Emotional disability days: prevalence and predictors

"The ship is sinking, yet the band plays on": COVID-19 and academia

Objective: Researchers sought to examine experiences of stress, mental health, and work outcomes for those in higher education during the COVID-19 pandemic. Participants: Graduate students and professors completed an online survey in June 2020 (N = 1,794). Methods: Participants completed measures of stress, depression, and anxiety as well as items related to work quality, productivity, and fulfillment. Results: 70% of graduate students reported higher than normal levels of anxiety, depression, and stress according to the DASS-21. Nearly half of professors reported higher than normal levels of anxiety, depression, and stress. Multiple linear regression analyses found that higher levels of work fulfillment predicted greater productivity (f2grad = .15; f2prof = .08) and quality of work (f2grad = .10; f2prof = .12). Conclusions: Individuals in higher education are struggling with their mental health and considerations need to be made to help this group. Additionally, we discuss the implications of self-determination theory on work fulfillment.

The PERSIAN Cohort: Prevalence of Psychiatric Disorders Among Employees

BACKGROUND

Considering the impact of psychiatric disorders on the productivity of individuals and society's economy, we aimed to determine the prevalence of psychiatric disorders among the employees of Tabriz University of Medical Sciences.

METHODS

This cross-sectional study was conducted on 1282 employees of Tabriz University of Medical Sciences in 2019. The required data were collected by trained psychologists using Composite International Diagnostic Interview (CIDI). In this process, psychiatric disorders were considered dependent variables, and demographic variables as independent variables. The relationship between independent and dependent variables was assessed using the chi-square test and Binary logistic regression in Stata version 17.

RESULTS

The prevalence of generalized anxiety disorder (GAD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD) among employees was 14.12%, 12.48%, and 3.9%, respectively. The prevalence of GAD in women was significantly higher than men (17.06% vs. 10.02%, P<0.001). The prevalence of GAD was 42.86%, 15.97%, 13.49%, and 16.67 in widowed, single, married, and divorced employees, respectively (P=0.016). The prevalence of MDD in women was significantly higher than men (16.59% vs. 7.64%, P<0.001). The prevalence of MDD was 16.3%, 11.2%, 9.6%, and 8.56% in employees with Bachelor's, Associate, Master's degree, and High school diploma, respectively (P=0.009).

CONCLUSION

Considering the relatively high prevalence of GAD and MDD among the employees of Tabriz University of Medical Sciences, strengthening counseling centers in the university and encouraging employees to participate in these centers, and examining them in terms of mental health help identify people at risk of mental disorders in time and provide counseling services to these people.

The role of effort-reward imbalance and depressive symptoms in the relationship between long working hours and presenteeism among Chinese village doctors: a moderated mediation model

BACKGROUND

Long working hours and effort-reward imbalance (ERI) among medical workers may contribute to poor mental health and reduced productivity. However, the potential mechanisms among them are not well understood. This study aimed to explore the role of depressive symptoms and ERI in the relationship between long working hours and presenteeism among village doctors.

METHODS

We conducted a cross-sectional study in Jiangsu Province, eastern China. 705 village doctors were assessed for working hours, ERI (the Effort-Reward Imbalance Questionnaire, ERI questionnaire), presenteeism (6-item Stanford Presenteeism Scale, SPS-6 Scale), and depressive symptoms (12-item General Health Questionnaire, GHQ-12). A moderated mediation model was used to test the role of depressive symptoms (M), and ERI (W) in the relationship between long working hours (X) and presenteeism (Y).

RESULTS

45.11% of the village doctors worked more than 55 h per week, and 55.89% were exposed to ERI. The prevalence of depressive symptoms among Chinese village doctors was 40.85%. Long working hours (≥ 55 h per week) were significantly associated with presenteeism behaviors (β = 2.17, P < 0.001). Mediation analysis demonstrated that depressive symptoms (GHQ score > 3) could partly mediate the relationship between long working hours and presenteeism (indirect effect β = 0.64, P < 0.001). Moderated mediation further indicated that the interaction of long working hours and ERI was significantly and positively associated with depressive symptoms, which in turn predicted elevated presenteeism behaviors.

CONCLUSIONS

Depressive symptoms had a mediating role in the association of long working hours with presenteeism behaviors among Chinese village doctors and ERI augment their negative effects.

Association between sleep duration and quality and depressive symptoms among university students: A cross-sectional study

Sleep duration and quality have several effects on human health. Some previous studies have shown an association between sleep duration and quality and mental health, but the results of those studies were inconsistent. Additionally, studies on sleep duration and its impact on depressive symptoms specifically among young Chinese adults are limited. Hence, this study aimed to investigate the association between duration and quality of sleep and depressive symptoms among Chinese university students. We designed a cross-sectional study comprising 9,515 Chinese university students. Sleep duration and quality were assessed using a self-reported questionnaire. Depressive symptoms were assessed based on the Self-rating Depression Scale score. Logistic regression models were used to analyze the association between sleep duration and quality and depressive symptoms. The results showed that good sleep quality was associated with a lower prevalence of depressive symptoms. In the final adjusted model, the odds ratios and 95% confidence intervals for the prevalence of depressive symptoms in those with poor sleep quality compared with those with normal and good sleep quality were 0.88 (0.77, 1.01) and 0.82 (0.81, 0.96), respectively (p for trend = 0.014). Moreover, short sleep duration was associated with a higher prevalence of depressive symptoms based on the crude model and final adjusted model (p for trend = 0.048 and 0.042, respectively). Poor sleep quality and short sleep duration were associated with a higher prevalence of depressive symptoms in this study population. These results suggest that reduced sleep duration and quality may be risk factors for mental health disorders among university students.

Sleep Quality, Anxiety, and Depression Are Associated with Fall Risk Factors in Older Women

Gait, dynamic balance, and functional mobility problems are well-known fall risk factors. Furthermore, sleep disturbances, anxiety, and depression are prevalent among older women. This study aimed to analyze the associations of sleep quality, anxiety, and depression with functional mobility, gait speed, and dynamic balance in community-dwelling postmenopausal women aged ≥ 60 years. A total of 271 women (69.18 ± 5.69 years) participated in this study. Functional mobility (Timed Up-and-Go Test), dynamic balance (3-meter tandem walk test), gait speed (OptoGait® optical detection system), sleep quality (Pittsburgh Sleep Quality Index), and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed. Our results showed that poor sleep efficiency and the use of sleeping medication were related to decreased gait speed (R2 = 0.072). Poor functional mobility was linked to depression and the use of sleeping medication (R2 = 0.159). Additionally, increased symptoms of anxiety and depression were associated with worsened dynamic balance (R2 = 0.127). In conclusion, poorer sleep quality is associated with slower gait speed and reduced functional mobility, which is also related, along with impaired dynamic balance, to higher levels of anxiety and depression.

Sickness absence indicating depressive symptoms of working population in South Korea

BACKGROUND

Sickness absence has been regarded as an important indicator of workers' health and work productivity. This study is aimed to evaluate the association between depressive symptoms and sickness absence in workers of South Korea.

METHODS

We used nationwide cross-sectional survey data from 2889 individuals in the working population aged over 19 years in South Korea. Depressive symptoms were measured using Patient Health Questionnaire-9 (PHQ-9). Those respondents who scored above 10 on PHQ-9 were regarded as having depressive symptoms. Sickness absence was considered a binary variable with an absence of at least 1 day in the past month. The survey instrument contained questions about sociodemographic factors, lifestyle, work-related factors, and chronic illnesses. Logistic regression models were used to find odds ratios and confidence intervals.

RESULTS

The prevalence of sickness absence was found to be overall 4.6%. The adjusted odds ratio of sickness absence with depressive symptoms (PHQ-9 score ≥ 10) was 3.63 (Confidence Interval: 2.13-6.20) after controlling of possible confounders. Compared to minimal depressive symptoms (PHQ-9 < 5), the differences between other types of severity of depressive symptoms (mild, moderate, and moderately severe) in terms of mean of all sickness absences were more significant.

LIMITATION

The sickness absence based on the memory of the respondent in this study may result in a recall bias.

CONCLUSIONS

Incidence of at least 1 day of sickness absence per month increased the risk of depressive symptoms after controlling for the possible confounding factors in general working population. It may be necessary to consider strategies for assessing depression in the workers who take sick leaves.

Lower Quadriceps Rate of Force Development Is Associated With Worsening Physical Function in Adults With or at Risk for Knee Osteoarthritis: 36-Month Follow-Up Data From the Osteoarthritis Initiative

OBJECTIVE

To determine the association between quadriceps rate of force development (RFD) and decline in self-reported physical function and objective measures of physical performance.

DESIGN

Longitudinal cohort study.

SETTING

Community-based sample from 4 urban areas.

PARTICIPANTS

Osteoarthritis Initiative participants with or at risk for knee osteoarthritis, who had no history of knee/hip replacement, knee injury, or rheumatoid arthritis (N=2630).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Quadriceps RFD (N/s) was measured during isometric strength testing. Worsening physical function was defined as the minimal clinically important difference for worsening self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale score, 20-m walk time, and repeated chair stand time over 36 months.

RESULTS

Compared with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an odds ratio (OR) of .68 (95% confidence interval [CI], .51-.92) after adjustment for age, sex, body mass index, depression, history of chronic diseases, and knee pain. In women, in comparison with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an adjusted OR of .57 (95% CI, .38-.86). This decreased risk did not reach statistical significance in men (OR, 0.81; 95% CI, 0.52-1.27). No statistically significant associations were detected between baseline RFD and walk or chair stand times.

CONCLUSIONS

Our results indicate that higher RFD is associated with decreased risk for worsening self-reported physical function but not with decreased risk for worsening of physical performance.

Chapter 7. Sickness absence and psychiatric disorders

There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).

Self-Determination Among Mental Health Consumers/Survivors

It is well known that people with psychiatric disabilities lack self-determination in their lives. A number of studies have demonstrated the high rates of poverty experienced by many of these individuals, leading them to confront a variety of barriers to a higher quality of life. Moreover, concepts of self-determination and client control have not yet proliferated in the public mental health system. In spite of this, consumers/survivors have organized to demand their civil rights and full inclusion in making decisions regarding their own treatment. This article traces the history of self-determination for citizens with psychiatric disabilities, describes major barriers to self-determination, presents several theories of self-determination with potential relevance for mental health consumers/survivors, and offers ways in which self-determination and consumer control might be achieved both within and outside of service systems.

The Implications of Positive Psychological Capital on Employee Absenteeism

Drawing from positive psychology and positive organizational behavior (Luthans, 2002a, 2002b) this study utilized a field study in a high tech manufacturing firm to demonstrate how positive psychological capital reduces levels of both involuntary and voluntary absenteeism. Previous studies setting out to determine job attitude antecedents of absenteeism have been generally disappointing and account for only small levels of variance. In addition, with few exceptions conceptualization of absenteeism has been uni-dimensional despite calls by previous researchers to consider the significant differences in semantic networks of voluntary and involuntary absenteeism as separate metrics. We make this dual dimension distinction and show how previous antecedents of absenteeism contribute to one dimension more than the other. The utility of the study findings conclude the article.

Employers' perceptions and attitudes toward the Canadian national standard on psychological health and safety in the workplace: A qualitative study

The estimated societal and economic costs of mental illness and psychological injury in the workplace is staggering. Governments, employers and other stakeholders have been searching for policy solutions. This qualitative, exploratory study sought to uncover organizational receptivity to a voluntary comprehensive standard for dealing with psychological health and safety in the workplace. A series of five focus groups were conducted in a large Western Canadian city in November 2013. The seventeen participants were from the fields of healthcare, construction/utilities, manufacturing industries, business services, and finance. They worked in positions of management, consulting, human resources, health promotion, health and safety, mediation, and occupational health and represented organizations ranging in size from 20 to 100,000 employees. The findings confirm and illustrate the critical role that psychological health and safety plays across workplaces and occupations. This standard resonated across the represented organizations and fit with their values. This alignment posed challenges with articulating its added value. There appears to be a need for simplified engagement and implementation strategies of the standard that can be tailored to the nuanced differences between types and sizes of industries. It appears that organizations in the most need of improving psychological health and safety may be the least receptive.

Previous anxiety and depression as risk factors for early labour force exit

BACKGROUND

Individuals with a history of mental illness have lower earnings than individuals without. A possible reason is that those with prior anxiety or depression may be more likely to exit the labour force prior to retirement age, but evidence has been mixed and limited. Our objective was to compare risk of early labour force exit between employed adults with a history of depression or anxiety versus those without, separately for men and women.

METHODS

We used data from the Baltimore Epidemiological Catchment Area Follow-up Cohort, which collected baseline data in 1981 and follow-up data 1993-1996 and 2004-2005. Cox proportional hazards models estimated the relative risk of labour force exit comparing those with versus without prior history of anxiety or depressive disorders.

RESULTS

Women with prior anxiety or depression are at 37% increased risk of dropping out of the labour force as compared to women without, controlling for age, socioeconomic status, race and marital status (HR: 1.37, 95% CI 1.04 to 1.79). Men with prior anxiety or depression are 18% more likely to subsequently drop out of the labour force as compared to men without, controlling for the above confounders as well as veteran status, but this association is not statistically significant (HR: 1.18, 95% CI 0.72 to 1.27).

CONCLUSIONS

Prior anxiety or depression increases risk of early labour force exit for women. These findings may help explain previously reported lower earnings among female individuals with a history of mental illness and highlight the importance of considering anxiety and depressive disorders in policies supporting labour force participation.

Treatment and outcomes for patients with depression who are partial responders to SSRI treatment: post-hoc analysis findings from the FINDER European observational study

BACKGROUND

Remission is the goal in depression, but in practice many patients only experience a partial response to treatment. We sought to determine the prevalence, management and subsequent outcomes of partial responder patients.

METHODS

Patients enrolled in the naturalistic Factors Influencing Depression Endpoints Research (FINDER) study with the Hospital Anxiety and Depression Scale depression subscale (HADS-D) score >10 at baseline who received only SSRI(s) between 0 and 3 months comprised the study cohort (n=1147). Patients were categorized as remitters, partial responders or non-responders at 3 months and then followed up at 6 months.

RESULTS

At 3 months, 29.4% of the study population were considered non-responders, 27.6% were partial responders, and 39.3% were remitters. Most partial responders at 3 months remained on the same SSRI for the next 3 months. Of the 247 partial responders at 3 months and remained on the same SSRI(s) between 3 and 6 months, 10.9% met criteria for non-response at 6 months, 32.4% remained partial responders, and 56.3% achieved remission. Quality of life outcomes for the partial responders were significantly worse than those in remission (p<0.05).

LIMITATIONS

FINDER was an observational study; the current analysis was conducted post-hoc. Multivariable methods were not applied and findings are primarily descriptive and exploratory.

CONCLUSIONS

Partial response is common and patients in partial response have a poorer quality of life than those achieving remission. Despite this, the majority of partial responders continue to take the same SSRI. Our findings underscore the importance of continuing to strive for remission.

Unique and related predictors of major depressive disorder, posttraumatic stress disorder, and their comorbidity after Hurricane Katrina

The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.

Major depressive disorder: a qualitative study on the experiences of Iranian patients

Major depressive disorder (MDD) is one the most common mental disorders; it affects about 5-10% of the world population. This study explores the experiences of people with major depressive disorder in Zanjan, Iran. In order to identify recurring themes and patterns in individuals' experiences of major depressive disorder, semi-structured interviews with 18 patients were recorded and transcribed verbatim. The transcripts were then analyzed based on conventional qualitative content analysis. Five main categories emerged. The first category was called emotional paralysis and included the subcategories feeling severely depressed; feeling anxious; feeling impatient and irritable; and having dyshedonia. The second category was disturbance of thinking and was comprised of the subcategories of preoccupation, instable spiritual beliefs, and guilt. Cognitive decline was the third identified category and was further divided into subcategories of frustration, unawareness of the disorder, negative evaluation, indecisiveness, and loss of focus and loss of memory. Another major category was physical illnesses with the subcategories of physical discomfort, sleep problems, appetite disturbance, facial changes, sexual dysfunction, and medical conditions. The final category was failure in life, which had failure in personal affairs, jeopardized interpersonal relations, and unstable work life as subcategories. These findings provide a base for further research in this area. They also have clinical relevance for health care providers working with patients with MDD. Related cultural issues also are discussed.

Association of psychotherapy with disability benefit claim closure among patients disabled due to depression

Background

Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.

Methods

Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.

Results

We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI] = 0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure.

Conclusions

We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.

Mental disorders: employment and work productivity in Singapore

AIM

To examine the association between mental disorders and work disability in the adult resident population in Singapore.

METHOD

Data are from the Singapore Mental Health Study, which was a household survey of a nationally representative sample. The main instrument used was the Composite International Diagnostic Interview (CIDI). Employment-related information was collected using the modified employment module of the CIDI.

RESULTS

A total of 6,429 respondents were included in the analysis, 71 % (n = 4,594) were employed, 24.5 % (n = 1,522) were economically inactive and 4.5 % (n = 313) were unemployed. Among the employed, 2.3 % had a 12-month prevalence of at least one mental disorder, while 5.3 % of the unemployed had at least one mental disorder. The average number of work loss days (absenteeism) per capita among those with a mental disorder was 0.5 per month that is equivalent to an annualized national projection of approximately 0.3 million productivity days. The average work-cutback days (presenteeism) were 0.4 days among this group. Of the mentally ill in the workforce, a high proportion (86.5 %) did not ever seek help for problems related to mental health.

CONCLUSION

Our findings provide information on the significant consequences of mental disorders on the workforce in terms of lost work productivity, which could pave the way for a more rational allocation of scarce resources.

Perceived needs for and use of workplace accommodations by individuals with a depressive and/or anxiety disorder

OBJECTIVE

To estimate the percentages of need for and use of workplace mental health accommodations, and to identify factors related to the use of accommodations.

METHODS

Participants with a mental disorder, identified from the community, were questioned about need for and use of workplace accommodations (n = 784). Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Eighty-three percent needed accommodations; only 30.5% had received accommodations. Having received accommodations was not related to demographic or socioeconomic factors. Participants with a 12-month disorder were less likely to have received accommodations than others.

CONCLUSIONS

A significant proportion of workers with a mental disorder and need for accommodations have not received accommodations at their workplaces. The accommodations needed by this population are not expensive and can potentially be provided by modifying management practices.

Evidence-based pharmacotherapy of panic disorder: an update

The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option. Temporary co-administration of benzodiazepines can be considered. Maintenance treatment reduces relapse rates, but further research to determine optimal duration is needed. For patients not responding to first-line agents several pharmacotherapy options are available, but there is a notable paucity of data on the optimal choice.

Three job-related stress models and depression: a population-based study

OBJECTIVES

To estimate the current prevalence of major depression in a sample of working population, and to examine the associations between job strain, effort-reward imbalance and family-work conflicts and major depression.

METHODS

A sample of employees who were between the ages of 25 and 65 years and who were working in Alberta at the time of survey was recruited using the method of random digit dialing (n = 4,302). Data about job stress, effort-reward imbalance and work-family conflicts and depression were collected via telephone. Depression was assessed by the Patient Health Questionnaire (PHQ-9) for depression.

RESULTS

The 2-week prevalence of major depression based on the DSM algorithm was 3.2%. The prevalence of severe depression was 0.8%. Job strain, effort-reward imbalance and work-family conflicts were strongly associated with continuous depression score. Effort-reward imbalance was significantly associated with depression scores in women, but not in men. Effort-reward imbalance was significantly associated with depression scores in participants with job strain ratio >1, but not in those with a lower job strain ratio. The association between work to family conflict and depression score was stronger in participants with a job strain ratio greater than one than in those whose job strain ratio was one or less.

CONCLUSIONS

The three job-related stress models are widely used in occupational health research. They are equally important in predicting depression and interact with each other. Improving work environment based on these models holds potentials to reduce the synergetic effects, therefore, improving employees' mental health.

Physical and mental illness burden: disability days among working adults

This study examines the association between physical and mental health conditions and disability days among a nationally representative working population, after controlling for basic sociodemographic variables, moderating variables, and comorbidities. Cross-sectional data from the Medical Expenditure Panel Survey (MEPS) for 2007 was used. T tests and linear regressions were used to examine differences in disability days by comorbidities. The average number of disability days by condition ranged from 4 days for impulse control disorders to a maximum of 18 days for stroke. Comorbidities explain all of the disability days for allergies. The contribution of comorbidities to disability days varied from 0% for stroke and 14% for cancer to 72% for diabetes and 77% for asthma. Among those with mental illnesses, comorbidities contributed 64% of the disability days for anxiety and only 18% for depression. The associations between comorbidities and disability days varied by type of physical and mental condition. Except for stroke, cancer, and depression, illness burden was exacerbated by comorbidities. Treatment strategies and plans must focus on comanagement of chronic conditions to reduce disability days.

Prevalence, treatment, and control of depressive symptoms in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2005-2008

BACKGROUND

depression remains a major public health problem that is most often evaluated and treated in primary care settings. The objective of this study was to examine the prevalence, treatment, and control of depressive symptoms in a national data sample using a common primary care screening tool for depression.

METHODS

we analyzed a sample of adults (n = 4836) from 2005 to 2008 National Health and Nutrition Examination Survey data. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) to determine the overall prevalence, rates of treatment, and antidepressant control of mild, moderate, moderately severe, and severe depressive symptoms.

RESULTS

of the sample, 20.1% reported significant depressive symptoms (PHQ-9) score, ≥ 5), the majority of whom had mild depressive symptoms (PHQ-9) score, 5-9). Even among individuals with severe depressive symptoms, a large percentage (36.9%) received no treatment from a mental health professional or with antidepressant medication. Of those taking antidepressants, 26.4% reported mild depressive symptoms and 18.8% had moderate, moderately severe, or severe depressive symptoms.

CONCLUSIONS

despite greater awareness and treatment of depression in primary care settings, the prevalence of depressive symptoms remains high, treatment levels remain low, and control of depressive symptoms are suboptimal. Primary care providers need to continue to focus their efforts on diagnosing and effectively treating this important disease.

The prevalence of mental disorders in the working population over the period of global economic crisis

OBJECTIVES

The ongoing global economic crisis may have affected people's mental health. This study aimed to, among a sample of the working population, estimate and compare the prevalence of depressive and anxiety disorders in different time intervals from January 2008 to October 2009 and to examine the demographic and socioeconomic correlates of mental disorders.

METHODS

From January 2008 to October 2009, 3579 employees in Alberta were recruited using the random digit dialing method. Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview-Auto 2.1. The lifetime and 12-month prevalence of depressive and anxiety disorders in different time intervals were estimated and compared.

RESULTS

The 12-month prevalence of major depressive disorder (MDD) before September 1, 2008; between September 1, 2008, and March 1, 2009; and between March 1, 2009, and October 30, 2009, was 5.1%, 6.8%, and 7.6% (P = 0.03), respectively. The lifetime prevalence of dysthymia reported during the 3 periods was 0.4%, 0.7%, and 1.5% (P = 0.006), respectively. No changes in the 12-month prevalence of social phobia, panic disorder, and generalized anxiety disorder were found over time.

CONCLUSIONS

The ongoing global economic crisis may have contributed to the increased prevalence of MDD. Future studies are needed to monitor the changes in the prevalence and to describe how the event may affect people's employment status, income, and health.

Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder

OBJECTIVE

To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described.

DATA SOURCES

PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search.

STUDY SELECTION

Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning.

DATA EXTRACTION

Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described.

DATA SYNTHESIS

MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs.

CONCLUSIONS

In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.

Clinical and subthreshold panic disorder

BACKGROUND

Panic disorder (PD) is a highly prevalent and disabling condition, and subthreshold cases may be even more prevalent. This study examined psychiatric comorbidities, work functioning, and health-care utilization of individuals with subthreshold panic. The purpose of this study was to add to the accumulating evidence of significant comorbidity and disability associated with subthreshold PD.

METHODS

Data are drawn from the Health Care for Communities study, a national household survey of the United States' adult, civilian, noninstitutionalized population (N=9585). Data assessing psychiatric disorders, employment and work productivity, and health-care utilization were collected. Seven categories of panic and subthreshold panic were created.

RESULTS

The prevalence of clinical and subthreshold panic in the general population was 40%. Subthreshold panic was associated with increased odds of several comorbid disorders, including depression, dysthymia, psychosis, generalized anxiety disorder, bipolar disorder, and alcohol and drug use disorders. Subthreshold panic was also associated with greater likelihood of health-care service utilization but not with the intensity of mental health services.

CONCLUSION

Psychiatric comorbidities and health-care utilization are common among patients with subthreshold panic. The relationship between varying degrees of panic symptomology and other mental health problems and indices of functioning impairment warrants further investigation. These results inform further research focusing on the course of subthreshold PD and its impact on quality of life.

Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees

Workplace discrimination reports have recently increased in the U.S. Few studies have examined racial/ethnic differences and the mental health consequences of this exposure. We examined the association between self-reported workplace discrimination and depressive symptoms among a multi-ethnic sample of hospital employees. Data came from the prospective case-control Gradients of Occupational Health in Hospital Workers (GROW) study (N = 664). We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms and measured the occurrence, types, and frequency of workplace discrimination. African Americans were more likely than other racial/ethnic employees to report frequent and multiple types of discrimination exposure. Multivariate relationships were examined while controlling for socio-demographic factors, job strain, and general social stressors. After adjustment, workplace discrimination occurrence and frequency were positively associated with depressive symptoms. The positive association between workplace discrimination and depressive symptoms was similar across racial and ethnic groups. Reducing workplace discrimination may improve psychosocial functioning among racial/ethnic minority hospital employees at greatest risk of exposure.

Using the interaction of mental health symptoms and treatment status to estimate lost employee productivity

OBJECTIVE

In Australia it has been estimated that mental health symptoms result in a loss of $ AU2.7 billion in employee productivity. To date, however, there has been only one study quantifying employee productivity decrements due to mental disorders when treatment-seeking behaviours are considered. The aim of the current paper was to estimate employee work productivity by mental health symptoms while considering different treatment-seeking behaviours.

METHOD

A total of 60 556 full-time employees responded to the World Health Organization Health and Work Performance Questionnaire. This questionnaire is designed to monitor the work productivity of employees for chronic and acute physical and mental health conditions. Contained within the questionnaire is the Kessler 6, a scale measuring psychological distress along with an evaluation of employee treatment-seeking behaviours for depression, anxiety and any other emotional problems. A univariate analysis of variance was performed for employee productivity using the interaction between Kessler 6 severity categories and treatment-seeking behaviours.

RESULTS

A total of 9.6% of employees have moderate psychological distress and a further 4.5% have high psychological distress. Increasing psychological distress from low to moderate then to high levels is associated with increasing productivity decrements (6.4%, 9.4% and 20.9% decrements, respectively) for employees in current treatment. Combining the prevalence of Kessler 6 categories with treatment-seeking behaviours, mean 2009 salaries and number of Australian employees in 2009, it is estimated that psychological distress produces an $ AU5.9 billion reduction in Australian employee productivity per annum.

CONCLUSIONS

The estimated loss of $ AU5.9 billion in employee productivity due to mental health problems is substantially higher than previous estimates. This finding is especially pertinent given the global economic crisis, when psychological distress among employees is likely to be increasing. Effective treatment for mental health problems yields substantial increases in employee productivity and would be a sound economic investment for employers.

Improvement of postmenopausal depressive and anxiety symptoms after treatment with isoflavones derived from red clover extracts

OBJECTIVE

To evaluate the effect of isoflavones derived from red clover extracts (MF11RCE) over anxiety and depressive symptoms among postmenopausal women.

METHODS

One hundred and nine postmenopausal women aged 40 or more were randomly assigned to receive two daily capsules of MF11RCE (80mg red clover isoflavones, Group A) or placebo of equal appearance (Group B) for a 90-day period. After a washout period of 7 days, medication was crossed over and taken for 90 days more. Anxiety and depressive symptoms were measured at baseline, 90 and 187 days with the Hospital Anxiety and Depression Scale (HADS) and Zung's Self Rating Depression Scale (SDS).

RESULTS

After receiving the MF11RCE compound the total HADS (anxiety and depression subscale scores also) and the total SDS scores decreased significantly. This effect was equivalent to a 76.9% reduction in the total HADS score (76% for anxiety and 78.3% for depression) and an 80.6% reduction in the total SDS score. After placebo, total HADS (anxiety and depression subscale also) and total SDS scores also decreased significantly in comparison to baseline but only equivalent to an average 21.7% decline.

CONCLUSION

Red clover derived isoflavones (MF11RCE) were effective in reducing depressive and anxiety symptoms among postmenopausal women.

Racial/ethnic differences in the effects of psychiatric disorders on employment

Prior research on the disability burden of mental disorders has focused on the non-Latino white population, despite the growing size and importance of racial/ethnic minorities in the labor market and in the US population as a whole. This paper is one of the first to test for racial/ethnic differences in the effects of mental disorder on employment outcomes with data from the National Institute of Mental Health (NIMH) Collaborative Psychiatric Epidemiological Studies (CPES). We find that recent psychiatric disorder is associated with a reduction in the likelihood of employment for men of all racial/ethnic groups relative to non Latino whites with the possible exception of Caribbeans. These findings are driven by the effects of anxiety and affective disorders. For females, only affective disorders appear to detract from employment overall. Much larger negative effects are found for Latino women with anxiety disorders.

Prevalence and Correlates of Childhood-Onset Anxiety Disorders among Latinos and Non-Latino Whites in the United States

Anxiety disorders are the most prevalent class of psychiatric disorders (Kessler, et al., 2005) and their early onset places individuals at risk for a wide range of subsequent problems (Weissman, et al., 1999). Data from the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R) were used to investigate the prevalence and correlates of childhood-onset anxiety disorders among U.S.-born whites, U.S.-born Latinos, and foreign-born Latinos. Significant differences in rates of childhood-onset anxiety disorders were found, with foreign-born Latinos reporting the lowest rates. Across all three ethnicity/nativity groups, individuals with childhood-onset anxiety disorders had equal or higher levels of past-year impairment, relative to individuals with adult-onset anxiety disorders. The chronic course associated with childhood-onset anxiety disorders was also revealed to be present regardless of ethnicity and nativity, as indicated by the similarities across groups in the mean number of lifetime disorders and comorbidity rates. Treatment and assessment recommendations are discussed with respect to the findings.

Employee absenteeism measures reflecting current work practices may be instrumental in a re-evaluation of the relationship between psychological distress/mental health and absenteeism

Absenteeism rates are the cornerstone metrics guiding corporate policy for health care investment in employees. However, traditional absenteeism measures do not reflect the contemporary workplace milieu. It is accepted practice that employees work evenings or weekends to makeup time. Using a hours-based absenteeism measure, that accounts for time made-up as well as time lost, this paper evaluates the impact of psychological distress on employee absenteeism.Psychological distress and absenteeism data were collected from 54,264 full-time employees. Consistent with traditional approaches, employees indicated how many days they were absent. Hours based absenteeism was formulated from the ratio of how many hours the employees worked and how many hours were they expected to work in the past seven-days.Concordant with previous concinnous evidence, traditional absenteeism computation indicated that elevated psychological distress is associated with increasing absenteeism. Using the hours-based method psychological distress did not significantly influence absenteeism.Traditional calculations of absenteeism do not reflect the current work practices of the majority of employees. Employees with psychological distress may take time off work but it appears that they make up for lost time possibly to stay up to speed with task driven occupations and avoid performance review.

Mediators of the association between depression and role functioning

OBJECTIVE

While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear.

METHOD

Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning.

RESULTS

The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant).

CONCLUSIONS

Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning.

Sickness absence due to depressive symptoms

OBJECTIVE

There is no information on the duration of absence of depressed Dutch workers. The aim of this study was to determine the duration of sickness absence due to depressive symptoms in the working population.

METHODS

In this observational study of 15% of the Dutch working population, all absence episodes (n = 9,910) starting between April 2002 and November 2005 diagnosed as depression were selected. For these episodes, Kaplan-Meier survival curves were computed.

RESULTS

The mean (and median) duration of sickness absence due to depressive symptoms was 200 (179) days in men and 213 (201) days in women. In both sexes, older employees had longer absence durations. Depressive symptoms had an estimated rate of chronicity (1 year of absence) of 24%. Employees in educational and public services (232 days in men and 242 days in women), commercial services (213 days in men and 219 days in women) and health care (212 days in men and 214 days in women) had the longest mean duration of absence with depressive symptoms. Men in the industrial sector (189 days) had the shortest absence periods. Employees in large sized companies (188 days in men and 208 days in women) had shorter absence episodes as compared to companies with less than 75 employees (214 days in men and 226 days in women).

CONCLUSIONS

Workers with depressive symptoms were absent for a long time. Explanations for the long duration are discussed. It is recommended to develop and apply tools for recognizing employees at risk for chronic depression.

The prevalence and correlates of workplace depression in the national comorbidity survey replication

OBJECTIVE

To review evidence on the workplace prevalence and correlates of major depressive episodes, with a particular focus on the National Comorbidity Survey Replication, the most recent national survey to focus on these issues.

METHOD

Nationally representative survey of Diagnostic and Statistical Manual, 4th Revision Mental Disorders.

RESULTS

A total of 6.4% of employed National Comorbidity Survey Replication respondents had 12-month major depressive disorder. An additional 1.1% had major depressive episodes due to bipolar disorder or mania-hypomania. Only about half of depressed workers received treatment. Fewer than half of treated workers received care consistent with published treatment guidelines.

CONCLUSIONS

Depression disease management programs can have a positive return-on-investment from the employer perspective, but only when they are based on best practices. Given the generally low depression treatment quality documented here, treatment quality guarantees are needed before expanding workplace depression screening, outreach, and treatment programs.

Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders

This study assessed the factor structure, internal consistency, and discriminatory validity of the World Health Organization Disability Assessment Schedule (WHODAS) version used in the European Study of the Epidemiology of Mental Disorders (ESEMeD). In total 8796 adults were assessed using the ESEMeD WHODAS (22 severity and 8 frequency items). An Exploratory Factor Analysis (EFA) with promax rotation was done with a random 50%. The other half was used for confirmatory factor analysis (CFA) comparing models (a) suggested by EFA; (b) hypothesized a priori; and (c) reduced with four items. A CFA model with covariates was conducted in the whole sample to assess invariance across Mediterranean (Spain, France and Italy) and non-Mediterranean (Belgium, Germany and the Netherlands) countries. Cronbach's alphas and discriminatory validity were also examined. EFA identified seven factors (explained variance: 80%). The reduced model (six factors, four frequency items excluded) presented the best fit [Confirmatory Fit Index (CFI) = 0.992, Tucker-Lewis Index (TLI) = 0.996, Root Mean Square Error of Approximation (RMSEA) = 0.024]. The second-order factor structure also fitted well (CFI = 0.987, TLI = 0.991, RMSEA = 0.036). Measurement non-invariance was found for Embarrassment. Cronbach's alphas ranged from 0.84 for Participation to 0.93 for Mobility. Preliminary data suggest acceptable discriminatory validity. Thus, the ESEMeD WHODAS may well be a valuable shortened version of the WHODAS-II, but future users should reconsider the filter questions.

Psychiatric disorders and labor market outcomes: evidence from the National Latino and Asian American Study

This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes in two rapidly growing populations that have not been studied to date-ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study (NLAAS), we examine the labor market effects of meeting diagnostic criteria for any psychiatric disorder in the past 12 months as well as the effects of psychiatric distress in the past year. The labor market outcomes analyzed are current employment status, the number of weeks worked in the past year among those who are employed, and having at least one work absence in the past month among those who are employed. Among Latinos, psychiatric disorders and mental distress are associated with detrimental effects on employment and absenteeism, similar to effects found in previous analyses of mostly white, American born populations. Among Asians, we find more mixed evidence that psychiatric disorders and mental distress detract from labor market outcomes. Our findings suggest that reducing disparities and expanding access to effective treatment may have significant labor market benefits-not just for majority populations, as has been demonstrated, but also for Asians and Latinos.

The global burden of anxiety and mood disorders: putting the European Study of the Epidemiology of Mental Disorders (ESEMeD) findings into perspective

This article compares the preliminary, descriptive European Study of The Epidemiology of Mental Disorders (ESEMeD) findings reported in this supplement with 8 broad patterns of results found in previous psychiatric epidemiologic surveys. It is a systematic review of the literature on community epidemiologic surveys of anxiety and mood disorders. It concludes that the ESEMeD findings are broadly consistent with the patterns found in previous surveys but faults the preliminary ESEMeD analyses for failing to distinguish cases by severity and to consider the effects of severity on need for treatment. The fact that the ESEMeD surveys collected much richer data than previous psychiatric epidemiologic surveys on role impairment, symptom severity, and episode duration makes it possible to develop more useful classifications of clinical severity in future analyses. Elaborations that feature such distinctions have the potential to substantially increase the relevance of the ESEMeD findings for European health care policy.

Risk factors for depression after a disaster

Environmental stressors such as mass disasters may contribute to an increased prevalence of depression within the population affected. We examined the prevalence of probable major depression and risk factors for depression in the 6-month period after the September 11, 2001, attacks on the World Trade Center among New York City (NYC) metropolitan residents. A total of 2700 persons who were representative of the NYC metropolitan area were included in this cross-sectional telephone survey. The prevalence of probable major depression in the 6 months after the attacks was 9.4%. Multivariate logistic regression covariates associated with the likelihood of probable major depression included being directly affected by the attacks, having a perievent panic attack, experiencing multiple life stressors, and having been exposed to previous traumatic events. Mass traumatic event exposure appears to be an independent environmental risk factor for depression in the postdisaster context; specific reactions such as perievent panic attacks may have prognostic value.

Depression and activity limitations: examining gender differences in the general population

BACKGROUND

This study examines the relationship between major depression, subclinical depressive symptomatology and activity limitation in a representative sample of Canadian men and women, with a particular emphasis on examining gender differences.

METHODS

Over a 4-year period, the three waves of data were collected from a representative sample of Canadian adults aged 18-60 beginning in 1994. A brief diagnostic interview for major depression, current limitations in home, work, and other activities (e.g., leisure), presence of each of 13 chronic medical conditions, and other sociodemographic information were gathered. Regression analyses adjusted for potential confounding of time-dependent and time-invariant covariates. These analyses were performed separately for men and women.

RESULTS

Major depression had a significant adverse impact on all types of activities for the entire community sample, and this impact was generally robust when controlling for potential confounders. Gender differences were observed for leisure activities with depressed men showing a higher likelihood of limitation in these activities than depressed women.

CONCLUSIONS

The findings provide further evidence that major depression leads to impairments in a range of daily activities. Gender differences in the impact of depression on leisure activities may be important to consider in depression treatment.

Prevalência de transtornos mentais em trabalhadores de uma universidade pública do estado de São Paulo

Em uma amostra com 552 trabalhadores de uma universidade pública do interior do estado de São Paulo, realizou-se um estudo epidemiológico de corte transversal, objetivando estimar a prevalência anual de Suspeição para Transtornos Mentais (STM). Foi utilizado o Questionário de Morbidade Psiquiátrica de Adultos-QMPA (SANTANA, 1982) em versão validada para uso em população trabalhadora (GUIMARÃES, 1992). Encontrou-se uma prevalência anual de 35% de STM. Associações estatisticamente significativas foram obtidas entre STM e: gênero (p = 0,01); estado civil (p = 0,05); religião (p = 0,05); renda familiar (p = 0,01); maior número de faltas/mês (p = 0,00). Não foram encontradas associações estatisticamente significativas entre STM e: idade, escolaridade, local de trabalho. Obteve-se somente uma tendência à associação entre STM e mudança de local de trabalho no último ano (p = 0,08). A alta prevalência de STM encontrada alerta para a magnitude do problema na organização, evidenciando a urgência da implantação de medidas preventivas relativas aos fatores psicossociais de risco e a necessidade de intervenções adequadas para o enfrentamento dos mesmos.

Empirical limits for the forensic assessment of PTSD litigants

This paper discusses the limits of expert opinion on posttraumatic stress disorder (PTSD) in personal injury claims. The construct of PTSD is hampered by several empirical limitations. Multiple reliable measures of PTSD exist, but have not been evaluated sufficiently within litigating samples and are infrequently used by forensic assessors. Common methods for trauma screening appear insensitive. Opinions about causation of PTSD and disability are complicated by retrospective memory biases, as well as the failure of most anxiety disorders to be detected within primary medical care. PTSD appears to have a steep spontaneous remission curve during the first year, but at least 10% of trauma-exposed people suffer chronic distress. Little is known about the course beyond 1 year. Efficacious psychological treatments have been developed for PTSD, but are not in common use limiting claimants' access to rehabilitative treatments. Research on functional disability associated with PTSD is in its infancy, but it seems likely that PTSD will account for only a part of the variance in work disability. We provide suggestions for improving forensic practice, advising the courts about the limitations of forensic opinions, and necessary research.

The National Comorbidity Survey Replication (NCS-R): background and aims

The National Comorbidity Survey Replication (NCS-R) is a new nationally representative community household survey of the prevalence and correlates of mental disorders in the US. The NCS-R was carried out a decade after the original NCS. The NCS-R repeats many of the questions from the NCS and also expands the NCS questioning to include assessments based on the more recent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostics system (American Psychiatric Association, 1994). The NCS-R was designed to (1) investigate time trends and their correlates over the decade of the 1990s and (2) expand the assessment of the prevalence and correlates of mental disorders beyond the assessment in the baseline NCS in order to address a number of important substantive and methodological issues that were raised by the NCS. This paper presents a brief review of these aims.

Anxiety disorders in women

Women have higher overall prevalence rates for anxiety disorders than men. Women are also much more likely than men to meet lifetime criteria for each of the specific anxiety disorders: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), simple phobia, panic disorder, and agoraphobia. Considerable evidence suggests that anxiety disorders remain underrecognized and undertreated despite their association with increased morbidity and severe functional impairment. Increasing evidence suggests that the onset, presentation, clinical course, and treatment response of anxiety disorders in women are often distinct from that associated with men. In addition, female reproductive hormone cycle events appear to have a significant influence on anxiety disorder onset, course, and risk of comorbid conditions throughout a woman's life. Further investigations concerning the unique features present in women with anxiety disorders are needed and may represent the best strategy to increase identification and optimize treatment interventions for women afflicted with these long-neglected psychiatric disorders.

The economic burden of depression and the cost-effectiveness of treatment

Cost-of-illness research has shown that depression is associated with an enormous economic burden, in the order of tens of billions of dollars each year in the US alone. The largest component of this economic burden derives from lost work productivity due to depression. A large body of literature indicates that the causes of the economic burden of depression, including impaired work performance, would respond both to improvement in depressive symptomatology and to standard treatments for depression. Despite this, the economic burden of depression persists, partly because of the widespread underuse and poor quality use of otherwise efficacious and tolerable depression treatments. Recent effectiveness studies conducted in primary care have shown that a variety of models, which enhance care of depression through aggressive outreach and improved quality of treatments, are highly effective in clinical terms and in some cases on work performance outcomes as well. Economic analyses accompanying these effectiveness studies have also shown that these quality improvement interventions are cost efficient. Unfortunately, widespread uptake of these enhanced treatment programmes for depression has not occurred in primary care due to barriers at the level of primary care physicians, healthcare systems, and purchasers of healthcare. Further research is needed to overcome these barriers to providing high-quality care for depression and to ultimately reduce the enormous adverse economic impact of depression disorders.

Disability and its economic impact among adults with diabetes

The objective of this study was to estimate the annual cost of disability among people with diabetes. Data from the 1994 Behavioral Risk Factor Surveillance System (n = 83,566) of US individuals aged 18 to 64 years were used to estimate the annual cost of disability among people with self-reported diabetes. After we adjusted for relevant socioeconomic characteristics, logistic regression analyses demonstrated that people with diabetes are more likely to stop working outside the home (for men: adjusted odds ratio, 3.1; 95% confidence interval, 1.2 to 8.0; for women: adjusted odds ratio, 2.9; 95% confidence interval, 1.0 to 8.8). The annual cost of disability among people with diabetes was estimated at $9.3 billion in 1994. Disability among people with diabetes is a major public health problem. Efforts to reduce disability in this population could create substantial gains in productivity.

Public policy and employment of people with disabilities: exploring new paradigms

A "sea change" in public attitudes, legislation, and political power at the end of the 20th century in the United States has helped set the stage in the early 21st century for the entry of people with disabilities into the labor force. Major pieces of federal legislation have altered national policy with the intention of maximizing the work force participation of people with disabilities. At the same time, a new theoretical paradigm of disability has emerged, which emphasizes community inclusion, accommodation, and protection of civil rights. This "New Paradigm" of disability can be applied in concert with rigorous behavioral science methodologies to shed light on the outcomes of recent federal policy changes regarding the labor force participation of people with disabilities. In so doing, social science can be used in more meaningful ways to understand both the intended and unintended consequences of federal policy.