Zahari Zarkov

National Center of Public Health and Analyses · DIRECTORATE “MENTAL HEALTH AND PREVENTION OF ADDICTIONS”

Background Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not ‘excessive’ relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessi...

Background Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. Methods Data were ob...

Objective The standard method of generating disorder‐specific disability scores has lay raters make rankings between pairs of disorders based on brief disorder vignettes. This method introduces bias due to differential rater knowledge of disorders and inability to disentangle the disability due to disorders from the disability due to comorbidities....

Summary 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-o...

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 diso...

SARS-CoV-2 и възникналата пандемия от COVID-19 постави на из-питание всички аспекти на обществения и икономиче-ски живот в различните държави, техните системи на здравеопазване, както и психичното здраве на насе-лението. Въвеждането на противоепидемични мерки с различна продължителност и тежест временно отне някои от демократичните свободи и достиж...

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-institutio...

Aim We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment. Methods Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843)....

Aims Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcome...

Background Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after...

Background The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods Face-to-face interviews with community samples totaling n = 49 919 respondents in t...

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 pa...

Background Although randomized trials show that social 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-ba...

Background: CMHTs deliver healthcare that supports the recovery of people with mental illness. They should achieve a sufficient level of good quality teamwork, composed of individual professional skills as well their adaptation within the clearly defined roles in teams in order to work efficiently. This paper analyses to what extent team members of...

Background Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45. Methods We used data from 24158 participants (aged 45+) i...

В началото на 2020 г. Европа беше сполетяна от неочаквано и неуправляемо бедствие, което преобърна редица представи за сигурността на здравните системи в света и чувството за безопасност и защитеност на модерния европеец. Епидемията от коронавирус се зароди в Китай и светкавично се пренесе в центъра на Европа, като за много кратко време засегна вси...

Aims Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined...

The review is prepared on publications exploring the relationship between mental health and social inequalities in Bulgaria. We make a reconstruction of the main approaches and of the hypotheses tested in representative surveys where data for Bulgaria are available. Non-representative data and sub-population surveys are excluded from the review. Th...

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 pe...

Background The Bulgarian Ministry of Health invited the European Psychiatric Association (EPA) to evaluate Bulgarian mental health care service provision in 2018. Bulgarian mental health services face very significant challenges including a legacy of historic underfunding, internal conflicts, poor planning, and the emigration of very high numbers o...

Background: Illicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative inv...

Conducting a second national representative epidemiological study of the disease of common mental disorders. Examination of self-assessment of general physical and mental health by gender, age and place of residence. A US research methodology has been used to allow an in-depth investigation into the psychiatric complaints of the population by non-m...

Background: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received a...

Background The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Methods...

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what...

Mental disorders among college students in the World Health Organization World Mental Health Surveys – CORRIGENDUM - R. P. Auerbach, J. Alonso, W. G. Axinn, P. Cuijpers, D. D. Ebert, J. G. Green, I. Hwang, R. C. Kessler, H. Liu, P. Mortier, M. K. Nock, S. Pinder-Amaker, N. A. Sampson, S. Aguilar-Gaxiola, A. Al-Hamzawi, L. H. Andrade, C. Benjet, J....

Background: Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and h...

To conduct a national representative epidemiological study on the prevalence of common mental disorders EPIBUL 2. The study is a replication of an identical study EPIBUL 1 (1) conducted in 2002-2006 by using the same tools and a new sample. The study aims to identify the prevalence of common mental disorders (CMDs) in Bulgaria as compared to a numb...

Background. Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. Methods. The World Health Organization World Mental Health Surveys were used to examine the associations of ment...

Background: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventi...

The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Survey...

Background: To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD). Method: Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in...

Variation in the course of major depressive disorder (MDD) is not strongly predicted by existing subtype distinctions. A new subtyping approach is considered here. Two data mining techniques, ensemble recursive partitioning and Lasso generalized linear models (GLMs), followed by k-means cluster analysis are used to search for subtypes based on inde...

Background: Although variation in the long-term course of major depressive disorder (MDD) is not strongly predicted by existing symptom subtype distinctions, recent research suggests that prediction can be improved by using machine learning methods. However, it is not known whether these distinctions can be refined by added information about co-mo...

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 inappropriatel...

Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have exa...

This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. Data were derived from the World Mental Health Surveys (N = 66,387; n = 357 activ...

According to the World Health Organization (WHO), suicide is one of the leading causes of death in the world. For Bulgaria deliberate self-harm is an 8 out of 10 leading causes of death. The presence of mental illness can predict suicidal ideation, but it is difficult to say whom of those with suicidal ideation and mental illness will proceed to su...

The study EPIBUL is nationally representative for Bulgaria and covers 5318 respondents over 18, for the period 2003 to 2007. This study is a part of WHO World Mental Health Initiative led by a team of Harvard University. The used diagnostic tool is based on DSM IV and CIDI 3.0. Ten chronic somatic and nine psychiatric disorders were investigated wi...

Although irritability is a core symptom of DSM-IV major depressive disorder (MDD) for youth but not adults, clinical studies find comparable rates of irritability between nonbipolar depressed adults and youth. Including irritability as a core symptom of adult MDD would allow detection of depression-equivalent syndromes with primary irritability hyp...

Background: In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the aff...

Summary Objectives: The aim of this paper is to explore the days out of role due to health problems of somatic and mental origin in Bulgaria. Data from national representative epidemiological study EPIBUL 2003-2007 for Bulgaria, show the share of common somatic and psychiatric disorders in the total days out of role in Bulgaria Methods: The study...

Background. In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the affl...

Aims: To investigate the relation between life traumatic events and succeeding PTSD, its burden among the population and demographic factors that could have a role in its appearance. Method: EPIBUL is a nationally representative study for Bulgaria, part of the WHO World Mental Health Initiative. It covered 5318 respondents over 18, for the period 2...

Based on results from a national representative study of common mental disorders (EPIBUL), this article presents data on usage of mental health services over a 12 month period disaggregated by type of disorder and area of services. The target group is 5318 individuals aged 18 years or more who have received any type of psychiatric treatment in the...

Based on results from a national representative study of common mental disorders (EPIBUL), this article presents data on usage of mental health services over a 12 month period disaggregated by type of disorder and area of services. The target group is 5318 individuals aged 18 years or more who have received any type of psychiatric treatment in the...

There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey In...

Based on results from a National represen tative study of common mental disorders (EPIBUL), 12 month usage of services disaggrega ted by type of disorder and area of services is presented. The target group is out of 5318 respondents above 18 years age that have reported any type of treatm ent received 12 mont hs before the interview in the peri...

Objectives: The aim of the current study is to provide epidemiological data for the annual (12 month) and lifetime prevalence, severity and co-morbidity in the following groups of common psychiatric disorders in Bulgaria: Anxiety disorders: panic disorder, generalized anxiety disorder, agoraphobia without panic disorder, specific phobia, social ph...

The epidemiology of rapid-cycling bipolar disorder in the community is largely unknown. To investigate the epidemiological characteristics of rapid-cycling and non-rapid-cycling bipolar disorder in a large cross-national community sample. The Composite International Diagnostic Interview (CIDI version 3.0) was used to examine the prevalence, severit...

Aim:The objectives of this study are: (a) to describe and analyze the current status of mental health services in selected Eastern European countries (the Czech Republic, Slovakia, Romania, and Bulgaria) and (b) to identify common trends as well as national specifics in organizing the mental health services and to find opportunities for trans...

Objectives: The aim of the current study is to provide epidemiological data for the annual (12 month) and lifetime prevalence, severity and co-morbidity in the following groups of common mental disorders in Bulgaria: Anxiety disorders: panic disorder, generalized anxiety disorder, agoraphobia without panic , specific phobia, social phobia, post-tr...

The paper reports the method and study design of a World Mental Health supported survey amongthe adulth (18 and above) population living in households in Bulgaria. The introduction of the CIDI-3 (Composite International Diagnostic Interview) based survey appoach at the beginning of the presentation place the findings for Bulgaria in context. The Bu...