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Czepiel D, McCormack C, da Silva AT, Seblova D, Moro MF, Restrepo-Henao A, Martínez AM, Afolabi O, Alnasser L, Alvarado R, Asaoka H, Ayinde O, Balalian A, Ballester D, Barathie JA, Basagoitia A, Basic D, Burrone MS, Carta MG, Durand-Arias S, Eskin M, Fernández-Jiménez E, Frey MIF, Gureje O, Isahakyan A, Jaldo R, Karam EG, Khattech D, Lindert J, Martínez-Alés G, Mascayano F, Mediavilla R, Narvaez Gonzalez JA, Nasser-Karam A, Nishi D, Olaopa O, Ouali U, Puac-Polanco V, Ramírez DE, Ramírez J, Rivera-Segarra E, Rutten BP, Santaella-Tenorio J, Sapag JC, Šeblová J, Soto MTS, Tavares-Cavalcanti M, Valeri L, Sijbrandij M, Susser ES, Hoek HW, van der Ven E. Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic. Glob Ment Health (Camb) 2024; 11:e34. [PMID: 38572248 PMCID: PMC10988139 DOI: 10.1017/gmh.2024.18] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 04/05/2024] Open
Abstract
Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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Affiliation(s)
- Diana Czepiel
- Parnassia Psychiatric Institute, Parnassia Groep, The Hague, The Netherlands
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Clare McCormack
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY, USA
| | - Andréa T.C. da Silva
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Faculty of Medicine Santa Marcelina, São Paulo, Brazil
| | - Dominika Seblova
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria F. Moro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alexandra Restrepo-Henao
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Epidemiology Group, National School of Public Health, University of Antioquia, Medellín, Colombia
| | - Adriana M. Martínez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Oyeyemi Afolabi
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Lubna Alnasser
- Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Rubén Alvarado
- Department of Public Health, School of Medicine, University of Valparaíso, Valparaiso, Chile
- School of Public Health, University of Chile, Santiago, Chile
| | - Hiroki Asaoka
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Olatunde Ayinde
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Arin Balalian
- Question Driven Design and Analysis Group, New York, NY, USA
| | - Dinarte Ballester
- University Hospital, Federal University of Rio Grande, Rio Grande, Brazil
| | - Josleen A.l. Barathie
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Armando Basagoitia
- Unidad de Investigación, Consultora Salud Global Bolivia, Sucre, Bolivia
| | - Djordje Basic
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - María S. Burrone
- Institute of Health Sciences, Universidad de O’Higgins, Rancagua, Chile
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sol Durand-Arias
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Mehmet Eskin
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Eduardo Fernández-Jiménez
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Marcela I. F. Frey
- Social and Community Academic Unit, University of Chubut, Chubut, Argentina
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Anna Isahakyan
- National Institute of Health Named After Academician S. Avdalbekyan, Yerevan, Armenia
| | - Rodrigo Jaldo
- Social and Community Academic Unit, University of Chubut, Chubut, Argentina
| | - Elie G. Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, University of Balamand,Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Dorra Khattech
- Department Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
| | - Jutta Lindert
- Faculty of Health and Social Work, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Franco Mascayano
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
| | - Javier A. Narvaez Gonzalez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Maestría en Epidemiología, División de Postgrados, El Bosque University, Bogotá, Colombia
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
| | - Aimee Nasser-Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, University of Balamand,Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Olusegun Olaopa
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Victor Puac-Polanco
- Departments of Health Policy & Management and Epidemiology & Biostatistics, Downstate Health Sciences University, Brooklyn, NY, USA
- Faculty of Medical Sciences, University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Dorian E. Ramírez
- Faculty of Medical Sciences, University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Jorge Ramírez
- School of Public Health, University of Chile, Santiago, Chile
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Bart P.F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julian Santaella-Tenorio
- Department of Clinical Epidemiology and Biostatistics, Pontifical Xavierian University, Bogotá, Colombia
| | - Jaime C. Sapag
- Department of Public Health and Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jana Šeblová
- Emergency Department, Motol University Hospital, Prague, Czech Republic
- Czech Society for Emergency and Disaster Medicine, Czech Medical Association of J. E. Purkyně, Prague, Czech Republic
| | - María T. S. Soto
- Dirección de Investigación Ciencia y Tecnología, Universidad San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Maria Tavares-Cavalcanti
- School of Medicine and Psychiatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Linda Valeri
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Hans W. Hoek
- Parnassia Psychiatric Institute, Parnassia Groep, The Hague, The Netherlands
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Els van der Ven
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Carta MG, Moro MF, Piras M, Ledda V, Prina E, Stocchino S, Orrù G, Romano F, Brasesco MV, Freire RC, Nardi AE, Tondo L. Megacities, migration and an evolutionary approach to bipolar disorder: a study of Sardinian immigrants in Latin America. ACTA ACUST UNITED AC 2020; 42:63-67. [PMID: 31269095 PMCID: PMC6986479 DOI: 10.1590/1516-4446-2018-0338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
Objective: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. Methods: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. Results: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). Conclusions: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.
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Affiliation(s)
- Mauro G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Maria F Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martina Piras
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Vanessa Ledda
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Eleonora Prina
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Serena Stocchino
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Germano Orrù
- Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | | | - Maria V Brasesco
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Rafael C Freire
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antonio E Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Leonardo Tondo
- Centro Lucio Bini Cagliari, Cagliari/Rome, Italy.,McLean Hospital, Harvard Medical School, Boston, MA, USA
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Carta MG, Said M, Piras M, Moro MF. [An evolutionist approach of mood disorders from a transcultural perspective]. Encephale 2019; 45:530-532. [PMID: 30879780 DOI: 10.1016/j.encep.2018.12.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The objective of this paper is to verify if traits and symptoms defined as pathological and maladjusted in certain contexts may produce adaptive effects in other contexts, especially if they occur in sub-threshold forms. METHODS A historical examination of how the symptoms of depression have changed in front of great social changes and an analysis of Sardinian migrants' thymic profiles toward several metropolises. RESULTS AND CONCLUSIONS Mood disorders have been increasing since the "English malady" in the 17th century, and we suppose that some forms of mood disorders might have an adaptive advantage. Otherwise, the increase of such an epidemic would have been self-limited. From a sociobiological point of view, it is highly probable that the environment of a rapidly evolving society can select people who are explorers and able to support accelerated biorhythms and that the condition of social change stimulates psychological and psychopathologic changes. It is also possible that hyperthymic persons modulate and create the new environment. If this model can explain the epidemic of mood disorders, its verification should guide future research.
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Affiliation(s)
- M G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italie
| | - M Said
- Razi Hospital, Faculty of medicine of Tunis, Tunis, Tunisia.
| | - M Piras
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italie
| | - M F Moro
- Mailman School of Public Health Columbia University, New York, United States
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Sancassiani F, Carta MG, Montisci R, Preti A, Machado S, Moro MF, Marchetti MF, Meloni L. Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder. Clin Pract Epidemiol Ment Health 2018; 14:26-32. [PMID: 29541148 PMCID: PMC5838620 DOI: 10.2174/1745017901814010026] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim was to study the association between mood and anxiety disorders and the Tako-Tsubo Syndrome (TTS) and to determine the role of antidepressants and the impairment of quality of life due the comorbid psychiatric disorder. METHODS Case-control study: 19 consecutive patients (17 female) with TTS compared to 76 controls without TTS, were randomly selected from the database of a nationwide epidemiological study after matching (gender, age and residence) by controls. Psychiatric diagnoses were carried out according to the ICD-10 using semi-structured interview tools (ANTAS-SCID) administered by clinical staff. Quality of Life (Qol) was assessed by means of SF-12. RESULTS Only Major Depressive Disorders (MDD) showed higher frequencies in cases with statistical significance difference (p=0.014) as well as at least one Mood Disorder Diagnosis [MDD or BD] (p=0.002). The lifetime prevalence of at least one anxiety disorder with no comorbid mood disorder did not show a higher frequency in cases (p=0.57).The score at SF-12 in the TTS group was similar to those of controls (p=0.71)In the TTS group, the score at SF-12 in people with one mood or anxiety diagnosis (N=7) was similar to those without mood or anxiety diagnosis (p=0.75). The use of antidepressants was higher in TTS group (15.79% vs 1.31%; p=0.030). CONCLUSION The study shows an association between TTS with depressive disorders and antidepressants use and does not confirm the association with anxiety syndromes. The study suggests the need to investigate the possible interactions between antidepressants use and mood disorders in studies with appropriate design and sample size.
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Affiliation(s)
- F. Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University, Niterói, Brazil
| | - Maria F. Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria F. Marchetti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Carta MG, Perra A, Atzeni M, D'Oca S, Moro MF, Kurotschka PK, Moro D, Sancassiani F, Minerba L, Brasesco MV, Mausel G, Nardi AE, Tondo L. An evolutionary approach to mania studying Sardinian immigrants to Argentina. ACTA ACUST UNITED AC 2017; 39:147-153. [PMID: 28300934 PMCID: PMC7111436 DOI: 10.1590/1516-4446-2016-2005] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
Objective: To ascertain lifetime prevalence of positivity to a screening questionnaire for bipolar disorders (BD) in Sardinian immigrants to Argentina and residents of Sardinia and assess whether such positivity affects quality of life (QoL) in either group. Our hypothesis is that screen positivity for BD may be more frequent in immigrants. Methods: Observational study. Subjects were randomly selected from the membership lists of associations of Sardinian immigrants in Argentina. A study carried out in Sardinia using the same methodology was used for comparison. The Mood Disorder Questionnaire was used to screen for mania/hypomania and the Short-Form Health Survey-12 to measure QoL. Results: A higher prevalence of manic/hypomanic episodes was found in Sardinian immigrants to Argentina (p < 0.0001; odds ratio = 3.0, 95% confidence interval 1.87-4.77). Positivity at screening was associated with a lower QoL both in Sardinian immigrants to Argentina and in residents of Sardinia. Conclusions: To the best of our knowledge, this is the first study to show a higher lifetime prevalence of manic/hypomanic episodes in a general-population sample of individuals who migrated to a foreign country. Our results are in agreement with the hypothesis that hyperactive/novelty-seeking features may represent an adaptive substrate in certain conditions of social change.
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Affiliation(s)
- Mauro G Carta
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Alessandra Perra
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Michela Atzeni
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Silvia D'Oca
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Maria F Moro
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter K Kurotschka
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Daniela Moro
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Dipartimento di Scienze Mediche e Sanitè Pubblica, Universitè degli studi di Cagliari, Cagliari, Italy
| | - Maria V Brasesco
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Gustavo Mausel
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Antonio E Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Leonardo Tondo
- Centro Lucio Bini Cagliari and Centro Lucio Bini Roma, Italy.,Harvard Medical School, McLean Hospital, Boston, MA, USA
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Carta MG, Moro MF, Lorefice L, Picardi A, Trincas G, Fenu G, Cocco E, Floris F, Bessonov D, Akiskal HS, Marrosu MG. Multiple sclerosis and bipolar disorders: the burden of comorbidity and its consequences on quality of life. J Affect Disord 2015; 167:192-7. [PMID: 24995886 DOI: 10.1016/j.jad.2014.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose is to measure the worsening of the Quality of Life (QoL) in people with Multiple Sclerosis (MS) and the concomitant role of co-morbid Major Depressive Disorder (MDD) and Bipolar Disorder (BD), the latter not yet studied even though it was found strictly associated with MS. CASES 201 consecutive-MS-patients. CONTROLS 804 sex-and-age-matched subjects without MS, randomly selected from an epidemiological database study. Psychiatric diagnoses according to DSM-IV were determined by physicians using structured interview tools (ANTAS-SCID). Bipolar Spectrum Disorders were identified by Mood Disorders Questionnaire (MDQ). QoL was measured by SF-12. RESULTS MS was the strongest determinant in worsening the QoL in the overall sample. Both MDD and BD type-II lifetime diagnoses were significantly associated with a poorer quality of life in the total sample as in cases of MS. In MS the impairment of the QoL attributable to BD type-II was even greater than that in MDD. LIMITATIONS The MS diagnosis was made differently in cases and controls. Although this may have produced false negatives in controls, it would have reinforced the null hypothesis (no role of MS in worsening the QoL); therefore, it does not invalidate the study. CONCLUSIONS MDD as well BD type-II are co-determinants in worsening QoL in MS. Clinicians should consider depressive symptoms as well as the hypomanic and mixed components in MS. Additional research is required to confirm our results and further clarify the manner in which BD and the mixed symptoms of BD type-II may affect awareness of both the underlying disease and psychiatric component and finally to what extent they impact treatment adherence with the available therapies for MS.
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Affiliation(s)
- M G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - M F Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - L Lorefice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - A Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - G Trincas
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - G Fenu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - E Cocco
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - F Floris
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - D Bessonov
- International Mood Center, University of California, San Diego, La Jolla, CA, United States.
| | - H S Akiskal
- International Mood Center, University of California, San Diego, La Jolla, CA, United States.
| | - M G Marrosu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
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Carta MG, Angermeyer MC, Matschinger H, Holzinger A, Pintus E, Pintus M, Moro MF. Recommendations of the Sardinian public for the treatment of depression. Int J Soc Psychiatry 2014; 60:619-26. [PMID: 24221099 DOI: 10.1177/0020764013509077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
BACKGROUND Public beliefs about appropriate treatment impact, help-seeking and treatment adherence. AIM To determine the recommendations of the Sardinian public for the treatment of depression. METHODS In 2012, a population-based survey was conducted by phone in Sardinia (N = 1,200). In the context of a fully structured interview, respondents were presented with a vignette depicting a case of depression. Subsequently, they were asked about their treatment recommendations. The results are contrasted with findings from a similar survey which had been conducted in Vienna 3 years before. RESULTS In Sardinia as in Vienna, psychotherapy was the uncontested favorite, while antidepressant medication was recommended by relatively few respondents. In Sardinia, there were also no marked differences between urban and rural areas with regard to these two treatments. However, between Sardinia and Vienna, as well as within Sardinia, great differences were found with regard to autogenic training and 'alternative' methods like homeopathic medicines and acupuncture. CONCLUSION Cross-cultural comparisons may help better understand treatment preferences of the public. In Sardinia, as in Vienna, there seems to be a need for improving the public's knowledge about the appropriate treatment of depression.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Matthias C Angermeyer
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy Center for Public Mental Health, Gösing am Wagram, Austria
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany Institute of Medical Sociology, Social Medicine and Health Economics, University of Hamburg, Germany
| | - Anita Holzinger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Elisa Pintus
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Mirra Pintus
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Maria F Moro
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
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Carta MG, Maggiani F, Pilutzu L, Moro MF, Mura G, Cadoni F, Sancassiani F, Vellante M, Machado S, Preti A. Sailing for rehabilitation of patients with severe mental disorders: results of a cross over randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10:73-9. [PMID: 25191520 PMCID: PMC4150377 DOI: 10.2174/1745017901410010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/22/2022]
Abstract
This study set out to evaluate the effectiveness of a sailing and learning-to-sail rehabilitation protocol in a sample of patients diagnosed with severe mental disorders. The study was a randomized, crossover, waiting-list controlled trial, following recruitment in the Departments of Mental Health of South Sardinia. Participants were outpatients diagnosed with severe mental disorders, recruited through announcements to the directors of the Departments of Mental Health of South Sardinia. Out of the 40 patients enrolled in the study, those exposed to rehabilitation with sailing during a series of guided and supervised sea expeditions near the beach of Cagliari (Sardinia), where the aim to explore the marine environment while sailing was emphasized, showed a statistically significant improvement of their clinical status (measured by BPRS) and, as well, of their general functioning (measured by HoNOS Scale) against the control group. The improvement was maintained at follow-up for some months only: after 12 months, the patients returned to their baseline values on the measures of psychopathology and showed a worsening trend of their quality of life. Sailing can represent a substitute of important experiences that the patients with severe mental disorders miss because of their illness.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Maggiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Laura Pilutzu
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Maria F Moro
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Gioia Mura
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Cadoni
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Marcello Vellante
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Sergio Machado
- Institute de Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ)
| | - Antonio Preti
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
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Moro MF, Carta MG, Pintus M, Pintus E, Melis R, Kapczinski F, Vieta E, Colom F. Validation of the Italian Version of the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN): Some Considerations on its Screening Usefulness. Clin Pract Epidemiol Ment Health 2014; 10:48-52. [PMID: 24987447 PMCID: PMC4076616 DOI: 10.2174/1745017901410010048] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022]
Abstract
Introduction: Abnormalities in biological rhythms (BR) may have a role in the pathophysiology of Bipolar Disorders (BD). The objective of this study is to validate the Italian version of the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), a useful tool in studying BR, and measure its accuracy in discriminating BD.
Methods: 44 outpatients with DSM-IV-TR diagnosis of BD and 38 controls balanced for sex and age were consecutively recruited. The discriminant validity of BRIAN for the screening of BD and its test re-test reliability in two evaluations were assessed. Results: BD patients scored 22.22±11.19 in BRIAN against 7.13±5.6 of the control group (P<0.0001). BRIAN showed a good accuracy to screen between BD non-BD at cutoff 16, a sensitivity was 68.2 and specificity was 92.5. The test-retest stability measured using Pearson’s coefficient found very high r values for each section and the total score, thus indicating a correlation at the two times of statistical significance in all measures. Cohen’s Kappa varied from 0.47 in the sociality section to 0.80 in the sleep section, with a total K mean of 0.65. Conclusion: The results show that the Italian version of BRIAN has good discriminant validity in detecting BD from healthy controls and shows good test-retest reliability. The study suggests the possibility of developing mixed screening tools by introducing items on dysregulation of biological rhythms to the usual measures of mood.
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Affiliation(s)
- Maria F Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Mirra Pintus
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Elisa Pintus
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Riccardo Melis
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Flavio Kapczinski
- Bipolar Disorders Program and Laboratory of Molecular Psychiatry, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350, 90035-000, Porto Alegre, RS, Brazil
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Colom
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Carta MG, Moro MF, Lorefice L, Trincas G, Cocco E, Del Giudice E, Fenu G, Colom F, Marrosu MG. The risk of Bipolar Disorders in Multiple Sclerosis. J Affect Disord 2014; 155:255-60. [PMID: 24295600 DOI: 10.1016/j.jad.2013.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 09/13/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim was to determine the risk of Mood Disorders (MD), particularly Bipolar Disorders (BD), in Multiple Sclerosis (MS) using standardized psychiatric diagnostic tools. METHODS Case-control study. CASES 201 consecutive-patients with MS. CONTROLS 804 sex- and age-matched subjects without MS, randomly selected from a database concurrently used for an epidemiological study on the MD prevalence in the community. Psychiatric diagnoses according to DSM-IV were determined by physicians using structured interview tools (ANTAS-SCID). RESULTS Compared to controls, MS patients had a higher lifetime prevalence of DSM-IV Major Depressive Disorders (MDD; P<0.0001), BD I (P=0.05), BD II (P<0.0001) and Cyclothymia (P=0.0001). As people with MS had a higher risk of depressive and bipolar spectrum disorders, ratio MDD/bipolar spectrum disorders was lower among cases (P<0.005) indicating a higher association with Bipolar Spectrum Disorders and MS. LIMITATIONS MS diagnosis was differently collected in cases and controls. Even if this might have produced false negatives in controls, it would have reinforced the null hypothesis of no increased risk for MD in MS; therefore, it does not invalidate the results of the study. CONCLUSIONS This study was the first to show an association between BD and MS using standardized diagnostic tools and a case-control design. The results suggest a risk of under-diagnosis of BD (particularly type II) in MS and caution in prescribing ADs to people with depressive episodes in MS without prior excluding BD. The association between auto-immune degenerative diseases (like MS) and BD may be an interesting field for the study of the pathogenic hypothesis.
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Affiliation(s)
- M G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - M F Moro
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - L Lorefice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - G Trincas
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - E Cocco
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - E Del Giudice
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy.
| | - G Fenu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
| | - F Colom
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain.
| | - M G Marrosu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy.
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Carta MG, Sancassiani F, Lecca ME, Pintus E, Pintus M, Pisano E, Congiu S, Moro MF, Angermeyer CM. Coping with the crisis: people with severe mental disorders acting for social change through sustainable energy. Clin Pract Epidemiol Ment Health 2013; 9:214-20. [PMID: 24363774 PMCID: PMC3866694 DOI: 10.2174/1745017901309010214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of the study was to examine the efficacy of a vocational training program on renewable energy sources in reducing disabilities of people with chronic psychosis (CP). The innovative element was that the project could produce major advantages regarding the economic needs of the whole area involved. METHODS Experimental Cohort, 26 subjects with CP (EC); Control Cohort1, 130 subjects with CP following pharmacotherapy plus other rehabilitation activities (CIC); Control Cohort2, 101 subjects with CP following the usual treatment (pharmacotherapy) (CUC). Study tool: Health of the Nation Outcome Scales (HoNOS). Assessment made at the start of the study (T0) and after three months (T1). Statistical analysis made by MANOVA. RESULTS Improvement in HoNOS total score in both groups (F=7.574, p=0.000) with non-significant differences between groups over time (F=1.336, p=0.252) was found comparing EC vs. CIC. Greater improvement in EC vs. CIC was shown in the HoNOS "impairment" scale (F=4.910, p=0.028). EC vs. CUC: both groups improved in HoNOS total score (F=9.440, p=0.000) but the improvement was greater in EC (F = 2.273, P=0.048). CONCLUSIONS Work inclusion, as well as other rehabilitation treatments, reduces the social needs of people with chronic psychosis. Work inclusion in a project with real relevance for the area where these people live, produces more improvement of cognitive, physical and somatic disabilities, probably related to a better outcome in self-efficacy.
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Affiliation(s)
- MG Carta
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - F Sancassiani
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - ME Lecca
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - E Pintus
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - M Pintus
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - E Pisano
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - S Congiu
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - MF Moro
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - CM Angermeyer
- Center for Public Mental Health, Gosing and Wagram, Vienna, Austria
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Carta MG, Oumar FW, Moro MF, Moro D, Preti A, Mereu A, Bhugra D. Trauma- and stressor related disorders in the tuareg refugees of a cAMP in burkina faso. Clin Pract Epidemiol Ment Health 2013; 9:189-95. [PMID: 24285982 PMCID: PMC3841965 DOI: 10.2174/1745017901309010189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/13/2013] [Accepted: 10/13/2013] [Indexed: 11/22/2022]
Abstract
Background: Post-traumatic stress disorder (PTSD) is reported to be common among refugees. We set out to explore risk of Trauma- and Stress-or-Related Disorders and the associated burden of psychological distress in a refugee camp of Malian Refugees in Burkina Faso. Methods: One out of five persons living in the camp was selected randomly and interviewed using the French version of the Short Screening Scale for PTSD and the validated K6 scale to measure psychiatric morbidity. Results: Around 60% of the interviewed sample (N=408) met the criteria for Trauma- and Stress-or-Related Disorders and also reported severe mental distress on K6 scores. Women aged 40 and over were found to be at higher risk of Trauma- and Stress-or-Related Disorders whereas young people (39 or younger) scored higher on K6 ratings. Around 83% of the surveyed subjects had a family member killed in the war, 91% a relative in the war, more than 80% had a family member suffering from physical injuries, and 90% reported problems with food and housing. The frequency of these life events was not surprisingly higher in persons with Trauma- and Stress-or-Related Disorders, with the death of a family member and severe problems with food being specifically related to them.Conclusion: These results point to important psychological suffering in a population that is often ignored by the media and international political authorities. Immediate steps are required to provide urgent legal and humanitarian protection to those who are forced to flee their homes and cross international borders because of disasters.
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Affiliation(s)
- M G Carta
- Department of Public Health, Clinical and Molecular Medicine, Cittadella, Universitaria di Monserrato, 09042 Monserrato, Calgiari, Italy
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Abstract
OBJECTIVE To examine whether the term "burnout" is particularly popular in Germany. METHODS Results from four representative population surveys on public beliefs and attitudes about mental disorders, which have been conducted in Germany, Austria, France, and Italy between 2009 and 2012, are compared. In all surveys, respondents had been presented with a case-vignette depicting someone suffering from a moderate depressive episode. Following that, they were asked how they would call the condition described in the case-vignette. RESULTS While in Germany and Austria over 10 % of respondents labeled the depressive symptoms as "burnout", in France only 2 % and in Italy not a single respondent used this "diagnosis". In Germany, another 9.5 % employed the German equivalent to the English term "burned out" or expressions like "exhausted" or "overworked" whereas in the other countries hardly anybody used those words. CONCLUSION Obviously the term "burnout" enjoys greater popularity in Germany and Austria than in France and Italy. Apart from linguistic and stigma-related aspects, this may be explained by differences in the perception of current work conditions in the various countries.
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