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Socio-demographic, behavioural and psycho-social factors associated with depression in two Russian cities. J Affect Disord 2021; 290:202-210. [PMID: 34004402 PMCID: PMC8626563 DOI: 10.1016/j.jad.2021.04.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/11/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Russia has a high burden of suicide and alcohol-attributable mortality. However there have been few studies of the epidemiology of depression. METHODS The study population was 5077 men and women aged 35-69 years from a cross-sectional population based survey in the cities of Arkhangelsk and Novosibirsk (2015-17). Moderate depression was defined as Patient Health Questionnaire-9 (PHQ-9) score≥10. Risk factors considered were socio-demographic factors (age, sex, marital status, living alone, education, employment status, financial constraints); health behaviours (smoking, alcohol use) and psycho-social factors (life events and social support). RESULTS After mutual adjustment for all other factors, there was evidence that PHQ-9≥10 was associated with sex (higher in women), financial constraints, employment status, being a non-drinker, problem drinking, smoking, not having enough people to confide in and the number of life events in the past 6 months. Employment status was more strongly associated in men (OR 1.84 (95%CI 1.17, 2.88)) than women (OR 1.15 95% CI 0.86, 1.55). The effect size was particularly striking for financial constraints (odd ratio over 3 times higher in those with not enough money for food and clothes compared to no financial constraints), problem drinking (OR 1.72 (1.12, 2.65) among drinkers with CAGE score of 2 and 2.25 (95% CI 1.42, 3.57) in those with score ≥3 compared to zero) and life events (85% higher odds in those experiencing one life event and over 4 times higher odds in those experiencing 3 or more life events) all of which demonstrated a dose-response with PHQ-9>=10. LIMITATIONS The study was cross-sectional in nature therefore temporal relationships could not be assessed. CONCLUSIONS We have identified here a range of risk factors for depression among the Russian general population consistent with findings from other populations. The strikingly strong association with financial constraints indicates the importance of social inequality for the burden of depression.
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Goodmann DR, Daouk S, Sullivan M, Cabrera J, Liu NH, Barakat S, Muñoz RF, Leykin Y. Factor analysis of depression symptoms across five broad cultural groups. J Affect Disord 2021; 282:227-235. [PMID: 33418371 DOI: 10.1016/j.jad.2020.12.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/24/2020] [Accepted: 12/24/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Core symptoms of depression are likely universal, however cultural groups differ in their experience of the condition. The purpose of this study was to examine differences and similarities of depression symptom groupings between broad cultural groups. METHOD 6,982 adults took part in an online multilingual depression screening study, and completed an 18-item major depression screener. Participants were categorized into five broad cultural groups by language and country of residence: Spanish speakers from Latin America (n = 3,411); English speakers from Southeast Asia (n = 1,265); Russian speakers from the former Soviet bloc (n = 642); English speakers from English-speaking Western countries (n = 999); and Chinese speakers from China (n = 665). Principal components analysis with promax rotation was used. RESULTS Both similarities and noteworthy differences in symptom clustering between groups were observed. For instance, though suicide-related items formed a separate cluster for most cultures, for the Latin-American group, worthlessness loaded with suicidality. Changes in appetite and changes in weight tended to load on different factors (except for Chinese and Russian groups). Hypersomnia tended to load with psychomotor agitation, and core depression symptoms tended to load with physical symptoms (except for the Russian group). LIMITATIONS Depression was assessed by a self-report measure aligned to DSM-IV. CONCLUSION The analysis contributes to a nuanced understanding of depression manifestations of various cultures, which may inform culturally sensitive clinical practice.
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Affiliation(s)
- Danielle R Goodmann
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Sariah Daouk
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Megan Sullivan
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | | | | | | | - Ricardo F Muñoz
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco
| | - Yan Leykin
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco.
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Cook S, Kudryavtsev AV, Bobrova N, Saburova L, Denisova D, Malyutina S, Lewis G, Leon DA. Prevalence of symptoms, ever having received a diagnosis and treatment of depression and anxiety, and associations with health service use amongst the general population in two Russian cities. BMC Psychiatry 2020; 20:537. [PMID: 33183249 PMCID: PMC7663865 DOI: 10.1186/s12888-020-02938-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the burden of common mental disorders in Russia despite high levels of suicide and alcohol-related mortality. Here we investigated levels of symptoms, self-reports of ever having received a diagnosis and treatment of anxiety and depression in two Russian cities. METHODS The study population was men and women aged 35-69 years old participating in cross-sectional population-based studies in the cities of Arkhangelsk and Novosibirsk (2015-18). Participants completed an interview which included the PHQ-9 and GAD-7 scales, questions on whether participants had ever received a diagnosis of depression or anxiety, and health service use in the past year. Participants also reported current medication use and medications were coded in line with the WHO anatomical therapeutic classification (ATC). Depression was defined as PHQ-9 ≥ 10 and Anxiety as GAD-7 ≥ 10. RESULTS Age-standardised prevalence of PHQ-9 ≥ 10 was 10.7% in women and 5.4% in men (GAD-7 ≥ 10 6.2% in women; 3.0% in men). Among those with PHQ-9 ≥ 10 17% reported ever having been diagnosed with depression (equivalent finding for anxiety 29%). Only 1.5% of those with PHQ-9 ≥ 10 reported using anti-depressants and 0.6% of those with GAD-7 ≥ 10 reported using anxiolytics. No men with PHQ-9 ≥ 10 and/or GAD-7 ≥ 10 reported use of anti-depressants or anxiolytics. Use of health services increased with increasing severity of both depression and anxiety. CONCLUSION There was a large gap between symptoms and reporting of past diagnosis and treatment of common mental disorders in two Russian cities. Interventions aimed at improving mental health literacy and reducing stigma could be of benefit in closing this substantial treatment gap.
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Affiliation(s)
- Sarah Cook
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway. .,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Alexander V. Kudryavtsev
- grid.10919.300000000122595234Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412254.40000 0001 0339 7822Northern State Medical University, Arkhangelsk, Russian Federation
| | - Natalia Bobrova
- grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lyudmila Saburova
- grid.426536.00000 0004 1760 306XInstitute of Philosophy and Law, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russian Federation
| | - Diana Denisova
- grid.415877.80000 0001 2254 1834Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Sofia Malyutina
- grid.415877.80000 0001 2254 1834Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation ,grid.445341.30000 0004 0467 3915Novosibirsk State Medical University, Russian Ministry of Health, Novosibirsk, Russian Federation
| | - Glyn Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - David A. Leon
- grid.10919.300000000122595234Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway ,grid.8991.90000 0004 0425 469XFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK ,grid.410682.90000 0004 0578 2005International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russian Federation
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Rezvy G, Andreeva E, Ryzhkova N, Yashkovich V, Sørlie T. Integrating mental health into primary care in Arkhangelsk County, Russia: the Pomor model in psychiatry. Int J Ment Health Syst 2019; 13:14. [PMID: 30911330 PMCID: PMC6416943 DOI: 10.1186/s13033-019-0271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primary health care is still peripheral in the identification and treatment of mental health and substance use disorders in the Russian Federation. However, the development of primary health services has been given priority. A long-standing collaboration between Arkhangelsk County and northern Norway on mental health service development in Arkhangelsk has promoted the integration of mental health into primary care. Aim To develop a model for mental health integration into primary care adapted to the conditions in Arkhangelsk County. Methods (a) Situational assessment, (b) development of a model for systematic cooperation between GPs and specialists, (c) initial evaluation of the model, (d) implementation and dissemination of the model. Results A local studies revealed major shortcomings in GPs’ diagnostic and treatment skills and in their collaboration with specialists in psychiatry. In order to promote better communication between GPs and specialists in this desolate and sparsely populated geographical area, an information communication technology (ICT)-based competence centre was established at a specialised community mental health centre in Arkhangelsk city (APND). Through a network including APND and involved primary health care centres, GPs gained access to specialists’ expertise when required in their work with psychiatric patients. GPs assess all patients’ mental health condition and treatment responsibility for patients in need of mental health care is divided between GPs and specialists according to problem severity. APND has the formal responsibility for ensuring that this collaboration with the health centres is established and practiced. Training in diagnostics and conversation skills ensures basic professional competence in the GPs. Initial evaluation showed that patients, GPs and specialists were satisfied with their experiences. The model is currently under implementation in 50% of the districts of the county. Conclusion Our cooperation has led to the development and implementation of a model for mental health care integration into primary care in an area with major geographical distances. Further improvements will be based on systematic evaluation of experiences with the model.
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Affiliation(s)
- Grigory Rezvy
- Finnmark Hospital Trust, Kirkenes, Norway.,2University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | | | | | - Vera Yashkovich
- Arkhangelsk Psychoneurological Dispenser, Arkhangelsk, Russia
| | - Tore Sørlie
- 2University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,6Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
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Wynn R. Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review. Int J Ment Health Syst 2018; 12:10. [PMID: 29588656 PMCID: PMC5865388 DOI: 10.1186/s13033-018-0189-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background It is an important objective of the psychiatric services to keep the use of involuntary procedures to a minimum, as the use of coercion involves clinical, ethical, and legal issues. It has been claimed that Norway has a relatively high rate of involuntary admissions. We reviewed the peer-reviewed literature on the use of involuntary admission in Norway, with the purpose of identifying the current state of knowledge and areas in need of further research. Methods A systematic review following the PRISMA statement was conducted. We searched the electronic databases PsycInfo, PubMed, Web of Science, CINAHL, and Embase for studies relating to involuntary admission to Norwegian adult psychiatric hospitals published in the period 1 January 2001 to 8 August 2016. The database searches were supplemented with manual searches of relevant journals, reference lists, and websites. Results Seventy-four articles were included and grouped into six categories based on their main topics: Patients’ experiences, satisfaction and perceived coercion (21 articles), the Referral and admission process (11 articles), Rates of admission (8 articles), Characteristics of the patients (17 articles), Staff attitudes (9 articles), and Outcomes (8 articles). Four of the included articles described intervention studies. Fifty-seven of the articles had a quantitative design, 16 had a qualitative design, and one a mixed-method design. There was a broad range of topics that were studied and considerable variation in study designs. The findings were largely in line with the international literature, but the particularities of Norwegian legislation and the Norwegian health services were reflected in the literature. The four intervention studies explored interventions for reducing rates of involuntary admission, such as modifying referring routines, improving patient information procedures, and increasing patients’ say in the admission process, and represent an important avenue for future research on involuntary admission in Norway. Conclusions The review suggests that Norway has a relatively high rate of involuntary admissions. The identified studies represent a broad mix of topics and designs. Four intervention studies were identified. More studies with strong designs are needed to bring research on involuntary admission in Norway to a next level. Electronic supplementary material The online version of this article (10.1186/s13033-018-0189-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rolf Wynn
- 1Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway.,2Division of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway
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Norheim AB, Grimholt TK, Loskutova E, Ekeberg O. Attitudes toward suicidal behaviour among professionals at mental health outpatient clinics in Stavropol, Russia and Oslo, Norway. BMC Psychiatry 2016; 16:268. [PMID: 27465292 PMCID: PMC4964267 DOI: 10.1186/s12888-016-0976-5] [Citation(s) in RCA: 16] [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: 09/22/2015] [Accepted: 06/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attitudes toward suicidal behaviour can be essential regarding whether patients seek or are offered help. Patients with suicidal behaviour are increasingly treated by mental health outpatient clinics. Our aim was to study attitudes among professionals at outpatient clinics in Stavropol, Russia and Oslo, Norway. METHODS Three hundred and forty-eight (82 %) professionals anonymously completed a questionnaire about attitudes. Professionals at outpatient clinics in Stavropol (n = 119; 94 %) and Oslo (n = 229; 77 %) were enrolled in the study. The Understanding Suicidal Patients (USP) scale (11 = positive to 55 = negative) and the Attitudes Towards Suicide Scale (ATTS) (1 = totally disagree, 5 = totally agree) were used. Questions about religious background, perceived competence and experiences of and views on suicidal behaviour and treatment (0 = totally disagree, 4 = totally agree) were examined. RESULTS All groups reported positive attitudes, with significant differences between Stavropol and Oslo (USP score, 21.8 vs 18.7; p < 0.001). Professionals from Stavropol vs. Oslo reported significantly less experience with suicidal patients, courses in suicide prevention (15 % vs 79 %) guidelines in suicidal prevention (23 % vs 90 %), interest for suicide prevention (2.0 vs 2.7; p < 0.001), and agreed more with the ATTS factors: avoidance of communication on suicide (3.1 vs 2.3; p < 0.001), suicide is acceptable (2.9 vs 2.6; p = 002), suicide is understandable (2.9 vs 2.7; p = 0.012) and (to a lesser extent) suicide can be prevented (4.2 vs 4.5; p < 0.001). In both cities, psychiatric disorders (3.4) were considered as the most important cause of suicide. Use of alcohol (2.2 vs 2.8; p < 0.001) was considered less important in Stavropol. Psychotherapy was considered significant more important in Stavropol than Oslo (3.6 vs 3.4; p = 0.001). CONCLUSIONS Professionals reported positive attitudes towards helping suicidal patients, with significant differences between cities. A need for further education was reported in both cities, but education was less integrated in mental health care in Stavropol than it was in Oslo. In both cities, psychiatric disorders were considered the major reasons for suicide, and psychotherapy was the most important treatment measure.
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Affiliation(s)
- Astrid Berge Norheim
- Diakonhjemmet hospital, Postboks 23, Vinderen, Oslo, 0319, Norway. .,Regional Centre of Violence Traumatic stress and suicide Prevention Eastern Norway, RVTS-East, Postboks 4623, Nydalen, Oslo, 0405, Norway.
| | - Tine K. Grimholt
- Regional Centre of Violence Traumatic stress and suicide Prevention Eastern Norway, RVTS-East, Postboks 4623, Nydalen, Oslo 0405 Norway ,Department of Acute Medicine, Oslo University Hospital Ullevål, Pb 4965, Nydalen, Oslo 0424 Norway
| | - Ekaterina Loskutova
- Ekaterina Loskutova, ProPsy, Lermontova str. 239/4, ofice 18, Stavropol, 355041 Russia
| | - Oivind Ekeberg
- Division of Mental Health and Addicion, Oslo University Hospital, Box 4956, Nydalen, Oslo 0424 Norway ,Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo, Pb 10/2 Blindern, Oslo, N-0316 Norway
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Sørlie T, Sørgaard KW, Bogdanov A, Bratlid T, Rezvy G. Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. BMC Psychiatry 2015; 15:187. [PMID: 26239359 PMCID: PMC4524124 DOI: 10.1186/s12888-015-0545-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/26/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures. METHODS An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality. RESULTS The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients. CONCLUSIONS Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.
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Affiliation(s)
- Tore Sørlie
- Institute of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway. .,Department of General Psychiatry, University Hospital of North Norway, Tromsø, Norway.
| | - Knut W Sørgaard
- Institute of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway. .,Nordland Hospital Trust, 8092, Bodø, Norway.
| | - Anatoly Bogdanov
- Archangelsk Clinical Psychiatric Hospital, Archangelsk, Russia. .,North State Medical University, Archangels, Russia.
| | - Trond Bratlid
- Institute of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway.
| | - Grigory Rezvy
- Institute of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway. .,Nordland Hospital Trust, 8092, Bodø, Norway.
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