The Sesto Fiorentino study: point and one-year prevalences of psychiatric disorders in an Italian community sample using clinical interviewers

Prevalence study of mental disorders in an Italian region. Preliminary report

BACKGROUND

Mental disorders are a major public health problem. However, over the last few years, there have been few studies aimed at evaluating their diffusion. Therefore, this study aimed at evaluating: the prevalence of the most frequent psychiatric disorders in the general population residing in Tuscany using a clinical scale administered by trainee in psychiatry.

METHODS

The study was carried out on a representative sample of the general population aged > 18 years, randomly extracted from the register of patients in the Tuscany region, adopting a proportional sampling method stratified by gender, age group and Local Health Units (LHU). Each person was contacted by letter followed by a phone call from an operator who makes an appointment with the trainee in psychiatry. The diagnostic interview conducted was the Mini-International Neuropsychiatric Interview (MINI). Point and lifetime prevalence by gender and age group were calculated. Differences and associations were considered statistically significant if their p-values were less than 0.05.

RESULTS

Of the 408 people involved, 390 people were enrolled (of which 52.6% female). The 28.5% of the sample had been affected by a psychiatric disorder during their lifetime. In their lifetime, the most represented psychiatric disorders were major depressive episode (20.4%), major depressive disorder (17.0%) and panic disorder (10.3%), more frequent in the female than the male group. Current conditions were predominantly major depressive episode (3.1%) and agoraphobia (2.8%). A 5.9% rate of current suicidal ideation was also found.

CONCLUSIONS

In the general population, 28.5% of people reported a psychiatric disorder during their lifetime. This prevalence is considerably higher than that reported in a previous study carried out in central Italy.

Burden of mental health and substance use disorders among Italian young people aged 10-24 years: results from the Global Burden of Disease 2019 Study

PURPOSE

The burden of mental health and substance use disorders among Italian young people have not yet been presented in detail, despite adolescents and young adults aged between 10 and 24 years constitute 14.5% of the Italian population. Therefore, the aim of this study was to provide data on the health burden of mental health and substance use disorders among young people (10-24 years) in Italy between 1990 and 2019.

METHODS

Ecological study design using data from the Global Burden of Disease Study 2019. Age- and sex-specific prevalence and years lived with disability (YLDs) of mental health and substance use disorders with the uncertainty intervals were reported as well as their percentual changes between 1990 and 2019.

RESULTS

Prevalence and YLDs rates of mental health and substance use disorders showed negative trends overall between 1990 and 2019. However, diagnoses of attention-deficit/hyperactivity, autism spectrum, conduct and eating (among males) disorders increased as well as cocaine use disorder. The highest levels of disability in terms of YLDs were due to anxiety, depressive, conduct and eating disorders and alcohol use, amphetamine use and opioid use disorders. The disease burden was higher in middle-late adolescence and young adulthood than early adolescence, among females than males for mental health disorders and among males compared to females for substance use disorders.

CONCLUSION

Findings of the study highlighted disorder-specific patterns of prevalence and YLDs rates and were discussed considering previous research. The public health system should continuously sustain mental health promotion and prevention efforts in young people.

The COVID-19 Pandemic and Posttraumatic Stress Disorder: Emotional Impact on Healthcare Professions

The COVID-19 pandemic, which began in March 2020, has resulted in the deaths of hundreds of thousands of people around the world in just a few months, putting at great risk the commitment of healthcare workers unprepared to manage a worldwide phenomenon at great risk. In the early stages especially, medical staff had to deal with the pandemic at the expense of their physical and mental health, putting them particularly at risk for experiencing posttraumatic stress disorder (PTSD). The study aims to analyze the psychopathological aspects associated with PTSD, focusing on the emotional impact caused by the COVID-19 pandemic on healthcare professionals compared with a control group. The sample analyzed over 2 months, from March to May 2021, included 214 participants into two groups, i.e., healthcare professionals (N = 107) and a control group (N = 107). The online assessment instrument used consisted of an anonymous questionnaire, assembled ad hoc with demographic information and different standardized assessment scales (e.g., Fear of COVID-19 scale, Profile of Mood States, and Maslach Burnout Inventory-Human Services Survey), while a further section of the survey used the DSM-5 criteria to investigate Posttraumatic stress disorder (e.g., COVID-19-PTSD). The results reported that healthcare professionals had a consistent perception of stress (mean = 26.18, SD = 14.60), but not at a level significantly higher than other categories of workers (mean = 25.75, SD = 14.65; t = 0.20, p = 0.84). However, they showed less emotional disturbance than the control sample, better anxiety management skills, and lower levels of depressive disorder and mental confusion. Specifically, the healthcare professionals showed a condition of emotional exhaustion (T = 0.64, D = 0.74, A = 0.62, S = 0.75, C = 0.64) and depersonalization (T = 0.41, D = 0.52, A = 0.49, S = 0.60, C = 0.40), which is common in the burnout syndrome. In conclusion, the results obtained are useful in understanding the determinants of the emotional involvement of healthcare professions and the risk of burnout syndrome and, therefore, for planning activities and support paths for these workers who are particularly at risk during prolonged and pervasive crises, such as the pandemic.

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy

OBJECTIVE

Current nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL).

METHODS

Community survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL.

RESULTS

In the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5-2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9-24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00.

CONCLUSION

One out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.

The course and clinical correlates of panic disorder during the postpartum period: a naturalistic observational study

OBJECTIVE

To investigate the course of panic disorder and its demographic and clinical correlates during the postpartum period.

METHODS

Data were collected from 38 consecutive postpartum women diagnosed with panic disorder. Psychiatric assessments were carried out on the first day after delivery and at 6-8 weeks postpartum. During the first assessment, the Panic and Agoraphobia Scale (PAS), Hospital Anxiety and Depression Scale (HADS), Coping Orientation to Problems Experienced (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered to the participants. PAS was also administered at the second assessment.

RESULTS

The mean PAS score reduced significantly from baseline to the second assessment. Logistic regression analysis indicated that a shorter duration of panic disorder independently predicted a ≥ 50-point decrease in the severity of panic symptoms during the postpartum period.

CONCLUSION

These findings suggest that patients with a short duration of illness may experience significant alleviation in the severity of panic symptoms during the postpartum period.

Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy

AIMS

Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy.

METHODS

All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes.

RESULTS

A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic.

CONCLUSIONS

The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health.

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

The CZEch Mental health Study (CZEMS): Study rationale, design, and methods

OBJECTIVES

The CZEch Mental health Study (CZEMS) was launched to inform the ongoing mental health care reform. This paper describes rationale, methods, and the plan for the future analyses of this project.

METHODS

A cross-sectional survey on a representative sample of the general adult noninstitutionalized population of the Czech Republic was conducted. Two-stage sampling was utilized and respondents were interviewed by centrally trained staff using a paper and pencil interviewing. The presence of mental disorders was assessed by The Mini-International Neuropsychiatric Interview. The study also collected information about disability, self-identification of having a mental illness, medical history, and help-seeking behaviour.

RESULTS

This survey had a 75% response rate, and the final sample consisted of 3,306 persons aged from 18 to 96 years (mean age 49 years old, 54% women) that were interviewed in their homes. The final sample is representative for the Czech Republic in terms of age, gender, education, and region.

CONCLUSIONS

CZEMS will provide up-to-date evidence about a prevalence of mental disorders in the Czech Republic, associated disability, and treatment gap. This will help informed decision-making about the current mental health care reform and future mental health care development in the Czech Republic.

The regional distribution of anxiety disorders: implications for the Global Burden of Disease Study, 2010

Anxiety disorders are increasingly acknowledged as a global health issue however an accurate picture of prevalence across populations is lacking. Empirical data are incomplete and inconsistent so alternate means of estimating prevalence are required to inform estimates for the new Global Burden of Disease Study 2010. We used a Bayesian meta-regression approach which included empirical epidemiological data, expert prior information, study covariates and population characteristics. Reported are global and regional point prevalence for anxiety disorders in 2010. Point prevalence of anxiety disorders differed by up to three-fold across world regions, ranging between 2.1% (1.8-2.5%) in East Asia and 6.1% (5.1-7.4%) in North Africa/Middle East. Anxiety was more common in Latin America; high income regions; and regions with a history of recent conflict. There was considerable uncertainty around estimates, particularly for regions where no data were available. Future research is required to examine whether variations in regional distributions of anxiety disorders are substantive differences or an artefact of cultural or methodological differences. This is a particular imperative where anxiety is consistently reported to be less common, and where it appears to be elevated, but uncertainty prevents the reporting of conclusive estimates.

Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: analysis from the World Mental Health Survey Initiative

Epidemiological studies have examined the relative importance of Traumatic Events (TEs) in accounting for the societal burden of post-traumatic stress disorder (PTSD). However, most studies used the worst trauma experienced, which can lead to an overestimation of the conditional risk of PTSD. Although a number of epidemiological surveys on PTSD have been carried out in the United States, only a few studies in limited sample have been conducted in Italy. This study, carried out in the framework of the World Mental Health Survey Initiative, is a cross-sectional household survey of a representative sample of the Italian adult population. Lifetime prevalence of TEs and 12-month prevalence of PTSD were evaluated using the Composite International Diagnostic Interview (CIDI). Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Network events was the most commonly reported class of TEs (29.4%). War events had the highest conditional risk of PTSD (12.2%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (24.1%) and having seen atrocities (18.2%). Being female was related to high risk of PTSD after experiencing a TE. Exposure to network events is commonly reported among Italian adults, but two TEs are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.

Social anxiety disorder, a lifelong disorder? A review of the spontaneous remission and its predictors

OBJECTIVE

Based on clinical observations, social anxiety disorder (SAD) is usually described as a chronic disorder. Its natural course in the community is less clear.

METHOD

The present review summarises prospective and retrospective spontaneous remission rates of SAD in the community and its predictors that were published after 1987. Remission rates were specified as partial, defined as still having social fears, but not fulfilling the diagnostic criteria, and full, defined as having no social fears anymore.

RESULTS

In prospective studies, remission rates of SAD varied between 36% and 93% and in retrospective studies between 3% and 80%. The estimated average remission rate in prospective studies was 50% for full remission and 79% when including partial remission. In retrospective studies, the average remission rate was 26% during the last year and 56% over the lifetime. Diverse predictors of remission of SAD have been found that can be clustered into less severe anxiety, less additional psychopathology, less stress, employment, and mental health.

CONCLUSION

The enormous variation in remission rates indicates that SAD might have different course types (short, fluctuating, and chronic) and is not necessarily a chronic disorder. Prevention and treatment should be focused on enhancing positive and reducing negative factors.

Factitious disorder-experience at a neuropsychiatric center in southern India

OBJECTIVE

Factitious disorder is amongst the more intriguing but less-studied psychological disorders. Studies from different parts of the world have reported of varying prevalence rates. Here, we try to study the prevalence of factitious disorder in a specific sample of patients attending a neuropsychiatric center in India.

MATERIALS AND METHODS

We did a retrospective review of our institute's database for cases with a diagnosis of factitious disorder in the 10-year duration from 2001 to 2010. We reviewed the available clinical and socio-demographic data.

RESULTS

Of the 81,176 patients seen in the 10-year duration, only 8 patients had been assigned the diagnosis of factitious disorder, leading to a prevalence rate of 0.985 per 10,000 patients in this sample. Most of the patients were lost to follow-up; hence.

CONCLUSION

Factitious disorder remains highly underdiagnosed in developing countries like India. Mental health professionals need to be more aware and inquisitive about this particular disorder, so that they do not miss the diagnosis.

Axis I and Axis II diagnoses in women with PCOS

OBJECTIVE

The objective was to determine the current prevalence of Axis I and Axis II psychiatric diagnoses in patients with polycystic ovary syndrome (PCOS).

METHOD

The study sample included 73 patients with PCOS and 73 control subjects. Psychiatric disorders were determined by structured clinical interviews.

RESULTS

The rate of any Axis I psychiatric disorder (28.8% vs. 15.1%), social phobia (13.7% vs. 2.7%), generalized anxiety disorder (11.0% vs. 1.4%), any Axis II psychiatric disorder (23.3% vs. 9.6%) and avoidant personality disorder (12.3% vs. 1.4%) was significantly more common in the patient group compared to the control group. Of women with PCOS, 21 (28.8%) had at least one Axis I and 17 (23.3%) had at least one Axis II diagnosis. The most common Axis I disorder was social phobia (13.7%) and the most common Axis II disorder was avoidant personality disorder (12.3%) in women with PCOS. Social phobia, generalized anxiety disorder, and avoidant personality disorder were significantly more common in the patient group compared to the control group.

CONCLUSION

Our results suggest that a considerable proportion of women with PCOS also present with anxiety and personality disorders.

Do psychiatric disorders continue during pregnancy in women with hyperemesis gravidarum: a prospective study

OBJECTIVE

We aimed to determine Axis I psychiatric disorders in women with hyperemesis gravidarum (HG) and to follow up the course of psychiatric disorder and its association with nausea and vomiting (NV) during pregnancy.

METHODS

The study sample was composed of 47 patients with HG. Psychiatric interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Other psychiatric interviews were performed in the second and third trimesters. On each visit, the subjects completed the Beck Depression Inventory and the Beck Anxiety Inventory.

RESULTS

The prevalence of any anxiety disorder was 25.5%, and the prevalence of any mood disorder was 14.9% in women with HG in the first trimester. Psychiatric disorders continued throughout the pregnancy in two thirds of the women who had HG and a psychiatric diagnosis. Any SCID diagnosis in the first trimester was higher in women whose NV had partially resolved than in women whose NV had fully resolved (P<.05).

CONCLUSION

The present studies suggest that psychiatric disorders may play a significant role in the etiology of HG. Our findings presented a potential connection between HG and anxiety disorders and major depressive disorder. Additionally, the NV symptoms in women with HG and a psychiatric disorder may persist during pregnancy.

Trends in alcohol-related deaths in the EU countries in 1980-2003

AIMS

To explore temporal trends since 1980 in alcohol-related death for people resident in the European Union (EU) and to examine differences between EU members admitted prior to 2004 and new EU members admitted since 2004.

METHODS

The data were extracted from the World Health Organization's European mortality database and the European Health for All database.

RESULTS

New EU members had higher rates of alcohol-related deaths (135.0 ± 18.48 vs 88.9 ± 18.93; t = -8.55 (d.f. = 46), p < .001) and higher death rates from alcohol abuse (whole population: 3.4 ± 1.24 vs 2.6 ± 0.12; t = -2.98 (d.f. = 23.45), p < .01; male population: 6.1 ± 2.17 vs 4.4 ± 0.19; t = -3.87 (d.f. = 23.35), p < .001) than early EU countries. However, a mortality gradient between groups of countries was visible only for female alcohol-related deaths when controlling for mortality rates from all causes. Multivariate regression analyses also indicated that alcohol-related deaths and alcohol consumption were associated negatively with the gross national product (GNP) of EU countries and positively with levels of urbanization.

CONCLUSIONS

Alcohol-related deaths represent more than 10% of all EU mortality and confirm the importance of national prevention strategies for alcohol problems.

Decreased gray matter volume of the medial orbitofrontal cortex in panic disorder with agoraphobia: a preliminary study

BACKGROUND

Patients with panic disorder with agoraphobia (PDA) have clinical symptoms such as the fear of being outside or of open spaces from which escape would be difficult. Although recent neurobiological studies have suggested that fear conditioning and extinction are associated with PDA, no study has examined the possible structural abnormalities in patients with PDA.

METHODS

This preliminary study compares the gray matter volume among patients with PDA, those with panic disorder without agoraphobia (PDW), and healthy controls (HC) using high-resolution 3.0 T magnetic resonance imaging (MRI) with voxel-based morphometry (VBM).

RESULTS

Compared with HC, patients with PDA showed decreased gray matter volume in their left medial orbitofrontal gyrus. However, differences were not found in the gray matter volumes of patients with PDW and whole panic disorder compared with HC.

CONCLUSIONS

These findings suggest that the phobic avoidance found in patients with PDA arise from abnormalities in the medial orbitofrontal cortex, which plays an important role in fear extinction. Future studies should investigate the neuroanatomical substrates of PDA and distinguish them from those of PDW.

Is hyperemesis gravidarum associated with mood, anxiety and personality disorders: a case-control study

OBJECTIVE

Intractable nausea and vomiting, known as hyperemesis gravidarum (HG), are relatively common medical problems among pregnant women. Although there are some studies based on psychiatric symptom scales, the relationship between HG and psychiatric disorders, particularly anxiety and personality disorders, is unclear. In this study, we aimed to investigate whether there is a difference among women with and without HG with respect to frequency of mood, anxiety and personality disorders.

METHODS

The study sample was composed of 52 patients with HG and 90 control pregnant women. Mood and anxiety disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Personality disorders were assessed with the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders (SCID-II).

RESULTS

The prevalence of any mood disorder and any anxiety disorder in women with HG was 15.4% and 36.5%, respectively. In addition, 19 (36.5%) of the patients with HG had at least one personality disorder. According to reports collected from the participants in the study, most of the mood or anxiety disorders occurred before the pregnancy in women with HG. The prevalence of major depression, generalized anxiety disorder, avoidant personality disorder and obsessive-compulsive personality disorder was significantly higher in women with HG compared to the control subjects.

CONCLUSIONS

The results of the present study suggest that mood and anxiety disorders, and personality disturbances are frequently observed among women with HG and that there is a potential relationship between these psychiatric disorders and HG during pregnancy.

Incidence and prevalence of "diagnosed OCD" in a primary care, treatment seeking, population

OBJECTIVE

To obtain valid and accurate estimates of the incidence and prevalence of OCD in a treatment-seeking primary care population and to compare these estimates with estimates from epidemiological community studies.

METHODS

A retrospective cohort study (1996-2007) was conducted in a GP research database with longitudinal electronic patient record data of 800,000 patients throughout The Netherlands. OCD was ascertained and classified by systematic review of computerized longitudinal medical records. Age and gender specific incidence rates were calculated per calendar year as the number of newly diagnosed cases per 100 person years.

RESULTS

Among 577,085 eligible patients, 346 patients were newly diagnosed with OCD resulting in a 1-year treatment-seeking incidence of 0.016% (95% CI: 0.014-0.018). Across the entire study period, a total of 780 patients had a clinical diagnosis of OCD resulting in a treatment-seeking prevalence of 0.14% (95% CI: 0.126-0.145). The incidence rate was highest among women and between the age of 20 and 29. No significant changes over time were observed.

CONCLUSIONS

The incidence rate and prevalence of OCD in treatment-seeking GP patients are at least 3 times lower than estimates known from the most conservative epidemiological community studies, suggesting that OCD may be under recognised and under treated.

Prevalence and related factors of mood and anxiety disorders in a clinical sample of postmenopausal women

PURPOSE

The purpose of the study was to investigate the prevalence and related factors of mood and anxiety disorders in postmenopausal women attending a gynecological outpatient clinic.

METHODS

The study sample included 269 postmenopausal women. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition was performed to determine the disorders.

RESULTS

Ninety-two (34.2%) women had at least one mood or anxiety disorder. The most common specific disorder was generalized anxiety disorder (15.6%). The existence of any mood or anxiety disorder was associated with poorer economic level.

CONCLUSIONS

Mood and anxiety disorders were frequently observed in postmenopausal women who were admitted to a gynecology outpatient clinic.

The size and burden of mental disorders and other disorders of the brain in Europe 2010

AIMS

To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.

METHOD

Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY).

RESULTS

Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke.

CONCLUSION

In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.

Mental disorders, psychological symptoms and quality of life 8 years after an earthquake: findings from a community sample in Italy

BACKGROUND AND AIMS

Various studies assessed mental disorders and psychological symptoms following natural disasters, including earthquakes. Yet, samples were often non-representative, and the periods of time between earthquake and assessments were usually short. This study aims to assess the prevalence of mental disorders, level of psychological symptoms and subjective quality of life in a random sample in a rural region in Italy 8 years after an earthquake.

METHODS

Using a random sampling method, a pool of potential participants of working age who had experienced the earthquake were identified 8 years after the earthquake. They were sequentially approached until the target sample of 200 was reached. Mental disorders were assessed on the MINI, psychological symptoms on the Brief Symptom Inventory (BSI) and the Impact of Event Scale-Revised (IES-R), and subjective quality of life on the Manchester Short Assessment of Quality of Life (MANSA).

RESULTS

200 people were interviewed, and the response rate of contacted people was 43%. In the MINI, 15 participants (7.5%) had any type of mental disorder; 5 participants had PTSD at any time since the earthquake, and 1 participant at the time of the interview. Symptom levels were low (Global Severity Index of BSI mean = 0.29, SD = 0.30; IES total mean = 0.40, SD = 3.33) and subjective quality of life (MANSA mean = 5.26, SD = 0.59) was in a positive range. The distribution of mental health outcomes made it difficult to explore factors associated with them.

CONCLUSION

There is no evidence that the earthquake had a negative impact on the mental health of the affected population years later. Possible reasons include the relatively weak nature of the earthquake, strong community support that helped overcome mental distress, the long period of time (8 years) between the occurrence of the earthquake and the study, and a capacity of people to maintain or restore mental health after a natural disaster in the long term.

Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country

Screening scales can be useful in searching for common mental disorders in primary care and in tracking relevant prevalence and correlates in community surveys. However, it is important to document their validity, before using them. We developed Italian versions of the widely-used K10 and K6 screening scales following the WHO forward-translation and back-translation protocol. To evaluate their effectiveness as screens for DSM-IV 12-month mood or anxiety disorders and "serious mental illness" (SMI), the scales were validated in a two-stage clinical reappraisal survey. In the first-phase, the scales were administered to 605 people. In the second-phase, a sub-sample of 147 first-phase respondents over-sampling screened positives was administered the 12-month version of the Structured Clinical Interview for DSM-IV Axis I Disorders as a clinical gold standard. Performance of the scales in screening for chosen disorders was assessed by calculating area under the receiver operating characteristic curve and stratum-specific likelihood ratios. Both the K10 and K6 performed well in detecting DSM-IV mood disorders, anxiety disorders, and serious mental illness (SMI), with areas under the curve (AUCs) (95% CIs) between 0.82 (0.75-0.89) and 0.91 (0.85-0.96). The Italian versions of the K6 and K10 scales have good psychometric properties, making them attractive inexpensive screens for mood disorders, anxiety disorders, and SMI.

Justice at work and psychiatric morbidity among the personnel of an Italian hospital

This study evaluated the association between justice in the workplace (and other psychosocial factors) and mental health among healthcare professionals. It was conducted in a sample of hospital employees in Italy. The prevalence of mental disorders was assessed and the relationships between having a disorder and the level of perceived justice, job control and effort-reward imbalance were investigated. Psychiatric morbidity among professionals with higher perceived justice were 0.3-0.9 times lower than those among those with lower perceived justice. This finding suggests that improving fairness at work does matter for disease prevention and mental health promotion policy.

The ESEMeD-WMH project: strenghtening epidemiological research in Europe through the study of variation in prevalence estimates

The European Study of the Epidemiology of Mental Disorders (ESEMeD) project is the first cross-national European survey to collect data on prevalence, risk factors, health-related quality of life and use of services associated with common mental disorders. Representative samples of the non-institutionalized populations of Belgium, France, Germany, Italy, the Netherlands and Spain were interviewed using the CIDI 3.0, totaling 21,425 adult individuals. There was important variation across countries in prevalence estimates of the disorders studied, with Belgium and France in the highest proportions and Italy and Spain the lowest. Comorbidity of mood and anxiety disorders was frequent in all countries. Use of services due to mental health is low in all European countries, but especially low in Italy. Remarkably, only about one in five participants with a mental disorder had consulted the health services in the prior year. We discuss about the possible explanations of cross-national differences in prevalence estimates of mental disorders, and some of the limitations of the data on alcohol abuse and dependence gathered in the study. We conclude that despite the advances in knowledge about determinants and treatment methods, the care of the mentally ill is rather limited in Europe.

Socioeconomic risk factors and depressive symptoms in alcohol use disorders among male suicides in South Tirol, Italy

The aim of the current study was to evaluate whether socioeconomics risk factors and depressive symptoms are associated with suicide in men with alcohol use disorders in South Tirol, Italy. The authors hypothesize that socioeconomics inequalities interact with greater psychopathology in men with alcohol use disorders who committed suicide. The authors found a positive association between unstable work positions and low educational attainment and alcohol use disorders in individuals who committed suicide. The results point to the need for careful assessment of subsyndromal depression in individuals with alcohol use disorders, especially when abuse is associated with socioeconomic risk factors such as lower educational attainment and unemployment or employment instability.

A population-based study on phobic fears and DSM-IV specific phobia in 70-year olds

This population-based study reports on the prevalence and characteristics of specific phobia (SP) and phobic fears in an elderly population. A representative population sample of Swedish 70-year-olds without dementia (N = 558) was examined using semi-structured interviews. Phobic fears included fear of animals, natural environment, specific situations, blood-injection-injury and 'other'. Mental disorders, including SP, were diagnosed according to DSM-IV. Phobic fears (71.0% vs. 37.9%) and SP (13.8% vs. 4.5%) were more common in women than in men. Among those with phobic fears, more than 80% reported onset before age 21. Of those with SP, 35.7% had another DSM-IV diagnosis compared to 8.5% of those reporting no fear. Fear of specific situations and 'other' fears were related to SP and other anxiety disorders. SP was related to lower global functioning. We conclude that specific phobia in the elderly should receive attention from health professionals as it is common and associated with a decrease in global functioning.

Alcohol consumption predicts the EU suicide rates in young women aged 15-29 years but not in men: analysis of trends and differences among early and new EU countries since 2004

The aims of this study were to study suicide rates in youths aged 15-29 years in the European Union (EU), to identify differences between early members and new members to the EU since 2004, and to evaluate the association between alcohol-related variables and suicide rates, while controlling for indicators of social stress. We explored temporal trends in age-adjusted suicide rates for youths aged 15-29 years resident in EU nations since 1980. Social changes in EU nations were associated with increased inequalities between the countries in suicide, especially in male youths (new/early EU members: relative risk=1.55; 95% confidence interval: 1.48/1.61). Pure alcohol consumption predicts suicide rates in female youths, whereas social stress related to violence against youths predicts suicide rates in male youths. EU political and heath agencies should devise policies to prevent youth suicide with a focus on alcohol misuse and societal stress associated with violence against youths.

Chronic pain and major depressive disorder in the general population

This study aims (1) to assess the prevalence of Chronic Painful Physical Condition (CPPC) and major depressive disorder (MDD) in the general population; (2) to evaluate their interaction and co-morbidity with sleep and organic disorders; and (3) to investigate their daily functioning and socio-professional consequences. A random sample of 3243 subjects (18years), representative of California inhabitants, was interviewed by telephone. CPPC duration was at least 6months. Frequency, severity, duration and consequences on daily functioning, consultations, sick leave and treatment were investigated. MDD were assessed using DSM-IV criteria. The point prevalence of CPPC was 49% (95% confidence interval: 47.0-51.0%). Back area pain was the most frequent; 1-month prevalence of MDD was at 6.3% (95% CI: 5.5-7.2%); 66.3% of MDD subjects reported at least one CPPC. In 57.1% of cases, pain appeared before MDD. Pain severity was increased by poor sleep, stress and tiredness in MDD subjects. Being confined to bed, taking sick leave and interference of pain with daily functioning were twice as frequent among MDD subjects with CPPC than in non-MDD subjects with CPPC; obese individuals with CP were 2.6 times as likely to have MDD. Pain is highly linked with depressive disorder. It deteriorates physical, occupational and socio-professional activities. Pain and sleep disturbances are a prime motive of consultation rather than depressed mood, underlining the risk of missing a depression diagnosis.

Social phobia and depression: prevalence and comorbidity

BACKGROUND

Social phobia may seriously impair the functioning of affected individuals. It is frequently associated with other mental disorders.

AIMS

To estimate the co-occurrence of social phobia with major depressive disorder (MDD) and to analyze their interaction.

METHOD

Subjects were 18,980 individuals, aged 15 years or older, representative of the general population of the United Kingdom, Germany, Italy, Spain and Portugal, who were interviewed by telephone. DSM-IV diagnoses were made with the Sleep-EVAL system.

RESULTS

The point prevalence for social phobia was 4.4% (95% confidence interval: 4.1-4.7%) of the sample. It was higher in women (odds ratio: 1.6) and decreased with age. MDDs were found in 19.5% of participants with social phobia. Co-occurrence of another anxiety disorder was high and increased when a MDD was present (65.2%). The odds of developing a major depressive episode 2 years after the appearance of the social phobia was of 5.74.

CONCLUSIONS

Social phobia is highly prevalent in the general population. It increases the risk of developing a MDD and has a high comorbidity with other mental disorders. Social phobia is often present in the course of depression, more obviously during remission period of MDD. Physicians must explore and treat more systematically this frequent pathology.

Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study

BACKGROUND

While in the last 5 years several studies have been conducted in Italy on the prevalence of mental disorders in adults, to date no epidemiological study has been targeted on mental disorders in adolescents.

METHOD

A two-phase study was conducted on 3,418 participants using the child behavior checklist/6-18 (CBCL) and the development and well-being assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians.

RESULTS

The prevalence of CBCL caseness and DSM-IV disorders was 9.8% (CI 8.8-10.8%) and 8.2% (CI 4.2-12.3%), respectively. DSM-IV Emotional disorders were more frequently observed (6.5% CI 2.2-10.8%) than externalizing disorders (1.2% CI 0.2-2.3%). In girls, prevalence estimates increased significantly with age; furthermore, living with a single parent, low level of maternal education, and low family income were associated with a higher likelihood of suffering from emotional or behavioral problems.

CONCLUSIONS

Approximately one in ten adolescents has psychological problems. Teachers and clinicians should focus on boys and girls living with a single parent and/or in disadvantaged socioeconomic conditions.

Entwicklungspsychopathologie Sozialer Angststörungen

Die Soziale Phobie (oder Soziale Angststörung) stellt eine häufige psychische Störung dar, die insbesondere aufgrund ihres chronischen Verlaufs mit umfassenden Beeinträchtigungen einhergeht. Voraussetzung für die langfristig wirksame Behandlung oder Prävention der Störung ist ein umfassendes Verständnis bedingender und aufrecht erhaltender Faktoren. Mittlerweile liegen neben einer Reihe deskriptiver Störungsmodelle zur Entstehung und Aufrechterhaltung eine Vielfalt empirischer Ergebnisse zu Risikofaktoren sozialer Ängste vor. Neben einem Überblick über Phänomenologie und Epidemiologie Sozialer Angststörungen liegt der Schwerpunkt der Arbeit auf der Diskussion möglicher Einflussfaktoren in einer Entwicklungspsychopathologie der Sozialen Phobie. Dabei werden internale Faktoren, wie Familiengenetik, Temperament, kognitive Stile und soziale Fertigkeiten, sowie externe Faktoren, wie Erziehungsverhalten der Eltern und Erfahrungen mit der sozialen Umwelt, berücksichtigt. Zur Integration dieser Befunde werden differenzierte Modelle zur Ausbildung und zu differenziellen Entwicklungsverläufen generalisierter und isolierter sozialer Ängste vorgeschlagen.

Agoraphobia and panic. Prospective-longitudinal relations suggest a rethinking of diagnostic concepts

BACKGROUND

The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions.

METHODS

DSM-IV syndromes were assessed via Composite International Diagnostic Interview - Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14-24 years at baseline.

RESULTS

(1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0-23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA.

CONCLUSIONS

Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.

Agoraphobia between panic and phobias: clinical epidemiology from the Sesto Fiorentino Study

In the last few decades, there has been a long debate on the existence of agoraphobia (AG) without a history of panic attacks (PAs). In the present study, the problem of the relationships between AG and PAs is addressed trough a reevaluation of the cases who had been diagnosed with AG in the community survey of Sesto Fiorentino. Forty-one of the 75 subjects who met the criterion of AG in the Sesto Fiorentino Study were reinterviewed by experienced clinical psychiatrists. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the Composite International Diagnostic Interview were used to make the diagnoses. The Mobility Inventory for Agoraphobia (MIA) and a specific adjunctive question, "why do/did you avoid?", were used to compare AG subjects with or without PD. Of the 41 subjects with a lifetime history of AG, 12 cases had original diagnosis of AG without PAs and the remaining 29 had PD with AG. After the reassessment, in 10 cases, the criteria for the diagnosis of AG without PAs were confirmed, totaling a lifetime prevalence of 0.4% (confidence interval, 0.2-0.8). Agoraphobia subjects with and without PAs were comparable as regard to sex, age, age of onset, duration of illness, family history for anxiety or mood disorders, MIA scores, number, and type of situations avoided. Thus, AG seems to exist also in absence of a history of PAs, and the one-way relationship between the occurrence of PAs and a following development of AG, postulated by DSM-IV, should be reconsidered for the future classifications.

The analytical epidemiology of obsessive-compulsive disorder: risk factors and correlates

In this qualitative systematic review, we evaluate studies of the demographic, innate, and environmental risk factors and correlates associated with the development of Obsessive-Compulsive Disorder (OCD) in epidemiological samples. We found that a significant proportion of the studies indicate that late adolescence is a period of increased vulnerability for the development of OCD; that OCD affects predominantly female adults and male children and adolescents; that those who are unmarried or abusing drugs are more likely to present with OCD; that OCD is a familial and genetic disorder, particularly when one considers symptom dimensions instead of categorical diagnosis and when the disorder begins at an early age; and that individuals with OCD from the community, like those seen in clinical settings, may be especially prone to present psychiatric conditions such as mood and anxiety disorders. Although there are plenty of data on the correlates and risk factors of OCD in epidemiological samples, more research is needed on other potential risk factors, including obstetrical and pregnancy problems, pre-morbid neurocognitive functioning, and streptococcal infections, among others.

Epidemiology of life events: life events and psychiatric disorders in the Sesto Fiorentino study

BACKGROUND

Although life events have been consistently reported as precipitating factors for most psychiatric disorders, there is no comprehensive investigation of the relationship between severe life events and psychiatric disorders in the general population.

METHODS

This is a community-based study of psychiatric disorders among a cohort representative of adults in an Italian town. A total of 2,363 subjects out of 2,500 selected to be representative of the population living in Sesto Fiorentino, central Italy, were interviewed by their own general practitioner using the Mini International Neuropsychiatric Interview. Of the 613 subjects, 609 who resulted positive for any psychiatric disorders and 123 out of a random sample of 130 negatives were re-interviewed by the psychiatrists using the Florence Psychiatric Interview. The Florence Psychiatric Interview was used to explore each distinct psychiatric episode. Life events were recorded in detail by a specific interview.

RESULTS

During the year prior to the onset of the first psychiatric disorder, 35.8% of cases suffered from at least a severe event, compared with 12.2% of non-cases during a comparable period (OR = 4.0, 95% CI = 2.3-7.1). The excess of life events occurred for almost all the diagnostic categories. The same results were reproduced even when only the 'independent' life events were considered. The distribution of the events through the 12 months taken into account showed an even distribution of events among non-cases, whereas there was a clear accumulation in the last 3 months prior to the onset of the pathology in the cases.

CONCLUSIONS

Life stress is one of the main precipitating factors of psychopathology.

Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases

BACKGROUND

Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians' diagnoses and compared with physically healthy probands.

METHODS

Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders.

RESULTS

Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders.

CONCLUSIONS

There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

Combination treatment for acute depression is superior only when psychotherapy is added to medication

BACKGROUND

Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination.

METHODS

A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD). The patients were treated for 12-16 weeks. At baseline, at 6 weeks and on completion of treatment, ratings were performed by independent raters. The primary outcome measure was the HAMD, and the Montgomery-Asberg Depression Rating Scale (MADRS) the secondary outcome measure.

RESULTS

Of the 193 patients included, 138 completed the trial. All treatments were effective. Using a random regression model, no differences between treatments were found on the HAMD. On the MADRS, however, the combination of medication with psychotherapy was more effective in reducing depressive symptoms compared to medication alone, but not to psychotherapy alone or IPT with pill-placebo.

CONCLUSIONS

The results of this study yield support for the use of combining medication with psychotherapy instead of using medication only in the treatment of depressed outpatients. Combination treatment does not have an advantage over psychotherapy alone in the present study.

Clinical epidemiology of eating disorders: results from the Sesto Fiorentino study

BACKGROUND

It is speculated that clinical samples do not fully reflect the characteristics of eating disorders (EDs) as they are in the general population, especially in their lowest range of severity. The present article reports the prevalence of EDs in a community sample aged >14 years, their clinical and psychopathological features, and their course and outcome on naturalistic grounds.

METHODS

The Sesto Fiorentino Study is a three-phase community-based survey where 2,355 out of 2,500 people representative of the population aged >14 years living in Sesto Fiorentino were evaluated by their own general practitioner using the Mini International Neuropsychiatric Interview plus six additional questions. All those who had positive results plus a probability sample of the non-cases were re-interviewed by psychiatrists using the Florence Psychiatric Interview. The subjects who reported ED symptoms were subsequently administered the Eating Disorder Examination (12th edition).

RESULTS

Overall, the lifetime prevalence of EDs was 1.21%. More precisely, 0.42% had anorexia nervosa, 0.32% bulimia nervosa, 0.32% binge eating disorder and 0.32% eating disorder not otherwise specified. All the subjects suffering from an ED fulfilled diagnostic criteria for at least another DSM-IV axis I psychiatric disorder. At the moment of the interview, conducted a few years (average 7 years) after the onset of the disorder, 50% had fully recovered from EDs, 26.9% were currently affected by an ED, 23.1% showed a persistent body image disturbance and/or the presence of compensatory behaviours.

CONCLUSIONS

Community surveys conducted by clinicians may provide useful additional information on the psychopathological features, natural course and outcome of these disorders on naturalistic grounds.

Lucid dreaming treatment for nightmares: a pilot study

BACKGROUND

The goal of this pilot study was to evaluate the effects of the cognitive-restructuring technique 'lucid dreaming treatment' (LDT) on chronic nightmares. Becoming lucid (realizing that one is dreaming) during a nightmare allows one to alter the nightmare storyline during the nightmare itself.

METHODS

After having filled out a sleep and a posttraumatic stress disorder questionnaire, 23 nightmare sufferers were randomly divided into 3 groups; 8 participants received one 2-hour individual LDT session, 8 participants received one 2-hour group LDT session, and 7 participants were placed on the waiting list. LDT consisted of exposure, mastery, and lucidity exercises. Participants filled out the same questionnaires 12 weeks after the intervention (follow-up).

RESULTS

At follow-up the nightmare frequency of both treatment groups had decreased. There were no significant changes in sleep quality and posttraumatic stress disorder symptom severity. Lucidity was not necessary for a reduction in nightmare frequency.

CONCLUSIONS

LDT seems effective in reducing nightmare frequency, although the primary therapeutic component (i.e. exposure, mastery, or lucidity) remains unclear.

The intellectual crisis of psychiatric research

The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.

Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)

OBJECTIVE

To present 1-month, 12-month and lifetime prevalence estimates of mood, anxiety and alcohol disorders in Italy; and the socio-demographic correlates and comorbidity patterns of these estimated disorders.

METHOD

A representative random sample of non-institutionalised citizens of Italy aged 18 or older (N=4,712) was interviewed between January 2001 and July 2003, with a weighted response rate of 71.3%. DSM-IV disorders were assessed by lay interviewers using Version 3.0 of the Composite International Diagnostic Interview (CIDI).

RESULTS

A total of 11% of respondents reported a lifetime history of any mood disorder, 10.3% any anxiety disorder and 1.3% any alcohol disorder. About 5% reported having an anxiety disorder in the past 12 months compared to 3.3% for any mood disorder and 0.2% for any alcohol disorder. Major depression and specific phobia were the most common mental disorders. Women were twice as likely as men to report a mood disorder and four times as likely as men to report an anxiety disorder, while men were twice as likely as women to report an alcohol disorder. High comorbidity of mood and anxiety disorders was observed. Prevalence estimates were generally lower than in parallel surveys carried out in other Western European countries.

CONCLUSION

A high proportion of adults in Italy have a history of mood, anxiety or alcohol disorders. The lower than expected prevalence estimate of alcohol use disorder may be due to under-reporting or to low social harm from alcohol consumption.

Prevalence of psychiatric disorders in an Italian town: low prevalence confirmed with two different interviews

BACKGROUND

In Italy, few studies on the prevalence of psychiatric disorders have considered all of the most common disorders and very few have adopted the most common tools, that is, the Composite International Diagnostic Interview (CIDI) and the Present State Examination (PSE). The objective of the present study was to estimate the prevalence of psychiatric disorders and its correlates in the town of Jesi, Italy, using the PSE and CIDI, administered 7 years apart.

METHODS

The two surveys were conducted among adults in Jesi (central Italy), using the PSE in 1993 and the CIDI in 2000. Participants were randomly chosen from the patient lists of general practitioners.

RESULTS

The one-month prevalence of persons with a psychiatric disorder was 7.3% (95% CI: 4.4-11.6) in 1993 and 6.0% (95% CI: 3.5-9.5) in 2000. The lifetime and 1-year prevalence rates were 21.0 and 8.2%, respectively. The most common disorders were depressive and anxiety disorders. Mood and anxiety disorders were more common among women and unmarried persons.

CONCLUSIONS

The prevalence is lower than that in most other areas of the world yet consistent with estimates for Italian populations reported by studies using the same (or similar) tools.

Agoraphobia in adults: incidence and longitudinal relationship with panic

BACKGROUND

Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.

AIMS

To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.

METHOD

A sample of 1920 adults in east Baltimore were assessed in 1981-1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatrist diagnoses were made in a subset of the sample at follow-up (n = 816).

RESULTS

Forty-one new cases of DIS/DSM-III-R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR = 12, 95% CI 3.2-45), as did younger age, female gender and other age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3-180; agoraphobia before panic OR=16, 95% CI 3.2-78).

CONCLUSIONS

The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV appears incorrect.

The descriptive epidemiology of obsessive-compulsive disorder

Since the early eighties, there has been a growing interest in the descriptive epidemiology of obsessive-compulsive disorder (OCD). In this narrative review, the authors describe the findings of a number of studies that employed selected instruments, such as the Diagnostic Interview Schedule, the Composite International Diagnostic Instrument, and the Schedule for Affective Disorders and Schizophrenia, to ascertain the prevalence and incidence rates for OCD in several different countries. We noted that there is a great heterogeneity of findings and that the potential reasons for this variability include not only the intrinsic characteristics of the population under study but also extrinsic factors (i.e., the several methodologically-informed decisions that are to be made before undertaking such investigations, such as the adoption of a specific diagnostic instrument). In order to further the knowledge on the epidemiology of OCD, it would be worthwhile to establish a global consensus regarding a standard assessment package for OCD, to produce more cross-culturally valid versions of the key research instruments, and to conduct studies specifically aimed at comparing the sociodemographic, clinical and prognostic aspects of OCD across different countries.

Psychogenic urinary retention ('paruresis'): diagnosis and epidemiology in a representative male sample

BACKGROUND

Although research interest in social phobias has expanded during the last decade, a special subtype of social phobia known as paruresis, which manifests in the inability to urinate in public rest rooms, is rarely mentioned. The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105).

METHOD

Due to the lack of well-established screening instruments for paruresis, the Paruresis Checklist (PCL) must be tested for reliability and validity. An empirically based cutoff score must be determined by using the subjective interference with everyday life as an external criterion.

RESULTS

Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis. In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.