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McGrath JJ, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Bromet EJ, Bruffaerts R, de Almeida JMC, Chardoul S, Chiu WT, Degenhardt L, Demler OV, Ferry F, Gureje O, Haro JM, Karam EG, Karam G, Khaled SM, Kovess-Masfety V, Magno M, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Plana-Ripoll O, Posada-Villa J, Rapsey C, Sampson NA, Stagnaro JC, Stein DJ, Ten Have M, Torres Y, Vladescu C, Woodruff PW, Zarkov Z, Kessler RC. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. Lancet Psychiatry 2023; 10:668-681. [PMID: 37531964 PMCID: PMC10529120 DOI: 10.1016/s2215-0366(23)00193-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. METHODS In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. FINDINGS We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. INTERPRETATION By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. FUNDING None.
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Affiliation(s)
- John J McGrath
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia; National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Ali Al-Hamzawi
- College of Medicine, University of Al-Qadisiya, Al Diwaniya, Iraq
| | - Jordi Alonso
- Health Services Research Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura H Andrade
- Section of Psychiatric Epidemiology, Institute of Psychiatry, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olga V Demler
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Computer Science, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Finola Ferry
- School of Psychology, Ulster University, Belfast, UK
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Centre for Biomedical Research on Mental Health, Madrid, Spain; Departament de Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar
| | | | - Marta Magno
- Unit of Epidemiological and Evaluation Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain; Murcia Biomedical Research Institute, Murcia, Spain; Centro de Investigación Biomédica en Red Epidemiology and Public Health-Murcia, Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, Instituto de Ciencias de la Salud, Medellín, Colombia
| | - Cristian Vladescu
- National Institute for Health Services Management, Bucharest, Romania
| | - Peter W Woodruff
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
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2
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Axinn WG, Bruffaerts R, Kessler TL, Frounfelker R, Aguilar-Gaxiola S, Alonso J, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chardoul S, Chiu WT, Cía A, Gureje O, Karam EG, Kovess-Masfety V, Petukhova MV, Piazza M, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Stein DJ, Torres Y, Williams DR, Kessler RC. Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders. JAMA Netw Open 2023; 6:e2318919. [PMID: 37338903 PMCID: PMC10282884 DOI: 10.1001/jamanetworkopen.2023.18919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/23/2023] [Indexed: 06/21/2023] Open
Abstract
Importance Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies. Objective To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II. Design, Setting, and Participants This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023. Exposures Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview. Main Outcomes and Measures The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders. Results This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure. Conclusions In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.
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Affiliation(s)
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit, Campus Gasthuisberg, Leuven, Belgium
| | - Timothy L. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Rochelle Frounfelker
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California, Davis Health System, Sacramento
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Biomedical Research Networking Center in Epidemiology and Public Health, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alfredo Cía
- Anxiety Disorders Research Center, Buenos Aires, Argentina
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | | | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Marina Piazza
- Instituto Nacional de Salud, Universidad Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J. Stein
- South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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3
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Kiekens G, Hasking P, Bruffaerts R, Alonso J, Auerbach RP, Bantjes J, Benjet C, Boyes M, Chiu WT, Claes L, Cuijpers P, Ebert DD, Mak A, Mortier P, O’Neill S, Sampson NA, Stein DJ, Vilagut G, Nock MK, Kessler RC. Non-suicidal self-injury among first-year college students and its association with mental disorders: results from the World Mental Health International College Student (WMH-ICS) initiative. Psychol Med 2023; 53:875-886. [PMID: 34140062 PMCID: PMC8683565 DOI: 10.1017/s0033291721002245] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders. METHODS Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder). RESULTS NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6). CONCLUSIONS NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.
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Affiliation(s)
- Glenn Kiekens
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, Australia
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, KU Leuven, Belgium
- Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
- Pompeu Fabra University, Barcelona, Spain
| | | | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, South Africa
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David D. Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Arthur Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Siobhan O’Neill
- School of Biomedical Sciences, Ulster University, Derry-Londonderry, Northern Ireland
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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4
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Bruffaerts R, Harris MG, Kazdin AE, Vigo DV, Sampson NA, Chiu WT, Al-Hamzawi A, Alonso J, Altwaijri YA, Andrade L, Benjet C, de Girolamo G, Florescu S, Haro JM, Hu CY, Karam A, Karam EG, Kovess-Masfety V, Lee S, McGrath JJ, Navarro-Mateu F, Nishi D, O'Neill S, Posada-Villa J, Scott KM, Have MT, Torres Y, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2079-2095. [PMID: 35262761 PMCID: PMC9458773 DOI: 10.1007/s00127-022-02249-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample. METHODS The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD. RESULTS In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders. CONCLUSIONS The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.
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Affiliation(s)
- Ronny Bruffaerts
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Queensland, Herston, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Wacol, Australia
| | - Alan E Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiyah University, Diwaniyah Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin A Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura Andrade
- Núcleo de Epidemiologia Psiquiátrica-LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chi-Yi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, China
| | - Aimee Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Wacol, Australia
- Queensland Brain Institute, University of Queensland, Queensland, St Lucia, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Región de Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Bogdan Wojtyniak
- Department of Population Health Monitoring and Analysis, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
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5
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Kessler RC, Kazdin AE, Aguilar‐Gaxiola S, Al‐Hamzawi A, Alonso J, Altwaijri YA, Andrade LH, Benjet C, Bharat C, Borges G, Bruffaerts R, Bunting B, de Almeida JMC, Cardoso G, Chiu WT, Cía A, Ciutan M, Degenhardt L, de Girolamo G, de Jonge P, de Vries Y, Florescu S, Gureje O, Haro JM, Harris MG, Hu C, Karam AN, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess‐Masfety V, Lee S, Makanjuola V, McGrath J, Medina‐Mora ME, Moskalewicz J, Navarro‐Mateu F, Nierenberg AA, Nishi D, Ojagbemi A, Oladeji BD, O'Neill S, Posada‐Villa J, Puac‐Polanco V, Rapsey C, Ruscio AM, Sampson NA, Scott KM, Slade T, Stagnaro JC, Stein DJ, Tachimori H, ten Have M, Torres Y, Viana MC, Vigo DV, Williams DR, Wojtyniak B, Xavier M, Zarkov Z, Ziobrowski HN. Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys. World Psychiatry 2022; 21:272-286. [PMID: 35524618 PMCID: PMC9077614 DOI: 10.1002/wps.20971] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
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Affiliation(s)
| | | | | | - Ali Al‐Hamzawi
- College of MedicineAl‐Qadisiya University, Diwaniya GovernorateIraq
| | - Jordi Alonso
- Health Services Research UnitIMIM‐Hospital del Mar Medical Research InstituteBarcelonaSpain
| | - Yasmin A. Altwaijri
- Epidemiology SectionKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiátrica ‐ LIM 23Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Guilherme Borges
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum ‐ Katholieke Universiteit LeuvenLeuvenBelgium
| | | | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Wai Tat Chiu
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Alfredo Cía
- Anxiety Disorders Research CenterBuenos AiresArgentina
| | - Marius Ciutan
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | | | - Peter de Jonge
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Silvia Florescu
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Oye Gureje
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAMUniversitat de BarcelonaBarcelonaSpain
| | - Meredith G. Harris
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning HospitalShenzhenChina
| | - Aimee N. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon
| | - Elie G. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Georges Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Andrzej Kiejna
- Psychology Research Unit for Public HealthWSB UniversityTorunPoland
| | - Viviane Kovess‐Masfety
- Laboratoire de Psychopathologie et Processus de Santé EA 4057Université de ParisParisFrance
| | - Sing Lee
- Department of PsychiatryChinese University of Hong KongTai PoHong Kong
| | | | - John J. McGrath
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia,National Centre for Register‐based ResearchAarhus UniversityAarhusDenmark
| | - Maria Elena Medina‐Mora
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | | | - Fernando Navarro‐Mateu
- Unidad de Docencia, Investigación y Formación en Salud MentalUniversidad de MurciaMurciaSpain
| | - Andrew A. Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Akin Ojagbemi
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | | | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca UniversityFaculty of Social SciencesBogotaColombia
| | | | - Charlene Rapsey
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Kate M. Scott
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud MentalUniversidad de Buenos AiresBuenos AiresArgentina
| | - Dan J. Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental DisordersUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Hisateru Tachimori
- National Institute of Mental HealthNational Center for Neurology and PsychiatryKodairaTokyoJapan
| | - Margreet ten Have
- Trimbos‐InstituutNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES UniversityMedellinColombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito SantoVitoriaBrazil
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada,Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
| | - David R. Williams
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population HealthNational Institute of Public Health ‐ National Research InstituteWarsawPoland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Zahari Zarkov
- Department of Mental HealthNational Center of Public Health and AnalysesSofiaBulgaria
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Nierenberg AA, Harris MG, Kazdin AE, Puac-Polanco V, Sampson N, Vigo DV, Chiu WT, Ziobrowski HN, Alonso J, Altwaijri Y, Borges G, Bunting B, Caldas-de-Almeida JM, Haro JM, Hu CY, Kiejna A, Lee S, McGrath JJ, Navarro-Mateu F, Posada-Villa J, Scott KM, Stagnaro JC, Viana MC, Kessler RC. Perceived helpfulness of bipolar disorder treatment: Findings from the World Health Organization World Mental Health Surveys. Bipolar Disord 2021; 23:565-583. [PMID: 33638300 PMCID: PMC8387507 DOI: 10.1111/bdi.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine patterns and predictors of perceived treatment helpfulness for mania/hypomania and associated depression in the WHO World Mental Health Surveys. METHODS Face-to-face interviews with community samples across 15 countries found n = 2,178 who received lifetime mania/hypomania treatment and n = 624 with lifetime mania/hypomania who received lifetime major depression treatment. These respondents were asked whether treatment was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Patterns and predictors of treatment helpfulness were examined separately for mania/hypomania and depression. RESULTS 63.1% (mania/hypomania) and 65.1% (depression) of patients reported ever receiving helpful treatment. However, only 24.5-22.5% were helped by the first professional seen, which means that the others needed to persist in help seeking after initial unhelpful treatments in order to find helpful treatment. Projections find only 22.9% (mania/hypomania) and 43.3% (depression) would persist through a series of unhelpful treatments but that the proportion helped would increase substantially if persistence increased. Few patient-level significant predictors of helpful treatment emerged and none consistently either across the two components (i.e., provider-level helpfulness and persistence after earlier unhelpful treatment) or for both mania/hypomania and depression. Although prevalence of treatment was higher in high-income than low/middle-income countries, proportional helpfulness among treated cases was nearly identical in the two groups of countries. CONCLUSIONS Probability of patients with mania/hypomania and associated depression obtaining helpful treatment might increase substantially if persistence in help-seeking increased after initially unhelpful treatments, although this could require seeing numerous additional treatment providers. In addition to investigating reasons for initial treatments not being helpful, messages reinforcing the importance of persistence should be emphasized to patients.
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Affiliation(s)
- Andrew A. Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel V. Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chi-yi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Andrzej Kiejna
- Psychology Research Unit for Public Health, WSB University, Torun, Poland
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J. McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud, Murcia, Región de Murcia, Spain
- IMIB-Arrixaca, Murcia, Región de Murcia, Spain
- CIBERESP, Murcia, Región de Murcia, Spain
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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7
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Stein DJ, Kazdin AE, Ruscio AM, Chiu WT, Sampson NA, Ziobrowski HN, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Bruffaerts R, Bunting B, de Girolamo G, de Jonge P, Degenhardt L, Gureje O, Haro JM, Harris MG, Karam A, Karam EG, Kovess-Masfety V, Lee S, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Posada-Villa J, Scott KM, Viana MC, Vigo DV, Xavier M, Zarkov Z, Kessler RC. Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry 2021; 21:392. [PMID: 34372811 PMCID: PMC8351147 DOI: 10.1186/s12888-021-03363-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. METHODS Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. RESULTS The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. CONCLUSIONS The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.
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Affiliation(s)
- Dan J. Stein
- grid.7836.a0000 0004 1937 1151Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alan E. Kazdin
- grid.47100.320000000419368710Department of Psychology, Yale University, New Haven, CT USA
| | - Ayelet Meron Ruscio
- grid.25879.310000 0004 1936 8972Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
| | - Wai Tat Chiu
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Nancy A. Sampson
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Hannah N. Ziobrowski
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Sergio Aguilar-Gaxiola
- grid.416958.70000 0004 0413 7653Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
| | - Jordi Alonso
- grid.20522.370000 0004 1767 9005Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5612.00000 0001 2172 2676Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin Altwaijri
- grid.415310.20000 0001 2191 4301Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ronny Bruffaerts
- grid.5596.f0000 0001 0668 7884Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- grid.12641.300000000105519715School of Psychology, Ulster University, Londonderry, UK
| | - Giovanni de Girolamo
- grid.419422.8IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Peter de Jonge
- grid.4830.f0000 0004 0407 1981Department of Developmental Psychology, University of Groningen, Groningen, Netherlands ,grid.4494.d0000 0000 9558 4598Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - Louisa Degenhardt
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Oye Gureje
- grid.412438.80000 0004 1764 5403Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G. Harris
- grid.1003.20000 0000 9320 7537School of Public Health, The University of Queensland, Herston, QLD 4006 Australia ,grid.417162.70000 0004 0606 3563Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4072 Australia
| | - Aimee Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Elie G. Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon ,grid.416659.90000 0004 1773 3761Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon ,grid.33070.370000 0001 2288 0342Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- grid.508487.60000 0004 7885 7602Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- grid.10784.3a0000 0004 1937 0482Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Maria Elena Medina-Mora
- grid.419154.c0000 0004 1776 9908National Institute of Psychiatry-Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jacek Moskalewicz
- grid.418955.40000 0001 2237 2890Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Fernando Navarro-Mateu
- grid.419058.10000 0000 8745 438XUDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Murcia, Spain
| | - Daisuke Nishi
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.419280.60000 0004 1763 8916National Center of Neurology and Psychiatry, Tokyo, Japan
| | - José Posada-Villa
- grid.441728.c0000 0004 1779 6631Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M. Scott
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Maria Carmen Viana
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Daniel V. Vigo
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Miguel Xavier
- grid.10772.330000000121511713Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- grid.416574.5Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
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de Vries YA, Harris MG, Vigo D, Chiu WT, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Benjet C, Bruffaerts R, Bunting B, de Almeida JMC, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Moskalewicz J, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Scott K, Torres Y, Zarkov Z, Nierenberg A, Kessler RC, de Jonge P. Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys. J Affect Disord 2021; 288:199-209. [PMID: 33940429 PMCID: PMC8154701 DOI: 10.1016/j.jad.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Región de Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia (Cundinamarca University, calle 28 # 5B 02, Bogotá, 11001000 (zip), Colombia)
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Andrew Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
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Stein DJ, Harris MG, Vigo DV, Chiu WT, Sampson N, Alonso J, Altwaijri Y, Bunting B, Caldas-de-Almeida JM, Cía A, Ciutan M, Degenhardt L, Gureje O, Karam A, Karam EG, Lee S, Medina-Mora ME, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Rapsey C, Torres Y, Carmen Viana M, Ziv Y, Kessler RC. Perceived helpfulness of treatment for posttraumatic stress disorder: Findings from the World Mental Health Surveys. Depress Anxiety 2020; 37:972-994. [PMID: 32667096 PMCID: PMC7722199 DOI: 10.1002/da.23076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Perceived helpfulness of treatment is an important healthcare quality indicator in the era of patient-centered care. We examine probability and predictors of two key components of this indicator for posttraumatic stress disorder (PTSD). METHODS Data come from World Mental Health surveys in 16 countries. Respondents who ever sought PTSD treatment (n = 779) were asked if treatment was ever helpful and, if so, the number of professionals they had to see to obtain helpful treatment. Patients whose treatment was never helpful were asked how many professionals they saw. Parallel survival models were estimated for obtaining helpful treatment in a specific encounter and persisting in help-seeking after earlier unhelpful encounters. RESULTS Fifty seven percent of patients eventually received helpful treatment, but survival analysis suggests that it would have been 85.7% if all patients had persisted in help-seeking with up to six professionals after earlier unhelpful treatment. Survival analysis suggests that only 23.6% of patients would persist to that extent. Odds of ever receiving helpful treatment were positively associated with receiving treatment from a mental health professional, short delays in initiating help-seeking after onset, absence of prior comorbid anxiety disorders and childhood adversities, and initiating treatment before 2000. Some of these variables predicted helpfulness of specific treatment encounters and others predicted persistence after earlier unhelpful encounters. CONCLUSIONS The great majority of patients with PTSD would receive treatment they considered helpful if they persisted in help-seeking after initial unhelpful encounters, but most patients whose initial treatment is unhelpful give up before receiving helpful treatment.
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Affiliation(s)
- Dan J. Stein
- Dept of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD, Australia
| | - Daniel V. Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo Cía
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Marius Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Aimee Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Elie G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; CIBERESP-Murcia, Región de Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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10
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Harris MG, Kazdin AE, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Cardoso G, Cía A, Florescu S, Gureje O, Hu C, Karam EG, Karam G, Mneimneh Z, Navarro-Mateu F, Oladeji BD, O’Neill S, Scott K, Slade T, Torres Y, Vigo D, Wojtyniak B, Zarkov Z, Ziv Y, Kessler RC. Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder. JAMA Psychiatry 2020; 77:830-841. [PMID: 32432716 PMCID: PMC7240636 DOI: 10.1001/jamapsychiatry.2020.1107] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
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Affiliation(s)
- Meredith G. Harris
- The University of Queensland School of Public Health, Herston, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Ali Al-Hamzawi
- Al-Qadisiya University College of Medicine, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- IMIM–Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain,Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain,CIBER en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM 23), Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Alfredo Cía
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | | | - Siobhan O’Neill
- Ulster University School of Psychology, Londonderry, United Kingdom
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bogdan Wojtyniak
- National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Directorate of Mental Health and Prevention of Addictions, Sofia, Bulgaria
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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11
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Rosellini AJ, Stein MB, Benedek DM, Bliese PD, Chiu WT, Hwang I, Monahan J, Nock MK, Sampson NA, Street AE, Zaslavsky AM, Ursano RJ, Kessler RC. Predeployment predictors of psychiatric disorder-symptoms and interpersonal violence during combat deployment. Depress Anxiety 2018; 35:1073-1080. [PMID: 30102442 PMCID: PMC6212319 DOI: 10.1002/da.22807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preventing suicides, mental disorders, and noncombat-related interpersonal violence during deployment are priorities of the US Army. We used predeployment survey and administrative data to develop actuarial models to identify soldiers at high risk of these outcomes during combat deployment. METHODS The models were developed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre-Post Deployment Study, a panel study of soldiers deployed to Afghanistan in 2012-2013. Soldiers completed self-administered questionnaires before deployment and one (T1), three (T2), and nine months (T3) after deployment, and consented to administrative data linkage. Seven during-deployment outcomes were operationalized using the postdeployment surveys. Two overlapping samples were used because some outcomes were assessed at T1 (n = 7,048) and others at T2-T3 (n = 7,081). Ensemble machine learning was used to develop a model for each outcome from 273 predeployment predictors, which were compared to simple logistic regression models. RESULTS The relative improvement in area under the receiver operating characteristic curve (AUC) obtained by machine learning compared to the logistic models ranged from 1.11 (major depression) to 1.83 (suicidality).The best-performing machine learning models were for major depression (AUC = 0.88), suicidality (0.86), and generalized anxiety disorder (0.85). Roughly 40% of these outcomes occurred among the 5% of soldiers with highest predicted risk. CONCLUSIONS Actuarial models could be used to identify high risk soldiers either for exclusion from deployment or preventive interventions. However, the ultimate value of this approach depends on the associated costs, competing risks (e.g. stigma), and the effectiveness to-be-determined interventions.
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Affiliation(s)
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Corresponding author: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA USA 02115; 617-432-3587 (voice); 617-432-3588 (fax);
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12
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Bernecker SL, Rosellini AJ, Nock MK, Chiu WT, Gutierrez PM, Hwang I, Joiner TE, Naifeh JA, Sampson NA, Zaslavsky AM, Stein MB, Ursano RJ, Kessler RC. Improving risk prediction accuracy for new soldiers in the U.S. Army by adding self-report survey data to administrative data. BMC Psychiatry 2018; 18:87. [PMID: 29615005 PMCID: PMC5883887 DOI: 10.1186/s12888-018-1656-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High rates of mental disorders, suicidality, and interpersonal violence early in the military career have raised interest in implementing preventive interventions with high-risk new enlistees. The Army Study to Assess Risk and Resilience in Servicemembers (STARRS) developed risk-targeting systems for these outcomes based on machine learning methods using administrative data predictors. However, administrative data omit many risk factors, raising the question whether risk targeting could be improved by adding self-report survey data to prediction models. If so, the Army may gain from routinely administering surveys that assess additional risk factors. METHODS The STARRS New Soldier Survey was administered to 21,790 Regular Army soldiers who agreed to have survey data linked to administrative records. As reported previously, machine learning models using administrative data as predictors found that small proportions of high-risk soldiers accounted for high proportions of negative outcomes. Other machine learning models using self-report survey data as predictors were developed previously for three of these outcomes: major physical violence and sexual violence perpetration among men and sexual violence victimization among women. Here we examined the extent to which this survey information increases prediction accuracy, over models based solely on administrative data, for those three outcomes. We used discrete-time survival analysis to estimate a series of models predicting first occurrence, assessing how model fit improved and concentration of risk increased when adding the predicted risk score based on survey data to the predicted risk score based on administrative data. RESULTS The addition of survey data improved prediction significantly for all outcomes. In the most extreme case, the percentage of reported sexual violence victimization among the 5% of female soldiers with highest predicted risk increased from 17.5% using only administrative predictors to 29.4% adding survey predictors, a 67.9% proportional increase in prediction accuracy. Other proportional increases in concentration of risk ranged from 4.8% to 49.5% (median = 26.0%). CONCLUSIONS Data from an ongoing New Soldier Survey could substantially improve accuracy of risk models compared to models based exclusively on administrative predictors. Depending upon the characteristics of interventions used, the increase in targeting accuracy from survey data might offset survey administration costs.
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Affiliation(s)
- Samantha L. Bernecker
- 000000041936754Xgrid.38142.3cDepartment of Psychology, Harvard University, Cambridge, MA USA ,000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Anthony J. Rosellini
- 0000 0004 1936 7558grid.189504.1Department of Psychological and Brain Sciences, Center for Anxiety and Related Disorders, Boston University, Boston, MA USA
| | - Matthew K. Nock
- 000000041936754Xgrid.38142.3cDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Wai Tat Chiu
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Peter M. Gutierrez
- 0000 0000 9751 469Xgrid.422100.5Department of Psychiatry, University of Colorado School of Medicine, and Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver Veterans Affairs Medical Center, Denver, CO USA
| | - Irving Hwang
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Thomas E. Joiner
- 0000 0004 0472 0419grid.255986.5Department of Psychology, Florida State University, Tallahassee, FL USA
| | - James A. Naifeh
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD USA
| | - Nancy A. Sampson
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Alan M. Zaslavsky
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Murray B. Stein
- 0000 0001 2107 4242grid.266100.3Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | - Robert J. Ursano
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
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13
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Rosellini AJ, Stein MB, Benedek DM, Bliese PD, Chiu WT, Hwang I, Monahan J, Nock MK, Petukhova MV, Sampson NA, Street AE, Zaslavsky AM, Ursano RJ, Kessler RC. Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army. Psychol Med 2017; 47:2275-2287. [PMID: 28374665 PMCID: PMC5679702 DOI: 10.1017/s003329171700071x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service. METHODS 21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition. RESULTS The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk. CONCLUSIONS Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.
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Affiliation(s)
- Anthony J. Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Rosellini AJ, Street AE, Ursano RJ, Chiu WT, Heeringa SG, Monahan J, Naifeh JA, Petukhova MV, Reis BY, Sampson NA, Bliese PD, Stein MB, Zaslavsky AM, Kessler RC. Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. Am J Public Health 2017; 107:732-739. [PMID: 28323466 DOI: 10.2105/ajph.2017.303693] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure. METHODS We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes. RESULTS Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2). CONCLUSIONS Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.
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Affiliation(s)
- Anthony J Rosellini
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Amy E Street
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Robert J Ursano
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Wai Tat Chiu
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Steven G Heeringa
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - John Monahan
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - James A Naifeh
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Maria V Petukhova
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Ben Y Reis
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Nancy A Sampson
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Paul D Bliese
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Murray B Stein
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Alan M Zaslavsky
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Ronald C Kessler
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
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15
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McGrath JJ, Saha S, Al-Hamzawi A, Andrade L, Benjet C, Bromet EJ, Browne MO, Caldas de Almeida JM, Chiu WT, Demyttenaere K, Fayyad J, Florescu S, de Girolamo G, Gureje O, Haro JM, Have MT, Hu C, Kovess-Masfety V, Lim CCW, Navarro-Mateu F, Sampson N, Posada-Villa J, Kendler K, Kessler RC. The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders. Am J Psychiatry 2016; 173:997-1006. [PMID: 26988628 PMCID: PMC5175400 DOI: 10.1176/appi.ajp.2016.15101293] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE While it is now recognized that psychotic experiences are associated with an increased risk of later mental disorders, we lack a detailed understanding of the reciprocal time-lagged relationships between first onsets of psychotic experiences and mental disorders. Using data from World Health Organization World Mental Health (WMH) Surveys, the authors assessed the bidirectional temporal associations between psychotic experiences and mental disorders. METHOD The WMH Surveys assessed lifetime prevalence and age at onset of psychotic experiences and 21 common DSM-IV mental disorders among 31,261 adult respondents from 18 countries. Discrete-time survival models were used to examine bivariate and multivariate associations between psychotic experiences and mental disorders. RESULTS Temporally primary psychotic experiences were significantly associated with subsequent first onset of eight of the 21 mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, adult separation anxiety disorder, bulimia nervosa, and alcohol abuse), with odds ratios ranging from 1.3 (95% CI=1.2-1.5) for major depressive disorder to 2.0 (95% CI=1.5-2.6) for bipolar disorder. In contrast, 18 of 21 primary mental disorders were significantly associated with subsequent first onset of psychotic experiences, with odds ratios ranging from 1.5 (95% CI=1.0-2.1) for childhood separation anxiety disorder to 2.8 (95% CI=1.0-7.8) for anorexia nervosa. CONCLUSIONS While temporally primary psychotic experiences are associated with an elevated risk of several subsequent mental disorders, these data show that most mental disorders are associated with an elevated risk of subsequent psychotic experiences. Further investigation of the underlying factors accounting for these time-order relationships may shed light on the etiology of psychotic experiences.
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Affiliation(s)
- John J. McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Discipline of Psychiatry, University of Queensland, St Lucia, QLD 4072, Australia,Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Discipline of Psychiatry, University of Queensland, St Lucia, QLD 4072, Australia,Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq
| | - Laura Andrade
- Department/Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, United States
| | | | - Jose M. Caldas de Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Wai Tat Chiu
- Department of Health Policy, Harvard University, Boston, MA, United States
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - John Fayyad
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Deïu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Netherlands
| | - Chiyi Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
| | - Carmen C. W. Lim
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Nancy Sampson
- Department of Health Policy, Harvard University, Boston, MA, United States
| | | | - Kenneth Kendler
- Department of Psychiatry, Virginia Commonwealth University, United States
| | - Ronald C. Kessler
- Department of Health Policy, Harvard University, Boston, MA, United States
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16
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Nock MK, Ursano RJ, Heeringa SG, Stein MB, Jain S, Raman R, Sun X, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE, Hwang I, Naifeh JA, Rosellini AJ, Sampson NA, Schoenbaum M, Zaslavsky AM, Kessler RC. Mental Disorders, Comorbidity, and Pre-enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Suicide Life Threat Behav 2015; 45:588-599. [PMID: 25622860 PMCID: PMC4515394 DOI: 10.1111/sltb.12153] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
Abstract
We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre-enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6-8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre-enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.
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Affiliation(s)
- Matthew K. Nock
- Department of Psychology; Harvard University; Cambridge Massachusetts USA
| | - Robert J. Ursano
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda Maryland USA
| | - Steven G. Heeringa
- Institute for Social Research; University of Michigan; Ann Arbor Michigan USA
| | - Murray B. Stein
- Department of Psychiatry and Department of Family and Preventive Medicine; VA San Diego Healthcare System; University of California San Diego; La Jolla California USA
| | - Sonia Jain
- Department of Family and Preventive Medicine; VA San Diego Healthcare System; University of California San Diego; La Jolla California USA
| | - Rema Raman
- Department of Family and Preventive Medicine and Department of Neurosciences; VA San Diego Healthcare System; University of California San Diego; La Jolla California USA
| | - Xiaoying Sun
- Department of Family and Preventive Medicine; VA San Diego Healthcare System; University of California San Diego; La Jolla California USA
| | - Wai Tat Chiu
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
| | - Lisa J. Colpe
- National Institute of Mental Health; Bethesda Maryland USA
| | - Carol S. Fullerton
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda Maryland USA
| | - Stephen E. Gilman
- Department of Social and Behavioral Sciences and Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
| | - Irving Hwang
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
| | - James A. Naifeh
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda Maryland USA
| | - Anthony J. Rosellini
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
| | - Nancy A. Sampson
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
| | | | - Alan M. Zaslavsky
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
| | - Ronald C. Kessler
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts USA
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17
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McGrath JJ, Saha S, Al-Hamzawi A, Alonso J, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, Chiu WT, de Jonge P, Fayyad J, Florescu S, Gureje O, Haro JM, Hu C, Kovess-Masfety V, Lepine JP, Lim CW, Mora MEM, Navarro-Mateu F, Ochoa S, Sampson N, Scott K, Viana MC, Kessler RC. Psychotic Experiences in the General Population: A Cross-National Analysis Based on 31,261 Respondents From 18 Countries. JAMA Psychiatry 2015; 72:697-705. [PMID: 26018466 PMCID: PMC5120396 DOI: 10.1001/jamapsychiatry.2015.0575] [Citation(s) in RCA: 318] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Community-based surveys find that many otherwise healthy individuals report histories of hallucinations and delusions. To date, most studies have focused on the overall lifetime prevalence of any of these psychotic experiences (PEs), which might mask important features related to the types and frequencies of PEs. OBJECTIVE To explore detailed epidemiologic information about PEs in a large multinational sample. DESIGN, SETTING, AND PARTICIPANTS We obtained data from the World Health Organization World Mental Health Surveys, a coordinated set of community epidemiologic surveys of the prevalence and correlates of mental disorders in representative household samples from 18 countries throughout the world, from 2001 through 2009. Respondents included 31,261 adults (18 years and older) who were asked about lifetime and 12-month prevalence and frequency of 6 types of PEs (2 hallucinatory experiences and 4 delusional experiences). We analyzed the data from March 2014 through January 2015. MAIN OUTCOMES AND MEASURES Prevalence, frequency, and correlates of PEs. RESULTS Mean lifetime prevalence (SE) of ever having a PE was 5.8% (0.2%), with hallucinatory experiences (5.2% [0.2%]) much more common than delusional experiences (1.3% [0.1%]). More than two-thirds (72.0%) of respondents with lifetime PEs reported experiencing only 1 type. Psychotic experiences were typically infrequent, with 32.2% of respondents with lifetime PEs reporting only 1 occurrence and 31.8% reporting only 2 to 5 occurrences. We found a significant relationship between having more than 1 type of PE and having more frequent PE episodes (Cochran-Armitage z = -10.0; P < .001). Lifetime prevalence estimates (SEs) were significantly higher among respondents in middle- and high-income countries than among those in low-income countries (7.2% [0.4%], 6.8% [0.3%], and 3.2% [0.3%], respectively; χ²₂ range, 7.1-58.2; P < .001 for each) and among women than among men (6.6% [0.2%] vs 5.0% [0.3%]; χ²₁ = 16.0; P < .001). We found significant associations with lifetime prevalence of PEs in the multivariate model among nonmarried compared with married respondents (χ²₂ = 23.2; P < .001) and among respondents who were not employed (χ²₄= 10.6; P < .001) and who had low family incomes (χ²₃ = 16.9; P < .001). CONCLUSIONS AND RELEVANCE The epidemiologic features of PEs are more nuanced than previously thought. Research is needed that focuses on similarities and differences in the predictors of the onset, course, and consequences of distinct PEs.
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Affiliation(s)
- John J. McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Discipline of Psychiatry, University of Queensland, St Lucia, QLD 4072, Australia,Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia,Corresponding author: Professor John McGrath, Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, 4076, Australia. , Phone: +61 7 3271 8694, Fax: +61 7 3271 8698
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia,Discipline of Psychiatry, University of Queensland, St Lucia, QLD 4072, Australia,Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain,CIBER en EpidemiologÕïa y Salud Puïblica (CIBERESP), Barcelona, Spain
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Belgium
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter de Jonge
- University of Groningen, University Medical Center, Groningen Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - John Fayyad
- Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), Beirut, Lebanon
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, China
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
| | - Jean Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes Paris, France
| | - Carmen W. Lim
- Department of Psychological Medicine, Dunedin School of Medecine, University of Otago, New Zealand
| | | | - Fernando Navarro-Mateu
- Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate Scott
- Department of Psychological Medicine, Dunedin School of Medecine, University of Otago, New Zealand
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Ursano RJ, Heeringa SG, Stein MB, Jain S, Raman R, Sun X, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE, Hwang I, Naifeh JA, Nock MK, Rosellini AJ, Sampson NA, Schoenbaum M, Zaslavsky AM, Kessler RC. Prevalence and correlates of suicidal behavior among new soldiers in the U.S. Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depress Anxiety 2015; 32:3-12. [PMID: 25338964 PMCID: PMC5113817 DOI: 10.1002/da.22317] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/21/2014] [Accepted: 08/23/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The prevalence of suicide among U.S. Army soldiers has risen dramatically in recent years. Prior studies suggest that most soldiers with suicidal behaviors (i.e., ideation, plans, and attempts) had first onsets prior to enlistment. However, those data are based on retrospective self-reports of soldiers later in their Army careers. Unbiased examination of this issue requires investigation of suicidality among new soldiers. METHOD The New Soldier Study (NSS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully structured self-administered measures to estimate preenlistment histories of suicide ideation, plans, and attempts among new soldiers reporting for Basic Combat Training in 2011-2012. Survival models examined sociodemographic correlates of each suicidal outcome. RESULTS Lifetime prevalence estimates of preenlistment suicide ideation, plans, and attempts were 14.1, 2.3, and 1.9%, respectively. Most reported onsets of suicide plans and attempts (73.3-81.5%) occurred within the first year after onset of ideation. Odds of these lifetime suicidal behaviors among new soldiers were positively, but weakly associated with being female, unmarried, religion other than Protestant or Catholic, and a race/ethnicity other than non-Hispanic White, non-Hispanic Black, or Hispanic. CONCLUSIONS Lifetime prevalence estimates of suicidal behaviors among new soldiers are consistent with retrospective reports of preenlistment prevalence obtained from soldiers later in their Army careers. Given that prior suicidal behaviors are among the strongest predictors of later suicides, consideration should be given to developing methods of obtaining valid reports of preenlistment suicidality from new soldiers to facilitate targeting of preventive interventions.
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Affiliation(s)
- Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland,Correspondence to: Robert J. Ursano, Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
| | - Steven G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California,VA San Diego Healthcare System, San Diego, California
| | - Sonia Jain
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California
| | - Rema Raman
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California,Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Xiaoying Sun
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Lisa J. Colpe
- National Institute of Mental Health, Bethesda, Maryland
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stephen E. Gilman
- Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, Maryland
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew K. Nock
- Department of Psychology, Harvard College, Cambridge, Massachusetts
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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19
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Rosellini AJ, Heeringa SG, Stein MB, Ursano RJ, Chiu WT, Colpe LJ, Fullerton CS, Gilman SE, Hwang I, Naifeh JA, Nock MK, Petukhova M, Sampson NA, Schoenbaum M, Zaslavsky AM, Kessler RC. Lifetime prevalence of DSM-IV mental disorders among new soldiers in the U.S. Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depress Anxiety 2015; 32:13-24. [PMID: 25338841 PMCID: PMC5111824 DOI: 10.1002/da.22316] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/15/2014] [Accepted: 08/24/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The prevalence of 30-day mental disorders with retrospectively reported early onsets is significantly higher in the U.S. Army than among socio-demographically matched civilians. This difference could reflect high prevalence of preenlistment disorders and/or high persistence of these disorders in the context of the stresses associated with military service. These alternatives can to some extent be distinguished by estimating lifetime disorder prevalence among new Army recruits. METHODS The New Soldier Study (NSS) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully structured measures to estimate lifetime prevalence of 10 DSM-IV disorders in new soldiers reporting for Basic Combat Training in 2011-2012 (n = 38,507). Prevalence was compared to estimates from a matched civilian sample. Multivariate regression models examined socio-demographic correlates of disorder prevalence and persistence among new soldiers. RESULTS Lifetime prevalence of having at least one internalizing, externalizing, or either type of disorder did not differ significantly between new soldiers and civilians, although three specific disorders (generalized anxiety, posttraumatic stress, and conduct disorders) and multimorbidity were significantly more common among new soldiers than civilians. Although several socio-demographic characteristics were significantly associated with disorder prevalence and persistence, these associations were uniformly weak. CONCLUSIONS New soldiers differ somewhat, but not consistently, from civilians in lifetime preenlistment mental disorders. This suggests that prior findings of higher prevalence of current disorders with preenlistment onsets among soldiers than civilians are likely due primarily to a more persistent course of early-onset disorders in the context of the special stresses experienced by Army personnel.
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Affiliation(s)
| | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Lisa J. Colpe
- National Institute of Mental Health, Bethesda, MD, USA
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephen E. Gilman
- Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard College, Cambridge, MA, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Address correspondence to Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. Tel. (617) 432-3587, Fax (617) 432-3588,
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20
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Wang JN, Wong TK, Kan CD, Wu JM, Chiu WT, Chan HC. P345Isolation and identification of a new source of human stem cells expanded from pediatric congenital heart disease. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu091.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Karam EG, Sampson N, Itani L, Andrade LH, Borges G, Chiu WT, Florescu S, Horiguchi I, Zarkov Z, Akiskal H. Under-reporting bipolar disorder in large-scale epidemiologic studies. J Affect Disord 2014; 159:147-54. [PMID: 24679403 DOI: 10.1016/j.jad.2014.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/31/2013] [Accepted: 01/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND To investigate if the prevalence of bipolar disorder in epidemiologic studies is an underestimate, as suggested by clinical studies. METHODS We analyzed data from 8 countries that participated in the World Mental Health Survey Initiative (n=47,552). We identified 6.8% and 18.9% of the sample who we think were screened out inappropriately (SCI) from the euphoric and irritable bipolar sections respectively. We compared them to those who were allowed to continue the section (CONT, 2.6% of the sample for euphoric; 1.0% for irritable) and to the reference group (REF, 69.5% of the sample). RESULTS The SCI group had consistently higher rates of major depression (29.1% vs. 6.4%), earlier age of onset (24.3y vs. 32.4y), more suicide attempts (13.3% vs. 5.9%), and more episodes (4.2 vs. 2.7) than the REF for the euphoric group. Similar findings exist for the irritable group. Also, comorbidity with anxiety, disruptive behavior disorders and substance use were much higher than the REF. LIMITATIONS As with all epidemiologic studies, recall bias cannot be ruled out. CONCLUSIONS The findings above suggest that a number of the SCI subjects belong to the bipolar group. A revision of instruments used in epidemiologic research will probably prove what clinical studies have been showing that bipolar disorder is more common than has been reported.
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Affiliation(s)
- Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon.
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Lynn Itani
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Laura Helena Andrade
- Institute of Psychiatry, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | | | - Zahari Zarkov
- National Center of Public Health and Analyses, Department Mental Health, Sofia, Bulgaria
| | - Hagop Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA
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22
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Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, de Graaf R, Maria Haro J, Kovess-Masfety V, O'Neill S, Posada-Villa J, Sasu C, Scott K, Viana MC, Xavier M. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 2013; 73:904-14. [PMID: 23290497 PMCID: PMC3628997 DOI: 10.1016/j.biopsych.2012.11.020] [Citation(s) in RCA: 726] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/21/2012] [Accepted: 11/21/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys. METHODS Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. RESULTS Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. CONCLUSIONS Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
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23
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Kawakami N, Abdulghani EA, Alonso J, Bromet E, Bruffaerts R, de Almeida JMC, Chiu WT, de Girolamo G, de Graaf R, Fayyad J, Ferry F, Florescu S, Gureje O, Hu C, Lakoma MD, LeBlanc W, Lee S, Levinson D, Malhotra S, Matschinger H, Medina-Mora ME, Nakamura Y, Browne MAO, Okoliyski M, Posada-Villa J, Sampson NA, Viana MC, Kessler RC. Early-life mental disorders and adult household income in the World Mental Health Surveys. Biol Psychiatry 2012; 72:228-37. [PMID: 22521149 PMCID: PMC3402018 DOI: 10.1016/j.biopsych.2012.03.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 01/04/2012] [Accepted: 03/03/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income. METHODS Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income. RESULTS Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income. CONCLUSIONS Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.
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Affiliation(s)
- Norito Kawakami
- Department of Mental Health, School of Public Health, the University of Tokyo, Japan
| | | | - Jordi Alonso
- IMIM-Institut de Recerca Hospital del Mar, Parc de Salut Mar and Pompeu Fabra University (UPF), Spain
| | - Evelyn Bromet
- State University of New York at Stony Brook Department of Psychiatry, Stony Brook, NY
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum Katholieke Universiteit Leuven (UPC-KUL), Belgium
| | - Jose Miguel Caldas de Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - John Fayyad
- Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), Lebanon
| | - Finola Ferry
- School of Psychology, University of Ulster, Northern Ireland
| | - Silvia Florescu
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar Bucuresti, (SNSPMPDSB), National School of Public Health Management and Professional Development, Romania
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences, Drug and Alcohol Abuse, Department of Psychiatry, University of Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzen, China
| | | | - William LeBlanc
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Sing Lee
- The Chinese University of Hong Kong, China
| | - Daphna Levinson
- Research & Planning, Mental Health Services Ministry of Health, Israel
| | - Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Germany
| | | | | | | | - Michail Okoliyski
- Department of Global Mental Health, National Centre of Public Health Protection, Bulgaria
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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24
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Chu TB, Liao CW, Huang YC, Chang YT, Costa ASRJ, Ji DD, Nara T, Tsubouchi A, Chang PWS, Chiu WT, Fan CK. Prevalence of Schistosoma intercalatum and S. haematobium Infection among Primary Schoolchildren in Capital Areas of Democratic Republic Of São Tomé and Príncipe, West Africa. Iran J Parasitol 2012; 7:67-72. [PMID: 23133474 PMCID: PMC3488823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 12/11/2011] [Indexed: 11/04/2022]
Abstract
BACKGROUND A parasitological survey of Schistosoma haematobium and S. intercalatum infection among primary schoolchildren in capital area of Democratic Republic of São Tomé and Príncipe (DRSTP) was undertaken. METHODS Subjects with positive infection were confirmed by the detection of S. haematobium ova in the urine or S. intercalatum ova in the stool by using centrifugation concentration or merthiolate-iodine-formalin concentration method. Totally, 252 urine and stool samples, respectively, were obtained from apparently healthy schoolchildren, of which 121 from boys (9.8 ± 1.4 yr) and 131 from girls (9.7 ± 1.3 yr). RESULTS None of participating schoolchildren were found having S. haematobium ova in the urinary specimen. While, among 4 primary schools studied, only schoolchildren from Saint Marçal were detected with S. intercalatum ova in the fecal specimen, making the overall prevalence of S. intercalatum infection among schoolchildren was 2.4% (6/252) and girls had insignificantly higher prevalence (3.1%, 4/131) than that (1.7%, 2/121) in boys (χ(2) = 0.5, P = 0.5). CONCLUSION Water control and sanitation as well as snails eliminated by molluscicides are urgently needed to reduce S. intercalatum infection in DRSTP inhabitants.
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Affiliation(s)
- TB Chu
- School of Health Care Administration, College of Public Health & Nutrition, Taipei Medical University, Taipei, Taiwan
| | - CW Liao
- Dept. of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan,Dept. of Molecular and Cellular Parasitology, Juntendo University School of Medicine, Tokyo, Japan
| | - YC Huang
- Dept. of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - YT Chang
- Taiwan Medical Mission in São Tomé, Democratic Republic of São Tomé and Príncipe
| | - ASRJ Costa
- Ministry of Health and Social Affairs, Democratic Republic of São Tomé and Príncipe
| | - DD Ji
- Laboratory of Parasitic Diseases, Center for Diseases Control, Dept. of Health, Taipei, Taiwan
| | - T Nara
- Dept. of Molecular and Cellular Parasitology, Juntendo University School of Medicine, Tokyo, Japan
| | - A Tsubouchi
- Dept. of Molecular and Cellular Parasitology, Juntendo University School of Medicine, Tokyo, Japan
| | - Peter WS Chang
- School of Public Health, College of Public Health & Nutrition, Taipei Medical University, Taipei, Taiwan
| | - WT Chiu
- Dept. of Neurosurgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - CK Fan
- Dept. of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan,Center for International Tropical Medicine, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan,Corresponding author:E-mail:
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Hughes M, Brymer M, Chiu WT, Fairbank JA, Jones RT, Pynoos RS, Rothwell V, Steinberg AM, Kessler RC. Posttraumatic stress among students after the shootings at Virginia Tech. ACTA ACUST UNITED AC 2011. [DOI: 10.1037/a0024565] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chu TB, Liao CW, D'Lamini P, Chang PWS, Chiu WT, Du WY, Fan CK. Prevalence of Schistosoma haematobium infection among inhabitants of Lowveld, Swaziland, an endemic area for the disease. Trop Biomed 2010; 27:337-342. [PMID: 20962734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We carried out a parasitological survey of Schistosoma haematobium infection among the residents of Lowveld Siphofaneni, Swaziland, an area which is devoid of sanitation. Subjects with positive infection were confirmed by the detection of S. haematobium ova in their urine. The intensity of the infection was estimated by calculating the total number of S. haematobium ova present in 10 ml urine specimen (geometric mean intensity; GMI). Overall, the prevalence of S. haematobium infection was 6.1% (18/295) with a GMI of 20.7 (95% CI=9.1~32.2). Female (10.5%, 16/153) had significantly higher prevalence than that in male (1.4%, 2/142) (ORs=8.2, 95% CI=1.8- 36.2, P<0.01); conversely, male had higher GMI (60.0) than that (17.3) in female. The age group of ≤5 yrs (15.3%, 9/59) had significantly higher prevalence than that in age group of ≥19 yrs (2.6%, 3/115) (ORs=0.2, 95% CI=0.04-0.57, P<0.01). The highest GMI of 27.9 (95% CI=7.6~48.2) was also seen in age group of ≤5 yrs.
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Affiliation(s)
- T B Chu
- Department and Graduate Institute of Business Administration, National Taiwan University, 1, Sec. 4, Roosevelt Road, 106 Taipei, Taiwan
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Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, Hwang I, Karam EG, Kessler RC, Sampson N, Alonso J, Andrade LH, Angermeyer M, Benjet C, Bromet E, de Girolamo G, de Graaf R, Florescu S, Gureje O, Horiguchi I, Hu C, Kovess V, Levinson D, Posada-Villa J, Sagar R, Scott K, Tsang A, Vassilev SM, Williams DR, Nock MK. Childhood adversities as risk factors for onset and persistence of suicidal behaviour. Br J Psychiatry 2010; 197:20-7. [PMID: 20592429 PMCID: PMC2894980 DOI: 10.1192/bjp.bp.109.074716] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood. AIMS To examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide. METHOD Respondents from nationally representative samples (n = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour. RESULTS Childhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2-5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents' lifetime mental disorder status. CONCLUSIONS Childhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.
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Affiliation(s)
- Ronny Bruffaerts
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium.
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Stein DJ, Chiu WT, Hwang I, Kessler RC, Sampson N, Alonso J, Borges G, Bromet E, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, He Y, Kovess-Masfety V, Levinson D, Matschinger H, Mneimneh Z, Nakamura Y, Ormel J, Posada-Villa J, Sagar R, Scott KM, Tomov T, Viana MC, Williams DR, Nock MK. Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS One 2010; 5:e10574. [PMID: 20485530 PMCID: PMC2869349 DOI: 10.1371/journal.pone.0010574] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/16/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues. METHODOLOGY/PRINCIPAL FINDINGS Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries. CONCLUSIONS/SIGNIFICANCE This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.
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Affiliation(s)
- Dan J. Stein
- Department of Psychiatry, Groote Schuur Hospital, Cape Town, South Africa
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jordi Alonso
- Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Guilherme Borges
- Department of Epidemiological Research, Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Evelyn Bromet
- Department of Psychiatry, State University of New York at Stony Brook, New York, United States of America
| | | | - Giovanni de Girolamo
- Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Florescu
- National School of Public Health and Health Services Management, Bucharest, Romania
| | - Oye Gureje
- University College Hospital, Ibadan, Nigeria
| | - Yanling He
- Shanghai Mental Health Center, Shanghai, China
| | | | - Daphna Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Zeina Mneimneh
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yosikazu Nakamura
- School of Public Health, Jichi Medical University, Tochigi-ken, Japan
| | - Johan Ormel
- Department of Psychiatry and Psychiatric Epidemiology, University Medical Center Groningen, University Center for Psychiatry, Groningen, Netherlands
| | | | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Kate M. Scott
- Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, Otago, New Zealand
| | - Toma Tomov
- Institute for Human Relations, New Bulgarian University, Sofia, Bulgaria
| | - Maria Carmen Viana
- Department of Psychiatric Epidemiology, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - David R. Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
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Liao CW, Lee YL, Sukati H, D'lamini P, Huang YC, Chiu CJ, Liu YH, Chou CM, Chiu WT, Du WY, Hung CC, Chan HC, Chu B, Cheng HC, Su J, Tu CC, Cheng CY, Fan CK. Seroprevalence of Toxoplasma gondii infection among children in Swaziland, southern Africa. Ann Trop Med Parasitol 2010; 103:731-6. [PMID: 20030998 DOI: 10.1179/000349809x12554106963474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C W Liao
- Department of Parasitology, Taipei Medical University College of Medicine, Taiwan
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30
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Degenhardt L, Dierker L, Chiu WT, Medina-Mora ME, Neumark Y, Sampson N, Alonso J, Angermeyer M, Anthony JC, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Karam AN, Kostyuchenko S, Lee S, Lépine JP, Levinson D, Nakamura Y, Posada-Villa J, Stein D, Wells JE, Kessler RC. Evaluating the drug use "gateway" theory using cross-national data: consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug Alcohol Depend 2010; 108:84-97. [PMID: 20060657 PMCID: PMC2835832 DOI: 10.1016/j.drugalcdep.2009.12.001] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is unclear whether the normative sequence of drug use initiation, beginning with tobacco and alcohol, progressing to cannabis and then other illicit drugs, is due to causal effects of specific earlier drug use promoting progression, or to influences of other variables such as drug availability and attitudes. One way to investigate this is to see whether risk of later drug use in the sequence, conditional on use of drugs earlier in the sequence, changes according to time-space variation in use prevalence. We compared patterns and order of initiation of alcohol, tobacco, cannabis, and other illicit drug use across 17 countries with a wide range of drug use prevalence. METHOD Analyses used data from World Health Organization (WHO) World Mental Health (WMH) Surveys, a series of parallel community epidemiological surveys using the same instruments and field procedures carried out in 17 countries throughout the world. RESULTS Initiation of "gateway" substances (i.e. alcohol, tobacco and cannabis) was differentially associated with subsequent onset of other illicit drug use based on background prevalence of gateway substance use. Cross-country differences in substance use prevalence also corresponded to differences in the likelihood of individuals reporting a non-normative sequence of substance initiation. CONCLUSION These results suggest the "gateway" pattern at least partially reflects unmeasured common causes rather than causal effects of specific drugs on subsequent use of others. This implies that successful efforts to prevent use of specific "gateway" drugs may not in themselves lead to major reductions in the use of later drugs.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Lin CM, Lin JW, Tsai JT, Ko CP, Hung KS, Hung CC, Su YK, Wei L, Chiu WT, Lee LM. Intracranial pressure fluctuation during hemodialysis in renal failure patients with intracranial hemorrhage. Acta Neurochir Suppl 2009; 101:141-4. [PMID: 18642649 DOI: 10.1007/978-3-211-78205-7_24] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coagulopathy in renal failure patients often makes them vulnerable to intracranial hemorrhage. Emergency decompression to remove the hematoma and to stop bleeding is always indicated. After the surgery, hemodialysis (HD) should be arranged to maintain the BUN/Cr. level, and I/O balance. During HD, intracranial pressure in all of the patients in this study fluctuated. This phenomenon always resulted in neurological deterioration in acute or chronic renal failure. We present intracranial pressure (ICP) changes during HD in five acute or chronic renal failure patients with intracranial hemorrhage. They all underwent craniectomy or craniotomy with ICP monitors implantation. Different HD protocols were arranged for these patients and then we observed clinical results. ICP elevated during HD and resulted in severe brain swelling. This situation was one of the clinical presentations of dialysis disequilibrium syndrome (DDS). Four patients died because of this complication and one survived. ICP fluctuation seemed to be correlated with the fluid amount and frequency of HD. The prevalence and pathophysiology of DDS remain unclear. Renal failure patient with intracranial hemorrhage may be complicated with DDS when HD was performed. An attempt to reduce the fluid amount and to increase the frequency of HD might help these patients.
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Affiliation(s)
- C M Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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32
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Degenhardt L, Chiu WT, Conway K, Dierker L, Glantz M, Kalaydjian A, Merikangas K, Sampson N, Swendsen J, Kessler RC. Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. Psychol Med 2009; 39:157-167. [PMID: 18466664 PMCID: PMC2653272 DOI: 10.1017/s0033291708003425] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The 'gateway' pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that 'violations' of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R). METHOD The NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and 'violations' defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence. RESULTS Gateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs. CONCLUSIONS Drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, Australia.
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33
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Chen CY, Ying SH, Yao MS, Chiu WT, Chan WP. Sphenoid sinus osteoma at the sella turcica associated with empty sella: CT and MR imaging findings. AJNR Am J Neuroradiol 2008; 29:550-1. [PMID: 18184833 DOI: 10.3174/ajnr.a0935] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY A 50-year-old woman presented with intermittent headache for the past few years. A paranasal sinus CT scan showed a diffusely calcified lesion at the roof of the sphenoid sinus and sella turcica, with the sellar floor bony cortex involved. Empty sella was noted. MR imaging revealed a soft-tissue lesion with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and heterogeneous enhancement on postgadolinium images. Histologic examination revealed an osteoma composed of mature lamellar bone.
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Affiliation(s)
- C Y Chen
- Department of Radiology, School of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
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34
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Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams DR. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008; 192:98-105. [PMID: 18245022 PMCID: PMC2259024 DOI: 10.1192/bjp.bp.107.040113] [Citation(s) in RCA: 1599] [Impact Index Per Article: 99.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not wellknown, especially in low- and middle-income countries. AIMS To report on the prevalence and risk factors for suicidal behaviours across 17 countries. METHOD A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors. RESULTS The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries. CONCLUSION There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.
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Affiliation(s)
| | - Guilherme Borges
- Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, State University of New York, Stony Brook
| | - Jordi Alonso
- Health Services Research Unit, Institut Municipal d'Investigacio Medica (IMIM), Barcelona, Spain
| | | | | | - Ronny Bruffaerts
- Department of Neurosciences and Psychiatry, University Hospitals, Gasthuisberg, Belgium
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School
| | | | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yueqin Huang
- Institute of Mental Health, Peking University, People’s Republic of China
| | - Elie Karam
- Department of Psychiatry and Psychology, St. George Hospital University Medical Center, Beirut, Lebanon
| | | | - Jean Pierre Lepine
- Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot
| | - Daphna Levinson
- Research and planning, Mental health services, Ministry of Health, Jerusalem, Israel
| | - Maria Elena Medina-Mora
- Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
| | | | - José Posada-Villa
- Colegio Mayor de Cundinamarca University; Saldarriaga Concha Foundation, Bogota, Colombia
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Ju DT, Lin JW, Lin MS, Lee LM, Tseng HM, Wei CP, Yen CH, Hung CC, Hung KS, Lin CM, Lin TJ, Chiu WT, Tsai JT. Hypofractionated CyberKnife stereotactic radiosurgery for acoustic neuromas with and without association to neurofibromatosis Type 2. Acta Neurochir Suppl 2008; 101:169-173. [PMID: 18642654 DOI: 10.1007/978-3-211-78205-7_29] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CyberKnife stereotactic radiosurgery (CKSRS) has been proved effective in treating intra-cranial lesions. To treat acoustic neuroma (AN) patients with or without neurofibromatosis Type 2 (NF2) associations, the functional preservation of hearing, trigeminal nerve, and facial nerve are important. Twenty-one patients were treated with hypofractionated CKSRS. Fourteen non-NF2 and seven NF2 patients were enrolled. Cranial nerve function, audiograms, and magnetic resonance images (MRI) were monitored. Mean follow-up was 15 month. Tumors with volumes ranging from 0.13 to 24.8 cm3 (mean 5.4 cm3) were irradiated with the marginal dose 1800-2000 cGy/3 fractions. Tumors were treated with an 80 to 89% isodose line (mean 83%) and mean 97.9% tumor coverage. Two patients experienced hearing deterioration (16.7%) in the non-NF2 group, and 3 patients (50%) in the NF2 group. No facial or trigeminal dysfunction, brain stem toxicity, or cerebellar edema occurred. Tumor regression was seen in 9 patients (43%) and stable in 12 patients (57%). 100% tumor control rate was achieved. Hypofractionated CKSRS was not only effective in tumor control but also excellent in hearing preservation for non-NF2 AN. But for NF2 patients, although the tumor control was remarkable, hearing preservation was modest as in non-NF2 patients.
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Affiliation(s)
- D T Ju
- National Defense Medical Center, Department of Neurological Surgery, Tri-Service General Hospital, Taipei, Taiwan
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36
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Lin JW, Tsai JT, Lin CM, Lee LM, Hung KS, Huang SJ, Hsiao SH, Chung WY, Tsai MD, Hsia CC, Hung CC, Chiu WT. Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury. Acta Neurochir Suppl 2008; 101:131-136. [PMID: 18642647 DOI: 10.1007/978-3-211-78205-7_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < or = 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < or = 60 mmHg. There have been some discrepancies of opinions about this recommendation in recent publications. In this study, we retrospectively reviewed 305 severe TBI (STBI) patients with Glasgow Coma Scales (GCS) < or = 8 between January 1, 2002 and March 31, 2003. The study group was stratified according to use or nonuse of intracranial pressure (ICP) monitoring, ICP levels, ages, and GCS levels in order to test the correlation between CCP and the prognosis. The patients < 50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels < 20 mmHg had lower mortality rates and better prognosis (GOS) (p < 0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained < or = 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.
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Affiliation(s)
- J W Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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Lin JW, Tsai JT, Lee LM, Lin CM, Hung CC, Hung KS, Chen WY, Wei L, Ko CP, Su YK, Chiu WT. Effect of hyperbaric oxygen on patients with traumatic brain injury. Acta Neurochir Suppl 2008; 101:145-149. [PMID: 18642650 DOI: 10.1007/978-3-211-78205-7_25] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hyperbaric oxygen therapy (HBOT) is the medical therapeutic use of oxygen at a higher atmospheric pressure. The United States Food and Drug Administration have approved several clinical applications for HBOT, but HBOT in traumatic brain injury (TBI) patients has still remained in controversial. The purpose of our study is to evaluate the benefit of HBOT on the prognosis of subacute TBI patients. We prospectively enrolled 44 patients with TBI from November 1, 2004 to October 31, 2005. The study group randomly included 22 patients who received HBOT after the patients' condition stabilization, and the other 22 corresponding condition patients were assigned into the matched control group who were not treated with HBOT. The clinical conditions of the patients were evaluated with the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) before and 3 to 6 months after HBOT. The GCS of the HBOT group was improved from 11.1 to 13.5 in average, and from 10.4 to 11.5 (p < 0.05) for control group. Among those patients with GOS = 4 before the HBOT, significant GOS improvement was observed in the HBOT group 6 months after HBOT. Based on this study, HBOT can provide some benefits for the subacute TBI patients with minimal adverse side effects.
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Affiliation(s)
- J W Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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Abstract
Because of the rapid industrial and economic growth, Taiwan and other developing countries have faced an enormous increase in the number of motorcycles, which has subsequently caused a rapid increase of the motorcycle-related traumatic brain injuries (TBI). In order to tackle this serious problem, stepwise approaches for TBI were implemented in Taiwan from 1991 to 2007. Step 1 was to do a nationwide TBI registry in order to identify the risk factors and determinants. We found that the major cause of TBI in Taiwan was motorcycle-related injury, and very few motorcyclists wore a helmet. Step 2 was to launch the implementation of the helmet use law on June 1, 1997. A rapid decline of TBI hospitalizations and deaths was demonstrated soon thereafter. Step 3 was to enroll into international collaborations with the Global Spine and Head Injury Prevention Project (Global SHIP Project) groups for TBI. The comparative results thus obtained could be used to develop prevention strategies for developing countries. Step 4 was to implement clinical researches for TBI, which included a Propofol study, hyperbaric oxygen therapy (HBOT), brain parenchymal oxygen (PbtO2) monitoring, etc. Step 5 was to develop guidelines for the management of severe TBI in Taiwan. Through a 2-year period of review, discussion, and integration, a 9-chapter guideline was published in June 2007. In summary, our experience and process for management of TBI in Taiwan can be used as a reference for other developing countries.
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Affiliation(s)
- J W Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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Abstract
BACKGROUND Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R). METHOD The NCS-R is a nationally representative household survey fielded in 2001-2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia. RESULTS The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose-response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment. CONCLUSIONS Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.
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Affiliation(s)
- A M Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age-of-onset (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM-IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM-IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide-related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.
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Degenhardt L, Chiu WT, Sampson N, Kessler RC, Anthony JC. Epidemiological patterns of extra-medical drug use in the United States: evidence from the National Comorbidity Survey Replication, 2001-2003. Drug Alcohol Depend 2007; 90:210-23. [PMID: 17481828 PMCID: PMC2739901 DOI: 10.1016/j.drugalcdep.2007.03.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 03/26/2007] [Accepted: 03/26/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 1994, epidemiological patterns of extra-medical drug use in the United States were estimated from the National Comorbidity Survey. This paper describes such patterns based upon more recent data from the National Comorbidity Survey Replication (NCS-R). METHODS The NCS-R was a nationally representative face-to-face household survey of 9282 English-speaking respondents, aging 18 years and older, conducted in 2001-2003 using a fully structured diagnostic interview, the WHO Composite International Diagnostic Interview (CIDI) Version 3.0. RESULTS The estimated cumulative incidence of alcohol use in the NCS-R was 92%; tobacco, 74%; extra-medical use of other psychoactive drugs, 45%; cannabis, 43% and cocaine, 16%. Statistically robust associations existed between all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Very robust birth cohort differences were observed for cocaine, cannabis, and other extra-medical drug use, but not for alcohol or tobacco. Trends in the estimated cumulative incidence of drug use among young people across time suggested clear periods of fluctuating risk. CONCLUSIONS These epidemiological patterns of alcohol, tobacco, and other extra-medical drug use in the United States in the early 21st century provide an update of NCS estimates from roughly 10 years ago, and are consistent with contemporaneous epidemiological studies. New findings on religion and religiosity, and exploratory data on time trends, represent progress in both concepts and methodology for such research. These estimates lead to no firm causal inferences, but contribute to a descriptive epidemiological foundation for future research on drug use and dependence across recent decades, birth cohorts, and population subgroups.
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Affiliation(s)
- Louisa Degenhardt
- Department of Epidemiology, Michigan State University, B601 West Fee Hall, East Lansing, MI 48824, USA.
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Borges G, Wang PS, Medina-Mora ME, Lara C, Chiu WT. Delay of first treatment of mental and substance use disorders in Mexico. Am J Public Health 2007; 97:1638-43. [PMID: 17666703 PMCID: PMC1963297 DOI: 10.2105/ajph.2006.090985] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied failure and delay in making initial treatment contact after the first onset of a mental or substance use disorder in Mexico as a first step to understanding barriers to providing effective treatment in Mexico. METHODS Data were from the Mexican National Comorbidity Survey (2001-2002), a representative, face-to-face household survey of urban residents aged 18 to 65 years. The age of onset for disorders was compared with the age of first professional treatment contact for each lifetime disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS Many people with lifetime disorders eventually made treatment contact, although the proportions varied for mood (69.9%), anxiety (53.2%), and substance use (22.1%) disorders. Delays were long: 10 years for substance use disorders, 14 years for mood disorders, and 30 years for anxiety disorders. Failure and delay in making initial treatment contact were associated with earlier ages of disorder onset and being in older cohorts. CONCLUSIONS Failure to make prompt initial treatment contact is an important reason explaining why there are unmet needs for mental health care in Mexico. Meeting these needs will likely require expansion and optimal allocation of resources as well as other interventions.
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Affiliation(s)
- Guilherme Borges
- National Institute of Psychiatry and the Metropolitan Autonomous University, Mexico City, Mexico.
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Ruscio AM, Chiu WT, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC. Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 2007; 21:662-76. [PMID: 17118626 PMCID: PMC2475335 DOI: 10.1016/j.janxdis.2006.10.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 10/06/2006] [Accepted: 10/26/2006] [Indexed: 01/22/2023]
Abstract
Concerns have been raised that the DSM-IV requirements of 6-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD.
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Chen CY, Chuang YL, Yao MS, Chiu WT, Chen CL, Chan WP. Posterior epidural migration of a sequestrated lumbar disk fragment: MR imaging findings. AJNR Am J Neuroradiol 2006; 27:1592-4. [PMID: 16908587 PMCID: PMC7977555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We present a 75-year-old man who, for 2 weeks, had progressive pain in both of his thighs when standing straight. MR imaging showed a sequestrated disk fragment, which had a signal intensity similar to that of a herniated disk with a rim enhancement in the posterior epidural space and a ruptured outermost annulus of the intervertebral disk at L2-3. Awareness of these MR imaging findings can help in the diagnosis of posterior epidural disk migration.
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Affiliation(s)
- C Y Chen
- Department of Radiology, School of Medicine, Taipei Medical University, Taipei 116, Taiwan
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Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. ACTA ACUST UNITED AC 2006; 63:415-24. [PMID: 16585471 PMCID: PMC1958997 DOI: 10.1001/archpsyc.63.4.415] [Citation(s) in RCA: 455] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). OBJECTIVE To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. DESIGN AND SETTING Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. PARTICIPANTS English-speaking respondents (N=9282) 18 years or older. MAIN OUTCOME MEASURES Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. RESULTS Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). CONCLUSION Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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Lin JW, Lin MS, Lin CM, Tseng CH, Tsai SH, Kan IH, Chiu WT. Idiopathic syringomyelia: case report and review of the literature. Acta Neurochir Suppl 2006; 99:117-20. [PMID: 17370776 DOI: 10.1007/978-3-211-35205-2_22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Syringomyelia is an uncommon disease that is caused most often by type I Chiari malformation, which develops in the hindbrain, and less frequently by other factors which are not limited to the hindbrain, including trauma, infection, or scoliosis. Idiopathic syringomyelia is rare. We present in this article a patient with idiopathic syringomyelia characterized by hypoesthesia and progressive weakness in the left lower limb. Decompression was attempted by means of laminectomy and a syringoarachnoid shunt. Motor, sensory, and bladder functions were monitored by the change in Japanese Orthopedic Association scores, which increased from 10 points preoperatively to 14 points 30 days postoperatively. This case demonstrates the effectiveness of surgical decompression in a patient with remarkable neurological deficit.
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Affiliation(s)
- J W Lin
- Division of Neurosurgery, Surgical Department, Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
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47
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Chiu WT, Lin PW, Chiou HY, Lee WS, Lee CN, Yang YY, Lee HM, Hsieh MS, Hu CJ, Ho YS, Deng WP, Hsu CY. Infrared thermography to mass-screen suspected SARS patients with fever. Asia Pac J Public Health 2005; 17:26-8. [PMID: 16044829 DOI: 10.1177/101053950501700107] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fever greater than 38 degrees C is a cardinal sign of patients with the severe acute respiratory syndromes (SARS). To reduce the risk of nosocomial cross infections, screening all patients and visitors who visit hospitals and clinics for fever at the entrance of every hospital building has become a standard protocol in Taiwan during the SARS epidemic from mid-April to mid-June 2003. We used a digital infrared thermal imaging (DITI) system (Telesis Spectrum 9000 MB) to conduct mass screening of patients and visitors who entered the hospital to identify those with fever. The DITI system has two components: a sensor head and a PC imaging workstation. The sensor head is an optic-mechanical device which consists of imagining optics for focusing the infrared source information on the infrared detector. The infrared images are further converted into electrical signals, which are then processed for real-time display on the monitor. During the period from April 13 to May 12 2003, 72,327 outpatients and visitors entered Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. A total of 305 febrile patients (0.42%) was detected by infrared thermography. Among them, three probable SARS patients were identified after thorough studies including contact history, laboratory tests and radiology examinations. The findings suggests that infrared thermography was an effective and reliable tool ideal for mass-screening patients with fever in the initial phase of screening for SARS patients at a busy hospital which sees approximately 3,000 outpatients every weekday during the SARS epidemic.
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Affiliation(s)
- W T Chiu
- Department of Neurosurgery, Taipei Medical University, Wan Fang Hospital.
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Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. ACTA ACUST UNITED AC 2005; 62:617-27. [PMID: 15939839 PMCID: PMC2847357 DOI: 10.1001/archpsyc.62.6.617] [Citation(s) in RCA: 6942] [Impact Index Per Article: 365.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about the general population prevalence or severity of DSM-IV mental disorders. OBJECTIVE To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. DESIGN AND SETTING Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. PARTICIPANTS Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. MAIN OUTCOME MEASURES Twelve-month DSM-IV disorders. RESULTS Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. CONCLUSION Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, Jin R, Pennell BE, Walters EE, Zaslavsky A, Zheng H. The US National Comorbidity Survey Replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 2004; 13:69-92. [PMID: 15297905 PMCID: PMC6878537 DOI: 10.1002/mpr.167] [Citation(s) in RCA: 563] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The National Comorbidity Survey Replication (NCS-R) is a survey of the prevalence and correlates of mental disorders in the US that was carried out between February 2001 and April 2003. Interviews were administered face-to-face in the homes of respondents, who were selected from a nationally representative multi-stage clustered area probability sample of households. A total of 9,282 interviews were completed in the main survey and an additional 554 short non-response interviews were completed with initial non-respondents. This paper describes the main features of the NCS-R design and field procedures, including information on fieldwork organization and procedures, sample design, weighting and considerations in the use of design-based versus model-based estimation. Empirical information is presented on non-response bias, design effect, and the trade-off between bias and efficiency in minimizing total mean-squared error of estimates by trimming weights.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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50
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Abstract
A mail survey was sent to cancer patients to determine how often they want, request, and receive a qualitativeprognosis (i.e., will they die from the disease?) and a quantitative estimate (how long they will survive). The survey included measures of social and psychological characteristics that were hypothesized to be associated with their desire for and willingness to request prognosis information (N = 352). Major findings are as follows: (a) Whereas about 80% of patients wanted a qualitative prognosis, only about one half wanted a quantitative one; (b) over 90% of those who wanted a qualitative prognosis were given one, but only about one half of those who wanted a quantitative prognosis were given one; and (c) about 15% ofthose who wanted a qualitative prognosis failed to ask for it, and over one third of those who wanted a quantitative prognosis failed to ask for it. Multivariate analyses indicate that the effects of education on wanting, asking for, and receiving prognosis information are slight, and the effects of sex are essentially nil. Older people were significantly less likely to request and to be given prognosis information. Those who had greater anxiety and who needed to avoid thinking about death wanted, requested, and received significantly less information. Fear had significant nonlinear effects on desire, request, and receipt of quantitative information. Those whose prognosis was worse were less likely to want, ask for, and receive quantitative information. Those least likely to want, request, and be given qualitative information were those who combined a bad prognosis with a need to avoid thinking about death.
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Affiliation(s)
- Stan A Kaplowitz
- Department of Sociology, Michigan State University, East Lansing 48824-1111, USA.
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