Dysthymia in a cross-cultural perspective
WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences, Drug and Substance Abuse, Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria. Current opinion in psychiatry
(Impact Factor: 3.94).
11/2010; 24(1):67-71. DOI: 10.1097/YCO.0b013e32834136a5
Dysthymia is a relatively less-studied condition within the spectrum of depressive disorders. New and important information about its status has emerged in recent scientific literature. This review highlights some of the findings of that literature.
Even though studies addressing the cross-cultural validity of dysthymia are being awaited, results of studies using comparable ascertainment procedures suggest that the lifetime and 12-month estimates of the condition may be higher in high-income than in low and middle-income countries. However, the disorder is associated with elevated risks of suicidal outcomes and comparable levels of disability whereever it occurs. Dysthymia commonly carries a worse prognosis than major depressive disorder and comparable or worse clinical outcome than other forms of chronic depression. Whereas there is some evidence that psychotherapy may be less effective than pharmacotherapy in the treatment of dysthymia, the best treatment approach is one that combines both forms of treatment.
Dysthymia is a condition of considerable public health importance. Our current understanding suggests that it should receive more clinical and research attention. Specifically, the development of better treatment approaches, especially those that can be implemented in diverse populations, deserves research attention.
Available from: Sami Pirkola
- "1% to 2 . 5% ( Gureje , 2011 ; Baumeister and Harter , 2007 ) . Nationally representative popula - tion surveys carried out in Western countries report prevalence rates from 1 . "
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ABSTRACT: Up-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years.
In a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting.
The MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation.
The CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting.
Depressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies.
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Available from: Diane L Elliot
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ABSTRACT: Background In 2006, Oregon Health & Science University began implementing changes to better integrate mental health and social science into the curriculum by addressing the Institute of Medicine's (IOM's) 2004 recommendation for the inclusion of six behavioural and social science (BSS) domains: health policy and economics, patient behaviour, physician-patient interaction, mind-body interactions, physician role and behaviour, and social and cultural issues.Methods We conducted three focus groups with a purposive sample of 23 fourth-year medical students who were exposed to 4 years of the new curriculum. Students were asked to reflect upon the adequacy of their BSS training specifically as it related to the six IOM domains. The 90-minute focus groups were recorded, transcribed and analysed.Results Students felt the MS1 and MS2 years of the curriculum presented a strong didactic orientation to behavioural and social science precepts. However, they reported that these principles were not well integrated into clinical care during the second two years. Students identified three opportunities to further the inclusion of BSS in their clinical training: presentation of BSS concepts prior to relevant clinical exposure, consistent BSS skills mentoring in the clinical setting, and improving cultural congruence between aspects of BSS and biomedicine.Conclusions Students exposed to the revised BSS curriculum tend to value its principles; however, modelling and practical training in the application of these principles during the second two years of medical school are needed to reinforce this learning and demonstrate methods of integrating BSS principles into practice.
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ABSTRACT: In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions ('depressive habituality'). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her 'depressive disabilities' (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence (Inkludenz), as described by Tellenbach, and discuss the limitations of this study.
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