1
|
Simcock G, Andersen T, McLoughlin LT, Beaudequin D, Parker M, Clacy A, Lagopoulos J, Hermens DF. Suicidality in 12-Year-Olds: The Interaction Between Social Connectedness and Mental Health. Child Psychiatry Hum Dev 2021; 52:619-627. [PMID: 32845408 DOI: 10.1007/s10578-020-01048-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicidal thoughts and behaviors (STB) are a leading cause of death in adolescence. To date, most research with youth has focused on risk factors for suicide; and less attention has been paid to resilience factors. This study examined whether positive beliefs and social connectedness moderate associations between mental health symptoms and STB. A community sample of 12-year-olds (N = 60) completed self-report questionnaires on their STB, mental health symptoms, positive beliefs and social connectedness. Nearly 20% of the adolescents reported STB. STB was associated with increased mental health symptoms and lower scores on the resilience measures. A significant moderating effect of social connectedness showed that youth with a combination of poor mental health and high levels of social support exhibited lower levels of STB. There was no significant moderating effect of positive beliefs. These results indicate that social support should be screened for in primary care and incorporated into youth suicide prevention programs.
Collapse
Affiliation(s)
- Gabrielle Simcock
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia.
| | - Thu Andersen
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Larisa T McLoughlin
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Denise Beaudequin
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Marcella Parker
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Amanda Clacy
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD, 4575, Australia
| |
Collapse
|
2
|
Associations between Facial Emotion Recognition and Mental Health in Early Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010330. [PMID: 31947739 PMCID: PMC6981578 DOI: 10.3390/ijerph17010330] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/17/2022]
Abstract
Research shows that adolescents with mental illnesses have a bias for processing negative facial emotions, and this may play a role in impaired social functioning that often co-exists with a mental health diagnosis. This study examined associations between psychological and somatic problems and facial emotion recognition in early adolescence; as any processing biases in this age-group may be an early indicator of later mental illnesses. A community sample of 40 12-year-olds self-rated their symptoms of anxiety, depression, and somatization via two mental health screeners. They also completed a computerized emotion recognition task in which they identified photographs of 40 faces showing expressions of anger, fear, sadness, happiness, or neutral expression. Results showed that increased symptoms of anxiety, depression, and somatization were significantly associated with fewer correct responses to angry expressions. These symptoms were also associated with faster and more accurate recognition of fearful expressions. However, there was no association between mental health and recognition of sad affect. Finally, increased psychological and/or somatic symptomology was also associated with better identification of neutral expressions. In conclusion, youth with increased psychological and/or somatic problems exhibited a processing bias for negative anger and fear expressions, but not sadness. They showed better processing of neutral faces than youth with fewer psychological and/or somatic problems. Findings are discussed in relation to indicators of mental illnesses in early adolescence and the potential underpinning neural mechanisms associated with mental health and emotional facial recognition.
Collapse
|
3
|
Scott J, Davenport TA, Parker R, Hermens DF, Lind PA, Medland SE, Wright MJ, Martin NG, Gillespie NA, Hickie IB. Pathways to depression by age 16 years: Examining trajectories for self-reported psychological and somatic phenotypes across adolescence. J Affect Disord 2018; 230:1-6. [PMID: 29355726 DOI: 10.1016/j.jad.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/16/2017] [Accepted: 12/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sex differences in rates of depression emerge during adolescence. However, it is unclear whether symptom patterns and trajectories differ significantly according to gender in youth. Barriers to research include the fact that most self-report tools are weighted towards psychological rather than somatic symptoms. METHODS Data were collected on symptoms of depression in about 1800 individuals at ages 12, 14 and 16 years. Odds ratios and 95% confidence intervals were used to examine the trajectory of psychological and somatic phenotypes and self-reported depression caseness over time. RESULTS At age 12, 24% of participants met criteria for self-reported depression caseness. Although there was only a small incremental increase in the prevalence over time (about 5%), 57% of participants met criteria for self-reported depression caseness at least once. Generic symptoms at age 12 were associated with depression longitudinally, although early transition to caseness was reported in females only. Categorization as a psychological phenotype at age 12 predicted depression at age 14 and/or 16 years, especially in females. The somatic phenotype was more common in males, but showed a weaker association with self-reported depression caseness over time. LIMITATIONS Depression was assessed by self-report; only 30% of participants had ratings for age 12, 14 and 16. CONCLUSIONS Although sub-threshold psychological and somatic syndromes often co-occur in cases of self-reported depression in adolescence, longitudinally they may represent independent symptom trajectories. However, it is important to remember that self-reported depression is indicative of, but not confirmation of a depressive episode that meets diagnostic criteria.
Collapse
Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Brain & Mind Centre, University of Sydney, Sydney, Australia.
| | | | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Penelope A Lind
- Queensland Brain Institute, the University of Queensland, Brisbane, Australia
| | - Sarah E Medland
- Centre for Advanced Imaging, the University of Queensland, Brisbane, Australia
| | - Margaret J Wright
- Queensland Brain Institute, the University of Queensland, Brisbane, Australia; Centre for Advanced Imaging, the University of Queensland, Brisbane, Australia
| | - Nicholas G Martin
- Queensland Brain Institute, the University of Queensland, Brisbane, Australia
| | - Nathan A Gillespie
- Centre for Advanced Imaging, the University of Queensland, Brisbane, Australia; Virginia Institute for Psychiatric and Behavioral Genetics, VCU, Richmond, VA, USA
| | - Ian B Hickie
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| |
Collapse
|
4
|
Busovaca E, Zimmerman ME, Meier IB, Griffith EY, Grieve SM, Korgaonkar MS, Williams LM, Brickman AM. Is the Alzheimer's disease cortical thickness signature a biological marker for memory? Brain Imaging Behav 2017; 10:517-23. [PMID: 26040979 DOI: 10.1007/s11682-015-9413-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent work suggests that analysis of the cortical thickness in key brain regions can be used to identify individuals at greatest risk for development of Alzheimer's disease (AD). It is unclear to what extent this "signature" is a biological marker of normal memory function - the primary cognitive domain affected by AD. We examined the relationship between the AD signature biomarker and memory functioning in a group of neurologically healthy young and older adults. Cortical thickness measurements and neuropsychological evaluations were obtained in 110 adults (age range 21-78, mean = 46) drawn from the Brain Resource International Database. The cohort was divided into young adult (n = 64, age 21-50) and older adult (n = 46, age 51-78) groups. Cortical thickness analysis was performed with FreeSurfer, and the average cortical thickness extracted from the eight regions that comprise the AD signature. Mean AD-signature cortical thickness was positively associated with performance on the delayed free recall trial of a list learning task and this relationship did not differ between younger and older adults. Mean AD-signature cortical thickness was not associated with performance on a test of psychomotor speed, as a control task, in either group. The results suggest that the AD signature cortical thickness is a marker for memory functioning across the adult lifespan.
Collapse
Affiliation(s)
- Edgar Busovaca
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 16, New York, NY, 10032, USA
| | - Molly E Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Irene B Meier
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 16, New York, NY, 10032, USA
| | - Erica Y Griffith
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 16, New York, NY, 10032, USA
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia
- Brain Dynamics Centre, Westmead Millennium Institute, Westmead, Australia
- Sydney Medical School, Westmead, Australia
| | - Mayuresh S Korgaonkar
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia
- Brain Dynamics Centre, Westmead Millennium Institute, Westmead, Australia
- Sydney Medical School, Westmead, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education, Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 16, New York, NY, 10032, USA.
| |
Collapse
|
5
|
Vasiliadis HM, Dezetter A. Les programmes de prise en charge financière des psychothérapies en Australie et en Angleterre. SANTE MENTALE AU QUEBEC 2016. [DOI: 10.7202/1036096ar] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
L’article décrit les programmes de prise en charge financière des psychothérapies en Australie et en Angleterre.
Au début des années 2000, le gouvernement australien a implanté une réforme de santé publique visant à permettre un meilleur accès, gratuit ou peu coûteux, aux psychothérapies brèves, en soin primaire, pour les personnes souffrant de troubles mentaux courants. Cette réforme reconnaît l’importance du rôle du médecin généraliste dans la prise en charge des troubles, et la collaboration avec les professionnels de santé mentale. Deux programmes ont été mis en oeuvre : Access to Allied Psychological Services en 2003 et Better Access en 2006. En 2009, deux millions d’Australiens ont reçu onze millions de séances de psychothérapies. Les études ont montré des résultats positifs sur l’amélioration de l’accès aux soins de santé mentale primaires et sur la santé des patients.
L’Angleterre a mis en place le programme Improving Access to psychological Therapies en 2007 en offrant un service de psychothérapies brèves pour les personnes souffrant de troubles mentaux courants. Le modèle de soin en étape suit les guides cliniques du National Institute for Health and Clinical Excellence, le type de professionnel (counselor ou psychothérapeute formés), le nombre de séances (4 à 13) et la méthode thérapeutique varient selon la sévérité du trouble. Un million de patients ont été traités depuis le début du programme. Les études ont aussi montré des résultats de santé positifs pour les patients du programme. En conclusion les programmes de prise en charge des psychothérapies s’avèrent coûts-efficaces.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Ph. D., M. Sc., Professeure agrégée, Département des sciences de la santé communautaire, Centre de recherche, Hôpital Charles-Le Moyne, Université de Sherbrooke
| | - Anne Dezetter
- Ph. D., Département des sciences de la santé communautaire, Centre de recherche, Hôpital Charles-Le Moyne, Université de Sherbrooke
| |
Collapse
|
6
|
Spronk DB, Veth CPM, Arns M, Schofield PR, Dobson-Stone C, Ramaekers JG, Franke B, de Bruijn ERA, Verkes RJ. DBH -1021C>T and COMT Val108/158Met genotype are not associated with the P300 ERP in an auditory oddball task. Clin Neurophysiol 2012; 124:909-15. [PMID: 23261162 DOI: 10.1016/j.clinph.2012.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 10/29/2012] [Accepted: 11/06/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The amplitude and latency of the P300 may be associated by variations in dopaminergic genes. The current study was conducted to determine whether functional variants of the catechol-O-methyltransferase (COMT) and dopamine beta-hydroxylase (DBH) gene were associated with P300 amplitude and latency in an auditory oddball task. METHODS The P300 ERP was assessed by a two-tone auditory oddball paradigm in a large sample of 320 healthy volunteers. The Val108/158Met polymorphism (rs4680) of the COMT gene and the -1021C>T polymorphism (rs1611115) of the DBH gene were genotyped. P300 amplitude and latency were compared across genotype groups using analysis of variance. RESULTS There were no differences in demographic characteristics in subjects for genotypic subgroups. No genotype associations were observed for the P300 amplitude and latency on frontal, central and parietal electrode positions. CONCLUSIONS COMT Val108/158Met and DBH -1021C>T polymorphisms do not show evidence of association with characteristics of the P300 ERP in an auditory oddball paradigm in healthy volunteers. SIGNIFICANCE We failed to find evidence for the association between dopaminergic enzymatic polymorphisms and the P300 ERP in healthy volunteers, in the largest study undertaken to date.
Collapse
Affiliation(s)
- D B Spronk
- Department of Psychiatry (966), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
The Brisbane Longitudinal Twin Study: Pathways to Cannabis Use, Abuse, and Dependence project-current status, preliminary results, and future directions. Twin Res Hum Genet 2012. [PMID: 23187020 DOI: 10.1017/thg.2012.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We describe the data being collected from the Brisbane Longitudinal Twin Study in Australia as part of the US National Institute on Drug Abuse (NIDA)-funded project, Pathways to Cannabis Use, Abuse and Dependence. The history, recruitment, assessment, and retention of twin families in this project are described in detail, along with preliminary findings and plans for future research. The goal of this NIDA project is to make a significant contribution to the discovery of quantitative trait loci influencing cannabis use disorders. Although the focus is cannabis use, abuse, and dependence in young adults, measures of comorbid illicit drug use disorders are also being collected. In addition, a variety of internalizing and externalizing disorders are being assessed, funded by support from the Australian National Health and Medical Research Council. Because these same twins have participated in numerous twin studies since 1992, future plans will include linking different phenotypes to investigate relationships between drug use, psychiatric disorders, and psychological phenotypes within cross-sectional and longitudinal or developmental frameworks.
Collapse
|
8
|
Noble KG, Grieve SM, Korgaonkar MS, Engelhardt LE, Griffith EY, Williams LM, Brickman AM. Hippocampal volume varies with educational attainment across the life-span. Front Hum Neurosci 2012; 6:307. [PMID: 23162453 PMCID: PMC3494123 DOI: 10.3389/fnhum.2012.00307] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 10/24/2012] [Indexed: 11/25/2022] Open
Abstract
Socioeconomic disparities—and particularly differences in educational attainment—are associated with remarkable differences in cognition and behavior across the life-span. Decreased educational attainment has been linked to increased exposure to life stressors, which in turn have been associated with structural differences in the hippocampus and the amygdala. However, the degree to which educational attainment is directly associated with anatomical differences in these structures remains unclear. Recent studies in children have found socioeconomic differences in regional brain volume in the hippocampus and amygdala across childhood and adolescence. Here we expand on this work, by investigating whether disparities in hippocampal and amygdala volume persist across the life-span. In a sample of 275 individuals from the BRAINnet Foundation database ranging in age from 17 to 87, we found that socioeconomic status (SES), as operationalized by years of educational attainment, moderates the effect of age on hippocampal volume. Specifically, hippocampal volume tended to markedly decrease with age among less educated individuals, whereas age-related reductions in hippocampal volume were less pronounced among more highly educated individuals. No such effects were found for amygdala volume. Possible mechanisms by which education may buffer age-related effects on hippocampal volume are discussed.
Collapse
Affiliation(s)
- Kimberly G Noble
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University New York, NY, USA ; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Comorbid externalising behaviour in AD/HD: evidence for a distinct pathological entity in adolescence. PLoS One 2012; 7:e41407. [PMID: 22984398 PMCID: PMC3440414 DOI: 10.1371/journal.pone.0041407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/22/2012] [Indexed: 11/20/2022] Open
Abstract
While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group - a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.
Collapse
|
10
|
Brickman AM, Meier IB, Korgaonkar MS, Provenzano FA, Grieve SM, Siedlecki KL, Wasserman BT, Williams LM, Zimmerman ME. Testing the white matter retrogenesis hypothesis of cognitive aging. Neurobiol Aging 2012; 33:1699-715. [PMID: 21783280 PMCID: PMC3222729 DOI: 10.1016/j.neurobiolaging.2011.06.001] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 05/16/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
The retrogenesis hypothesis postulates that late-myelinated white matter fibers are most vulnerable to age- and disease-related degeneration, which in turn mediate cognitive decline. While recent evidence supports this hypothesis in the context of Alzheimer's disease, it has not been tested systematically in normal cognitive aging. In the current study, we examined the retrogenesis hypothesis in a group (n = 282) of cognitively normal individuals, ranging in age from 7 to 87 years, from the Brain Resource International Database. Participants were evaluated with a comprehensive neuropsychological battery and were imaged with diffusion tensor imaging. Fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (DA), measures of white matter coherence, were computed in 2 prototypical early-myelinated fiber tracts (posterior limb of the internal capsule, cerebral peduncles) and 2 prototypical late-myelinated fiber tracts (superior longitudinal fasciculus, inferior longitudinal fasciculus) chosen to parallel previous studies; mean summary values were also computed for other early- and late-myelinated fiber tracts. We examined age-associated differences in FA, RD, and DA in the developmental trajectory (ages 7-30 years) and degenerative trajectory (ages 31-87 years), and tested whether the measures of white matter coherence mediated age-related cognitive decline in the older group. FA and DA values were greater for early-myelinated fibers than for late-myelinated fibers, and RD values were lower for early-myelinated than late-myelinated fibers. There were age-associated differences in FA, RD, and DA across early- and late-myelinated fiber tracts in the younger group, but the magnitude of differences did not vary as a function of early or late myelinating status. FA and RD in most fiber tracts showed reliable age-associated differences in the older age group, but the magnitudes were greatest for the late-myelinated tract summary measure, inferior longitudinal fasciculus (late fiber tract), and cerebral peduncles (early fiber tract). Finally, FA in the inferior longitudinal fasciculus and cerebral peduncles and RD in the cerebral peduncles mediated age-associated differences in an executive functioning factor. Taken together, the findings highlight the importance of white matter coherence in cognitive aging and provide some, but not complete, support for the white matter retrogenesis hypothesis in normal cognitive aging.
Collapse
Affiliation(s)
- Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Maddock GR, Startup M, Carter GL. Patient characteristics associated with GP referral to the Access to Allied Psychological Services Program: a case-control study. Aust N Z J Psychiatry 2012; 46:435-44. [PMID: 22368241 DOI: 10.1177/0004867412440341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND GPs have referred patients for psychological treatment under the Better Outcomes in Mental Health Care, Access to Allied Psychological Services (ATAPS) Program since 2003. It is not known how GPs might select patients for referral. We explored which characteristics identified ATAPS patients compared to usual GP patients. METHODS The study was conducted in GP Access, a Division of General Practice (Newcastle and Lower Hunter) in NSW, Australia. It was a case-control design with 63 cases (ATAPS patients), and 64 controls (GP patients never referred to ATAPS). Unadjusted and sequentially adjusted logistic regressions were used to identify independent predictors of being an ATAPS case based on official referral guidelines: ICD-10 diagnosis of depression or anxiety and scores on the K-10 (psychological distress) and DASS-21 (psychological symptoms). A multivariable logistic regression was also used to determine the best minimum set of predictor variables. RESULTS Eight-three per cent of ATAPS cases had anxiety or depression. In unadjusted models, any mood disorder, OR 7.68 (95% CI: 3.47, 17.01), any anxiety disorder, OR 2.88 (95% CI: 1.37, 6.05), higher K-10 score, OR 1.06 (95% CI: 1.04, 1.14) and higher DASS-21 score, OR 1.06 (95% CI: 1.03, 1.09) were associated with being an ATAPS case. Any mood disorder, any anxiety disorder, K-10 score and DASS-21 scores remained significant in most adjusted analyses and all models showed change when adjusted for mental disability and physical disability. Three variables predicted being an ATAPS case in the multivariable regression: greater mental disability, lesser physical disability and greater number of substances misused. CONCLUSION Cases had higher levels of mental disability and greater substance misuse, but lower levels of physical disability. This may reflect GP referral decision making and have implications for policy development.
Collapse
|
12
|
Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NRC, Scott EM, Toppler R, Murie P, O'Malley L, McCourt J, Friedlander M, Hickie IB, Lloyd AR. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol 2012; 30:1805-12. [PMID: 22508807 DOI: 10.1200/jco.2011.34.6148] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear. PATIENTS AND METHODS A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression. RESULTS The case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment; it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization. CONCLUSION CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
Collapse
|
13
|
Webber K, Mok K, Bennett B, Lloyd AR, Friedlander M, Juraskova I, Goldstein D. If I am in the mood, I enjoy it: an exploration of cancer-related fatigue and sexual functioning in women with breast cancer. Oncologist 2011; 16:1333-44. [PMID: 21835897 DOI: 10.1634/theoncologist.2011-0100] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy. METHODS Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment. RESULTS Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than nonresponders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction. CONCLUSIONS Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder.
Collapse
Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, New South Wales 2031, Australia.
| | | | | | | | | | | | | |
Collapse
|
14
|
Kavanagh L, Rowe D, Hersch J, Barnett KJ, Reznik R. Neurocognitive deficits and psychiatric disorders in a NSW prison population. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2010; 33:20-26. [PMID: 19922999 DOI: 10.1016/j.ijlp.2009.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Approximately 75% of inmates in New South Wales (NSW) have mental health issues (Butler & Alnutt, 2003). Scarce resources force the management of acute psychiatric symptoms only, meaning that co-morbid conditions such as neurocognitive deficits are less likely to be assessed. The objective of this study was to investigate the utility of a computerized battery in the assessment of inmates within the criminal justice system. Thirty male inmates were assessed. Data were compared to matched controls. The custodial sample was characterized by an increase in the prevalence of previous trauma; high levels of depression, anxiety and stress and neurocognitive deficits, including sustained attention, impulsivity and executive dysfunction.
Collapse
Affiliation(s)
| | | | - Jolyn Hersch
- School of Psychology, University of Sydney, NSW 2006, Australia
| | | | | |
Collapse
|
15
|
Paul R, Henry L, Grieve SM, Guilmette TJ, Niaura R, Bryant R, Bruce S, Williams LM, Richard CC, Cohen RA, Gordon E. The relationship between early life stress and microstructural integrity of the corpus callosum in a non-clinical population. Neuropsychiatr Dis Treat 2008; 4:193-201. [PMID: 18728817 PMCID: PMC2515911 DOI: 10.2147/ndt.s1549] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies have examined the impact of early life stress (ELS) on the gross morphometry of brain regions, including the corpus callosum. However, studies have not examined the relationship between ELS and the microstructural integrity of the brain. METHODS In the present study we evaluated this relationship in healthy non-clinical participants using diffusion tensor imaging (DTI) and self-reported history of ELS. RESULTS Regression analyses revealed significant reductions in fractional anisotropy (FA) within the genu of the corpus callosum among those exposed to the greatest number of early life stressors, suggesting reduced microstructural integrity associated with increased ELS. These effects were most pronounced in the genu of the corpus callosum compared to the body and splenium, and were evident for females rather than males despite no differences in total ELS exposure between the sexes. In addition, a further comparison of those participants who were exposed to no ELS vs. three or more ELS events revealed lower FA in the genu of the corpus callosum among the ELS-exposed group, with trends of FA reduction in the body and the whole corpus callosum. By contrast, there were no relationships between ELS and volumetric analysis of the CC regions. The two group did not differ significantly on measures of current depression, stress or anxiety. CONCLUSION Our results reveal that greater exposure to ELS is associated with microstructural alterations in the white matter in the absence of significant volumetric changes. Importantly, our results indicate that exposure to ELS is associated with abnormalities on DTI despite the absence of clinically significant psychiatric symptoms. Future studies are needed to determine whether specific types of ELS are more likely to impact brain structure and function.
Collapse
Affiliation(s)
- Robert Paul
- University of Missouri St. Louis, St. Louis, MO, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Paul RH, Grieve SM, Niaura R, David SP, Laidlaw DH, Cohen R, Sweet L, Taylor G, Clark RC, Pogun S, Gordon E. Chronic cigarette smoking and the microstructural integrity of white matter in healthy adults: a diffusion tensor imaging study. Nicotine Tob Res 2008; 10:137-47. [PMID: 18188754 PMCID: PMC2276564 DOI: 10.1080/14622200701767829] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Results from recent studies suggest that chronic cigarette smoking is associated with increased white matter volume in the brain as determined by in vivo neuroimaging. We used diffusion tensor imaging to examine the microstructural integrity of the white matter in 10 chronic smokers and 10 nonsmokers. All individuals were healthy, without histories of medical or psychiatric illness. Fractional anisotropy (FA) and trace were measured in the genu, body, and splenium of the corpus callosum. FA provides a measure of directional versus nondirectional water diffusion, whereas trace provides a measure of nondirectional water diffusion. Lower FA and higher trace values are considered to reflect less brain integrity. Voxel-based morphometry was used to define volumes in each of these regions of the corpus callosum. Chronic smokers exhibited significantly higher FA in the body and whole corpus callosum and a strong trend for higher FA in the splenium compared with nonsmokers. FA did not differ between groups in the genu, and neither trace nor white matter volumes differed between groups in any of the regions of interest. When subdivided by Fagerström score (low vs. high), the low Fagerström group exhibited significantly higher FA in the body of the corpus callosum compared with the high Fagerström group and the nonsmokers. These results suggest that, among healthy adults, lower exposure to cigarette smoking is associated with increased microstructural integrity of the white matter compared with either no exposure or higher exposure. Additional studies are needed to further explore differences in white matter integrity between smokers and nonsmokers.
Collapse
Affiliation(s)
- Robert H Paul
- Department of Psychology, Behavioral Neuroscience, University of Missouri, St. Louis, MO 63121, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Esposito E, Wang JL, Adair CE, Williams JVA, Dobson K, Schopflocher D, Mitton C, Newman S, Beck C, Barbui C, Patten SB. Frequency and adequacy of depression treatment in a Canadian population sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:780-9. [PMID: 18186178 DOI: 10.1177/070674370705201205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Population-based data about depression treatment are largely restricted to estimates of the frequency of antidepressant (AD) use. Such frequencies are difficult to interpret in the absence of information about dosages, reasons for taking the medications, and participation in nonpharmacologic treatment. The objective of this study was to describe the pattern of treatment for major depression (MD) in Alberta. METHOD Telephone survey methods were employed. Random digit dialing was used to select a sample of 3345 household residents aged 18 to 64 years in Alberta. A computer-assisted telephone interview that included the Mini Neuropsychiatric Diagnostic Interview and questions about pharmacotherapy and psychotherapy was administered. Estimates were weighted for design features and population demographics. RESULTS The point prevalence of MD was 4.4% (95% confidence interval [CI], 3.4% to 5.5%), and the overall prevalence of current AD use was 7.4% (95% CI, 6.2% to 8.6%). The ADs taken most commonly, serotonin-specific reuptake inhibitors, were taken at therapeutic dosages 87.4% of the time. Most (80.7%) of those taking ADs reported taking them for more than 1 year. The frequency of receiving counselling, psychotherapy, or talk therapy was 3.9% overall and 14.3% in respondents with MD. However, most of these subjects were unable to name the type of counselling they were receiving. CONCLUSIONS When compared with previous estimates, these results suggest continued progress in the delivery of evidence-based care to the population. There is room for additional improvement, especially in the provision of nonpharmacologic treatment.
Collapse
|
18
|
Gunstad J, Paul RH, Cohen RA, Tate DF, Spitznagel MB, Gordon E. Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Compr Psychiatry 2007; 48:57-61. [PMID: 17145283 DOI: 10.1016/j.comppsych.2006.05.001] [Citation(s) in RCA: 433] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 03/27/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022] Open
Abstract
There is growing evidence that obesity is linked to adverse neurocognitive outcome, including reduced cognitive functioning and Alzheimer disease. However, no study to date has determined whether the relationship between body mass index (BMI) and cognitive performance varies as a function of age. We examined attention and executive function in a cross-section of 408 healthy persons across the adult life span (20-82 years). Bivariate correlation showed that BMI was inversely related to performance on all cognitive tests. After controlling for possible confounding factors, overweight and obese adults (BMI > 25) exhibited poorer executive function test performance than normal weight adults (BMI, 18.5-24.9). No differences emerged in attention test performance, and there was no evidence of a BMI x age interaction for either cognitive domain. These results provide further evidence for the relationship between elevated BMI and reduced cognitive performance and suggest that this relationship does not vary with age. Further research is needed to identify the etiology of these deficits and whether they resolve after weight loss.
Collapse
Affiliation(s)
- John Gunstad
- Department of Psychology, Kent Hall, Kent State University, Kent, OH 44242, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Cohen RA, Hitsman BL, Paul RH, McCaffery J, Stroud L, Sweet L, Gunstad J, Niaura R, MacFarlane A, Bryant RA, Gordon E. Early life stress and adult emotional experience: an international perspective. Int J Psychiatry Med 2006; 36:35-52. [PMID: 16927577 DOI: 10.2190/5r62-9pqy-0nel-tlpa] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early life stress (ELS) has been linked to adult psychopathology, though few studies have examined the universality of specific adverse childhood events (ACEs) in healthy adults. We examined the co-occurrence of specific ACEs and their relationship to current emotional distress in an international sample of adults without psychopathology. Participants were 1659 men and women recruited for an international neurocognitive-neuroimaging database from sites in the United States, Australia, England, and the Netherlands. Participants had no current or prior diagnosis of major depression, anxiety, substance abuse, or neurological brain disorder. The occurrence and age on onset of 19 ACEs was assessed by a self-report questionnaire (ELSQ), and current symptoms of stress, depression, and anxiety by the Depression Anxiety Stress Scale (DASS). The relationship of specific ACEs to DASS symptoms was examined. Participants reported relatively high prevalence of ACEs. Only 27.6% of the sample reported no ACEs, while 39.5% reported one or two significant experiences and 32.9% reported more than two ACEs. Rates of most ACEs were quite similar across the three continents. Various ACEs were significantly associated with current DASS severity, particularly ACEs involving emotional abuse, neglect, and family conflict, violence, and breakup. Finding nearly one-third of the sample reported three or more ACEs suggest a high prevalence of ELS in otherwise healthy "normal" adults around the world. Associations between ELS and current emotional distress suggest that these events have functional relevance and deserve further investigation.
Collapse
|
20
|
Hoth KF, Paul RH, Williams LM, Dobson-Stone C, Todd E, Schofield PR, Gunstad J, Cohen RA, Gordon E. Associations between the COMT Val/Met polymorphism, early life stress, and personality among healthy adults. Neuropsychiatr Dis Treat 2006; 2:219-25. [PMID: 19412467 PMCID: PMC2671786 DOI: 10.2147/nedt.2006.2.2.219] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Efforts to identify genetic factors that confer an increased risk for the expression of psychiatric symptoms have focused on polymorphisms in variety of candidate genes, including the catechol-O-methyltransferase (COMT) gene. Results from previous studies that have examined associations between the functional COMT polymorphism (Val158Met) and mental health have been mixed. In the present study, we examined the relationships between COMT, early life stress, and personality in a healthy adult sample. Consistent with previous studies, we hypothesized that individuals with the low-activity genotype would have higher neuroticism and lower extraversion and that this effect would be more pronounced in females. In addition, we extended the previous literature by investigating the potential influence of early life stress. A total of 486 healthy adults underwent genetic testing and personality assessment. Results revealed that individuals homozygous for the COMT low enzyme activity allele had lower extraversion on the NEO-FFI and demonstrated a trend toward greater neuroticism. These relationships were not influenced by sex or the presence of reported early life stress. The finding that COMT genotype was associated with extraversion, and more weakly with neuroticism, is consistent with previous studies. Future research to clarify the influence of sex and gene-environmental interactions is warranted.
Collapse
Affiliation(s)
- Karin F Hoth
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Gunstad J, Paul RH, Spitznagel MB, Cohen RA, Williams LM, Kohn M, Gordon E. Exposure to early life trauma is associated with adult obesity. Psychiatry Res 2006; 142:31-7. [PMID: 16713630 DOI: 10.1016/j.psychres.2005.11.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 11/02/2005] [Accepted: 11/14/2005] [Indexed: 11/16/2022]
Abstract
Exposure to traumatic events during childhood is associated with an elevated risk of adult obesity. It has been hypothesized that the psychological sequelae from childhood trauma account for this risk, though no study has examined whether an increased risk of obesity is found in persons without psychological disorders. We examined exposure to early life stressors and body mass index (BMI) in 696 adults without significant medical or psychiatric history. Bivariate correlation showed that the total number of early life stressors (r=0.08), age (r=0.19), and sex (r=0.16) were significantly related to adult BMI. Given the relationship between sex and BMI, we examined the contribution of early life stressors to adult obesity separately for men and women. In men, hierarchical regression showed that exposure to early life stressors predicted adult obesity. Specifically, history of being bullied/rejected (Obese 31%, Normal weight, 9%) and emotional abuse (Obese, 17%; Normal weight, 2%) predicted adult obesity after controlling for the effects of age. In women, no relationship between early life stressors and adult obesity was found. These findings suggest that multiple processes mediate the relationship between early life stress and adult obesity and that their relative contributions may differ between men and women.
Collapse
Affiliation(s)
- John Gunstad
- Kent State University, Department of Psychology, Kent Hall, Kent OH 44242, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Younès N, Hardy-Bayle MC, Falissard B, Kovess V, Chaillet MP, Gasquet I. Differing mental health practice among general practitioners, private psychiatrists and public psychiatrists. BMC Public Health 2005; 5:104. [PMID: 16212666 PMCID: PMC1266376 DOI: 10.1186/1471-2458-5-104] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 10/07/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing care for mental health problems concerns General Practitioners (GPs), Private Psychiatrists (PrPs) and Public Psychiatrists (PuPs). As patient distribution and patterns of practice among these professionals are not well known, a survey was planned prior to a re-organisation of mental health services in an area close to Paris METHODS All GPs (n = 492), PrPs (n = 82) and PuPs (n = 78) in the South-Yvelines area in France were informed of the implementation of a local mental health program. Practitioners interested in taking part were invited to include prospectively all patients with mental health problem they saw over an 8-day period and to complete a 6-month retrospective questionnaire on their mental health practice. 180 GPs (36.6%), 45 PrPs (54.9%) and 63 PuPs (84.0%) responded. RESULTS GPs and PrPs were very similar but very different from PuPs for the proportion of patients with anxious or depressive disorders (70% v. 65% v. 38%, p < .001), psychotic disorders (5% v. 7% v. 30%, p < .001), previous psychiatric hospitalization (22% v. 26 v. 61%, p < .001) and receiving disability allowance (16% v. 18% v. 52%, p < .001). GPs had fewer patients with long-standing psychiatric disorders than PrPs and PuPs (52%, 64% v. 63%, p < .001). Time-lapse between consultations was longest for GPs, intermediate for PuPs and shortest for PrPs (36 days v. 26 v. 18, p < .001). Access to care had been delayed longer for Psychiatrists (PrPs, PuPs) than for GPs (61% v. 53% v. 25%, p < .001). GPs and PuPs frequently felt a need for collaboration for their patients, PrPs rarely (42% v. 61%. v. 10%, p < .001). Satisfaction with mental health practice was low for all categories of physicians (42.6% encountered difficulties hospitalizing patients and 61.4% had patients they would prefer not to cater for). GPs more often reported unsatisfactory relationships with mental health professionals than did PrPs and PuPs (54% v. 15% v. 8%, p < .001). CONCLUSION GP patients with mental health problems are very similar to patients of private psychiatrists; there is a lack of the collaboration felt to be necessary, because of psychiatrists' workload, and because GPs have specific needs in this respect. The "Yvelines-Sud Mental Health Network" has been created to enhance collaboration.
Collapse
Affiliation(s)
- N Younès
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, AP-HP, Paris, France
| | - MC Hardy-Bayle
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
| | - B Falissard
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, AP-HP, Paris, France
| | - V Kovess
- Mental Health Foundation, MGEN, Paris, France
| | - MP Chaillet
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
| | - I Gasquet
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, AP-HP, Paris, France
- Direction of Medical Policy, Assistance Publique – Hôpitaux de Paris, Paris
| |
Collapse
|
23
|
Wang J, Patten SB, Williams JVA, Currie S, Beck CA, Maxwell CJ, El-Guebaly N. Help-seeking behaviours of individuals with mood disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:652-9. [PMID: 16276857 DOI: 10.1177/070674370505001012] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study had the following objectives: 1) to estimate the 12-month prevalence of conventional and unconventional mental health service use by individuals with major depressive disorder (MDD) or mania in the past year, and 2) to identify factors associated with the use of conventional mental health services by individuals with MDD or mania in the past year. METHODS We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Respondents with MDD (n = 1563) or manic episodes (n = 393) in the past 12 months were included in this analysis. RESULTS An estimated 63.9% of respondents with MDD and 59.0% of those with manic episodes reported having used some type of help in the past 12 months; 52.9% of those with MDD and 49.0% of those with manic episodes used conventional mental health services. Approximately 21% of respondents with either MDD or manic episodes used natural health products specifically for emotional, mental health, and drug or alcohol use problems. Respondents who reported comorbid anxiety disorders and long-term medical conditions were more likely to have used conventional mental health services. CONCLUSIONS Relative to previous Canadian literature, our analysis suggests that the frequency of conventional mental health service use among persons with MDD has not increased significantly in the past decade. Further, the rate of conventional mental health service use by persons with manic episodes is unexpectedly low. These findings may reflect the lack of national initiatives targeting mood disorders in Canada. They have important implications for planning future education, promotion, and research efforts.
Collapse
Affiliation(s)
- JianLi Wang
- Department of Psychiatry, University of Calgary, Alberta.
| | | | | | | | | | | | | |
Collapse
|
24
|
Younes N, Gasquet I, Gaudebout P, Chaillet MP, Kovess V, Falissard B, Hardy Bayle MC. General Practitioners' opinions on their practice in mental health and their collaboration with mental health professionals. BMC FAMILY PRACTICE 2005; 6:18. [PMID: 15865624 PMCID: PMC1131897 DOI: 10.1186/1471-2296-6-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2004] [Accepted: 05/02/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.
Collapse
Affiliation(s)
- Nadia Younes
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, Paris, France
| | - Isabelle Gasquet
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, Paris, France
- Direction of Medical Policy, Assistance Publique – Hôpitaux de Paris, paris, France
| | - Pierre Gaudebout
- Direction of Medical Policy, Assistance Publique – Hôpitaux de Paris, paris, France
| | - Marie-Pierre Chaillet
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
| | | | - Bruno Falissard
- National Institute of Health and Medical Research (INSERM-U669), Hôpital Cochin, Paris, France
| | - Marie-Christine Hardy Bayle
- Academic Unit of Psychiatry, Centre Hospitalier de Versailles, 177 Rue de Versailles 78157 Le Chesnay Cedex. France
| |
Collapse
|
25
|
Liddell BJ, Brown KJ, Kemp AH, Barton MJ, Das P, Peduto A, Gordon E, Williams LM. A direct brainstem–amygdala–cortical ‘alarm’ system for subliminal signals of fear. Neuroimage 2005; 24:235-43. [PMID: 15588615 DOI: 10.1016/j.neuroimage.2004.08.016] [Citation(s) in RCA: 435] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 08/06/2004] [Accepted: 08/12/2004] [Indexed: 11/22/2022] Open
Abstract
We examined whether consciously undetected fear signals engage a collateral brainstem pathway to the amygdala and prefrontal cortex in the intact human brain, using functional neuroimaging. 'Blindsight' lesion patients can respond to visual fear signals independently from conscious experience, suggesting that these signals reach the amygdala via a direct pathway that bypasses the primary visual cortex. Electrophysiological evidence points to concomitant involvement of prefrontal regions in automatic orienting to subliminal signals of fear, which may reflect innervation arising from brainstem arousal systems. To approximate blindsight in 22 healthy subjects, facial signals of fear were presented briefly (16.7 ms) and masked such that conscious detection was prevented. Results revealed that subliminal fear signals elicited activity in the brainstem region encompassing the superior colliculus and locus coeruleus, pulvinar and amygdala, and in fronto-temporal regions associated with orienting. These findings suggest that crude sensory input from the superior colliculo-pulvinar visual pathway to the amygdala may allow for sufficient appraisal of fear signals to innervate the locus coeruleus. The engagement of the locus coeruleus could explain the observation of diffuse fronto-temporal cortical activity, given its role in evoking collateral ascending noradrenergic efferents to the subcortical amygdala and prefrontal cortex. This network may represent an evolutionary adaptive neural 'alarm' system for rapid alerting to sources of threat, without the need for conscious appraisal.
Collapse
|
26
|
Abstract
OBJECTIVE General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. METHOD Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000-02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990-1991) to investigate management changes over the past decade. RESULTS Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100,000 encounters (95% CI=9129- 10,237) in 1990-1991 to 11 557 (11,136-11 977) in 2000-2002. Prescription rates (from 63.3, 95% CI=60.5-66.1 to 69.1, 95% CI=67.1-71.1) and clinical treatments (from 36.0, 95% CI =33.4-38.7 to 53.1, 95% CI =51.3-54.9) increased. CONCLUSIONS This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.
Collapse
Affiliation(s)
- Christopher M Harrison
- Family Medicine Research Centre, University of Sydney, P.O. Box 533, Wentworthville 2145, New South Wales, Australia
| | | |
Collapse
|
27
|
Patten SB. Progress against major depression in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:775-80. [PMID: 12420657 DOI: 10.1177/070674370204700810] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Generally, public health strategies for major depression have focused on case-finding, public and professional education, and disease-management strategies. In principle, increased rates of treatment utilization and improved treatment outcomes should lead to improved mental health at the population level. Progress of this sort, however, has been difficult to confirm. METHODS The National Population Health Survey (NPHS) is a large-scale longitudinal study of a representative sample drawn from the Canadian population. To date, Statistics Canada has released data from 3 NPHS cycles: 1994-1995, 1996-1997, and 1998-1999. Treatment utilization and major depression measures were employed in the NPHS survey, providing a unique source of longitudinal Canadian data. In this study, major depression point prevalence (defined using a predictive instrument for annual major depressive episode [MDE] prevalence and responses from a distress scale) and associated treatment utilization were evaluated over time. RESULTS Between 1994-1995 and 1995-1996, the proportion of persons with depression receiving antidepressant treatment increased dramatically, from 18.2% (12.3% to 22.1%) in 1994-1995 to 32.6% (23.0% to 42.2%) in 1998-1999. Point prevalence of major depression was 2.4%, 1.8%, and 1.9% in the 3 NPHS iterations. CONCLUSIONS Data from the NPHS suggest public health progress against major depression in Canada. More people with major depression in Canada are receiving treatment, and these changes may have been associated with improved population health status. However, both random variation and extraneous societal factors could account for the observed trends in prevalence. It is impossible to relate changes in utilization directly to population health status using the NPHS data.
Collapse
Affiliation(s)
- Scott B Patten
- Alberta Heritage Foundation for Medical Research, Department of Community Health Sciences, Department of Psychiatry, University of Calgary, Calgary, Alberta.
| |
Collapse
|