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R D McDowell,
A Ryan,
B P Bunting,
S M O'Neill,
J Alonso,
R Bruffaerts,
R de Graaf,
S Florescu,
G Vilagut,
J M C de Almeida,
G de Girolamo, J M Haro,
H Hinkov,
V Kovess-Masfety,
H Matschinger,
T Tomov
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ABSTRACT: BACKGROUND: The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries. Method Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries. RESULTS: No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ⩾80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age. CONCLUSIONS: Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.
Psychological Medicine 05/2013; · 6.16 Impact Factor
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Susana Ochoa, J. M. Haro,
J. Autonell,
A. Pendàs,
F. Teba,
M. Màrquez,
S. Araya,
P. Asensio,
A. Benito,
E. Busquets, [......],
J. Ramon,
M. J. Rodríguez,
B. Sánchez,
A. Soler,
N. Tous,
J. Usall,
M. Valdelomar,
J. Vaquer,
E. Vicens,
M. NEDES Group Zamora
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ABSTRACT: Reports an error in "Met and unmet needs of schizophrenia patients in a Spanish sample" by S. Ochoa, J. M. Haro, J. Autonell, A. Pendàs, F. Teba, M. Màrquez, S. Araya, P. Asensio, J. Autonell, A. Benito, E. Busquets, C. Carmona, P. Casacuberta, M. Castro, N. Díaz, M. Dolz, A. Foix, J. M. Giralt, A. Gost, F. Martínez, R. Martínez, J. Miguel, M. C. Negredo, E. Osorio, E. Paniego, L. Pantinat, C. Pujol, J. Quilez, J. Ramon, M. J. Rodríguez, B. Sánchez, A. Soler, N. Tous, J. Usall, M. Valdelomar, J. Vaquer, E. Vicens and M. Zamora (
Schizophrenia Bulletin, 2003, Vol 29[2], 201-210). The e-mail address of Dr. Susana Ochoa was incorrect. Dr. Ochoa's correct e-mail address is provided in the erratum. (The following abstract of the original article appeared in record
2003-08619-003.) Deinstitutionalization of people with schizophrenia increases the importance of evaluating their needs. This study set out to identify the most common needs of people with schizophrenia who live in the community, analyze how those needs differ when evaluated by staff or by patients, describe the kind of help patients receive, and find out the variables that correlate with having unmet needs. A random sample of 231 outpatients with schizophrenia were evaluated with the Camberwell Assessment of Need and other predictor and outcome variables. Staff detected more needs than patients did. Mean number of needs as rated by patients was 5.36 and staff 6.6 (p
Schizophrenia Bulletin 10/2012; 29(4):No Pagination Specified. · 8.80 Impact Factor
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V Shahly,
S Chatterji,
M J Gruber,
A Al-Hamzawi,
J Alonso,
L H Andrade,
M C Angermeyer,
R Bruffaerts,
B Bunting,
J M Caldas-de-Almeida, [......],
C Hu,
E G Karam,
J-P Lépine,
D Levinson,
M E Medina-Mora,
J Posada-Villa,
N A Sampson,
J K Trivedi,
M C Viana,
R C Kessler
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ABSTRACT: BACKGROUND: Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. RESULTS: Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. CONCLUSIONS: Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
Psychological Medicine 08/2012; · 6.16 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate patterns of use of general practitioners (GPs) and/or mental health professionals (MHPs) for mental health reasons, across six European countries, and the extent to which these patterns of use are associated with differences in mental health-care delivering systems. METHODS: Data are based on the European Study of the Epidemiology of Mental Disorders (ESEMeD): a cross-sectional survey of a representative sample of 8,796 non-institutionalized adults from six European countries, conducted between 2001 and 2003 using computer-assisted interviews with the CIDI-3.0. Countries were classified into: MHP- for countries where access to medical professionals tends to predominate (Belgium, France, Italy), and MHP+ where access to non-medical MHPs predominates (Germany, Spain, The Netherlands). RESULTS: Among respondents consulting GPs and/or MHPs in the past year (n = 1,019), respondents from the MHP- group more often consulted GPs (68 vs. 55 % in MHP+ group), GPs and psychiatrists (23 vs. 14 %). People from the MHP+ group more often used MHPs only (45 vs. 32 %), GPs and non-medical MHPs (16 vs. 8 %). GPs from the MHP+ group were more inclined to refer patients to MHPs. Factors associated with use of GPs versus MHPs were: being over 49 years, not highly educated, lower income and suffering from mood or severe mental disorders. CONCLUSIONS: Differences in the use of GPs versus MHPs are markedly linked to individual as well as organizational factors. Interventions are needed, in countries fostering medical access, to reimburse sessions with non-medical MHPs and improve cooperation between professionals to obtain better practice in access to care.
Social Psychiatry 05/2012; · 2.05 Impact Factor
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ABSTRACT: Suicidality risk-factors between countries with similar economic and religious background have been rarely compared, especially within genders.
Lifetime prevalence of suicide ideation, plans, and attempts in the ESEMeD surveys were stratified on four separate groups: French women, Spanish women, French men, and Spanish men. Outcome odds-ratios (OR) were modelled within each group using logistic regression including demographic characteristics, lifetime mood/anxiety disorders, parental bonding, marital status, and health service-use.
Lifetime prevalence of suicide attempts was 3.4% in France (1.1% men, 5.4% women) and 1.5% in Spain (1.2% men, 1.7% women), with a significantly greater gender difference in France (p=0.001). Regarding risk-factors, French women reported suicide attempt more commonly with authoritarian mothers (OR=1.51; 95%CI=1.04-2.18), unlike Spanish women (OR=0.77; 95%CI=0.51-1.15) (p<0.001). Spanish men showed more than eight-times higher odds of suicide attempt with overprotecting mothers than French men (p=0.03). General practitioner-(GP)-use was significantly protective of suicide attempt among Spanish women (OR=0.08; 95%CI=0.02-0.35) with no effect in French women (OR=1.03; 95%CI=0.54-2.00) (p=0.01). No significant differences in the effect of marital status, any lifetime antidepressant use, mental disorders, or religiosity on suicide attempt were observed between France and Spain within gender-stratum.
Parental bonding is retrospective and potentially influenced by mental state. Response rate was considerably lower in France than in Spain.
Suicidality risk-factors play different roles across genders between France and Spain. Parental bonding dimensions may be interpreted differently according to country, underlining cultural importance. As recommended by WHO, mental health decisions must involve GPs in conjunction with psychiatrists or psychologists.
Journal of affective disorders 05/2011; 133(1-2):247-56. · 3.76 Impact Factor
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J Alonso,
G Vilagut,
S Chatterji,
S Heeringa,
M Schoenbaum,
T Bedirhan Üstün,
S Rojas-Farreras,
M Angermeyer,
E Bromet,
R Bruffaerts, [......], J M Haro,
A N Karam,
V Kovess,
D Levinson,
Z Liu,
M E Medina-Mora,
J Ormel,
J Posada-Villa,
H Uda,
R C Kessler
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ABSTRACT: The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles.
Face-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects.
The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity.
Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.
Psychological Medicine 04/2011; 41(4):873-86. · 6.16 Impact Factor
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ABSTRACT: Social functioning (SF) is the ultimate target aimed in treatment plans in schizophrenia, thus it is critical to know what are the factors that determine SF. Gender is a well-established variable influencing SF, yet it is not known how social variables and symptoms interact in schizophrenia patients. Furthermore, it remains unclear whether the interaction between social variables and symptoms is different in men compared to women. Our aim is to test whether social variables are better predictors of SF in community-dwelled individuals with schizophrenia, and whether men and women differ in how symptoms and social variables interact to impact SF. Community-dwelling individuals with schizophrenia (N = 231) were randomly selected from a register. Participants were assessed with symptom measures (PANSS), performance-based social scale (LSP), objective social and demographic variables. Stratification by gender and stepwise multivariate regression analyses by gender were used to find the best-fitting models that predict SF in both gender. Men had poorer SF than women in spite of showing similar symptom scores. On stepwise regression analyses, gender was the main variable explaining SF, with a significant contribution by disorganized and excitatory symptoms. Age of onset made a less marked, yet significant, contribution to explain SF. When the sample was stratified by gender, disorganized symptoms and 'Income' variable entered the model and accounted for a 30.8% of the SF variance in women. On the other hand, positive and disorganized symptoms entered the model and accounted for a 36.1% of the SF variance in men. Community-dwelling men and women with schizophrenia differ in the constellation of variables associated with SF. Symptom scores still account for most of the variance in SF in both genders.
Psychiatric Quarterly 02/2011; 82(4):261-74. · 1.26 Impact Factor
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R.C. Kessler,
J. Ormel,
M. Petukhova,
K.A. McLaughlin,
J.G. Green,
L.J. Russo,
D.J. Stein,
A.M. Zaslavsky,
S. Aguilar-Gaxiola,
J. Alonso, [......], J.M. Haro,
C.Y. Hu,
A. Karam,
S. Lee,
J.P. Lepine,
H. Matchsinger,
C. Mihaescu-Pintia,
J. Posada-Villa,
R. Sagar,
T.B. Ustun
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ABSTRACT: Context: Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity. Objective: To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys. Design: Nationally or regionally representative community surveys. Setting: Fourteen countries. Participants: A total of 21 229 survey respondents. Main Outcome Measures: First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview. Results: Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables. Conclusions: The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study
Archives of General Psychiatry. 01/2011; 68(1):90-100.
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M A Fullana,
G Vilagut,
N Ortega,
R Bruffaerts,
G de Girolamo,
R de Graaf, J M Haro,
V Kovess,
H Matschinger,
A Bulbena,
J Alonso
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ABSTRACT: Panic attacks are heterogeneous with regards to symptom profile. Subtypes of panic attacks have been proposed, of which the most investigated is respiratory panic attacks (RPA). Limited information exists about RPA in the general population.
The prevalence and correlates of RPA and non-respiratory panic attacks (NRPA) were examined in a subsample (n=8.796) of individuals participating in a cross-sectional survey of the adult general population of six European countries. Panic attacks, mental disorders, and chronic physical conditions were assessed with the Composite International Diagnostic Interview (CIDI) 3.0. Data on use of health services and disability were obtained.
The lifetime prevalence of RPA was 6.77 and the 12-month prevalence was 2.26. No robust associations of RPA with sociodemographic characteristics, mental disorders or physical conditions were found as compared to NRPA. RPA were associated with increased use of health services but similar disability in comparison to NRPA.
Few direct data are available on the validity of the CIDI to assess RPA. Other definitions of RPA exist in the literature.
Our findings suggest that there are very few differences between RPA and NRPA and do not support the need of subtyping panic attacks in current classification systems.
Journal of affective disorders 12/2010; 131(1-3):330-8. · 3.76 Impact Factor
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ABSTRACT: This study aimed to identify factors associated with medication adherence in bipolar disorder (BPD) patients.
EMBLEM is a 2-year, prospective, observational study on the outcomes of BPD patients initiating or changing treatment for a manic/mixed episode. Data were collected at baseline, during the first 12 weeks of treatment (acute phase) and up to 24 months of follow-up (maintenance phase). Adherence was assessed by investigators at every visit. Repeated measures logistic regression analyses identified variables associated with adherence.
Of 1,831 patients included in the analysis, 76.6% were adherent and 23.4% were non-adherent with their BPD medication during the maintenance phase. Patients were more likely to be adherent if they had insight into their illness at week 12. Patients were less likely to be adherent if they had cannabis abuse/dependence during the acute phase, work impairment or higher CGI hallucinations/delusions at baseline
Psychotic symptoms, poor insight, cannabis abuse/dependence and work impairment are negatively related to medication adherence during maintenance therapy of bipolar disorder. Patients with these characteristics may need a different therapeutic approach.
Pharmacopsychiatry 11/2010; 43(7):263-70. · 2.07 Impact Factor
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J Alonso,
M Petukhova,
G Vilagut,
S Chatterji,
S Heeringa,
T B Üstün,
A O Alhamzawi,
M C Viana,
M Angermeyer,
E Bromet, [......],
D Levinson,
M E Medina-Mora,
Y Nakamura,
J Ormel,
J Posada-Villa,
R Sagar,
K M Scott,
A Tsang,
D R Williams,
R C Kessler
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ABSTRACT: Days out of role because of health problems are a major source of lost human capital. We examined the relative importance of commonly occurring physical and mental disorders in accounting for days out of role in 24 countries that participated in the World Health Organization (WHO) World Mental Health (WMH) surveys. Face-to-face interviews were carried out with 62 971 respondents (72.0% pooled response rate). Presence of ten chronic physical disorders and nine mental disorders was assessed for each respondent along with information about the number of days in the past month each respondent reported being totally unable to work or carry out their other normal daily activities because of problems with either physical or mental health. Multiple regression analysis was used to estimate associations of specific conditions and comorbidities with days out of role, controlling by basic socio-demographics (age, gender, employment status and country). Overall, 12.8% of respondents had some day totally out of role, with a median of 51.1 a year. The strongest individual-level effects (days out of role per year) were associated with neurological disorders (17.4), bipolar disorder (17.3) and post-traumatic stress disorder (15.2). The strongest population-level effect was associated with pain conditions, which accounted for 21.5% of all days out of role (population attributable risk proportion). The 19 conditions accounted for 62.2% of all days out of role. Common health conditions, including mental disorders, make up a large proportion of the number of days out of role across a wide range of countries and should be addressed to substantially increase overall productivity.
Molecular psychiatry 10/2010; 16(12):1234-46. · 15.05 Impact Factor
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ABSTRACT: EMBLEM is a 2-year, prospective, observational study that enrolled patients initiating/changing oral treatment for an acute manic/mixed episode. This paper analysed remission and functional recovery in 1656 patients who entered the 2-year long-term phase. Cox models identified variables significantly associated with achieving remission and functional recovery at 2years. Of these patients, 64% achieved remission and 34% achieved functional recovery. Patients with a higher CGI-BP overall score at baseline, who had depressive episodes in the year before inclusion and who had poor social functioning (work or social impairment, not living independently or without a spouse/partner) were less likely to achieve remission or recovery. Prescription of typical antipsychotics and prescription of antidepressants at the first visit of the long-term treatment phase (12weeks) were independent predictors of lower remission and recovery rates. In conclusion, functional recovery occurred in approximately half of those who achieved remission. Impairment of work and social functioning was consistently associated with lower remission and recovery rates.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 10/2010; 21(4):287-93. · 3.68 Impact Factor
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ABSTRACT: Background Prior research on whether marriage is equally beneficial to the mental health of men and women is inconsistent due to methodological variation. This study addresses some prior methodological limitations and investigates gender differences in the association of first marriage and being previously married, with subsequent first onset of a range of mental disorders.
Psychological Medicine 08/2010; 40(09):1495 - 1505. · 6.16 Impact Factor
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ABSTRACT: To explore factors associated with work impairment at 2 years following an acute episode.
European Mania in Bipolar disorder Longitudinal Evaluation of Medication (EMBLEM) is a prospective, observational study on the outcomes of patients with a manic/mixed episode. Work impairment was measured using a Longitudinal Interval Follow-up Evaluation (slice of LIFE) item and patients were categorised with either low or high work impairment at each observation. Baseline factors associated with work impairment at 2 years were assessed using multivariate modelling.
At baseline (n=2289), 69% of patients had high work impairment. At 2 years (n=1393), high impairment reduced to 41%. Modelling identified rapid cycling as the strongest disease-related factor associated with high work impairment at 2 years, although high work impairment at baseline had the strongest association overall. Lower levels of education, recent admissions, CGI-BP overall severity in the 12 months prior to baseline and CGI-BP mania at baseline all predicted higher work impairment. Living together in a relationship and independent housing were both significantly associated with having low work impairment at 2 years.
Work impairment in bipolar disorder is maintained over long periods, and is strongly associated with relationship status, living conditions and various disease-related factors.
European Psychiatry 04/2010; 25(6):338-44. · 2.77 Impact Factor
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R. de Graaf,
M. Radovanovic,
M. van Laar,
B. Fairman,
L. Degenhardt,
S. Aguilar-Gaxiola,
R. Bruffaerts,
G. de Girolamo,
J. Fayyad,
O. Gureje, [......],
J.P. Lepine,
H. Matschinger,
M.E.M. Mora,
Y. Neumark,
J. Ormel,
J. Posada-Villa,
D.J. Stein,
H. Tachimori,
J.E. Wells,
J.C. Anthony
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ABSTRACT: Early-onset cannabis use is widespread in many countries and might cause later onset of depression. Sound epidemiologic data across countries are missing. The authors estimated the suspected causal association that links early-onset (age < 17 years) cannabis use with later-onset (age >= 17 years) risk of a depression spell, using data on 85,088 subjects from 17 countries participating in the population-based World Health Organization World Mental Health Survey Initiative (2001-2005). In all surveys, multistage household probability samples were evaluated with a fully structured diagnostic interview for assessment of psychiatric conditions. The association between early-onset cannabis use and later risk of a depression spell was studied using conditional logistic regression with local area matching of cases and controls, controlling for sex, age, tobacco use, and other mental health problems. The overall association was modest (controlled for sex and age, risk ratio = 1.5, 95% confidence interval: 1.4, 1.7), was statistically robust in 5 countries, and showed no sex difference. The association did not change appreciably with statistical adjustment for mental health problems, except for childhood conduct problems, which reduced the association to nonsignificance. This study did not allow differentiation of levels of cannabis use; this issue deserves consideration in future research
American Journal of Epidemiology. 01/2010; 172(2):149-159.
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M A Fullana,
G Vilagut,
S Rojas-Farreras,
D Mataix-Cols,
R de Graaf,
K Demyttenaere, J M Haro,
G de Girolamo,
J P Lépine,
H Matschinger,
J Alonso
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ABSTRACT: The prevalence of obsessive-compulsive symptom dimensions and their sociodemographic and psychopathological correlates at the population level are unknown.
Obsessive-compulsive symptom dimensions and mental disorders were assessed with the Composite International Diagnostic Interview 3.0 in a random subsample (n=2804) of individuals participating in a cross-sectional survey of the adult general population of six European countries.
The lifetime prevalence of any obsessive-compulsive symptom dimension was 13%. Harm/Checking was the most prevalent dimension (8%) followed by Somatic obsessions (5%) and Symmetry/Ordering (3%). Females were more likely to have symptoms in Contamination/Cleaning (OR=3, 95%CI=1.06-8.51) and Somatic obsessions (OR=1.88, 95%CI=1.05-3.37). All symptom dimensions were associated with an increased risk of most mental (but not physical) disorders. There were some differences in prevalence between countries.
The interference associated with each symptom dimension could not be assessed. Few direct data are available on the validity of the CIDI to assess obsessive-compulsive symptom dimensions.
Obsessive-compulsive symptom dimensions are relatively frequent in the general population. Their sociodemographic and psychopathological correlates may be slightly different in clinical and community samples. They are associated with an increased risk of most mental disorders.
Journal of affective disorders 12/2009; 124(3):291-9. · 3.76 Impact Factor
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K M Scott,
J E Wells,
M Angermeyer,
T S Brugha,
E Bromet,
K Demyttenaere,
G de Girolamo,
O Gureje, J M Haro,
R Jin,
A Nasser Karam,
V Kovess,
C Lara,
D Levinson,
J Ormel,
J Posada-Villa,
N Sampson,
T Takeshima,
M Zhang,
R C Kessler
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ABSTRACT: Prior research on whether marriage is equally beneficial to the mental health of men and women is inconsistent due to methodological variation. This study addresses some prior methodological limitations and investigates gender differences in the association of first marriage and being previously married, with subsequent first onset of a range of mental disorders.
Cross-sectional household surveys in 15 countries from the WHO World Mental Health survey initiative (n=34493), with structured diagnostic assessment of mental disorders using the Composite International Diagnostic Interview 3.0. Discrete-time survival analyses assessed the interaction of gender and marital status in the association with first onset of mood, anxiety and substance use disorders.
Marriage (versus never married) was associated with reduced risk of first onset of most mental disorders in both genders; but for substance use disorders this reduced risk was stronger among women, and for depression and panic disorder it was confined to men. Being previously married (versus stably married) was associated with increased risk of all disorders in both genders; but for substance use disorders, this increased risk was stronger among women and for depression it was stronger among men.
Marriage was associated with reduced risk of the first onset of most mental disorders in both men and women but there were gender differences in the associations between marital status and onset of depressive and substance use disorders. These differences may be related to gender differences in the experience of multiple role demands within marriage, especially those concerning parenting.
Psychological Medicine 11/2009; 40(9):1495-505. · 6.16 Impact Factor
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ABSTRACT: Antipsychotic treatment dose adjustments may influence treatment outcomes in patients with schizophrenia.
We analysed data from 4,247 outpatients with schizophrenia who started olanzapine monotherapy in the 3-year, prospective, observational SOHO study to determine factors associated with olanzapine dose adjustments and how these impact on treatment effectiveness and tolerability.
Regression analyses showed an association between changes in the Clinical Global Impression (CGI) and olanzapine dose changes: patients with a lack of effectiveness were more likely to have their dose increased, whereas patients with good treatment response were more likely to have a dose decrease. Improvement in tardive dyskinesia was associated with dose increase or no change (p=0.034) and worsening of sexual problems was associated with dose decrease (p=0.001). Conversely, an increase in olanzapine dose was associated with subsequent clinical improvement (CGI), but dose adjustment had no significant effects on tolerability outcomes.
These results indicate that psychiatrists tend to modify olanzapine dose according to treatment response. Dose increases seem to be associated with a better response to treatment and not with a worsening of side-effects.
Pharmacopsychiatry 08/2009; 42(4):135-40. · 2.07 Impact Factor
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ABSTRACT: The aim of this study was to compare the outcomes of olanzapine- and valproate-treated patients in an observational study of acute mania with the results of a randomised controlled trial (RCT) assessing the same treatments.
EMBLEM (European Mania in Bipolar Evaluation of Medication) was a 2-year, prospective, observational study of health outcomes associated with the treatment of mania. Severity of mania and depression were assessed at baseline and 6 weeks using the YMRS and the 5-item version of the HAMD, respectively.
621 patients were analysed (n=107 valproate, n=514 olanzapine). Both groups improved from baseline to 6 weeks in mean YMRS and HAMD-5 total scores, with greater mean improvements in the olanzapine compared with the valproate group. Olanzapine was associated with more weight gain and less gastrointestinal difficulties than valproate.
The EMBLEM results support those of the RCT, which suggest that olanzapine monotherapy seems to be more effective than valproate monotherapy in the treatment of acute mania.
Pharmacopsychiatry 08/2009; 42(4):145-52. · 2.07 Impact Factor
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S Lee,
A Tsang,
J Breslau,
S Aguilar-Gaxiola,
M Angermeyer,
G Borges,
E Bromet,
R Bruffaerts,
G de Girolamo,
J Fayyad,
O Gureje, J M Haro,
N Kawakami,
D Levinson,
M A Oakley Browne,
J Ormel,
J Posada-Villa,
D R Williams,
R C Kessler
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ABSTRACT: Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries.
To examine the association between early-onset mental disorder and subsequent termination of education.
Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM-IV mental disorders and subsequent non-attainment of educational milestones.
In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4-15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education.
Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.
The British journal of psychiatry: the journal of mental science 06/2009; 194(5):411-7. · 6.62 Impact Factor
