)
- Ana Antunes
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, nº5, 1150-082, Lisbon, Portugal. .,Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Diana Frasquilho
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, nº5, 1150-082, Lisbon, Portugal.,Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Sofia Azeredo-Lopes
- Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Manuela Silva
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, nº5, 1150-082, Lisbon, Portugal.,Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Graça Cardoso
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, nº5, 1150-082, Lisbon, Portugal.,Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, nº5, 1150-082, Lisbon, Portugal.,Nova Medical School, Nova University of Lisbon, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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13
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van der Feltz-Cornelis CM, Elfeddali I, Werneke U, Malt UF, Van den Bergh O, Schaefert R, Kop WJ, Lobo A, Sharpe M, Söllner W, Löwe B. A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study. Front Psychiatry 2018; 9:151. [PMID: 29867596 PMCID: PMC5961475 DOI: 10.3389/fpsyt.2018.00151] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe.
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Affiliation(s)
- Christina M. van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, Netherlands
- Tranzo Department, Tilburg University, Tilburg, Netherlands
| | - Iman Elfeddali
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, Netherlands
- Tranzo Department, Tilburg University, Tilburg, Netherlands
| | - Ursula Werneke
- Sunderby Research Unit, Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Ulrik F. Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Psychosomatic Medicine, Division of Mental Health and Dependency, University Hospital Oslo, Oslo, Norway
| | | | - Rainer Schaefert
- Division of Internal Medicine, Department of Psychosomatic Medicine, University and University Hospital Basel, Basel, Switzerland
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Antonio Lobo
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERSAM, National Institute of Health Carlos III, Zaragoza, Spain
| | | | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Bernd Löwe
- Institute for Psychosomatic Medicine and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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14
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van Eck van der Sluijs JF, Ten Have M, de Graaf R, Rijnders CAT, van Marwijk HWJ, van der Feltz-Cornelis CM. Predictors of Persistent Medically Unexplained Physical Symptoms: Findings From a General Population Study. Front Psychiatry 2018; 9:613. [PMID: 30524322 PMCID: PMC6262298 DOI: 10.3389/fpsyt.2018.00613] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: To explore the persistency of Medically Unexplained Symptoms (MUS) and its prognostic factors in the general adult population. Knowledge of prognostic factors of MUS may indicate possible avenues for intervention development. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face cohort study among the Dutch general population aged 18-64 years. We selected subjects with MUS at baseline and who participated at follow-up (N = 324) and reassessed those subjects for having MUS at 3 year follow-up. Logistic regression analyses were used to determine risk factors for persistency of MUS. Results: 36.4% of the subjects had persistent MUS at follow-up. In logistic regression analyses adjusted for sex and age, persistency of MUS was predicted by the number of comorbid chronic medical disorder(s), lower education, female sex, not having a paid job, parental psychopathology as well as lower functioning. In the logistic regression analysis in which all significant variables adjusted for sex and age were entered simultaneously, three variables predicted persistent MUS: parental psychopathology, the number of comorbid chronic medical disorder(s) and physical functioning, with odds ratios of 2.01 (1.20-3.38), 1.19 (1.01-1.40), and 0.99 (0.97-1.00), respectively. Conclusion: In the adult general population, MUS were persistent in over one third of the subjects with MUS at baseline. Persistency was significantly predicted by parental psychopathology, number of comorbid chronic medical disorders, and physical functioning. These findings warrant further research into early intervention and treatment options for persons with an increased risk of persistent MUS.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Top clinical Center for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Tranzo, Tilburg University, Tilburg, Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | | | - Harm W J van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, United Kingdom
| | - Christina M van der Feltz-Cornelis
- Top clinical Center for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Tranzo, Tilburg University, Tilburg, Netherlands.,Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
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15
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França MH, Barreto SM, Pereira FG, Andrade LHSGD, Paiva MCAD, Viana MC. Mental disorders and employment status in the São Paulo Metropolitan Area, Brazil: gender differences and use of health services. CAD SAUDE PUBLICA 2017; 33:e00154116. [DOI: 10.1590/0102-311x00154116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Abstract: Mental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the São Paulo Metropolitan Area, Brazil. Data from the São Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.
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16
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Bokma WA, Batelaan NM, van Balkom AJLM, Penninx BWJH. Impact of Anxiety and/or Depressive Disorders and Chronic Somatic Diseases on disability and work impairment. J Psychosom Res 2017; 94:10-16. [PMID: 28183397 DOI: 10.1016/j.jpsychores.2017.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Anxiety and/or Depressive Disorders (ADDs) and Chronic Somatic Diseases (CSDs) are associated with substantial levels of health-related disability and work impairment. However, it is unclear whether comorbid ADDs and CSDs additively affect functional outcomes. This paper examines the impact of ADDs, CSDs, and their comorbidity on disability, work absenteeism and presenteeism. METHODS Baseline data from the Netherlands Study of Depression and Anxiety (n=2371) were used. We assessed presence of current ADDs (using psychiatric interviews, CIDI) and presence of self-reported CSDs. Outcome measures were disability scores (WHO-DAS II questionnaire, overall and domain-specific), work absenteeism (≤2weeks and >2weeks; TiC-P) and presenteeism (reduced and impaired work performance; TiC-P). We conducted multivariate regression analyses adjusted for socio-demographics. RESULTS Both ADDs and CSDs significantly and independently impact total disability, but the impact was substantially larger for ADDs (main effect unstandardized β=20.1, p<.001) than for CSDs (main effect unstandardized β=3.88, p<.001). There was a positive interaction between ADDs and CSDs on disability (unstandardized β interaction=4.06, p=.004). Although CSDs also induce absenteeism (OR for extended absenteeism=1.42, p=.015) and presenteeism (OR for impaired work performance=1.42, p=.013), associations with ADDs were stronger (OR for extended absenteeism=6.64, p<.001; OR for impaired work performance=7.51, p<.001). CONCLUSION Both CSDs and ADDs cause substantial disability, work absenteeism and presenteeism, but the impact of ADDs far exceeds that of CSDs. CSDs and ADDs interact synergistically on disability, thereby bolstering the current view that patients with physical mental comorbidity (PM-comorbidity) form a severe subgroup with an unfavourable prognosis.
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Affiliation(s)
- Wicher A Bokma
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
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17
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Kye SY, Park K. Suicidal ideation and suicidal attempts among adults with chronic diseases: A cross-sectional study. Compr Psychiatry 2017; 73:160-167. [PMID: 27992846 DOI: 10.1016/j.comppsych.2016.12.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION About 14% of the global burden of disease has been attributed to neuropsychiatric disorders. The aim of this study was to show the general picture of suicidal ideation and behavior among Korean, and to test the hypothesis that there is a positive association between diseases and suicidality. METHOD A total of 19,599 individuals were asked if they had any chronic diseases, suicidal ideation and attempts. The data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V, 2010-2012) conducted by Korea Centers for Disease Control and Prevention (KCDC) were examined. RESULTS Stroke and osteoarthritis were associated with a 1.81 and 1.27 times increase in the odds of suicidal ideation, respectively (95% CI=1.24-2.65; 95% CI=1.09-1.48). Angina pectoris and osteoarthritis were associated with a 3.88 and 2.09 times increase in the odds of suicide attempts (95% CI=1.78-8.43; 95% CI=1.24-3.55). Having pulmonary tuberculosis increased the odds of a suicide attempt 12-fold (OR=12.47, 95% CI=1.12-138.66). Having renal failure was associated with a 4.92 times increase in the odds of suicide attempts (95% CI=1.25-19.30). Having lung cancer or cervical cancer increased the odds of suicide attempts more than 10-fold (OR=11.53, 95% CI=1.03-128.80; OR=17.66, 95% CI=1.58-197.01). CONCLUSIONS Various diseases were risk factors for suicidality. Physicians' communication skills for frank and clear discussions about suicidality should be developed through various training courses.
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Affiliation(s)
- Su-Yeon Kye
- Cancer Information and Education Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
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18
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Cardoso G, Xavier M, Vilagut G, Petukhova M, Alonso J, Kessler RC, Caldas-de-Almeida JM. Days out of role due to common physical and mental conditions in Portugal: results from the WHO World Mental Health Survey. BJPsych Open 2017; 3:15-21. [PMID: 28243461 PMCID: PMC5295249 DOI: 10.1192/bjpo.bp.115.002402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/08/2017] [Accepted: 01/15/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One important aspect of the societal burden of mental disorders is the extent to which these problems cause disability. AIMS To assess days out of role associated with commonly occurring mental disorders in comparison with physical disorders in Portugal. METHOD National cross-sectional survey, with home interviews carried out with 3849 adult (aged 18+) respondents (57.3% response rate). RESULTS Twelve-month prevalence for any mental disorder was 21.8%, any physical disorder 55.1% and any disorder 63.1%, with an average of 2.3 disorders per respondent with a disorder. Close to one out of every 10 respondents (9.2%) reported at least one day totally out of role in the past month (median of 6.4 days/any). The 18 conditions accounted for 78.2% of all days out of role, with 20.2% because of mental disorders and 59.2% because of physical disorders. CONCLUSIONS Mental disorders account for a substantial proportion of all role disability in the Portuguese population. Early detection and intervention would have a positive societal effect. Owing to highly frequent comorbidity, simultaneous management of mental and physical disorder comorbidities is advised for greater effect. DECLARATION OF INTEREST R.C.K. in the past 3 years has been a consultant for Hoffmann-La Roche Inc., Johnson & Johnson's Wellness and Prevention, Inc. and Sanofi-Aventis Groupe. He has served on advisory boards for Mensante Corporation, Johnson & Johnson Services, Inc., Lake Nona Life Project and U.S. Preventive Medicine, Inc. He is a co-owner of DataStat, Inc. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Graça Cardoso
- , MD, PhD, Chronic Diseases Research Centre (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Xavier
- , MD, PhD, Chronic Diseases Research Centre (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gemma Vilagut
- , PhD, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Petukhova
- , PhD, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jordi Alonso
- , MD, PhD, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ronald C Kessler
- , PhD, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - José Miguel Caldas-de-Almeida
- , MD, PhD, Chronic Diseases Research Centre (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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19
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Ennis E, O'Neill S, Murphy S, Bunting B. Days out of role due to common physical and mental conditions: results from the Northern Ireland study of health and stress. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1539-1546. [PMID: 27517674 DOI: 10.1007/s00127-016-1273-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Days out of role due to health problems are a major source of lost human capital. We examined the relative importance of common physical and mental disorders in accounting for days out of role in Northern Ireland using the Northern Ireland Study of Health and Stress (NISHS) WHO World Mental Health (WMH) Survey. METHODS Face-to-face interviews were carried out with 4340 respondents (68.4 % response rate). Multiple regression analysis estimated associations of specific chronic physical disorders and mental disorders conditions and comorbidities with days out of role controlling for basic socio-demographics. RESULTS Overall, 16.8 % of respondents had at least one day totally out of role in the previous year. The strongest population-level effect was associated with arthritis, which accounted for 23.5 % of all days out of role. The strongest individual-level effects (days out of role per year) were associated with any anxiety disorder (32.3) arthritis (26.1) and pain (22.0). The 11 conditions accounted for 93 % of all days out of role, as measured by population attributable risk proportions (PARPs). CONCLUSIONS Common health conditions, including mental disorders, make up a large proportion of the number of days out of role and should be addressed to substantially increase overall productivity.
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Affiliation(s)
- Edel Ennis
- School of Psychology, Ulster University, Northland Rd., L. Derry, Coleraine, BT48 7JL, Northern Ireland, UK.
| | - S O'Neill
- School of Psychology, Ulster University, Northland Rd., L. Derry, Coleraine, BT48 7JL, Northern Ireland, UK
| | - S Murphy
- School of Psychology, Ulster University, Northland Rd., L. Derry, Coleraine, BT48 7JL, Northern Ireland, UK
| | - B Bunting
- School of Psychology, Ulster University, Northland Rd., L. Derry, Coleraine, BT48 7JL, Northern Ireland, UK
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20
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Tegethoff M, Stalujanis E, Belardi A, Meinlschmidt G. Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents. PLoS One 2016; 11:e0165196. [PMID: 27768751 PMCID: PMC5074457 DOI: 10.1371/journal.pone.0165196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/08/2016] [Indexed: 01/10/2023] Open
Abstract
Background The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities. Methods This article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13–18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report. Results The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74). Conclusions Findings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.
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Affiliation(s)
- Marion Tegethoff
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Esther Stalujanis
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Angelo Belardi
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
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21
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Abdin E, Subramaniam M, Picco L, Pang S, Vaingankar JA, Shahwan S, Sagayadevan V, Zhang Y, Chong SA. The importance of considering differential item functioning in investigating the impact of chronic conditions on health-related quality of life in a multi-ethnic Asian population. Qual Life Res 2016; 26:823-834. [PMID: 27679497 DOI: 10.1007/s11136-016-1418-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The present study aims to examine the impact of chronic conditions after adjusting for differential item functioning (DIF) on the various aspects of health-related quality of life (HRQoL) in a multi-ethnic Asian population in Singapore. METHOD Data on 3006 participants from a nation-wide cross-sectional survey of mental health literacy conducted in Singapore were used. Multiple Indicators Multiple Causes model was used to investigate the effects of chronic medical conditions on various HRQoL dimensions assessed with the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) after adjusting for DIF. RESULTS Twenty out of 36 items were detected with DIF for chronic conditions including high blood pressure, cardiovascular disorders, diabetes, cancer, neurological disorders and ulcer as well as for a few demographic factors such age, gender and marital status. Twenty significant associations between chronic conditions and SF-36 domains were observed. After controlling for all chronic conditions, socio-demographic and DIF items, a significant association emerged between cardiovascular disorders and physical functioning, while the association between diabetes and ulcer and general health became nonsignificant. All other associations remained statistically significant. CONCLUSION Our findings provide useful information and important implications of DIF on the impact of chronic conditions on HRQoL. We found the impact of DIF with respect to the impact of chronic conditions on HRQoL to be minimal after accounting for measurement bias in this multiracial Asian population.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
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22
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van Eck van der Sluijs JF, ten Have M, Rijnders CA, van Marwijk HWJ, de Graaf R, van der Feltz-Cornelis CM. Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study. Neuropsychiatr Dis Treat 2016; 12:2063-72. [PMID: 27574433 PMCID: PMC4993555 DOI: 10.2147/ndt.s109504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms. METHODS Data were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18-64 years. We selected subjects with medically unexplained symptoms (MUS) only (MUSonly; n=177), explained physical symptoms only (PHYonly, n=1,952), combined MUS and explained physical symptoms (MUS + PHY, n=209), and controls without physical symptoms (NONE, n=4,168). We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0. RESULTS At the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95) for MUSonly, 1.55 (1.13, 2.12) for PHYonly, and 2.25 (1.41, 3.57) for MUS + PHY. At the specialized mental health care level, this was the case only for MUSonly subjects (adjusted odds ratio 1.65 [1.04, 2.61]). In both the primary and specialized mental health care, there were no significant differences between the four groups in the number of treatment contacts once they entered into treatment. CONCLUSION All sorts of physical symptoms, unexplained as well as explained, were associated with significant higher entry into primary care for mental problems. In specialized mental health care, this was true only for MUSonly. No differences were found in the number of treatment contacts. This warrants further research aimed at the content of the treatment contacts.
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Affiliation(s)
| | | | - Cees A Rijnders
- Department of Residency training, GGz Breburg, Tilburg, the Netherlands
| | - Harm WJ van Marwijk
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht
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Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, de Graaf R, ten Have M, van der Horst HE, van Schaik A, van Marwijk HW, Smit F. Non-fatal disease burden for subtypes of depressive disorder: population-based epidemiological study. BMC Psychiatry 2016; 16:139. [PMID: 27176611 PMCID: PMC4865028 DOI: 10.1186/s12888-016-0843-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major depression is the leading cause of non-fatal disease burden. Because major depression is not a homogeneous condition, this study estimated the non-fatal disease burden for mild, moderate and severe depression in both single episode and recurrent depression. All estimates were assessed from an individual and a population perspective and presented as unadjusted, raw estimates and as estimates adjusted for comorbidity. METHODS We used data from the first wave of the second Netherlands-Mental-Health-Survey-and-Incidence-Study (NEMESIS-2, n = 6646; single episode Diagnostic and Statistical Manual (DSM)-IV depression, n = 115; recurrent depression, n = 246). Disease burden from an individual perspective was assessed as 'disability weight * time spent in depression' for each person in the dataset. From a population perspective it was assessed as 'disability weight * time spent in depression *number of people affected'. The presence of mental disorders was assessed with the Composite International Diagnostic Interview (CIDI) 3.0. RESULTS Single depressive episodes emerged as a key driver of disease burden from an individual perspective. From a population perspective, recurrent depressions emerged as a key driver. These findings remained unaltered after adjusting for comorbidity. CONCLUSIONS The burden of disease differs between the subtype of depression and depends much on the choice of perspective. The distinction between an individual and a population perspective may help to avoid misunderstandings between policy makers and clinicians.
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Affiliation(s)
- Karolien E.M. Biesheuvel-Leliefeld
- Department of General Practice and Elderly Care Medicine, and EMGO+ Institute for Health and Care Research, VU University medical centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Gemma D. Kok
- Department of Clinical and Experimental Psychology, University of Groningen, Groningen, The Netherlands
| | - Claudi L.H. Bockting
- Department of Clinical and Experimental Psychology, University of Groningen, Groningen, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henriette E. van der Horst
- Department of General Practice and Elderly Care Medicine, and EMGO+ Institute for Health and Care Research, VU University medical centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Anneke van Schaik
- Department of Psychiatry, and the EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Harm W.J. van Marwijk
- Department of General Practice and Elderly Care Medicine, and EMGO+ Institute for Health and Care Research, VU University medical centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Filip Smit
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands ,Department of Clinical Psychology, and EMGO+ Institute for Health and Care Research, VU University and VU University medical centre, Amsterdam, The Netherlands ,Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University medical centre, Amsterdam, The Netherlands
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Tegethoff M, Belardi A, Stalujanis E, Meinlschmidt G. Comorbidity of Mental Disorders and Chronic Pain: Chronology of Onset in Adolescents of a National Representative Cohort. THE JOURNAL OF PAIN 2015; 16:1054-64. [DOI: 10.1016/j.jpain.2015.06.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 12/22/2022]
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Association of urinary biomarker COLL2-1NO₂ with incident clinical and radiographic knee OA in overweight and obese women. Osteoarthritis Cartilage 2015; 23:1398-404. [PMID: 25891749 DOI: 10.1016/j.joca.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/24/2015] [Accepted: 04/08/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between urinary biomarker Coll2-1NO2 (uColl2-1NO2) and incident knee OA after 2.5 years follow-up in middle-aged overweight and obese women at high risk for knee osteoarthritis (OA). DESIGN Data were used from PROOF, a randomized controlled trial with 2.5 years follow-up evaluating the preventive effects of a diet and exercise program and oral glucosamine sulphate (double blind and placebo controlled), on development of incident knee OA in women with body mass index ≥ 27 kg/m(2) without signs of knee OA at baseline. Baseline and 2.5 years uColl2-1NO2 concentrations were assessed with enzyme-linked immunosorbent assay (ELISA). Primary outcome measure was incidence of knee OA in one or both knees, defined as incidence of either Kellgren & Lawrence grade ≥2, joint space narrowing of ≥1.0 mm or knee OA according to the combined clinical and radiographic ACR-criteria. We used binary logistic regression for the association analyses. RESULTS 254 women were available for analyses. At 2.5 years follow-up, incident knee OA was present in 72 of 254 women (28.3%). An inversed association was found between baseline uColl2-1NO2 and incident knee OA at 2.5 years (OR 0.74, 95% CI 0.55-0.99). The concentration at 2.5 years and the change in concentration over 2.5 years did not show significant associations with the outcome. CONCLUSIONS In overweight and obese middle-aged women, not higher but lower baseline uColl2-1NO2 concentration was significantly associated with an increased risk for incident knee OA. This interesting but counterintuitive outcome makes further validation of this biomarker warranted.
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van Eck van der Sluijs J, ten Have M, Rijnders C, van Marwijk H, de Graaf R, van der Feltz-Cornelis C. Medically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders. PLoS One 2015; 10:e0123274. [PMID: 25853676 PMCID: PMC4390312 DOI: 10.1371/journal.pone.0123274] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/18/2015] [Indexed: 12/02/2022] Open
Abstract
Background Clinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect. Aim To study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population. Method Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952), with MUS only (n=177), with both MUS and PHY (n=209), and a reference group with no physical symptoms (n=4168). The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics. Results MUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74)). Conclusion In the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.
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Affiliation(s)
- Jonna van Eck van der Sluijs
- Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, the Netherlands
- * E-mail:
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Cees Rijnders
- Department of Residency training, GGz Breburg, Tilburg, The Netherlands
| | - Harm van Marwijk
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Department of General Practice & Elderly Care Medicine and the EMGO+-Institute for Health and Care Research of VU University medical centre (VUmc), Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Christina van der Feltz-Cornelis
- Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, the Netherlands
- Department of Residency training, GGz Breburg, Tilburg, The Netherlands
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Association between mental disorders and physical diseases in adolescents from a nationally representative cohort. Psychosom Med 2015; 77:319-32. [PMID: 25851547 DOI: 10.1097/psy.0000000000000151] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Pediatric health care and research focus mostly on single morbidities, although the single-disease framework has been challenged. The main objective was to estimate associations between childhood mental disorders and physical diseases. METHODS This study is based on weighted data (n = 6482) from the National Comorbidity Survey Replication Adolescent Supplement (age, 13-18 years). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders were assessed using the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Lifetime medical conditions and doctor-diagnosed diseases were assessed by adolescent self-report. RESULTS Of 6469 participants, 2137 (35.33%) reported at least one mental disorder and one physical disease. The most substantial associations included those between affective disorders and diseases of the digestive system (odds ratio [OR] = 3.46, 95% confidence interval [CI] = 2.28-5.24), anxiety disorders and arthritis (OR = 2.27, CI = 1.34-3.85), anxiety disorders and heart diseases (OR = 2.41, CI = 1.56-3.73), anxiety disorders and diseases of the digestive system (OR = 2.18, CI = 1.35-3.53), and eating disorders and epilepsy/seizures (OR = 5.45, CI = 1.57-18.87). Sociodemographic factors did not account for the association between mental disorders and physical diseases. CONCLUSIONS Findings suggest that mental disorders and physical diseases often co-occur in childhood. This association is a major public health challenge, and the child health system needs additional strategies in patient-centered care, research, medical education, health policy, and economics to develop well-coordinated interdisciplinary approaches linking mental and physical care in children.
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Rodic D, Meyer AH, Meinlschmidt G. The Association between Depressive Symptoms and Physical Diseases in Switzerland: A Cross-Sectional General Population Study. Front Public Health 2015; 3:47. [PMID: 25853116 PMCID: PMC4370044 DOI: 10.3389/fpubh.2015.00047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the association between depressive symptoms and physical diseases in Switzerland, as respective findings might inform about future estimates of mental and physical health care costs. METHODS A population-based study, using data from the Swiss Health Survey collected by computer-assisted telephone interviews and additional written questionnaires during the year 2007 (n = 18,760) in Switzerland. The multistage stratified random sample included subjects aged 15 years and older, living in a private Swiss household with a telephone connection. Complete data were available for 14,348 subjects (51% of all subjects reached by telephone). Logistic regression analyses were used to estimate the associations between depressive symptoms and any physical disease, or a specific physical disease out of 13 non-communicable physical diseases assessed with a self-report checklist on common physical diseases. Analyses were adjusted for sex, age, education, occupation, and household income. RESULTS In the adjusted models, depressive symptoms were associated with arthrosis and arthritis [Odds Ratio (OR) = 1.79, 95% confidence interval (CI) = 1.28-2.50] and any physical disease (OR = 1.67, 95% CI = 1.33-2.10) after controlling for multiple testing. CONCLUSION Our findings contribute to a better understanding of the comorbidity of depressive symptoms and arthrosis and arthritis in Switzerland and might have implications for more precise future estimates of mental and physical health care costs.
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Affiliation(s)
- Donja Rodic
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
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Days out of role due to mental and physical illness in the South African stress and health study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:461-8. [PMID: 25096982 PMCID: PMC4322217 DOI: 10.1007/s00127-014-0941-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 07/28/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Both mental and physical disorders can result in role limitation, such as 'days out of role', which have an important impact on national productivity losses. This paper analyses data from the South African Stress and Health Study (SASH) on the association of both mental and physical disorders with days out of role. METHODS Face-to-face interviews were conducted with a representative sample of 4,351 adult South Africans. The World Health Organization's Composite International Diagnostic Interview (WHO-CIDI) was used to assess the presence of 21 mental and physical disorders that were grouped into 10 disorder categories for the analysis: major depressive disorder, any anxiety disorders, any substance abuse disorders, headaches or migraine, arthritis, chronic pain, cardiovascular, respiratory, diabetes and digestive disorders. Multiple regression techniques were used to explore associations between individual disorders, comorbid conditions, and annual days spent out of role. The estimated societal effects of the disorders [population attributable risk proportion (PARP)] were obtained. RESULTS The majority of respondents who reported a mental or physical disorder also reported another disorder (62.98 %). The average number of disorders reported by respondents who had at least one disorder was 2.3. Overall 12.4 % of respondents reported any days out of role due to mental or physical disorder. Anxiety disorders and depression were associated with highest days out of role (28.2 and 27.2, respectively) followed closely by arthritis and pain (24.7 and 21.7, respectively). Any mental disorder was associated with 23.6 days out of role, while any physical disorder was associated with 15.5 days out of role. Of the mental disorders, anxiety disorders had the highest PARP in relation to days out of role (9.0 %) followed by depression (4.8 %) and substance disorder (3.3. %). More than one-third (37.6 %) of days out of role are attributable to physical disorders and 16.1 % to mental disorders. CONCLUSIONS Comorbidity is common in both mental and physical disorders, and both are associated with substantial days out of role in South Africa. These data indicate substantial social and economic loss associated with these conditions, and emphasize the need to integrate health services to include common mental disorders in all basic packages of care and to assess for and manage comorbid conditions.
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Tegethoff M, Stalujanis E, Belardi A, Meinlschmidt G. School mental health services: signpost for out-of-school service utilization in adolescents with mental disorders? A nationally representative United States cohort. PLoS One 2014; 9:e99675. [PMID: 24911241 PMCID: PMC4050047 DOI: 10.1371/journal.pone.0099675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/19/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors. METHODS Analyses are based on weighted data (N = 6483) from the United States National Comorbidity Survey Replication Adolescent Supplement (participants' age: 13-18 years). Lifetime DSM-IV mental disorders were assessed using the fully structured WHO CIDI interview, complemented by parent report. Adolescents and parents provided information on mental health service use across multiple sectors, based on the Service Assessment for Children and Adolescents. RESULTS School mental health service use predicted subsequent out-of-school service utilization for mental disorders i) in the medical specialty sector, in adolescents with affective (hazard ratio (HR) = 3.01, confidence interval (CI) = 1.77-5.12), anxiety (HR = 3.87, CI = 1.97-7.64), behavior (HR = 2.49, CI = 1.62-3.82), substance use (HR = 4.12, CI = 1.87-9.04), and eating (HR = 10.72, CI = 2.31-49.70) disorders, and any mental disorder (HR = 2.97, CI = 1.94-4.54), and ii) in other service sectors, in adolescents with anxiety (HR = 3.15, CI = 2.17-4.56), behavior (HR = 1.99, CI = 1.29-3.06), and substance use (HR = 2.48, CI = 1.57-3.94) disorders, and any mental disorder (HR = 2.33, CI = 1.54-3.53), but iii) not in the mental health specialty sector. CONCLUSIONS Our findings indicate that in the United States, school mental health services may serve as guide to out-of-school service utilization for mental disorders especially in the medical specialty sector across various mental disorders, thereby highlighting the relevance of school mental health services in the trajectory of mental care. In light of the missing link between school mental health services and mental health specialty services, the promotion of a stronger collaboration between these sectors should be considered regarding the potential to improve and guarantee adequate mental care at early life stages.
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Affiliation(s)
- Marion Tegethoff
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Esther Stalujanis
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Angelo Belardi
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
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Al-Hamzawi AO, Rosellini AJ, Lindberg M, Petukhova M, Kessler RC, Bruffaerts R. The role of common mental and physical disorders in days out of role in the Iraqi general population: results from the WHO World Mental Health Surveys. J Psychiatr Res 2014; 53:23-9. [PMID: 24581572 PMCID: PMC3992882 DOI: 10.1016/j.jpsychires.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 02/05/2023]
Abstract
In an effort to support mental health policy planning efforts in conjunction with the reconstruction of Iraq, a nationally representative face-to-face household survey was carried out that assessed the prevalence and correlates of common mental disorders in the Iraqi population. A total of 4332 adult (ages 18+) respondents were interviewed (95.2% response rate). The current report presents data on the role impairments (number of days out-of-role in the past 30 days) associated with the nine mental disorders assessed in the survey in comparison to the impairments associated with ten chronic physical disorders also assessed in the survey. These disorders were all assessed with the WHO Composite International Diagnostic Interview. Days out-of-role were assessed with the WHO Disability Assessment Schedule. Both individual-level and societal-level effects of the disorders were estimated. Strongest individual-level predictors were bipolar and drug abuse disorders (176-195 days per year), with mental disorders making up five of the seven strongest predictors. The strongest population-level predictors were headache/migraine and arthritis (22-12% population proportions). Overall population proportions were 57% of days out-of-role due to the chronic physical disorders considered here and 18% for the mental disorders. Despite commonly-occurring mental disorders accounting for more individual-level days out-of-role than the physical disorders, mental disorders are much less likely to receive treatment in Iraq (e.g., due to stigma). These results highlight the need for culturally tailored mental health prevention and treatment programs in Iraq.
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Affiliation(s)
- Ali Obaid Al-Hamzawi
- Department of Psychiatry, College of Medicine, Qadisia University, Diwania, Iraq
| | | | - Marrena Lindberg
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA, USA.
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum – KU Leuven (UPC-KUL), Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
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Icick R, Kovess V, Gasquet I, Lépine JP. [Days out of role due to common mental and physical disorders: French results from the WHO World Mental Health surveys]. Encephale 2014; 40:338-44. [PMID: 24726139 DOI: 10.1016/j.encep.2013.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/29/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The burden of health problems, including mental disorders, can be assessed in several ways such as through healthcare costs or loss of productivity. Their impact on daily activities as a whole has received much less attention, especially in France. Therefore, we undertook the analysis of the French general population data from the World Mental Health (WMH) surveys promoted by the World Health Organization (WHO) assessing the number of days out of role due to common mental and physical disorders. METHODS Face-to-face interviews were carried out with 2894 respondents (45.9% pooled response rate). Presence of ten chronic physical disorders and nine mental disorders was assessed for each respondent along with information about the number of days in the past month each respondent reported being totally unable to work or carry out their other normal daily activities because of problems with either physical or mental health. Multiple regression analysis was used to estimate associations of specific conditions and comorbidities with days out of role, after controlling for basic socio-demographics. RESULTS One thousand four hundred and thirty-six subjects reporting at least one core-symptom of a mental disorder underwent the whole assessment. The mean annual number of days out of role was high among those with at least one mental disorder (24.2±8.3). The population attributable risk proportion (PARP), i.e. the proportion of days out of role that would have been avoided if the considered disorder had remitted, was also estimated. Mental disorders as a whole accounted for 49.5% of the PARP. DISCUSSION French data on days out of role from the WHO WMH surveys showed the high burden of mental illness in the general population. These results may have been underestimated, taking into account that subjects who were hospitalized at the time of recruitment, whose disorders might also account for a high proportion of days out of role, could not be assessed with our design. CONCLUSION Common health conditions, especially mental disorders, make up a large proportion of the number of days out of role. Such data should be considered to design more efficient public health strategies.
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Affiliation(s)
- R Icick
- Service de psychiatrie d'adultes du Pr-Jean-Pierre-Lépine, hôpital Fernand-Widal, AP-HP, Inserm U705, universités Paris-5-et-7, 200, rue du Faubourg-Saint-Denis, 75475 Paris cedex 10, France.
| | - V Kovess
- EA 4069, université Paris 5, École de sante publique EHESP, 75004 Paris, France
| | - I Gasquet
- Inserm U669, maison des adolescents, 97, boulevard de Port-Royal, 75679 Paris cedex 14, France; Direction de la politique médicale (DPM), AP-HP, 75184 Paris cedex 04, France
| | - J-P Lépine
- Service de psychiatrie d'adultes du Pr-Jean-Pierre-Lépine, hôpital Fernand-Widal, AP-HP, Inserm U705, universités Paris-5-et-7, 200, rue du Faubourg-Saint-Denis, 75475 Paris cedex 10, France
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Abstract
Objective Despite the burden of rheumatic and musculoskeletal diseases (RMDs), these conditions probably deserve more attention from public health authorities in several countries including developed ones. We assessed their contribution to disability. Methods Data on disabilities associated with RMDs were extracted from the national 2008–2009 Disability-Health Survey of 29,931 subjects representative of the population in France. We used the core set of disability categories for RMDs of the World Health Organization's International Classification of Functioning, Disability and Health for analysis. Diagnosis and disabilities were self-reported. We assessed the risk of disability associated with RMDs using odds ratios (ORs) and the societal impact of RMDs using the average attributable fraction (AAF). Results Overall 27.7% (about 17.3 million people) (95% CI 26.9–28.4%) of the population reported having RMDs. The most prevalent RMDs were low back pain (12.5%, 12.1–13.1) and osteoarthritis (12.3%, 11.8–12.7). People reporting osteoarthritis were more disabled in walking (adjusted OR 1.9, 1.7–2.2) than those without. People reporting inflammatory arthritis were more limited in activities of daily living (from 1.4, 1.2–1.8 for walking to 2.1, 1.5–2.9 for moving around). From a societal perspective, osteoarthritis was the main contributor to activity limitations (AAF 22% for walking difficulties). Changing jobs was mainly attributed to neck pain (AAF 13%) and low back pain (11.5%). Conclusion RMDs are highly prevalent and significantly affect activity limitations and participation restrictions. More effort is needed to improve care and research in this field.
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Kessler R, Shahly V, Hudson J, Supina D, Berglund P, Chiu W, Gruber M, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Haro J, Murphy S, Posada-Villa J, Scott K, Xavier M. A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys. Epidemiol Psychiatr Sci 2014; 23:27-41. [PMID: 24054053 PMCID: PMC4100465 DOI: 10.1017/s2045796013000516] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 02/05/2023] Open
Abstract
Background. Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN). Methods. Community surveys assessed 23 000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment. Results. BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders. Conclusions. Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED-BN on secondary disorders.
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Affiliation(s)
- R.C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J.I. Hudson
- Psychiatric Epidemiology Research Program, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - D. Supina
- Health Economics, Outcomes Research and Epidemiology, Shire Pharmaceuticals, Wayne, Pennsylvania
| | - P.A. Berglund
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - W.T. Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - S. Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, CTSC Building, Sacramento, California, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L.H. Andrade
- Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), campus Gasthuisberg, Leuven, Belgium
| | - G. de Girolamo
- IRCCS Centro S. Giovanni di Dio Fatebenefratelli Brescia, Bologna, Italy
| | - R. de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S.E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - J.M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - S.D. Murphy
- School of Psychology, University of Ulster, Londonderry, Northern Ireland
| | | | - K. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - M. Xavier
- Department of Mental Health – CEDOC and Faculdade Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Batelaan NM, ten Have M, van Balkom AJLM, Tuithof M, de Graaf R. Anxiety disorders and onset of cardiovascular disease: the differential impact of panic, phobias and worry. J Anxiety Disord 2014; 28:252-8. [PMID: 24513159 DOI: 10.1016/j.janxdis.2013.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/06/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Anxiety has been linked to onset of cardiovascular disease. This study examines the differential impact of types of anxiety (panic, phobia and worry) on 3-year onset of non-fatal cardiovascular disease (CVD). By investigating anxiety disorders as opposed to anxiety symptoms and by using a reliable diagnostic instrument to assess anxiety, limitations of previous studies are considered. 5149 persons at risk for CVD were interviewed using the Composite International Diagnostic Interview. The panic-type included panic disorder and panic attacks; the phobic-type included agoraphobia and social phobia, and the worry-type included generalized anxiety disorder. CVD was self-reported and required treatment or monitoring by a doctor. Analyses were adjusted for sociodemographics, behavioral variables, and comorbid somatic and psychiatric disorders. During follow-up, 62 persons (1.2%) developed CVD. Baseline generalized anxiety disorder was strongly associated with onset of CVD (adjusted OR: 3.39). Further research should replicate findings and focus on biological underpinnings of this association.
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Affiliation(s)
- Neeltje M Batelaan
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, Bruffaerts R, Caldas-de-Almeida JM, Florescu S, de Girolamo G, Gureje O, He Y, Hu C, de Jonge P, Karam EG, Kovess-Masfety V, Medina-Mora ME, Moskalewicz J, Murphy S, Nakamura Y, Piazza M, Posada-Villa J, Stein DJ, Taib NI, Zarkov Z, Kessler RC, Scott KM. Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psychooncology 2014; 23:40-51. [PMID: 23983079 PMCID: PMC3992888 DOI: 10.1002/pon.3372] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. METHODS Data were derived from the World Mental Health Surveys (N = 66,387; n = 357 active cancer, n = 1373 cancer survivors, n = 64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12 months. Cancer status was ascertained by self-report of physician's diagnosis. RESULTS Twelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE = 2.1) than cancer-free respondents (13.3%, SE = 0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR) = 1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE = 0.9) compared with cancer-free respondents did not differ significantly (AOR = 0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12 months, 59% sought services for mental health problems (SE = 5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE = 6.0; 41.2%, SE = 3.0; 35.6%, SE = 0.6) and low-middle-income countries (46.4%, SE = 11.0; 22.5%, SE = 9.1; 17.4%, SE = 0.7). CONCLUSIONS Community respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors.
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Affiliation(s)
- Ora Nakash
- School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare & Health Sciences, Haifa University, Haifa, Israel
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities (CRHD), Community Engagement Program of the Clinical Translational Science Center (CTSC), University of California, Davis, School of Medicine, Sacramento, CA, US
| | - Jordi Alonso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Institute of Psychiatry University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon, Portugal
| | - Slivia Florescu
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania
| | | | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Yanling He
- Shangai Mental Health Center, Shangai, PR China
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Peter de Jonge
- University Medical Center Groningen, Groningen, The Netherlands
| | - Elie G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC) Medical Institute for Neuropsychological Disorders (MIND); Department of Psychiatry & Clinical Psychology St. George Hospital University Medical Center Balamand University, Faculty of Medicine Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Department of Epidemiology and Biostatistics, Paris Descartes University research Unit EHESP School for Public Health, Paris, France
| | | | | | | | | | | | | | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, South Africa
| | | | - Zahari Zarkov
- National Center of Public Health and Analyses, Department of Mental Health, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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Andrade LH, Baptista MC, Alonso J, Petukhova M, Bruffaerts R, Kessler RC, Silveira CM, Siu ER, Wang YP, Viana MC. Days out-of-role due to common physical and mental health problems: results from the São Paulo Megacity Mental Health Survey, Brazil. Clinics (Sao Paulo) 2013; 68:1392-9. [PMID: 24270949 PMCID: PMC3812560 DOI: 10.6061/clinics/2013(11)02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/22/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil. METHODS The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area.
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Affiliation(s)
- Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
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de Graaf R, van Dorsselaer S, Tuithof M, ten Have M. Sociodemographic and psychiatric predictors of attrition in a prospective psychiatric epidemiological study among the general population. Result of the Netherlands Mental Health Survey and Incidence Study-2. Compr Psychiatry 2013; 54:1131-9. [PMID: 23810078 DOI: 10.1016/j.comppsych.2013.05.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In prospective psychiatric epidemiological studies, attrition at follow-up can be selective, and can bias the research findings. Therefore, knowledge of predictors of attrition and of its different types (noncontact, refusal, inability to participate) is of importance. METHODS By means of (multinomial) logistic regression analyses, predictors of attrition were studied in the first 3-year follow-up of the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a prospective psychiatric epidemiological study among 6646 subjects of the general population aged 18-64 years. Baseline sociodemographic characteristics, physical health, mental disorders and their clinical characteristics, and experience with the previous interview were studied as predictors of attrition and of its different types. RESULTS The attrition rate at follow-up was 20.2%. Refusal (14.2%) was more common than noncontact (4.6%) and inability to participate (1.4%). Compared to respondents, nonrespondents were more often younger, lower educated, unemployed and born outside the Netherlands. A less positive experience with the baseline interview and shorter interview duration also predicted attrition. Any 12-month mental disorder, the categories and separate mental disorders, and their clinical characteristics, were not significantly associated with attrition, after controlling for sociodemographics. Sociodemographic predictors and experience with the baseline interview differed between the three types of attrition, but these types were also hardly or not associated with previous mental disorders. CONCLUSIONS The authors conclude that bias due to selective attrition was limited to sociodemographics and experience with the baseline interview. Mental health status at baseline was not of influence, possibly due to the large time investment to persuade respondents to re-participate and to find them in case of noncontact or removal to an unknown address. During follow-up waves of future prospective studies it is important to implement an intensive recruitment period with special efforts among young adults and the lower educated.
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Affiliation(s)
- Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands.
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de Graaf R, ten Have M, Tuithof M, van Dorsselaer S. First-incidence of DSM-IV mood, anxiety and substance use disorders and its determinants: results from the Netherlands Mental Health Survey and Incidence Study-2. J Affect Disord 2013; 149:100-7. [PMID: 23399481 DOI: 10.1016/j.jad.2013.01.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/04/2013] [Accepted: 01/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prospective studies measuring first-incidence of DSM-IV mood, anxiety and substance use disorders in the general population are rare. We assessed these incidence rates in the Dutch population; and identified baseline sociodemographic, physical and psychopathological variables, and negative changes in sociodemographics and physical health between baseline and follow-up, as determinants of first-onset main categories of disorders. METHOD Data are from NEMESIS-2, a representative face-to-face survey including 5303 subjects aged 18-64 interviewed twice (2007-2009; 2010-2012) with the CIDI 3.0. RESULTS In three years, 8.86% of adults without prior psychopathology experienced any mental disorder, corresponding with 3.09 cases per 100 person-years. Incidence was highest for anxiety (1.69 per 100 person-years) and mood disorder (1.65), and lowest for substance use disorder (0.97). For the separate disorders, incidence was highest for major depression (1.58), specific phobia (0.79) and alcohol abuse (0.73). For mood and anxiety disorder, incidence rate was higher among women and for substance use disorder it was higher among men. Age was inversely related to all disorder categories. Changes in sociodemographics, like no longer living with a partner and decrease in income, were stronger determinants than the corresponding sociodemographics. Incident mood disorder was predicted by baseline anxiety and substance use disorder, incident anxiety disorder by mood and substance use disorder, and incident substance use disorder by adult ADHD. LIMITATIONS Validity of lifetime diagnoses can be questioned because of difficulty of accurate recall. Only determinants of categories of disorders were studied, due to low numbers of incident cases of most separate disorders. CONCLUSION First-onset of mental disorders in a 3-year period is not an uncommon phenomenon. Results about determinants of incident disorders are important for prevention and early intervention initiatives aimed at reducing burden of mental disorders.
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Affiliation(s)
- Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Subramaniam M, Vaingankar JA, Abdin E, Chong SA. Psychiatric morbidity in pain conditions: results from the Singapore Mental Health Study. Pain Res Manag 2013; 18:185-90. [PMID: 23936892 PMCID: PMC3812189 DOI: 10.1155/2013/798205] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic pain is a common problem among the general population and has been found to be associated with psychiatric disorders in studies based on both clinical samples and epidemiological surveys. OBJECTIVES To establish the prevalence, correlates and comorbidities of chronic pain disorders among the adult population of Singapore. METHODS The data used in the present analysis were derived from the Singapore Mental Health Study, a cross-sectional epidemiological survey of a representative sample of the adult resident population of Singapore. Diagnoses of psychiatric disorders were established using the Composite International Diagnostic Interview version 3.0. A modified version of the Composite International Diagnostic Interview 3.0 checklist of chronic medical disorders was used, in which the chronic medical disorders were reclassified into eight types of physical disorders. Chronic pain disorders included arthritis or rheumatism, back problems including disk or spine problems, and migraine headaches. RESULTS The lifetime prevalence estimates for arthritis, back pain and migraine in the Singapore general population were 6.0% (n=282), 7.0% (n=436) and 5.6% (n=446), respectively. After adjusting for sociodemographic factors, comorbid pain disorders and the presence of other chronic physical conditions, migraine remained significantly associated with major depressive disorder (adjusted OR=2.4), generalized anxiety disorder (adjusted OR=3.0) and alcohol use disorders (adjusted OR=2.1), while back pain was significantly associated with major depressive disorder (adjusted OR=2.0). CONCLUSIONS The significant association between pain and psychiatric disorders emphasizes the need to screen individuals with chronic pain conditions for psychiatric disorders, particularly depression. There is a need to develop integrated pharmacological and psychological treatments for both conditions.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, Singapore.
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Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, de Graaf R, Maria Haro J, Kovess-Masfety V, O'Neill S, Posada-Villa J, Sasu C, Scott K, Viana MC, Xavier M. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 2013; 73:904-14. [PMID: 23290497 PMCID: PMC3628997 DOI: 10.1016/j.biopsych.2012.11.020] [Citation(s) in RCA: 749] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/21/2012] [Accepted: 11/21/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys. METHODS Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. RESULTS Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. CONCLUSIONS Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
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Subramaniam M, Abdin E, Vaingankar JA, Nan L, Heng D, McCrone P, Chong SA. Impact of psychiatric disorders and chronic physical conditions on health-related quality of life: Singapore Mental Health Study. J Affect Disord 2013; 147:325-30. [PMID: 23261141 DOI: 10.1016/j.jad.2012.11.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/18/2012] [Accepted: 11/19/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have established Quality Adjusted Life Years (QALY) losses associated with mental and chronic physical conditions in the community. The aim of the current study was to establish and compare the QALY losses associated with select mental and chronic physical conditions in Singapore. METHODS The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample. The diagnosis of psychiatric disorders was established using the Composite International Diagnostic Interview (CIDI 3.0) and health related quality of life (HRQoL) was measured using the Euro-Qol-5D (EQ-5D). RESULTS Pain conditions, hypertension and MDD were associated with the highest loss of QALYs in Singapore at a population level. The marginal effect on HRQoL by - Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD) and Bipolar Disorder was higher than the effect of any physical condition. LIMITATIONS The presence of chronic physical diseases was established using a check-list rather than with more objective measures and UK tariffs were used as local tariffs are not available and this might introduce some cultural bias. CONCLUSIONS QALY losses associated with psychiatric disorders were high, emphasizing the need for recognizing them as major public health concerns and the need for appropriate resource allocation.
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Affiliation(s)
- Mythily Subramaniam
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore.
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de Graaf R, Tuithof M, van Dorsselaer S, ten Have M. Comparing the effects on work performance of mental and physical disorders. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1873-83. [PMID: 22434047 DOI: 10.1007/s00127-012-0496-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate work loss days due to absenteeism and presenteeism associated with commonly occurring mental and physical disorders. METHODS In a nationally representative face-to-face survey (Netherlands Mental Health Survey and Incidence Study-2) including 4,715 workers, the presence of 13 mental and 10 chronic physical disorders was assessed using the Composite International Diagnostic Interview 3.0 and a physical disorder checklist. Questions about absent days due to illness and days of reduced quantitative and qualitative functioning while at work were based on the WHO Disability Assessment Schedule. Total work loss days were defined as the sum of the days of these three types of loss, where days of reduced functioning were counted as half. Both individual and population-level effects of disorders on work loss were studied, taking comorbidity into account. RESULTS Any mental disorder was associated with 10.5 additional absent days, 8.0 days of reduced-qualitative functioning and 12.0 total work loss days. For any physical disorder, the number of days was 10.7, 3.5 and 11.3, respectively. Adjusted for comorbidity, drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of additional total work loss days. At population-level, major depression, chronic back pain, respiratory disorders, drug abuse and digestive disorders contributed the most. Annual total work loss costs per million workers were estimated at <euro>360 million for any mental disorder; and <euro>706 million for any physical disorder. CONCLUSIONS Policies designed to lessen the impact of commonly occurring disorders on workers will contribute to a reduction in absenteeism and presenteeism. As the indirect costs of (mental) disorders are much higher than their medical costs, prevention and treatment of these conditions may be cost-effective.
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Affiliation(s)
- Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands.
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Childhood and family influences on depression, chronic physical conditions, and their comorbidity: findings from the Ontario Child Health Study. J Psychiatr Res 2012; 46:1475-82. [PMID: 22959202 DOI: 10.1016/j.jpsychires.2012.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has shown that various childhood risk factors are related to depression and chronic physical conditions (CPCs) later in life. However, little is known about risk factors associated with comorbidity for these conditions. The purpose of this study was to examine the association between individual (school performance, childhood physical and sexual abuse) and family risk variables (socioeconomic status, parental mental health, medical condition, and functional limitation) with depression only, chronic pain conditions (back pain and headaches) or other CPCs (respiratory, cardiovascular and digestive disorders, and diabetes) and the comorbidity of either CPC category with depression assessed in early adulthood. METHODS We used data from the Ontario Child Health Study, a prospective, population-based study of 3294 children (ages 4-16) enrolled in 1983 and meeting inclusion criteria at follow-up in 2001 (N = 1475; ages 21-35 years). RESULTS Using multinomial logistic regression models, controlling for sex and age, childhood history of physical abuse was associated with most outcomes (OR = 1.86, 95% confidence interval [CI] 1.16-2.97 to 4.36, 95% CI, 1.74-10.97). Parental mental health, childhood functional limitation, childhood history of sexual abuse and family functioning were all related to comorbid depression and chronic pain conditions. Parental mental health was also related to increased risk of other CPCs (ORs = 1.66; 95% CI, 1.08-2.55). CONCLUSION We found that the greatest disease risk (comorbid depression and chronic pain conditions) was related to the greatest number of childhood risk factors. Although there was some evidence of specificity, there was overlap in childhood physical abuse predicting almost all outcomes. Efforts targeting the prevention and treatment of childhood maltreatment are critical in order to prevent the long lasting impact of childhood adversity on mental and physical outcomes in early adulthood.
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Senicato C, Barros MBDA. Social inequality in health among women in Campinas, São Paulo State, Brazil. CAD SAUDE PUBLICA 2012; 28:1903-14. [PMID: 23090170 DOI: 10.1590/s0102-311x2012001000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess social inequalities in health status and use of health services according to level of schooling in women. This was a cross-sectional population-based study with a sample of 508 women from 20 to 59 years of age living in Campinas, São Paulo State, Brazil (ISA-Camp 2008). Women with less schooling showed higher prevalence of hypertension, circulatory problems, headache, dizziness, obesity, common mental disorders, worse self-rated health, use of dental prosthesis, and visual impairment, but lower prevalence for use of eyeglasses. There were no differences between the two schooling strata in prevalence of medical visits in the previous two weeks, use of medicines in the three previous days, Pap smear, breast self-examination, clinical breast examination, hospitalizations and surgeries in the previous year, and rubella vaccination any time in life. The only significant differences were in use of dental services and mammograms. The results show social inequalities in various health indicators and equity in access to various components of the health services.
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Affiliation(s)
- Caroline Senicato
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo 126, Campinas, SP, Brazil.
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Lerner Y, Levinson D. Who gets mental health treatment from the GP? Results from the Israel National Epidemiological Mental Health Survey. Fam Pract 2012; 29:561-6. [PMID: 22389430 PMCID: PMC3450435 DOI: 10.1093/fampra/cms017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In view of the pending mental health (MH) reform, an increase in demand of MH services is expected. Primary care physicians will presumably be involved in meeting this expected increased demand. OBJECTIVES To identify the preferable route of service use of populations with MH problems based on data from the Israel National Health Survey (INHS). METHODS The sample was drawn from the INHS which assessed mental disorders as well as the existence of chronic physical diseases in the population and the use of services for MH problems (specialty and primary care). The examined variables were (i) the existence of any mood or anxiety disorder and its severity, (ii) suffering from a chronic physical disease, (iii) use of MH services and (iv) use of general health services for MH problems. RESULTS Fifty-one per cent of all those treated for MH problems were treated in the MH specialty sector and 49% in the general sector. Among those who met the diagnostic Composite International Diagnostic Interview criteria of any mood or anxiety disorder, the percentages were 62% and 38%, respectively. Irrespective of diagnosis, the proportion of those using the services of the GP is significantly greater among people above the age 50 years than among younger people. CONCLUSIONS People with emotional problems above the age of 50 years are more likely to prefer help for their problems from their GP regardless of the presence of any mental disorder or of a chronic medical disease.
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Affiliation(s)
- Yaacov Lerner
- Falk Institute for Mental Health Service Research, Jerusalem, Israel.
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Palazzo C, Ravaud JF, Trinquart L, Dalichampt M, Ravaud P, Poiraudeau S. Respective contribution of chronic conditions to disability in France: results from the national Disability-Health Survey. PLoS One 2012; 7:e44994. [PMID: 23024781 PMCID: PMC3443206 DOI: 10.1371/journal.pone.0044994] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 08/15/2012] [Indexed: 11/30/2022] Open
Abstract
Background Representative national data on disability are becoming increasingly important in helping policymakers decide on public health strategies. We assessed the respective contribution of chronic health conditions to disability for three age groups (18–40, 40–65, and >65 years old) using data from the 2008–2009 Disability-Health Survey in France. Methods Data on 12 chronic conditions and on disability for 24,682 adults living in households were extracted from the Disability-Health Survey results. A weighting factor was applied to obtain representative estimates for the French population. Disability was defined as at least one restriction in activities of daily living (ADL), severe disability as the inability to perform at least one ADL alone, and self-reported disability as a general feeling of being disabled. To account for co-morbidities, we assessed the contribution of each chronic disorder to disability by using the average attributable fraction (AAF). Findings We estimated that 38.8 million people in France (81.7% [95% CI 80.9;82.6]) had a chronic condition: 14.3% (14.0;14.6) considered themselves disabled, 4.6% (4.4;4.9) were restricted in ADL and 1.7% (1.5;1.8) were severely disabled. Musculoskeletal and sensorial impairments contributed the most to self-reported disability (AAF 15.4% and 12.3%). Neurological and musculoskeletal diseases had the largest impact on disability (AAF 17.4% and 16.4%, respectively). Neurological disorders contributed the most to severe disability (AAF 31.0%). Psychiatric diseases contributed the most to disability categories for patients 18–40 years old (AAFs 23.8%–40.3%). Cardiovascular conditions were also among the top four contributors to disability categories (AAFs 8.5%–11.1%). Conclusions Neurological, musculoskeletal, and cardiovascular chronic disorders mainly contribute to disability in France. Psychiatric impairments have a heavy burden for people 18–40 years old. These findings should help policymakers define priorities for health-service delivery in France and perhaps other developed countries.
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Gadermann AM, Alonso J, Vilagut G, Zaslavsky AM, Kessler RC. Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depress Anxiety 2012; 29:797-806. [PMID: 22585578 PMCID: PMC4005614 DOI: 10.1002/da.21924] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/13/2012] [Accepted: 01/28/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Disease burden estimates rarely consider comorbidity. Using a recently developed methodology for integrating information about comorbidity into disease burden estimates, we examined the comparative burdens of nine mental and 10 chronic physical disorders in the National Comorbidity Survey Replication (NCS-R). METHODS Face-to-face interviews in a national household sample (n = 5,692) assessed associations of disorders with scores on a visual analog scale (VAS) of perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate these associations. Simulation was used to estimate incremental disorder-specific effects adjusting for comorbidity. RESULTS The majority of respondents (74.9%) reported one or more disorders. Of respondents with disorders, 73.8-98.2% reported having at least one other disorder. The best-fitting model to predict VAS scores included disorder main effects and interactions for number of disorders. Adjustment for comorbidity reduced individual-level disorder-specific burden estimates substantially, but with considerable between-disorder variation (0.07-0.69 ratios of disorder-specific estimates with and without adjustment for comorbidity). Four of the five most burdensome disorders at the individual level were mental disorders based on bivariate analyses (panic/agoraphobia, bipolar disorder, posttraumatic stress disorder, major depression) but only two based on multivariate analyses, adjusting for comorbidity (panic/agoraphobia, major depression). Neurological disorders, chronic pain conditions, and diabetes were the other most burdensome individual-level disorders. Chronic pain conditions, cardiovascular disorders, arthritis, insomnia, and major depression were the most burdensome societal-level disorders. CONCLUSIONS Adjustments for comorbidity substantially influence estimates of disease burden, especially those of mental disorders, underlining the importance of including information about comorbidity in studies of mental disorders.
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Affiliation(s)
- Anne M. Gadermann
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain, and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain, and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Fernández A, Mendive JM, Salvador-Carulla L, Rubio-Valera M, Luciano JV, Pinto-Meza A, Haro JM, Palao DJ, Bellón JA, Serrano-Blanco A. Adjustment disorders in primary care: prevalence, recognition and use of services. Br J Psychiatry 2012; 201:137-42. [PMID: 22576725 DOI: 10.1192/bjp.bp.111.096305] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care. AIMS To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs). METHOD Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories. RESULTS The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription. CONCLUSIONS Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).
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Affiliation(s)
- Anna Fernández
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Fundació Sant Joan de Déu, Dr Antoni Pujadas 42, Sant Boi de Llobregat, Barcelona, Spain.
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Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R). Mol Psychiatry 2012; 17:748-58. [PMID: 21577213 PMCID: PMC3165095 DOI: 10.1038/mp.2011.56] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 US adults. Medically recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic conditions checklist, and comorbid DSM-IV mental disorders with the Composite International Diagnostic Interview. Lifetime epilepsy prevalence was estimated at 1.8%. Epilepsy was comorbid with numerous neurological and general medical conditions and with a sporadic cluster of mental comorbidities (panic, PTSD, conduct disorder and substance use disorders). Although comorbid disorders explain part of the significant gross associations of epilepsy with impairment, epilepsy remains significantly associated with work disability, cognitive impairment and days of role impairment after controlling comorbidities. The net association of epilepsy with days of role impairment after controlling for comorbidities is equivalent to an annualized 89.4 million excess role impairment days among US adults with epilepsy, arguing that role impairment is a major component of the societal costs of epilepsy per se rather than merely due to disorders comorbid with epilepsy. This estimated burden is likely conservative as some parts of the effects of epilepsy are presumably mediated by secondary comorbid disorders.
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