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Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication
Abstract
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
... Тревожните разстройства засягат около 30% от хората в даден момент от живота им [8]. За една година е два до три пъти по-вероятно да се развият тревожни разстройства, отколкото нарушенията на настроението или злоупотребата с наркотици [9]. Поради значителните увреждания в социалното, емоционалното и физическото функциониране, които тревожността причинява, заедно с високата степен на потребление на здравни услуги, това представлява сериозен риск за общественото здраве [10]. ...
... Тревожното разстройство оказва своето влияние не само върху протичане на бременността, но остава своята следа и върху последващите етапи на възстановяване на майката и адаптацията на плода [9][10][11]. Отчитат се понезадоволителни неонатални резултати, включително преждевременно раждане, ниско тегло при раждане, по-ниски оценка по Apgar. ...
Бременността е период на значителни физиологични, психологически, хормонални и социални промени, които увеличават риска от емоционален стрес и психиатрични разстройства. Преходът към родителството води до съществени трансформации както на индивидуално, така и на партньорско ниво, които оказват влияние върху психичното здраве на бъдещите родители и често водят до повишени нива на тревожност и депресивни симптоми. Разбирането на факторите, които предизвикват пренатална тревожност, е от съществено значение за разработването на протоколи за пренатална грижа и наблюдение. Създаването и интегрирането на мултидисциплинарен екип за проследяване на бременните жени и родилките ще допринесе за подобряване на физическото и психическото им състояние.
... Students from Samegrelo-Zemo Svaneti display higher optimism; depression and anxiety levels differ, with Shida Kartli students showing the highest depression scores, while Tbilisi students report the highest anxiety levels. This can likely be attributed to social-economic factors and access to mental health resources (Kessler et al., 2005;Diener et al., 2003). Depression -The high levels of depression among students underscore the urgent need for mental health support in educational institutions. ...
... ). Negative correlations between life orientation and DAS total, depression, and anxiety indicate that positive life orientation protects against psychological distress. Thus, promoting optimism alleviates death anxiety and depression(Scheier & Carver, 1992).A strong positive correlation between depression and anxiety reflects their co-occurrence, suggesting that addressing one condition may benefit the other(Kessler et al., 2005).Complex Relationship Between Death Anxiety and PsychologicalFactors -Linear regression analysis shows that high anxiety is associated with fear of death, while high life satisfaction and depression are linked to low fear of death. These results support existing research indicating that enhancing life satisfaction is advisable to overcome anxiety caused by fear of death(Seligman & Csikszentmihalyi, 2000;Solomon, Greenberg, & Pyszczynski, 1991). ...
Since the 1990s, the conflicts and destructive processes that began in Abkhazia and South Ossetia have remained a major crisis for the population of Georgia. For nearly 30 years, the populations of both regions, governed by powerful Russian influence and de facto authorities, have been isolated from the rest of Georgia. The lack of social and intensive interactions, limited communication, and ideological confrontations have further distanced Georgians, Abkhazians, and Ossetians from one another. Under conditions of constant fear, socio-economic hardship, and restricted mobility, protecting the rights of students living in border and conflict regions, ensuring access to essential services, and addressing their mental health remain significant challenges for Georgian society. Students are a crucial part of society who can not only participate in processes of change and development but also become initiators of transformative processes. Given that mental health is linked to an individual’s psychosocial and physical well-being, studying students' mental health is important not only in terms of their knowledge and skills but also in terms of assessing their psychological condition and providing appropriate responses. Therefore, the aim of this study is to examine the psychological condition of students living in border conflict regions. To achieve this goal, the research utilized instruments adapted for the Georgian population, including the Death Anxiety Scale (DAS), Life Orientation Test–Revised (LOT-R), Patient Health Questionnaire-9 (PHQ-9), and PROMIS Emotional Distress—Anxiety—Short Form. By employing these tools, it became possible to analyze the mental health challenges faced by students in border conflict regions and identify differences in their psychological conditions based on specific characteristics.
... This shift is particularly relevant given that, among treatmentseeking individuals with MDD, the prevalence of concurrent SUDs ranges from 8.6% to 25%, with lifetime prevalence estimates as high as 42.8% [3,4]. Co-occurring MDD and SUD are associated with heightened symptom severity [5], psychosocial instability, and substantial societal and medical burdens due to disability and healthcare costs [6][7][8][9]. ...
... SD=5.08, median=8.5, range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. See Table 3. ...
BACKGROUND
Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed.
OBJECTIVE
To better understand the potential underlying causes of these mixed findings, we described intervention characteristics, examined evidence-based treatment strategies within integrated digital treatments, reported the frequency of specific evidence-based strategies across different treatment modalities, and identified overlap between various treatment strategies and critical gaps in existing literature.
METHODS
In June 2024, a literature search was conducted in Google Scholar to identify digital integrated interventions for comorbid MDD and SUD. Articles were included if they described interventions targeting both conditions simultaneously, were grounded in CBT, MI, or MET, and were delivered at least in part via digital modalities. Fourteen studies meeting these criteria were coded using an open coding approach to identify treatment strategies. Statistical analyses summarized the number, frequency, and overlap of these strategies.
RESULTS
Half of studies (50.0%, n=7) included participants with mild to moderate depression symptom severity and hazardous substance use. Only 35.7% (n=5) of the studies required that participants meet the full diagnostic criteria for MDD, as assessed by the SCID or MINI, for inclusion and 21.4% (n=3) required a SUD diagnosis. Web-based (35.3%, n=6), computer-based (21.4%, n=3) and supportive text messaging interventions (21.4%, n=3) were included. Treatment duration averaged 10.3 weeks (SD=6.8). Common treatment strategies included self-monitoring (78.6%, n=11), psychoeducation (71.4%, n=10), and coping skills (64.3%, n=9). Interventions often combined therapeutic strategies, with psychoeducation frequently paired with self-monitoring (64.3%, n=9) and coping skills (50%, n=7).
CONCLUSIONS
Among integrated digital interventions for comorbid depression and substance use, there was significant variability in inclusion criteria, digital modalities, methodology, and treatment strategies, significant methodological challenges, and underrepresentation of evidence-based practices. Without standardized methodologies comparison of the clinical outcomes across studies is challenging. These results emphasize the critical need for future research to adopt standardized approaches, thereby facilitating more accurate comparisons and a deeper understanding of intervention efficacy.
... MSDs have been associated with suboptimal HIV care continuum outcomes, including late HIV diagnosis, suboptimal ART adherence and virologic failure [9][10][11][12]. Among the general population, psychiatric multimorbidity, the presence of two or more co-occurring mental or substance use disorders, is common and has been associated with greater psychiatric symptom severity and worse mental health outcomes [14][15][16][17][18][19]. Data on the prevalence, co-occurrence and correlates of MSDs among older PWH in resource-limited settings remain scarce. ...
... Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. The prevalence of Symptoms of common mental disorders Depression 387 (14) 172 (66) 109 (69) 91 (15) 23 (17) Anxiety 262 (9) 172 (44) 102 (64) 71 (12) 22 (17) PTSD 159 (6) 109 (28) 102 (39) 57 (9) 20 (15) Symptoms depression, anxiety or PTSD 512 (18) 131 (22) 39 (30) Number of common mental disorders 1 303 (11) 193 (50) 75 (29) 35 (22) 67 (11) 19 (14) 2 122 (4) 107 (28) 100 (38) 37 (23) 40 (7) 14 (11) 3 87 (3) 87 (22) (11) 233 (60) 205 (78) 144 (91) 168 (28) 76 (58) Missingness by variable Depression n = 3; Anxiety n = 4; PTSD n = 3; Unhealthy alcohol use n = 4; Unhealthy drug use n = 1; Symptoms of depression, anxiety or PTSD n = 1. Abbreviation: PTSD, post-traumatic stress disorder. ...
Introduction
Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co‐occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co‐occurrence of MSDs among ageing PWH remains limited, particularly in low‐ and middle‐income countries (LMICs).
Methods
We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co‐occurrence of unhealthy alcohol use (AUDIT‐C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ‐9 ≥10), anxiety (GAD‐7 ≥10) and post‐traumatic stress disorder (PTSD) (PCL‐5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio‐demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use.
Results
Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men.
Conclusions
Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi‐focus mental health treatment approaches in HIV care settings should be examined.
... Major depressive disorder (MDD) is one of the most common mental illnesses and the leading cause of disability worldwide [1,2]. Research spanning across academic disciplines and levels of analysis [3] has robustly established a causal link between stress and the onset and maintenance of MDD [4,5]. ...
... However, this contextual interview approach to retrospective assessment has greater reliability with reports of maltreatment taken at the time of the abuse (either officially documented reports or self-report) than self-report checklists [43]. Third, assessing peripheral eCBs as an index of the eCB system neglects the complexity of this system, including regulation at the 1 To test whether our results were specific to left hippocampal volume, and not due to overall volumetric differences, we re-ran the models with the residual of left hippocampal volume, parsing out either total brain volume or total intracranial volume, as the dependent variable. Results were unchanged and, therefore, are presented with left hippocampal volume in its raw form for ease of interpretation. ...
Evidence from preclinical animal models suggests that the stress-buffering function of the endocannabinoid (eCB) system may help protect against stress-related reductions in hippocampal volume, as is documented in major depressive disorder (MDD). However, stress exposure may also lead to dysregulation of this system. Thus, pathways from marked stress histories, such as childhood maltreatment (CM), to smaller hippocampal volumes and MDD in humans may depend on dysregulated versus intact eCB functioning. We examined whether the relation between MDD and peripheral eCB concentrations would vary as a function of CM history. Further, we examined whether eCBs moderate the relation of CM/MDD and hippocampal volume. Ninety-one adults with MDD and 62 healthy comparison participants (HCs) were recruited for a study from the Canadian Biomarker Integration Network in Depression program (CAN-BIND-04). The eCBs, anandamide (AEA) and 2-arachidonylglycerol (2-AG), were assessed from blood plasma. Severe CM history was assessed retrospectively via contextual interview. MDD was associated with eCBs, though not all associations were moderated by CM or in the direction expected. Specifically, MDD was associated with higher AEA compared to HCs regardless of CM history, a difference that could be attributed to psychotropic medications. MDD was also associated with higher 2-AG, but only for participants with CM. Consistent with hypotheses, we found lower left hippocampal volume in participants with versus without CM, but only for those with lower AEA, and not moderate or high AEA. Our study presents the first evidence in humans implicating eCBs in stress-related mechanisms involving reduced hippocampal volume in MDD.
... The coexistence of substance abuse and psychiatric disorders, often referred to as dual diagnosis or comorbidity, is a pervasive issue that significantly impacts individuals, families, and healthcare systems worldwide. Epidemiological studies have consistently demonstrated a high prevalence of substance use disorders among individuals with psychiatric disorders and vice versa (Regier et al., 1990;Kessler et al., 2005). Despite this, there remains a considerable gap in the recognition and treatment of these cooccurring conditions. ...
... High Prevalence of Co-Occurrence Substance abuse and psychiatric disorders frequently co-occur, with numerous studies documenting high rates of comorbidity. The National Comorbidity Survey Replication (NCS-R) found that approximately 50% of individuals with a substance use disorder also had a co-occurring mental disorder (Kessler et al., 2005). Similarly, the Epidemiologic Catchment Area (ECA) study reported that individuals with psychiatric disorders were more than twice as likely to have a substance use disorder compared to those without psychiatric conditions (Regier et al., 1990). ...
Substance abuse and psychiatric disorders are two prevalent and interrelated public health concerns that often coexist, leading to complex clinical scenarios. This comorbidity poses significant challenges in diagnosis, treatment, and understanding the causal relationships between the two conditions. Frequently, one disorder is neglected in favor of the other, and misconceptions abound regarding which condition precipitates the other. This article explores the common comorbidity of substance abuse and psychiatric disorders, delving into the prevalence, diagnostic challenges, treatment implications, and the bidirectional nature of causality. By examining current research and clinical practice, we aim to shed light on the misconceptions and emphasize the need for integrated approaches to effectively address both conditions concurrently.
... According to the National Comorbidity Survey Adolescent Supplement (NCS-A), an estimated lifetime prevalence of any anxiety disorder among U.S. adolescents aged 13-18 is 31.9% and estimated 8.3% had severe impairment. Furthermore, prevalence of any anxiety disorder among adolescents was higher for females (38.0%) than for males (26.1%) (Kessler, Chiu, Demler, & Walters, 2005). ...
Anxiety disorders have become a significant subset of mental health challenges in the context of complex modern social life. The widespread integration of social media into daily life has created platforms for individuals to share their updates, offering a rich resource for linguistic and behavioural analysis outside traditional clinical settings. Among these platforms, Reddit stands out as a valuable tool for researchers due to its rich and diverse textual data. This paper leverages five commonly used machine learning models: decision tree, random forest (RF), k-nearest neighbours, linear regression, and naive Bayes to explore the emotional dynamics present in Reddit posts for detecting anxiety. Reddit posts from 1,800 users, categorized as either anxiety or non-anxiety, were used for model training, validation, and testing, with data split into 70%, 15%, and 15%, respectively. The decision-making process of the best-performing model was evaluated by incorporating feature importance. RF achieved the best performance among all models, with an accuracy of 89%. Its interpretation revealed that average emotion scores and normalized emotion gaps were key factors, highlighting the significance of emotional intensity and variability over time. Furthermore, the results indicate that emotions such as sadness and joy play a particularly significant role in detecting anxiety.
... The overall PTSD rate was estimated to be 33.7%, far exceeding the rate that is typical in the general population (Kessler et al., 2005), and also exceeding, but to a lesser degree, rates published for other public safety jobs involving high exposure to traumatic events, such as police officers, firefighters, and combat military (Corneil et al., 1999;Fulton et al., 2015;Gates et al., 2012;Perrin et al., 2007). ...
This article provides a profile MCO corrections staff health and well-being based on organizational and empirical assessment results.
... Out of the total number of patients, only one individual, which accounts for 3.6% of the total, is classified into the age category of 46-65 years. There is a significant difference from previous study, which states that most of all bipolar cases occur at the age of 25 [14]. Bipolar disorder usually develops during the later stages of adolescence or the early stages of adulthood [15]. ...
A key component of SDG 3, which is about good health and wellbeing, is mental illness. The burden of disease and mental illness is a priority for global development. Bipolar is a mental illness that causes unusual changes in mood, energy, physical activity, and concentration. Combinations of mood stabilizers and antipsychotic drugs have significantly altered the long-term prognosis for bipolar patients. This study aims to evaluate the drug utilization of mood stabilizers and antipsychotics in bipolar disorder patients. We conducted a retrospective, descriptive, hospital-based cross-sectional study among bipolar patients attending the psychiatric department at Hospital X, Yogyakarta, Indonesia, from January to May 2017. This study employed two methods to analyse the data: calculating the percentage of rational prescriptions and computing based on the defined daily dose (DDD) per 1000 patient days. In this study, there were 28 respondents between the ages of 26 and 46, with 98 total bipolar cases. 53.6% of participants were female, while 46.4% were male. The rational use of the concurrent administration of mood stabilizers and antipsychotics to patients with bipolar disorder was as follows: 69.39% precise use, 90.82% precise dose, 98.98% precise indication, 76.53% precise patient, and 76.53% precise drug. The result showed that mood stabilizer lithium had the lowest total annual consumption of 2.15 DDD/1000 outpatient visits, and sodium divalproex had the highest total annual consumption of 26.66 DDD/1000 outpatient visits. Risperidone was the antipsychotic with the highest quantity, at 25.92% DDD/1000 outpatient visits, while trifluoperazine had the lowest, at 0.17% DDD/1000 outpatient visits.
... In line with other WMH surveys [36,37], disorder persistence was indirectly estimated from the proportion of lifetime cases that had a disorder in the 12-months preceding the interview (12-months/lifetime), while episode persistence was indirectly estimated from the proportion of 12-month cases that had an episode in the 30-days preceding the interview (30-day/12-months). ...
Background
Substance use disorders (SUDs), encompassing alcohol (AUDs) and drug use disorders (DUDs), are significant global public health concerns. While SUDs are well-documented worldwide, data on their prevalence and impact in Saudi Arabia remain scarce. This study investigates the epidemiology and burden of SUDs in Saudi Arabia using data from the Saudi National Mental Health Survey (SNMHS).
Methods
The SNMHS is a nationally representative cross-sectional epidemiological household survey, consisting of a sample of 4,004 participants aged 15–65. The survey employed a stratified multistage clustered sampling design and used the WHO CIDI 3.0 to determine diagnoses. Descriptive statistics and multivariate binary logistic regression were used to analyze the data.
Results
The lifetime, 12-month, and 30-day prevalence of any SUD were 4.03%, 1.88%, and 0.78% (p < 0.05), respectively. DUDs were more prevalent than AUDs overall. SUDs were significantly associated with younger age, lower education, low income, exposure to traumatic events, family burden, and childhood adversities. High psychiatric comorbidity and role impairment were observed. Treatment seeking was moderate, with only 44.9% of those with lifetime SUDs seeking any form of treatment.
Conclusions
SUDs in Saudi Arabia are more prevalent than previously thought, associated with significant psychiatric comorbidities and role impairment. Despite this, treatment seeking remains inadequate. These findings underscore the need for targeted prevention and intervention programs tailored to the demographic and cultural context of Saudi Arabia.
... (14,15) However, bidirectional associations between social anxiety and unemployment are untested. High comorbidity between depression and social anxiety (16), though, suggests that a bidirectional relationship may similarly exist. ...
Objective
Previous research has found that social anxiety and depression are associated with occupational impairment, including unemployment and decreased productivity. However, longitudinal studies are limited to depression and only examine effects of anxiety cross‐sectionally. Furthermore, prior studies only measured occupational impairment dichotomously as either employed or unemployed. The present secondary data analysis sought to build upon these gaps and investigate bidirectional relationships between hours worked, measured continuously, and symptoms of social anxiety and depression over the course of 48 weeks following a brief intervention for job‐seekers with social anxiety disorder, many of whom reported elevated levels of depression. Employment was operationalized as the average number of hours spent working in a given week.
Methods
Two cross‐lagged panel models were tested to investigate these relationships in 250 diverse job‐seeking individuals (59.2% female, 40.8% Black or African‐American, and 16.4% Hispanic/Latine).
Results
In partial support of initial hypotheses, social anxiety and depression symptoms both negatively predicted subsequent hours worked. Hours worked did not predict subsequent social anxiety or depression symptoms.
Conclusions
This was the first study to investigate relationships among depression, social anxiety, and employment that operationalized employment as a continuous variable. The findings contribute novel information about the longitudinal impact of both social anxiety and depression on hours worked and suggest that symptoms of social anxiety or depression may serve as a barrier to seeking or maintaining employment. Interventions for unemployment should consider incorporating simultaneous treatment of social anxiety and depression.
... The interaction of external factors (life) and internal factors (long-term impact of the condition) can increase the severity of the disease [12]. Therefore, an increasing number of studies support viewing mental illnesses as a continuum [13,14] rather than a simple binary categorization of being ill or not. Additionally, the heterogeneity in diagnoses indicates [15] that even with the same diagnosis, the symptom combinations can vary significantly among individuals. ...
Adolescence is a critical phase for the onset of various mental and psychological disorders. Yet, traditional diagnostic approaches have overlooked the study of the pathophysiology of mental illnesses in this age group, hindering early intervention and treatment. Consequently, research based on a transdiagnostic approach is indispensable in modern psychiatry, playing a significant role in diagnosing and treating diseases. This study employed high-resolution structural MRI scanning technology combined with mixed linear models to analyze brain imaging data from 11,878 adolescents aged 9-10 across 21 regions in the United States. Additionally, the study incorporated the UPPS Impulsive Behavior Scale and the BIS Impulsivity Scale to assess the relationship between individual behavioral characteristics and brain structural changes. The results revealed that adolescents with externalizing disorders exhibited significantly increased cortical thickness in several brain regions, particularly in the left temporal gyrus and right inferior temporal gyrus. Compared to healthy controls, these patients also showed significant reductions in cortical area in specific brain regions, while white matter FA values were significantly increased in some areas. These structural changes were significantly correlated with behavioral test results for impulsivity and attention deficits, classic symptoms of externalizing disorders. The findings suggest that changes in the cortical structure of adolescents' brains are closely linked to mental health issues, providing potential biomarkers for future preventative and interventional measures to aid in the early identification and treatment of mental illnesses in adolescents.
... Arguably, exploring this topic in relation to young people is particularly important as this group is especially vulnerable to MHPs. Specifically, 75% of MHPs begin before individuals turn 25, and affect more 16-24-year-olds than other age-groups (Kessler et al., 2005;McManus et al., 2016). Young people tend to engage in a range of fictional content, and fictional depictions of MHPs targeted towards this group have increased in recent decades (Monaghan, 2016;Roberts & Foehr, 2008). ...
Young people with mental health problems (MHPs) are increasingly exposed to representations of MHPs within fiction, but little is known about this process. This study used grounded theory to develop a preliminary understanding of how 16- to 25-year-olds with MHPs experience and are affected by fictional media representation of MHPs. Fourteen individual interviews were conducted with nine young people. The developed theory suggests that fiction was experienced as a reflection on participants’ own reality, a process made up of two key stages, identification with fiction and transferring beyond fiction, whereby the representative portrayals led to both helpful and harmful impacts. Such effects seemed to depend on both personal context and the nature of the fiction. Findings are discussed in terms of relevant theory and outcomes for wellbeing, with study limitations and implications for practice and research considered.
... In this model, the symptoms for dysthymia and generalized anxiety disorder (GAD) were taken from the supplementary materials of Boschloo et al. (2015), with the exception of the GAD symptom "sleep disturbance," which we split in two: insomnia and hypersomnia. The item discriminations of each symptom were set to 1, indicating that symptoms are interchangeable, and item difficulties were set to 0. All latent variables were simulated to be normally distributed with a standard deviation of 1, and the correlation between dysthymia and GAD was set to 0.55-similar to the empirically estimated comorbidity (Kessler et al., 2005). Nodes 2 and 3 in dysthymia and nodes 6 and 7 in GAD are mutually exclusive, which we modeled by adding orthogonal Rank−2 (n = 5000) Figure 3 . ...
Network models, in which psychopathological disorders are conceptualized as a complex interplay of psychological and biological components, have become increasingly popular in the recent psychopathological literature. These network models often contain significant numbers of unknown parameters, yet the sample sizes available in psychological research are limited. As such, general assumptions about the true network are introduced to reduce the number of free parameters. Incorporating these assumptions, however, means that the resulting network will lead to reflect the particular structure assumed by the estimation method---a crucial and often ignored aspect of psychopathological networks. For example, observing a sparse structure and simultaneously assuming a sparse structure does not imply that the true model is, in fact, sparse. To illustrate this point, we discuss recent literature and show the effect of the assumption of sparsity in three simulation studies.
... Second, there exists a vast body of research on depression's symptoms, structure, and their inter-relationships, providing a strong theoretical reference against which to compare [22][23][24]. Lastly, depression is a highly heterogeneous disorder comprised of cognitive, affective, behavioral, and somatic symptoms [25]; depression is also highly co-morbid with other conditions, including anxiety [26], substance use [27], somatic disorders [28] and other internalizing conditions [29]. Thus, understanding GPT-4's schema of depression suggests generalizations to many aspects and forms of psychopathology. ...
Use of large language models such as ChatGPT (GPT-4) for mental health support has grown rapidly, emerging as a promising route to assess and help people with mood disorders, like depression. However, we have a limited understanding of GPT-4's schema of mental disorders, that is, how it internally associates and interprets symptoms. In this work, we leveraged contemporary measurement theory to decode how GPT-4 interrelates depressive symptoms to inform both clinical utility and theoretical understanding. We found GPT-4's assessment of depression: (a) had high overall convergent validity (r = .71 with self-report on 955 samples, and r = .81 with experts judgments on 209 samples); (b) had moderately high internal consistency (symptom inter-correlates r = .23 to .78 ) that largely aligned with literature and self-report; except that GPT-4 (c) underemphasized suicidality's -- and overemphasized psychomotor's -- relationship with other symptoms, and (d) had symptom inference patterns that suggest nuanced hypotheses (e.g. sleep and fatigue are influenced by most other symptoms while feelings of worthlessness/guilt is mostly influenced by depressed mood).
... As mentioned in previous research, the median span for those who seeking psychological support was 36 months, while those who with no experience may need a longer time, approximately 64 months. 16 This largely reduced one's life quality and affected the prognosis of treatments. Therefore, it was necessary for healthcare institutions to conduct screening for PTSD symptoms at different time points after discharge for COVID-19 hospitalized patients so that timely psychological intervention and assistance could be provided to those in need. ...
Background
During the peak of the epidemic, hospitalized patients frequently encountered significant health risks and potentially life-threatening circumstances, including uncertainty regarding treatment and the potential for complications.
Objective
The present study aimed to explore the prevalence of post-traumatic stress disorder (PTSD) symptoms among hospitalized patients 3 months after discharge during the first peak of the epidemic, and the association of PTSD with disease-related characteristics.
Design
A single-center and full-sample follow-up study was conducted on COVID-19 patients from the Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China. Data were collected during their hospitalization and 3 months after discharge.
Methods
PTSD symptoms were evaluated by primary care post-traumatic stress disorder (PC-PTSD), a total score of 3 or above was considered as clinically significant PTSD symptoms. Demographic and disease-related characteristics were collected to identify related associations with PTSD symptoms.
Results
A total of 903 patients completed the follow-up survey, yielding a response rate of 63.5%. A total of 212 (23.5%) of the patients were positive in PC-PTSD screening. Univariate regression analysis identified several factors correlated with PTSD symptoms, including female gender, younger age, a lower body mass index (BMI), preexisting sleep problems, bereavement due to COVID-19, a severe clinical diagnosis, the presence of three or more clinical symptoms at disease onset, and residual respiratory symptoms after discharge. Notably, in the multivariate regression analysis, experiencing three or more clinical symptoms at onset emerged as a robust predictor of PTSD symptoms (OR = 2.09, 95% CI: 1.48–2.95). An intriguing finding was that patients who underwent radiological assessment post-discharge reported a higher incidence of PTSD symptoms, whereas those who underwent re-testing for IgG or IgM antibodies exhibited a lower prevalence of PTSD symptoms.
Conclusion
Three months post-recovery, PTSD symptoms prevalence among COVID-19 patients was 23.5%. Those with three or more clinical symptoms at onset or residual respiratory symptoms post-discharge showed higher risk. These findings highlighted the long-term effect of COVID-19 on mental health, urging enhanced attention and interventions for survivors.
... Besides being at high risk for developing depression and anxiety [4], current research shows that ACHD present an elevated prevalence of post-traumatic stress symptoms (PTSS) compared to the general population (about 3.5% of post-traumatic stress disorder (PTSD)) [5,6] with a prevalence rate of 20.5% [7]. PTSS can arise after cardiacrelated events, such as surgery or symptoms like arrhythmia, and may include flashbacks, avoidant behavior, sleep problems, and emotional numbing but do not represent a manifest diagnosis of PTSD [8]. ...
Background
Due to various reasons explored in previous studies, adults with congenital heart disease (ACHD) are at risk of developing post-traumatic stress symptoms (PTSS). The aim of this study is to explore multiple potential psychosocial protective factors in ACHD and to understand their role in different complexities of congenital heart disease (CHD) and PTSS.
Method
This study was part of the “ABS-AHF” study, where 234 ACHD were recruited from November 2021 to August 2022 at a tertiary CHD care center. Data were collected on PTSS (PDS), resilience (RS-13), sense of coherence (SOC-L9), and social support (F-SozU K-14).
Results
The mean scores were 70.55 + / − 12.31 [21–91] for resilience, 35.83 + / − 4.81 [15–60] for sense of coherence (SOC), and 4.30 + / − 0.79 [0.93–5] for social support. SOC (OR, .91; p = .024 [.84; 9.98]) and social support (OR, .48; p = .001 [.29; 7.96]) were shown to reduce the likelihood of PTSS. Low resilience (OR, 2.40, p = .0248 [1.18; 5.18]) seems to increase this likelihood.
Conclusion
Integrating parents and relatives early on seems to be an important protective resource. Parental support in childhood affects the development of SOC which is in line with social support related to lower PTSS. With regard to resilience and SOC, a brief and manageable screening option for personal resources is available to refer potentially vulnerable patients to specialized psychosocial care. Care offers should address coping styles and life with CHD. Offering multidisciplinary care, integrating the patient’s social network, and education for patients to increase resilience and SOC might provide a way to enhance psychosocial outcomes, quality of life, and adherence in ACHD.
... It is known that it starts to be seen more in early adolescence or late childhood (Pine & McClure, 2007). According to Kessler et al. (2005), while the earliest age of social phobia is seen is 5 years old, the highest rate for a 12-year-old individual is diagnosed as 12 years old. If no treatment is sought or precautions are not taken during these stages, it can reach higher levels during adolescence. ...
... At first glance, these findings are in line with the multitude of research showing ER difficulties in most disorders from the emotion disorders spectrum, including affective and anxiety disorders 9,16-20 . However, emotional disorders are highly comorbid on both the syndrome, as well as the symptom level [1][2][3][4] . To accommodate to these prerequisites, and to identify the unique variance the different emotion disorders' symptoms have in common with ER indices, we calculated additional regression analyses controlling for co-occurring symptoms. ...
Here, we investigated the association of different emotion regulation (ER) indices with symptom severity across a large transdiagnostic sample of patients with emotional disorders (cross-sectional approach) and the predictive validity these ER indices have for the outcome of routine care CBT (longitudinal approach). We assessed the trait-like use of adaptive (reappraisal) and maladaptive (suppression, externalizing behaviors) ER strategies via questionnaire as well as the situational ability to regulate emotions with an experimental ER paradigm. Psychopathology was assessed dimensionally using the depression, anxiety, and stress scale. Cross-sectionally symptom severity was predicted by less trait-like use of adaptive and more trait-like use of maladaptive ER strategies, but no associations were found for situational ER ability. This association was more pronounced for depression and stress symptoms rather than anxiety symptoms. In a striking dissociation, the longitudinal analyses revealed the reverse picture: Better situational ER ability, but not trait-like use of ER strategies was associated with less symptom severity after the CBT treatment. Our data argues in favor of a distinction between trait-like and situational ER abilities in individuals with emotional disorders, highlighting challenges in applying adaptive ER strategies in daily life despite demonstrating intact ER skills in experimental settings. Our findings also inform transdiagnostic models of psychopathology and suggest that distress/depression rather than anxiety symptomatology to be driving forces for the occurrence of ER deficits across the depression/anxiety disorders spectrum.
... Historically, research has predominantly focused on men firefighters [1,3e5], leaving a gap in understanding the unique impacts on women firefighters. In one study within a large urban United States (US) department, 20% of women firefighters reported post-traumatic stress disorder (PTSD) symptoms, higher than the 12% rate among their men counterparts in the same department [6] and the 5.2% one-year prevalence rate in the US population [7]. Furthermore, women firefighters exhibit a high prevalence of depression (15.1%; based on the Center for the Epidemiological Studies of Depression Short Form (CES-D 10) score !4) [8], nearly double the rate observed in the US adult women population (8.1%-10.0%) ...
... "Anxiety disorders are among the most prevalent mental health issues. As of 2005 over 40 million Americans experience conditions such as panic disorder, agoraphobia, PTSD, OCD, panic disorder, or generalized anxiety disorder (GAD)" [1]. "The widespread occurrence and lack of adequate treatment for anxiety disorders are significant issues in both industrialized and developing countries, though global prevalence estimates vary" [2]. ...
Objectives: This study aimed to assess the haematological and nephrotoxic effects of diazepam at varying doses in male albino rats. Materials and Methods: Rats were administered therapeutic (0.062 mg/kg/day), high (0.33 mg/kg/day), and extremely high (0.661 mg/kg/day) doses of diazepam orally for 14 and 28 days. Blood and kidney samples were collected for haematological and biochemical analysis.Results: Diazepam administration significantly reduced red blood cell count (RBC), packed cell volume (PCV), and platelet count (PLT), while other haematological indices were not notably affected. Plasma creatinine and urea levels increased, and total protein decreased across all doses. The treatment also elevated renal thiobarbituric acid reactive substances (TBARS) levels, while reducing antioxidant enzyme activity superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH). Conclusions: Diazepam poses significant risks of oxidative stress, haematotoxicity, and nephrotoxicity. While effective in managing anxiety, caution is necessary due to its potentially harmful effects on blood and renal function.
... Anxiety disorder is the most common psychiatric disorder with a 12-month prevalence of 18.1%. 6 While there are many studies on hypertension and anxiety disorders separately, the number of studies investigating the relationship between these two diseases is relatively few. We found that BMI, waist circumference, total cholesterol, and LDL-C levels of patients with severe anxiety were found to be significantly higher compared to those with minimal anxiety symptoms. ...
Aims: Although the role of anxiety in the pathogenesis of hypertension is known, the effect of anxiety on metabolic parameters in hypertension has not been demonstrated. This study aimed to evaluate the effect of anxiety on metabolic parameters and blood pressure regulation in patients with primary hypertension. Methods: The study was designed as a single-center, descriptive cross-sectional study. A total of 150 patients receiving antihypertensive therapy for primary hypertension were included in the study. Patients were divided into minimal, mild, moderate, and severe anxiety groups according to the Beck Anxiety Inventory. Anthropometric measurements, metabolic parameters, and blood pressure measurements were compared between groups. Results: Significant positive correlations were found between anxiety severity and total cholesterol, LDL cholesterol, body mass index, and waist circumference (p<0.05). Subgroup analyses showed that total cholesterol, LDL cholesterol, body mass index, and waist circumference were higher in the severe anxiety group than in the minimal anxiety group (p<0.05). Conclusion: Anxiety in patients with primary hypertension appears to have negative consequences on total cholesterol, LDL cholesterol, body mass index, and waist circumference. In hypertension, female gender and obesity are associated with increased anxiety levels.
... Major depressive disorder (MDD) is a recurring neuropsychiatric illness that has a lifetime prevalence of~17% in the U.S., and is a leading cause of disability worldwide [1]. Despite the significant economic and human impact, the effectiveness of treatments remains suboptimal, underscoring MDD's inherent heterogeneity and our limited comprehension of the molecular and functional mechanisms that underlie its etiology [2]. ...
Major depressive disorder (MDD) is associated with disruptions in glutamatergic and GABAergic activity in the medial prefrontal cortex (mPFC), leading to altered synaptic formation and function. Low doses of ketamine rapidly rescue these deficits, inducing fast and sustained antidepressant effects. While it is suggested that ketamine produces a rapid glutamatergic enhancement in the mPFC, the temporal dynamics and the involvement of GABA interneurons in its sustained effects remain unclear. Using simultaneous photometry recordings of calcium activity in mPFC pyramidal and GABA neurons, as well as chemogenetic approaches in Gad1-Cre mice, we explored the hypothesis that initial effects of ketamine on glutamate signaling trigger subsequent enhancement of GABAergic responses, contributing to its sustained antidepressant responses. Calcium recordings revealed a biphasic effect of ketamine on activity of mPFC GABA neurons, characterized by an initial transient decrease (phase 1, <30 min) followed by an increase (phase 2, >60 min), in parallel with a transient increase in excitation/inhibition levels (10 min) and lasting enhancement of glutamatergic activity (30-120 min). Previous administration of ketamine enhanced GABA neuron activity during the sucrose splash test (SUST) and novelty suppressed feeding test (NSFT), 24 h and 72 h post-treatment, respectively. Chemogenetic inhibition of GABA interneurons during the surge of GABAergic activity (phase 2), or immediately before the SUST or NSFT, occluded ketamine's behavioral actions. These results indicate that time-dependent modulation of GABAergic activity is required for the sustained antidepressant-like responses induced by ketamine, suggesting that approaches to enhance GABAergic plasticity and function are promising therapeutic targets for antidepressant development.
... Anxiety occurs and affects many people regularly; it is a fact of life. Therefore, anxiety disorders comprise the most frequent variant of mental health problems (Kessler et al., 2005). However, anxiety disorders entail more than temporary distress or fear. ...
The study aims to explore the impact of anxiety on English learning for preparatory schools students in Iraq, specifically by revealing a strong connection between anxiety and academic challenges in the official context. Sixty-four participants (male and female) were randomly selected from the preparatory schools. The study discovered significant differences in the rates of learning English as a foreign language. The participants indicated a strong relationship between English tests and anxiety in classroom activities. The Chi-square test showed a positive relationship between the two variables: anxiety and speaking skills c2 (63,1),11.00=.003, p<0.05. On the contrary, the Chi-Square test revealed a negative correlation between anxiety and language skills, including listening, reading and writing skills, respectively. In comparison, the results demonstrate that the likelihood of females suffering an anxiety disorder is not statistically significantly higher compared to the case of males (t=.089, Sig.=.930). The participants obtained the lowest mean scores for the four language skills. Based on the responses provided by 31% of the participants to the FLCAS questionnaire (M= 25.3, SD= 3.2), speaking emerges as the most challenging skill for foreign language learners in preparatory schools. The study's recommendations underscore teachers' critical role in alleviating the adverse impact of anxiety on learning. Specifically, it suggests that teachers should identify the root cause of the anxiety and assist students in coping with anxiety while engaging in academic activities. Furthermore, they should establish a safe atmosphere for English learning, which could prove vital for future studies.
... Anxiety disorders (AD), including panic disorder and/or agoraphobia (PD/AG), social anxiety disorder (SAD), and specific phobia (SP), are among the most common mental disorders. Their 12-month prevalence lies between 14.0% (EU rates; [1]) and 18.1% (US rates; [2]), posing a substantial challenge to both patients and society [3]. Modern psychopathological models advocate for a transdiagnostic viewpoint, emphasizing underlying similarities that transcend diagnostic labels [4]. ...
Anxiety disorders (AD) are associated with altered connectivity in large-scale intrinsic brain networks. It remains uncertain how much these signatures overlap across different phenotypes due to a lack of well-powered cross-disorder comparisons. We used resting-state functional magnetic resonance imaging (rsfMRI) to investigate differences in functional connectivity (FC) in a cross-disorder sample of AD patients and healthy controls (HC). Before treatment, 439 patients from two German multicenter clinical trials at eight different sites fulfilling a primary diagnosis of panic disorder and/or agoraphobia (PD/AG, N = 154), social anxiety disorder (SAD, N = 95), or specific phobia (SP, N = 190) and 105 HC underwent an 8 min rsfMRI assessment. We performed categorical and dimensional regions of interest (ROI)-to-ROI analyses focusing on connectivity between regions of the defensive system and prefrontal regulation areas. AD patients showed increased connectivity between the insula and the thalamus compared to controls. This was mainly driven by PD/AG patients who showed increased (insula/hippocampus/amygdala—thalamus) and decreased (dorsomedial prefrontal cortex/periaqueductal gray—anterior cingulate cortex) positive connectivity between subcortical and cortical areas. In contrast, SAD patients showed decreased negative connectivity exclusively in cortical areas (insula—orbitofrontal cortex), whereas no differences were found in SP patients. State anxiety associated with the scanner environment did not explain the FC between these regions. Only PD/AG patients showed pronounced connectivity changes along a widespread subcortical-cortical network, including the midbrain. Dimensional analyses yielded no significant results. The results highlighting categorical differences between ADs at a systems neuroscience level are discussed within the context of personalized neuroscience-informed treatments. PROTECT-AD’s registration at NIMH Protocol Registration System: 01EE1402A and German Register of Clinical Studies: DRKS00008743. SpiderVR’s registration at ClinicalTrials.gov: NCT03208400.
... The main symptoms of the disorder include inattentiveness, hyperactivity, and impulsivity. In addition, individuals with ADHD often experience the burden of psychiatric comorbidity [5][6][7][8][9], and research findings indicate that comorbidity rates with disorders including anxiety and depression are high among adult patients with ADHD [10,11]. ADHD is also associated with functional impairments that affect work performance, psychosocial functioning [12,13], educational functioning [1,14] and quality of life [15]. ...
Background
Mental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.
Methods
This feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.
Results
Feasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.
Conclusions
This proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.
Trial registration
NCT03425, 09/11/2017.
... They identified that most of the patients with generalized anxiety disorder also had depression, and the rate was even higher for other anxiety disorders such as panic disorder and social anxiety disorder. The study emphasized the significant overlap between these two conditions and suggested that treatment plans for anxiety disorders should also consider potential depressive symptoms [22] . Kalin et al. indicated that anxiety and depressive disorders were among the most common psychiatric illnesses. ...
... Social anxiety disorder (SAD), which involves fear of situations where one may be scrutinized (American Psychiatric Association, 2013), is common (Baxter, Patton, Scott, Degenhardt, & Whiteford, 2013;Kessler, Chiu, Demler, & Walters, 2005;Wittchen et al., 2011) and impairing (Aderka et al., 2012;Stein et al., 2017). Serotonin reuptake inhibitors (SSRIs) pharmacotherapy is an efficacious first-line treatment for SAD (Curtiss, Andrews, Davis, Smits, & Hofmann, 2017;Davis, Smits, & Hofmann, 2014;Mayo-Wilson et al., 2014), but many patients fail to respond to treatment (Blanco et al., 2010;Davidson et al., 2004). ...
Background
Delineation of changes in neural function associated with novel and established treatments for social anxiety disorder (SAD) can advance treatment development. We examined such changes following selective serotonin reuptake inhibitor (SSRI) and attention bias modification (ABM) variant – gaze-contingent music reward therapy (GC-MRT), a first-line and an emerging treatments for SAD.
Methods
Eighty-one patients with SAD were allocated to 12-week treatments of either SSRI or GC-MRT, or waitlist ( n s = 22, 29, and 30, respectively). Baseline and post-treatment functional magnetic resonance imaging (fMRI) data were collected during a social-threat processing task, in which attention was directed toward and away from threat/neutral faces.
Results
Patients who received GC-MRT or SSRI showed greater clinical improvement relative to patients in waitlist. Compared to waitlist patients, treated patients showed greater activation increase in the right inferior frontal gyrus and anterior cingulate cortex when instructed to attend toward social threats and away from neutral stimuli. An additional anterior cingulate cortex cluster differentiated between the two active groups. Activation in this region increased in ABM and decreased in SSRI. In the ABM group, symptom change was positively correlated with neural activation change in the dorsolateral prefrontal cortex.
Conclusions
Brain function measures show both shared and treatment-specific changes following ABM and SSRI treatments for SAD, highlighting the multiple pathways through which the two treatments might work. Treatment-specific neural responses suggest that patients with SAD who do not fully benefit from SSRI or ABM may potentially benefit from the alternative treatment, or from a combination of the two.
Trial Registration
ClinicalTrials.gov, Identifier: NCT03346239. https://clinicaltrials.gov/ct2/show/NCT03346239
... Major depressive disorder (MDD) is a debilitating psychiatric disorder that affects approximately 6.7% of the US population (Kessler et al., 2005) and an estimated 3.8% of the global population, amounting to 280 million people in the world (World Health Organization, 2023). In 2017, the World Health Organization (WHO) declared depression to be the leading cause of disability worldwide (World Health Organization, 2017), far earlier than the previously projected year of 2030 (Mathers and Loncar, 2006). ...
Background
Standard antidepressant treatments often take weeks to reach efficacy and are ineffective for many patients. (R,S)-ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been shown to be a rapid-acting antidepressant and to decrease depressive symptoms within hours of administration. While previous studies have shown the importance of the GluN2B subunit of the NMDA receptor (NMDAR) on interneurons in the medial prefrontal cortex (mPFC), no study has investigated the influence of GluN2B-expressing adult-born granule cells (abGCs).
Methods
Here, we examined whether (R,S)-ketamine’s efficacy depends upon these adult-born hippocampal neurons using a genetic strategy to selectively ablate the GluN2B subunit of the NMDAR from Nestin+ cells in male and female mice, tested across an array of standard behavioral assays.
Results
We report that in male mice, GluN2B expression on 6-week-old adult-born neurons is necessary for (R,S)-ketamine’s effects on behavioral despair in the forced swim test (FST) and on hyponeophagia in the novelty suppressed feeding (NSF) paradigm, as well on fear behavior following contextual fear conditioning (CFC). In female mice, GluN2B expression is necessary for effects on hyponeophagia in the NSF. These effects were not replicated when ablating GluN2B from 2-week-old adult-born neurons. We also find that ablating neurogenesis increases fear expression in CFC, which is buffered by (R,S)-ketamine administration.
Conclusions
In line with previous studies, these results suggest that 6-week-old adult-born hippocampal neurons expressing GluN2B partially modulate (R,S)-ketamine’s rapid-acting effects. Future work targeting these 6-week-old adult-born neurons may prove beneficial for increasing the efficacy of (R,S)-ketamine.
Background
FOXP1 syndrome is a genetic neurodevelopmental disorder associated with complex clinical presentations including global developmental delay, mild to profound intellectual disability, speech and language impairment, autism traits, attention-deficit/hyperactivity disorder (ADHD), and a range of behavioral challenges.. To date, much of the literature focuses on childhood symptoms and little is known about the FOXP1 syndrome phenotype in adolescence or adulthood.
Methods
A series of caregiver interviews and standardized questionnaires assessed psychiatric and behavioral features of 20 adolescents and adults with FOXP1 syndrome. Interviews captured change in various psychiatric manifestations over time. Medication, social, educational, and vocational history was collected and visual analog scales measured top caregiver concerns during childhood and adolescence/adulthood.
Results
Anxiety and externalizing behaviors were common in this cohort and psychiatric features, such as psychosis or bipolar symptoms, were present in two participants. There was no reported regression or loss of skills, early in development or during adolescence/adulthood. Caregivers reported continued development in adaptive skills even into adolescence/adulthood. Medication use was common particularly for features of ADHD, although multiple trials were required for some participants to achieve benefit. Standardized assessments accurately picked up on externalizing symptoms and were less sensitive to internalizing symptoms. Educational setting varied up until late elementary school and gradually shifted to special education. Cognitive and developmental concerns were reported as primary during childhood and independence/safety and housing concerns became top concerns by adolescence/adulthood. Caregivers reported continued development in adaptive skills even into adulthood.
Conclusions
Taken together, results are reassuring, with many families reporting their adolescent and adult children continued to gain skills over time, particularly related to increased independence in communication and personal care. There were no reports of developmental regression, neuropsychiatric decompensation or catatonia.
In his discussion of "marginalized bodies," Leder maintains that members of oppressed social groups encounter not just discriminatory treatment and limited access to societal resources, but also "em-bodied injustice". Such injustice occurs when an "inferior group" is not only identified with the body as such, but also labeled as "having the wrong kind of body". This devaluation of certain kinds of bodies results in an alteration of people's embodied ways of feeling, perceiving, and acting in the world. Both in injury or illness and in cases of embodied injustice, there is often (a) a constriction of lived space, (b) a disruption of lived time, and (c) isolation. To illustrate how these distressing disruptions to the body-world relation are caused largely by social factors, Leder turns to incarcerated persons (Chap. 6) and elders (Chap. 7) as case studies. Building upon this discussion, I argue that depression is both an illness that involves the sorts of alterations to the body schema that Leder outlines, and also the result of various socially caused harms. Just as the restrictions imposed by illness and incarceration can become mutually reinforcing , so, too, can the restrictions imposed by depression and the social stigmatization that often accompanies it. This has some important implications for healing and treatment. █ Riassunto Ingiustizia epistemica, malattie socialmente generate e depressione-Nel discutere i "corpi emar-ginati" Leder sostiene che i membri dei gruppi sociali oppressi non affrontano solo trattamenti discrimina-tori e accesso limitato alle risorse della società, ma anche una "ingiustizia incarnata". Tale ingiustizia si ve-rifica quando un "gruppo inferiore" viene non solo identificato con il corpo in quanto tale, ma anche eti-chettato come "avente il tipo sbagliato di corpo". Questa svalutazione di certi tipi di corpi porta a un'alterazione dei modi incarnati di sentire, percepire e agire nel mondo delle persone. Sia in caso di infor-tunio o malattia, sia in situazioni di ingiustizia incarnata, spesso si verifica (a) una restrizione dello spazio vissuto, (b) una disgregazione del tempo vissuto e (c) un isolamento. Per illustrare come questi sconvolgi-menti angoscianti nel rapporto corpo-mondo siano causati in gran parte da fattori sociali, Leder si rivolge a persone incarcerate (Cap. 6) e anziani (Cap. 7) come studi di caso. Sulla base di questa discussione, so-stengo che la depressione sia una malattia che comporta i tipi di alterazioni dello schema corporeo, che Leder descrive, e il risultato di vari danni causati socialmente. Proprio come le restrizioni imposte dalla malattia e dall'incarcerazione possono diventare reciprocamente rinforzanti, così possono esserlo anche le restrizioni imposte dalla depressione e dalla stigmatizzazione sociale che spesso l'accompagna. Questo ha alcune importanti implicazioni per la guarigione e il trattamento.
There are unique challenges to the care of women with epilepsy, including the gender-specific influences that women may experience owing to their age, hormonal status, and co-morbidities. Many healthcare providers are not informed about the unique issues facing women with epilepsy. This new edition comprehensively reviews the impacts of epilepsy at different life-stages, from adolescence, through pregnancy and to menopause, highlighting appropriate therapies. The book covers topics including managing patients' fertility and preconception counselling, obstetric and fetal monitoring and post-partum seizure management. Chapters on drug-drug interactions, the effect of hormones and anti-epileptic drugs have been thoroughly updated according to new guidelines. Information is presented practically, with bullet points allowing readers to access take home messages easily. This is a highly practical, up-to-date and concise manual for the practical approach in caring for women with epilepsy aimed at general practitioners, midwives, obstetricians, general neurologists, and anesthetists.
Bu çalışmada, Travma Sonrası Stres Bozukluğu (TSSB) ile Travma Sonrası Büyüme (TSB) arasındaki ilişkide peritravmatik stres ve peritravmatik dissosiyasyonun aracı rolünün incelenmesi amaçlanmıştır. Çalışmanın örneklemini 18 yaş ve üstü 414 katılımcı oluşturmaktadır. Çalışma amaçları doğrultusunda, katılımcılara Sosyodemografik Bilgi Formu, Travma Sonrası Stres Tanı Ölçeği (1. ve 2. Bölümler), DSM-5 için Travma Sonrası Stres Bozukluğu Kontrol Listesi, Peritravmatik Stres Envanteri, Travma Sonrası Dissosiyatif Yaşantı Ölçeği-R ve Travma Sonrası Büyüme Envanteri uygulanmıştır. Çalışma sorularına yanıt bulmak amacıyla Bağımsız Gruplar t Testleri, Tek Yönlü ANOVA Testleri, Pearson Momentler Çarpımı Korelasyon Analizi, Lineer Hiyerarşik Regresyon Analizi ve Paralel Çoklu Aracı Değişken Analizi yürütülmüştür. Yapılan analizler sonucunda, TSSB, peritravmatik stres, peritravmatik dissosiyasyon ve TSB düzeyinin bazı sosyodemografik değişkenlere göre farklılaştığı bulunmuştur. Yanı sıra, çalışmada kullanılan bütün ölçek ve alt ölçek puanları arasında pozitif yönde korelasyonel ilişkiler olduğu saptanmıştır. TSB düzeyini yordayan değişkenleri incelemek amacı ile yapılan analiz, cinsiyet, maruz kalınan travmatik olay sayısı ve peritravmatik dissosiyasyonun TSB üzerinde yordayıcı güçlerinin olduğunu ancak psikiyatrik tanı öyküsü varlığı, peritravmatik stres düzeyi ve TSSB düzeyinin TSB düzeyi üzerinde yordayıcı etkilerinin olmadığını ortaya çıkarmıştır. Söz konusu bulgu, kadınların sosyal ve bilişsel becerileri; travmatik yaşantıların olumlu etkilerinin de kümülatif olabileceği bakımından ve travmatik olay esnasında dissosiye olarak anlık duygu yoğunluğundan kendini koruyan bireyin zaman ile travmatik anıyı işlemleyecek gücü kendinde bularak, yaşantının olumsuz etkilerinden kendine yeni anlamlar çıkararak büyüme yolunda ilerlemesinin mümkün olabildiği açısından ele alınmıştır. Son olarak, yapılan analizde, TSSB ile TSB arasındaki ilişkide peritravmatik dissosiyasyonun, aracı rolü olduğu tespit edilmiş, ancak peritravmatik stresin aracı rolü olmadığı görülmüştür. Söz konusu bulgu, peritravmatik stres ve peritravmatik dissosiyasyon yaşantılarının doğaları, nitelikleri ve maruz kalınan travmatik olayın türü açısından ele alınarak ilgili alanyazın ışığında tartışılmıştır.
This study aims to examine the mediating role of peritraumatic stress and peritraumatic dissociation in the relationship between Posttraumatic Stress Disorder (PTSD) and Posttraumatic Growth (PTG). The sample of the study consists of 414 participants aged 18 and above. In line with the study purposes, Sociodemographic Information Form, Posttraumatic Stress Diagnostic Scale (Parts 1 and 2), Post-Traumatic Stress Disorder Checklist for DSM-5, Peritraumatic Distress Inventory, Peritraumatic Dissociative Experience Scale and Posttraumatic Growth Inventory has been implemented. In order to answer the study questions, Independent Groups t Tests, One-Way ANOVA Tests, Pearson Product Moment Correlation Analysis, Linear Hierarchical Regression Analysis and Parallel Multiple Mediator Variable Analysis were conducted. As a result of the analyses, it was found that levels of PTSD, peritraumatic stress, peritraumatic dissociation and PTG differed according to some sociodemographic variables. In addition, positive correlations were found between level of PTSD and peritraumatic stress, peritraumatic dissociation, PTG and all of their subscales. The analysis performed to examine the variables that predict the level of PTG revealed that gender, number of exposed traumatic events and peritraumatic dissociation had predictive powers on PTG. However, the presence of a psychiatric diagnosis history, peritraumatic stress level and PTSD level did not have predictive effects on the level of PTG. This finding was interpreted considering the social and cognitive skills of women; the cumulative positive effects of traumatic experiences and the possibility that individuals who protect themselves from emotional intensity by dissociating during the traumatic event may find the strength to process the traumatic memory over time, leading to growth by deriving new meanings from the negative effects of the experience. Finally, it was revealed that peritraumatic stress has a mediating role in the relationship between PTSD and PTG, whereas peritraumatic dissociation has not. This finding was discussed in light of the relevant literature, considering the nature and characteristics of peritraumatic stress and peritraumatic dissociation experiences, as well as the type of traumatic event experienced.
Bu çalışma ile toplumda eksikliği düşünülen afetlere hazırlıklı olma durumu incelenecektir. Bireylerin afete hazırlıklı olma durumu incelendiğinde afet risk algısı ön plana çıkmaktadır. Afet risk algısı gelişmiş bireylerin, afetlere hazırlığının artacağı düşünülmektedir. Bunun yanı sıra eğitim durumu ve alınan eğitimin türü, duygusal zeka düzeyi, afete maruz kalma durumu, sosyo-demografik özellikler gibi faktörler bireylerin afet risk algısı ve hazırbulunuşluğunu etkilediği düşünülmektedir. Bu özelliklerin geliştiği bireylerde afet farkındalığının artacağı, afetlere hazırlık konusunda tutum ve davranışlarında değişiklik olacağı düşünülmektedir. Bu çalışmada ön lisans-lisans öğrencileri evren olarak belirlenmiştir. Ön lisans-lisans öğrencilerine Afet Risk Algısı Ölçeği ve Schutte Duygusal Zeka Testi Ölçeği uygulanmıştır ve toplamda 298 öğrenciye ulaşılmıştır. Katılımcıların %71,8 kadın, %28,2’si erkektir. Afet risk algının alt boyutları; maruziyet, anksiyete, etki ve yönetilmezliktir. Araştırmanın sonucunda duygusal zekanın afet risk algısını yordayıcı faktörü olduğu ve duygusal zeka düzeyi azaldıkça afet risk algısının da azalacağı sonucuna varılmıştır. Ayrıca cinsiyet, yaş, eğitim düzeyi ve afete maruz kalıp kalmama durumunda afet risk algısını etkileyen faktörler arasında olduğu bulunmuştur. Literatür taraması sonucu afet risk algısı ve duygusal zeka arasında ilişkiyi ölçen herhangi bir çalışmaya rastlanmamış ve bu çalışmanın literatüre katkı sağlaması hedeflenmiştir. Çalışma farklı gruplarla yürütülerek bu iki değişken arasındaki ilişki farklı araştırmacılar tarafından ölçülebilir.
Background
Music therapy is a commonly used intervention added to usual care for psychiatric disorders.
Aims
We review the evidence for music therapy and assess its efficacy as an adjunct therapy across psychiatric disorders.
Method
A systematic literature search was conducted in four scientific databases to identify relevant meta-analyses. Articles were assessed with the AMSTAR-2 tool. The results of the high-quality articles were recalculated with the data from the primary studies. We decided to add the results of the lower-rated articles, using a narrative approach. We pooled the primary studies and calculated standardised mean differences (SMD) for the transdiagnostic outcomes of depression, anxiety and quality of life. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the level of evidence.
Results
Meta-analyses were available for autism, dementia, depression, insomnia, schizophrenia and substance use disorders. We identified 40 relevant articles. One article per domain was identified as high quality. Music therapy added to treatment as usual showed therapeutic value in each disorder. The transdiagnostic results showed a positive effect of music therapy on depression (SMD = 0.57, 95% CI 0.36–0.78), anxiety (SMD = 0.47, 95% CI 0.27–0.66) and quality of life (SMD = 0.47, 95% CI 0.24–0.71). However, these effects were not maintained at follow-up, and all results were based on low or very low evidence.
Conclusions
Music therapy shows promising potential as an adjunctive treatment for psychiatric disorders, but methodological weaknesses and variability limit the evidence. More high-quality, well-powered studies are needed to reliably confirm its effect size.
PTSD is a psychological condition induced by attesting or witnessing traumatic events like violence, abuse, accidents, terrorism, or warfare. It involves three main aspects: reliving the trauma through distressing memories or flashbacks, avoiding reminders of the event, and heightened arousal. These events can affect up to 90% of susceptible individuals, leading to significant psychological distress. The evolution of PTSD diagnosis is discussed, from its introduction in the DSM-III in 1980 to the current DSM-5 criteria, which include four core features: intrusion, active avoidance, adverse changes in cognition and mood, and hyperarousal symptoms. Studies demonstrate a high prevalence of PTSD among internally displaced persons and survivors of war, with rates reaching as high as 68.9% in certain populations. The occurrence of PTSD is influenced by various factors such as age, gender, socioeconomic status and the nature of trauma encountered. The review places a strong emphasis on closing the treatment gap for mental health illnesses worldwide and incorporating mental health services into trauma care. Patient decision aids can help with outcomes, and psycho education is essential. Psychotherapies centred on trauma have been shown to be beneficial over time. It is customary to prescribe SSRIs and SNRIs as treatments for PTSD. The reader will have a better understanding of PTSD from this review, as well as improved ability to identify and manage the syndrome and appreciate the intrenist's role in treating PTSD.
The present study explores effectiveness of the of developmental coaching intervention for studentsin distance education. Digital transformation and economic necessity made distance education mainstream, forcing educational providers at all levels to adapt to a remote learning mode. Distance learning by its nature is more stressful for students. Inthe environment of limited face to face interaction between student and lecturer,coaching aid may provide invaluable and much needed support to students in distance education. Using qualitative and quantitative methodology, the study confirms a high level of students’ anxiety and its negative effect on students’ motivation. The study results provedthe necessity for additional support mechanisms for students in distance education with the developmental coaching being one of them, which may provide new opportunities for the students’ personal and professional development. The coachingis found to have a substantial impact on developing soft skills and dealing with adaptive challenges. The greatest coaching effect was reported by participants onthe level of motivation and self-acceptance. In the context of active technological innovations and tendency for the education personification, integration of coaching into the educational process can better facilitate the academic process which is oriented towards combining the progress when mastering the academic knowledge withthe steady personal growth.
This bibliometric analysis examines the evolution and current state of mental health research from a comprehensive, data-driven perspective. Using VOSviewer for visual mapping, this study highlights key terms, thematic developments, and influential authors within the field over several decades. The analysis reveals a strong ongoing focus on core issues such as "mental illness," "anxiety," and "depression," alongside a notable rise in the integration of technological innovations like telepsychiatry and mobile health applications. The study also identifies significant authorship networks that suggest robust collaborative efforts, which are crucial for advancing research and implementing effective mental health interventions. The findings point towards an increasing recognition of the impact of social and environmental factors on mental health, suggesting new directions for future research and policy-making. This study underscores the need for a dynamic approach to mental health research, one that adapts to emerging challenges and leverages technological advances to improve access to care and treatment outcomes.
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common stress-related psychiatric disorders. Genetic and neurobiology research has supported the viewpoint that PTSD and MDD may possess common and disorder-specific underlying mechanisms. In this systematic review, we summarized evidence for the similarities and differences in brain functional and structural features of MDD, PTSD and their comorbidity, as well as the effects of extensively used therapies in patients with comorbid PTSD and MDD (PTSD + MDD). These functional magnetic resonance imaging (MRI) studies highlight the 1) shared hypoactivation in the prefrontal cortex during cognitive and emotional processing in MDD and PTSD, 2) higher activation in fear processing regions including amygdala, hippocampus and insula in PTSD compared to MDD, and 3) distinct functional deficits in brain regions involved in fear and reward processing in patients with PTSD + MDD relative to those with PTSD-alone. These structural MRI studies suggested that PTSD and MDD share features of reduced volume in focal frontal areas. The treatment effects in patients with PTSD + MDD may correlate with the normalization trend of structural alterations. Neuroimaging predictors of repetitive transcranial magnetic stimulation response in patients with PTSD + MDD may differ from the mono-diagnostic groups. In summary, neuroimaging studies to date have provided limited information about the shared and disorder-specific features in MDD and PTSD. Further research is essential to pave the way for developing improved diagnostic markers and eventually targeted treatment approaches for the shared and distinct brain alterations presented in patients with MDD and PTSD.
Depression and anxiety are common, highly co-morbid conditions associated with a range of learning and decision-making deficits. While the computational mechanisms underlying these deficits have received growing attention, the transdiagnostic vs. diagnosis-specific nature of these mechanisms remains insufficiently characterized. Individuals with affective disorders (iADs; i.e., depression with or without co-morbid anxiety; N = 168 and 74, respectively) completed a widely-used decision-making task. To establish diagnostic specificity, we also incorporated data from a sample of individuals with substance use disorders (iSUDs; N = 147) and healthy comparisons (HCs; N = 54). Computational modeling afforded separate measures of learning and forgetting rates, among other parameters. Compared to HCs, forgetting rates (reflecting recency bias) were elevated in both iADs and iSUDs ( p = 0.007, η² = 0.022). In contrast, iADs showed faster learning rates for negative outcomes than iSUDs ( p = 0.027, η² = 0.017), but they did not differ from HCs. Other model parameters associated with learning and information-seeking also showed suggestive relationships with early adversity and impulsivity. Our findings demonstrate distinct differences in learning and forgetting rates between iSUDs, iADs, and HCs, suggesting that different cognitive processes are affected in these conditions. These differences in decision-making processes and their correlations with symptom dimensions suggest that one could specifically develop interventions that target changing forgetting rates and/or learning from negative outcomes. These results pave the way for replication studies to confirm these relationships and establish their clinical implications.
The integration of mental health services into primary care has gained significant attention as a strategy to address mental health crises, particularly for vulnerable populations such as the elderly, children, and individuals with chronic illnesses. This paper explores the critical importance of incorporating mental health services within primary care settings, where healthcare professionals are often the first point of contact for individuals experiencing mental health challenges. By establishing a comprehensive framework for early detection, mental health screening, and the development of individualized care plans, healthcare providers can more effectively identify and manage at-risk patients. Special emphasis is placed on safeguarding mechanisms to protect these patients from risks of abuse, neglect, and self-harm, which are prevalent in populations with mental health vulnerabilities. The role of primary care practitioners is highlighted, along with a focus on collaborative care models, where mental health professionals work alongside general practitioners to provide holistic care. Strategies for enhancing mental health literacy among primary care staff, improving referral systems, and ensuring continuity of mental health services are explored in detail. Additionally, the paper examines policy implications, the need for increased funding, and the importance of creating mental health-friendly environments within primary care settings. Overall, this research underscores the necessity of integrating mental health services into primary care to safeguard the well-being of vulnerable patients, offering pathways for more accessible, sustainable, and equitable mental health care.
To fully understand the opioid epidemic, it is necessary to elucidate the role of depression in mutually reinforcing relationships with pain and prescription opioid use. By bringing together contributions from neuroscience, pain psychiatry, clinical epidemiology, pharmacoepidemiology, clinical trials, and research on social determinants of health, this volume integrates currently siloed areas of investigation and clinical knowledge. Readers will come to understand the central role of depression, other psychiatric disorders, and social determinants that contribute to pain management outcomes, the opioid epidemic, and our response to opioid dependence and opioid use disorder. By taking a multidisciplinary approach to compiling what is known about the relationships between pain, depression, other psychiatric disorders, and opioids, this work serves as a valuable resource for trainees and clinicians working in a range of healthcare settings while also spawning new directions for researchers.
The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination Items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.
En el estudio nacional de salud mental, realizado mediante CIDI y el CIE-10 se éncontro que de 4.544 colombianis de cinco regiones urbanas, de 18 a 65 años; 40.1% presentó como mínimo un trastorno algunavez, el 16,0% en el último año y el 7,4 el último mes. Los más frecuentes fueron los trastornos de ansiedad ( 19,3% alguna vez), los afectivos (15,0%) los fóbicos (12,6 alguna vez), el episodio depresivo mayor ( 12,1%), ansiedad de separación del adulto (8,2%), abuso de alchol (6,7%) trastornos de conducta (5,5%) y los de uso de sustancias (10,6%) de inico temprano el déficit de trastornos de conducta ( 5 años), la fobia específica (7años), el de ansiedad de separación (8 años), el de conducta y negativista desafiante (10 años). Bogotá tiene mayor prevalencia de los tratornos de estado de ánimo ( 476,7%) los trastornos de sustancias (12,3) la región pacifica. El 4,9% de la población ha intentado suicidarse alguna vez, el 1,3 en el último mes.
A model based on the latent class model is developed for the effects of genes and environment on multivariate categorical data in twins. The model captures many essential features of dimensional and categorical conceptions of complex behavioral phenotypes and can include, as special cases, a variety of major locus models including those that allow for etiological heterogeneity, differential sensitivity of latent classes to measured covariates, and genotype environment interaction (GE). Many features of the model are illustrated by an application to ratings on eight items relating to conduct disorder selected from the Rutter Parent Questionnaire (RPQ). Mothers rated their 8-to 16-year-old male twin offspring [174 monozygotic (MZ) and 164 dizygotic (DZ) pairs]. The impact of age on the frequency of reported symptoms was relatively slight. Preliminary latent class analysis suggests that four classes are required to explain the reported behavioral profiles of the individual twins. A more detailed analysis of the pairwise response profiles reveals a significant association between twins for membership of latent classes and that the association is greater in MZ than DZ twins, suggesting that genetic factors played a significant role in class membership. Further analysis shows that the frequencies of MZ pairs discordant for membership of some latent classes are close to zero, while others are definitely not zero. One possible explanation of this finding is that the items reflect underlying etiological heterogeneity, with some response profiles reflecting genetic categories and others revealing a latent environmental risk factor. We explore two four-class models for etiological heterogeneity which make different assumptions about the way in which genes and environment interact to produce complex disease phenotypes. The first model allows for genetic heterogeneity that is expressed only in individuals exposed to a high-risk (predisposing) environment. The second model allows the environment to differentiate two forms of the disorder in individuals of high genetic risk. The first model fits better than the second, but neither fits as well as the general model for four latent classes associated in twins. The results suggest that a single-locus/two-allele model cannot fit the data on these eight items even when we allow for etiological heterogeneity. The pattern of endorsement probabilities associated with each of the four classes precludes a simple unidimensional model for the latent process underlying variation in symptom profile in this population. The extension of the approach to larger pedigrees and to linkage analysis is briefly considered.
In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
During the past 2 decades, psychiatric epidemiological studies have contributed a rapidly growing body of scientific knowledge on the scope and risk factors associated with mental disorders in communities. Technological advances in diagnostic criteria specificity and community case-identification interview methods, which made such progress feasible, now face new challenges. Standardized methods are needed to reduce apparent discrepancies in prevalence rates between similar population surveys and to differentiate clinically important disorders in need of treatment from less severe syndromes. Reports of some significant differences in mental disorder rates from 2 large community surveys conducted in the United States--the Epidemiologic Catchment Area study and the National Comorbidity Survey--provide the basis for examining the stability of methods in this field. We discuss the health policy implications of discrepant and/or high prevalence rates for determining treatment need in the context of managed care definitions of "medical necessity."
Behavior problems among youths cannot be understood without explaining their age and gender differences, but age and gender differences cannot be explained until they have been accurately described. In a household survey of 1,285 youths aged 9 to 17 years, there were no gender differences in oppositional behavior, but aggression, property offenses, and status offenses were more common among boys. Levels of oppositional behavior were greater at younger ages, aggression peaked near the middle of this age range, and property and status offenses were more prevalent at older ages. These findings are generally consistent with developmental models of conduct problems but are inconsistent with a recent model of gender differences and raise questions about the external validity of current taxonomies.
We analyzed the underlying latent structure of 12-month DSM-III-R diagnoses of 9 common disorders for the general population in the Netherlands. In addition, we sought to establish (1) the stability of the latent structure underlying mental disorders across a 1-year period (structural stability) and (2) the stability of individual differences in mental disorders at the level of the latent dimensions (differential stability).
Data were obtained from the first and second measurement of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) (response rate at baseline: 69.7%, n = 7076; 1 year later, 79.4%, n = 5618). Nine common DSM-III-R diagnoses were assessed twice with the Composite International Diagnostic Interview with a time lapse of 1 year. Using structural equation modeling, the number of latent dimensions underlying these diagnoses was determined, and the structural and differential stability were assessed.
A 3-dimensional model was established as having the best fit: a first dimension underlying substance use disorders (alcohol dependence, drug dependence); a second dimension for mood disorders (major depression, dysthymia), including generalized anxiety disorder; and a third dimension underlying anxiety disorders (simple phobia, social phobia, agoraphobia, and panic disorder). The structural stability of this model during a 1-year period was substantial, and the differential stability of the 3 latent dimensions was considerable.
Our results confirm the 3-dimensional model for 12-month prevalence of mental disorders. Results underline the argument for focusing on core psychopathological processes rather than on their manifestation as distinguished disorders in future population studies on common mental disorders.
We analyzed survey data from Canada, Chile, Germany, The Netherlands, and the United States to study the prevalence and treatment of mental and substance abuse disorders. Total past-year prevalence estimates range between 17.0 percent (Chile) and 29.1 percent (U.S.). Many cases are mild. Although disorder severity is strongly related to treatment, one- to two-thirds of serious cases receive no treatment each year. Most treatment goes to minor and mild cases. Undertreatment of serious cases is most pronounced among young poorly educated males. Outreach is needed to reduce barriers to care among serious cases and young people at risk of serious disorders.
This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity.
A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years.
Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls.
The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.
This study presents analyses of 7 common psychopathological syndromes in the World Health Organization (WHO) Collaborative Study of Psychological Problems in General Health Care (T. B. Ustun & N. Sartorius, 1995). Data on depression, somatization, hypochondriasis, neurasthenia, anxious worry, anxious arousal, and hazardous use of alcohol were analyzed for 14 countries (Ns for each country ranged from 196 to 800). Four models were evaluated: a 1-factor model; a 2-factor model in which all syndromes except hazardous use of alcohol represented internalizing problems; and two 3-factor models. The 2-factor model fit best. These results extend previous research on the 2-factor model to the current complaints of attendees of general health care clinics, to a new set of syndromes, and to a variety of both Western and non-Western countries.
Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries.
To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative.
Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia.
The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview.
The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.
Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
The key quantity needed for Bayesian hypothesis testing and model selection is the marginal likelihood for a model, also known as the integrated likelihood, or the marginal probability of the data. In this paper we describe a way to use posterior simulation output to estimate marginal likelihoods. We describe the basic LaplaceMetropolis estimator for models without random effects. For models with random effects the compound Laplace-Metropolis estimator is introduced. This estimator is applied to data from the World Fertility Survey and shown to give accurate results. Batching of simulation output is used to assess the uncertainty involved in using the compound Laplace-Metropolis estimator. The method allows us to test for the effects of independent variables in a random effects model, and also to test for the presence of the random effects. KEY WORDS: Laplace-Metropolis estimator; Random effects models; Marginal likelihoods; Posterior simulation; World Fertility Survey. 1 Introduction...
Preliminary results of an epidemiological study in the general population of a small town near Paris are presented. This study investigates the prevalence of depressive and anxiety states and the risk factors associated with these disorders. The study methodology is reported in detail, especially the instruments chosen (some sections of the DIS/CIDI, questionnaires on social support, life events and self-rating questionnaires). Anxiety and depressive disorders are frequent in this population: life-time prevalence of Panic Disorder in men amounted to 2.3% and in women 3.1%, Generalised Anxiety Disorder in men 5.4% and in women 13.4%, Major Depressive Episode in men 8.5% and in women 21.9%. Panic Disorder is assessed with regard to different definitions and criteria (DSM III, DSM III-R). A wide difference in results is found according to the criteria used. Specifically, when anticipatory anxiety is taken into account, this increases the frequency rate of Panic Disorder. A significant comorbidity is found between anxiety and depressive disorders.
Attention-Deficit/Hyperactivity Disorder is a relatively common condition of childhood onset and is of significant public health concern. Over the past two decades there have been 19 community-based studies offering estimates of prevalence ranging from 2% to 17%. The dramatic differences in these estimates are due to the choice of informant, methods of sampling and data collection, and the diagnostic definition. This article provides a critical review of the community-based studies on the prevalence of ADHD in children and adolescents. Based on 19 studies reviewed, the best estimate of prevalence is 5% to 10% in school-aged children. The review also examines age and gender effects on the frequency of ADHD. The article closes with a discussion of psychosocial correlates and patterns of comorbidity in ADHD.
Describes the initial development and evaluation of the Psychosis Screening Questionnaire (PSQ). 90 interviews were conducted with attenders at general practice, followed by interviews with 50 psychiatric inpatients and 50 outpatients. The interview was composed of 2 parts. In Part 1 of the interview, the interviewer read out all the questions in the PSQ and recorded the answers. In Part 2, the interviewer interviewed the Ss, using parts of the Schedules for Clinical Assessment in Neuropsychiatry that were relevant to the diagnosis of psychosis and the registration of symptoms of hypomania. The PSQ had a sensitivity of 96.9%, a specificity of 95.3%, a positive predictive value of 91.2%, and a negative predictive value of 98.4%. Despite the overall excellent performance of the PSQ, given a true prevalence of 1%, 6 people would have to be interviewed to identify 1 case of psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper reports the results of methodological studies carried out in conjunction with the US National Comorbidity Survey (NCS) to evaluate Version 1.0 of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). These studies relied on recent survey data collection methodology literature to investigate problems regarding question comprehension, instruction comprehension, respondent motivation to report accurately, and regarding the limits of respondent ability to report accurately. Insights and strategies developed by survey methodologists were used to modify the CIDI in an effort to address these problems. The paper describes these strategies and methodological studies that evaluated their effects, including a clinical reappraisal study and a field experiment that evaluated the impact of question modifications on prevalence estimates. The paper closes with a discussion of remaining methodological problems with the CIDI and potentially useful future studies that might be able to develop solutions to these problems. Copyright © 1998 Whurr Publishers Ltd. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/34217/1/33_ftp.pdf
The Lifetime and 6 month DSM-III prevalence rates of mental disorders from an adult general population sample of former West Germany are reported. The most frequent mental disorders (lifetime) from the Munich Follow-up Study were anxiety disorders (13.87%), followed by substance (13.51%) and affective (12.90%) disorders. Within anxiety disorders, simple and social phobia (8.01%) were the most common, followed by agoraphobia (5.47%) and panic disorder (2.39%). Females had about twice the rates of males for affective (18.68% versus 6.42%), anxiety (18.13% versus 9.07%), and somatization disorders (1.60% versus 0.00%); males had about three times the rates of substance disorders (21.23% versus 6.11%) of females. Being widowed and separated/divorced was associated with high rates of major depression. Most disordered subjects had at least two diagnoses (69%). The most frequent comorbidity pattern was anxiety and affective disorders. Simple and social phobia began mostly in childhood or early adolescence, whereas agoraphobia and panic disorder had a later average age of onset. The majority of the cases with both anxiety and depression had depression clearly after the occurrence of anxiety. The DIS-DSM-III findings of our study have been compared with both ICD-9 diagnoses assigned by clinicians independently as well as other epidemiological studies conducted with a comparable methodology.
This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.
This analysis applies methods of screening to the problem of psychosis. A probability sample of 810 individuals from the Eastern Baltimore Mental Health Survey was interviewed in the self-report modality with the Diagnostic Interview Schedule and shortly thereafter by a psychiatrist. It is shown that a configuration of responses in the self-report modality can screen moderately well for psychosis, as measured by psychiatrists in the clinical modality. (C) Williams & Wilkins 1991. All Rights Reserved.
The most dramatic finding was the very high prevalence of alcohol abuse, using DSM-III criteria, among men in Seoul, Korea. The prevalence of other psychiatric disorders was lower than in St. Louis, Missouri. With the current biological emphasis in psychiatry, questions may be raised regarding the different prevalence rates of schizophrenia, affective disorders, and even alcoholism. The deficit of the aldehyde dehydrogenase isoenzyme 1 has been hypothesized to reduce the prevalence of alcohol abuse among Asians. Twenty-five percent of Koreans have been found to be deficient in the enzyme, but despite this their prevalence of alcohol abuse is higher than among Americans. Cultural issues are paramount in the much lower prevalence of alcohol abuse among women in Korea.
Three person-based computer files were linked to provide a data-set of a random sample of 32,679 Swedes, drawn for interviews regarding perceived health, socioeconomic conditions, and psychoactive drug use. All diagnoses from inpatient psychiatric care in the sample during a 15-year period and the causes of death after the sampling point were combined with the interview responses. Among those admitted for inpatient psychiatric care, substance abuse was an infrequent diagnosis; the majority of schizophrenics and of those with an affective disorder appeared not to medicate regularly; survey non-responders had higher rates of mental disorders than responders. Drug use correlated with both subjective and objective measures of mental ill health. The rate of prescription drug abuse was low. Automated record-linkage is a feasible method to generate hypotheses about mental health in the general population.
The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS-CM). This study presents the lifetime and one-year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS-CM -- excluding tobacco dependence -- was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one-year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.
3,258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Lifetime prevalence for 16 DIS/DSM III diagnoses are given. Overall 33.8% of the population had one or more diagnoses and, excluding substance use disorders, one fifth of the population had a diagnosis. The most common lifetime diagnosis was alcohol abuse/dependence, followed by phobia and major depressive episode. Men were more likely to have had substance use disorders and antisocial personality disorder and women more likely to have had major depressive episode, dysthymia, agoraphobia and simple phobia. Those who were married had generally lower lifetime prevalences. Those over age 65 had the lowest prevalence of any age groups.
The study examines to what degree well-documented present and life-time psychotic symptoms in a group of former psychiatric inpatients are ascertained when using the Diagnostic Interview Schedule (DIS). The Inpatient Multidimensional Psychiatric Scale (IMPS) and the Manual for the Assessment and Documentation of Psychopathology/Diagnostische Sichtlochkartei (AMDP/DiaSika) Interview-Checklist approach were used for the "clinical" evaluations of symptoms. The results indicate fair concordance between the two clinical approaches and the DIS with regard to the presence of any delusional or hallucination symptoms. Low to poor agreement was found in the assessment of many of the rather specific hallucinations and delusions. Generally, the concordance found was higher when compared to the more clinical AMDP/DiaSiKa approach than to the IMPS. More detailed comparisons with diagnostic subgroups of schizophrenic and schizoaffective patients substantiated the findings in the overall sample. Overall it was reconfirmed that the DIS approach is limited to those patients who are cooperative and at least partly remitted.
An epidemiologic survey of the lifetime and six-month prevalence rates of several psychiatric disorders was conducted in Puerto Rico. This study, carried out in 1984, applied selected schedules of a Spanish translation of the Diagnostic Interview Schedule to a stratified, island-wide probability sample of the population. With few exceptions, prevalence rates in this study were similar to those obtained in the US communities studied in the Epidemiologic Catchment Area program. The demographic correlates of the disorders are reviewed, and differences between the results of this study and those of previous studies suggesting a higher rate of mental disorder among Puerto Rican populations are discussed.
We seek to estimate lifetime prevalence and demographic correlates of nonaffective psychosis in the US population assessed by a computer-analyzed structured interview and a senior clinician.
In the National Comorbidity Survey, a probability subsample of 5877 respondents were administered a screen for psychotic symptoms. Based on the response to this screening, detailed follow-up interviews were conducted by mental health professionals (n = 454). The initial screen and clinical reinterview were reviewed by a senior clinician. Results are presented for narrowly (schizophrenia or schizophreniform disorder) and broadly (all nonaffective psychoses) defined psychotic illness.
One or more psychosis screening questions were endorsed by 28.4% of individuals. By computer algorithm, lifetime prevalences of narrowly and broadly defined psychotic illness were 1.3% and 2.2%, respectively. Of those assigned a narrow diagnosis by the computer, the senior clinician assigned narrow and broad diagnoses to 10% and 37%, respectively. By clinician diagnosis, lifetime prevalence rates of narrowly and broadly defined psychosis were 0.2% and 0.7%, respectively. A clinician diagnosis of nonaffective psychosis was significantly associated with low income; unemployment a marital status of single, divorced, or separated; and urban residence Clinician confirmation of a computer diagnosis was predicted by hospitalization, neuroleptic treatment, duration of illness, enduring impairment, and thought disorder.
Lifetime prevalence estimates of psychosis in community samples are strongly influenced by methods of assessment and diagnosis. Although results using computer algorithms were similar in the National Comorbidity Survey and Epidemiologic Catchment Area studies, diagnoses so obtained agreed poorly with clinical diagnoses. Accurate assessment of psychotic illness in epidemiologic samples may require collection of extensive contextual information for clinician review.
Several recent studies have documented that substantial functional impairment is associated with many of the mental disorders seen in primary care. However, brief measures of mental health-related functional impairment are not commonly applied in primary care settings. The Sheehan Disability Scale (SDS), a three-item instrument for assessing such impairment, is evaluated in this study.
A psychometric analysis of the SDS was conducted with a sample of 1001 primary care patients at Kaiser Permanente In Oakland, California. The SDS and the Symptom Driven Diagnostic System for Primary Care assessments were completed.
The internal consistency reliability of the SDS is high, with coefficient alpha of 0.89. The construct validity was substantiated in two ways. A one-factor model fit the data quite well. Furthermore, patients with each of six psychiatric disorders had significantly higher impairment scores than those who did not. Finally, over 80 percent of the patients with mental disorder diagnoses had an elevated SDS score and nearly 50 percent of those with elevated SDS scores had at least one disorder.
The psychometric properties of the SDS were evaluated in primary care. The internal consistency reliability was high. The analyses also lend empirical support for the construct validity. The scale is a sensitive tool for identifying primary care patients with mental health-related functional impairment, who would warrant a diagnostically-oriented mental health assessment.
The authors present nationally representative descriptive data on 12-month use of outpatient services for psychiatric problems. They focused on the relationship between DSM-III-R disorders and service use in four broadly defined service sectors as well as the distribution of service use in multiple service sectors.
Data from the National Comorbidity Survey were examined.
Summary measures of the seriousness and complexity of illness were significantly related to probability of use, number of sectors used, mean number of visits, and specialty treatment. One-fourth of the people in outpatient treatment were seen in multiple service sectors, but no evidence was found of multisector offset in number of visits.
Use of outpatient services for psychiatric problems appears to have increased over the decade between the early 1980s and early 1990s, especially in the self-help sector. Aggregate allocation of treatment resources was related to need, highlighting the importance of making provisions for specialty care in the triage systems currently evolving as part of managed care.
This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US civilians who completed structured diagnostic interviews.
Patterns of comorbidity among DSM-III-R mental disorders were analyzed via confirmatory factor analyses for the entire National Comorbidity Survey sample (N = 8098; age range, 15-54 years), for random halves of the sample, for men and women separately, and for a subsample of participants who were seeing a professional about their mental health problems. Four models were compared: a 1-factor model, a 2-factor model in which some disorders represented internalizing problems and others represented externalizing problems, a 3-factor variant of the 2-factor model in which internalizing was modeled as having 2 subfactors (anxious-misery and fear), and a 4-factor model in which the disorders represented separate affective, anxiety, substance dependence, and antisocial factors.
The 3-factor model provided the best fit in the entire sample. This result was replicated across random halves of the sample as well as across women and men. The substantial empirical intercorrelation between anxious-misery and fear (0.73) suggested that these factors were most appropriately conceived as subfactors of a higher-order internalizing factor. In the treatment sample, the 2-factor model fit best.
The results offer a novel perspective on comorbidity, suggesting that comorbidity results from common, underlying core psychopathological processes. The results thereby argue for focusing research on these core processes themselves, rather than on their varied manifestations as separate disorders.
To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN: The National Comorbidity Survey; cross-sectional, nationally representative household survey.
An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months.
Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own.
Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.
Intermittent explosive disorder (IED) is characterised by discrete episodes of aggressive impulses that result in serious assaultive acts towards people or destruction of property. IED causes severe impairments in daily function. The diagnosis of IED should be made only after a thorough medical work-up. A structured or semi-structured diagnostic interview is helpful to ensure that comorbid and pre-existing conditions are considered. There is a lack of controlled trials of agents for the treatment of patients with IED, but there is evidence that mood stabilisers, antipsychotics, beta-blockers, alpha(2)-agonists, phenytoin and antidepressants may be useful. Behavioural interventions may be valuable as part of the overall treatment of IED.