Original Article
The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being
- OYE GUREJE, LOLA KOLA, RICHARD UWAKWE, OWOIDOHO UDOFIA, ABBA WAKIL, EBENEZER AFOLABI
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- Published online by Cambridge University Press:
- 12 March 2007, pp. 821-830
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Background. Suicide is a leading cause of death worldwide but information about it is sparse in Sub-Saharan Africa. Suicide-related behaviours can provide an insight into the extent of this compelling consequence of mental illness.
Method. Face-to-face interviews were conducted with a representative sample of persons aged 18 years and over (n=6752) in 21 of Nigeria's 36 states (representing about 57% of the national population). Suicide-related outcomes, mental disorders, as well as history of childhood adversities were assessed using the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).
Results. Lifetime prevalence estimates of suicide ideation, plan and attempts were 3·2% [95% confidence interval (CI) 1·4–6·5], 1·0% (95% CI 0·4–7·5) and 0·7% (95% CI 0·5–1·0) respectively. Almost two of every three ideators who made a plan went on to make an attempt. The highest risks for transition from ideation to plan and from plan to attempt were in the first year of having ideation or plan respectively. Mental disorders, especially mood disorders, were significant correlates of suicide-related outcomes. Childhood adversities of long separation from biological parents, being raised in a household with much conflict, being physically abused, or being brought up by a woman who had suffered from depression, anxiety disorder, or who had attempted suicide were risk factors for lifetime suicide attempt.
Conclusions. History of childhood adversities and of lifetime mental disorders identify persons at high-risk for suicide-related outcomes. Preventive measures are best delivered within the first year of suicide ideation being expressed.
Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study
- MICHAEL C. MONUTEAUX, STEPHEN V. FARAONE, LARA MICHELLE GROSS, JOSEPH BIEDERMAN
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- Published online by Cambridge University Press:
- 24 April 2007, pp. 1731-1741
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Background
Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.
MethodWe conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16·7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.
ResultsBaseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5·8, 95% confidence interval (CI) 2·9–11·5, p<0·001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (⩾12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.
ConclusionsADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.
Contrasting models of genetic co-morbidity for cannabis and other illicit drugs in adult Australian twins
- A. AGRAWAL, M. T. LYNSKEY, K. K. BUCHOLZ, N. G. MARTIN, P. A. F. MADDEN, A. C. HEATH
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- Published online by Cambridge University Press:
- 01 November 2006, pp. 49-60
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Background. The use of cannabis and other illicit drugs (OIDs) and their co-morbid misuse are frequently reported in the literature. Correlated vulnerabilities and causal or gateway influences have been implicated in this association. We investigated the source of this co-morbidity between cannabis use (experimentation, early and repeated use, and problems) and OID experimentation and problems using genetic models proposed by Neale and Kendler (American Journal of Human Genetics 1995, 57, 935–953).
Method. In a sample of 4152 same-sex male and female adult Australian twin individuals, we fit 13 genetically informative models of co-morbidity to data on experimentation, early use, repeated use of cannabis and co-morbid OID experimentation, and to abuse/dependence (A/D) problems with cannabis and OIDs.
Results. Model-fitting results suggest that common genetic, shared and unique environmental factors are responsible for the association between cannabis experimentation, early use, repeated use and A/D problems and OID experimentation or problems. The liability causation model, which is a reduced form of the correlated vulnerabilities model, also fit very well. In women, we found evidence for high-risk cannabis experimenters and repeated users to be at increased risk for OID experimentation, despite being below the risk threshold on the liability distribution for OID experimentation (extreme multiformity).
Conclusions. Co-morbid cannabis and OID use and misuse are due partly to a common predisposition to substance use disorders. Putative causal effects could not be ruled out. These models warrant further research, so that features of the correlated vulnerabilities model and the gateway models can be studied jointly in a single series of adaptive nested models.
Natural history of suicidal behaviors in a population-based sample of young adults
- JELENA BREZO, JOEL PARIS, EDWARD DYLAN BARKER, RICHARD TREMBLAY, FRANK VITARO, MARK ZOCCOLILLO, MARTINE HÉBERT, GUSTAVO TURECKI
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- Published online by Cambridge University Press:
- 02 May 2007, pp. 1563-1574
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Background
Suicidal behaviors in young individuals represent an important public health problem. Understanding their natural history and relationships would therefore be of clinical and research value. In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts.
MethodParticipants were members of a prospectively studied, representative, population-based school cohort followed since age 6 (n=3017) through mid-adolescence (n=1715) to their early twenties (n=1684). Outcome measures included suicidal ideation, attempts and completions.
ResultsApproximately one in 500 individuals died by suicide. About 33% had suicidal ideas and 9·3% made at least one suicide attempt. Over half (4·9%) of the self-reported attempters made their first attempt before age 18. With the exception of current suicidal ideas, non-fatal suicidal behaviors were more prevalent in females. In general, parental and cross-sectional self-reports underestimated suicidality rates. Aikaike (AIC) and Bayesian (BIC) information criteria suggested the ordinal model, and dimensional conceptualization of suicide attempts of different onset age, to be more optimal than its multinomial/categorical counterpart (ordinal: AIC 567.55, BIC 635.67; multinomial: AIC 616.59, BIC 723.83). Both models, nevertheless, identified five common factors of relevance to suicidal diathesis: gender, disruptive disorders, childhood anxiousness and abuse, and suicidal thoughts.
ConclusionsNon-fatal suicidal behaviors in adolescents and young adults are more common than suggested by cross-sectional studies and parental reports. The dimensional model may be more useful in explaining the relationship of suicide attempts of different age of onset.
Longitudinal modeling of genetic and environmental influences on self-reported availability of psychoactive substances: alcohol, cigarettes, marijuana, cocaine and stimulants
- NATHAN A. GILLESPIE, KENNETH S. KENDLER, CAROL A. PRESCOTT, STEVEN H. AGGEN, CHARLES O. GARDNER, KRISTEN JACOBSON, MICHAEL C. NEALE
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- Published online by Cambridge University Press:
- 20 April 2007, pp. 947-959
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Background. Although an obvious environmental factor influencing drug use, the sources of individual differences in drug availability (DA) are unknown.
Method. This report is based on 1788 adult males from the Mid-Atlantic Twin Registry who participated in a structured telephone interview that included retrospective assessments of DA (cigarette, alcohol, marijuana, cocaine and stimulants) between ages 8 and 25. We fitted a biometric dual change score (DCS) model, adapted for ordinal data, to model latent growth and estimate the genetic and environmental components of variance over time.
Results. DA, despite being considered an environmental risk factor, is under both genetic and environmental control. For cigarette, alcohol, marijuana and cocaine availability, there was an overall increase in additive genetic variance and a decline in shared environmental variance over time. Non-shared environmental variance remained steady. Stimulant availability did not follow this pattern. Instead, there was an upswing in shared environmental effects with increasing age.
Conclusion. We have modeled the genetic and environmental architecture of changes in DA across adolescence. The rise in additive genetic variance over time coincides with acceleration in the expression of individual differences, probably brought on by an increase in personal freedom and a reduction in social constraints. Understanding the etiology of DA is likely to reveal key components, acting directly or indirectly, in the pathway(s) leading to drug initiation, abuse and dependence.
Genetic and environmental influences on dimensional representations of DSM-IV cluster C personality disorders: a population-based multivariate twin study
- TED REICHBORN-KJENNERUD, NIKOLAI CZAJKOWSKI, MICHAEL C. NEALE, RAGNHILD E. ØRSTAVIK, SVENN TORGERSEN, KRISTIAN TAMBS, ESPEN RØYSAMB, JENNIFER R. HARRIS, KENNETH S. KENDLER
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- Published online by Cambridge University Press:
- 30 November 2006, pp. 645-653
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Background. The DSM-IV cluster C Axis II disorders include avoidant (AVPD), dependent (DEPD) and obsessive-compulsive (OCPD) personality disorders. We aimed to estimate the genetic and environmental influences on dimensional representations of these disorders and examine the validity of the cluster C construct by determining to what extent common familial factors influence the individual PDs.
Method. PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV) in a sample of 1386 young adult twin pairs from the Norwegian Institute of Public Health Twin Panel (NIPHTP). A single-factor independent pathway multivariate model was applied to the number of endorsed criteria for the three cluster C disorders, using the statistical modeling program Mx.
Results. The best-fitting model included genetic and unique environmental factors only, and equated parameters for males and females. Heritability ranged from 27% to 35%. The proportion of genetic variance explained by a common factor was 83, 48 and 15% respectively for AVPD, DEPD and OCPD. Common genetic and environmental factors accounted for 54% and 64% respectively of the variance in AVPD and DEPD but only 11% of the variance in OCPD.
Conclusion. Cluster C PDs are moderately heritable. No evidence was found for shared environmental or sex effects. Common genetic and individual environmental factors account for a substantial proportion of the variance in AVPD and DEPD. However, OCPD appears to be largely etiologically distinct from the other two PDs. The results do not support the validity of the DSM-IV cluster C construct in its present form.
Estrogen, menstrual cycle phases, and psychopathology in women suffering from schizophrenia
- NIELS BERGEMANN, PETER PARZER, BENNO RUNNEBAUM, FRANZ RESCH, CHRISTOPH MUNDT
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- Published online by Cambridge University Press:
- 24 April 2007, pp. 1427-1436
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Background
Estrogen has been hypothesized to have a protective and antipsychotic-like effect in women at risk for schizophrenia. The aim of the present study was to evaluate the association between menstrual cycle and/or estrogen levels and psychotic symptoms in a sample of women with schizophrenia.
MethodOne hundred and twenty-five premenopausal women with schizophrenia and regular menses were examined. The levels of 17β-estradiol and other hormones of the gonadal axis were assessed in the follicular, peri-ovulatory, and luteal phases of the menstrual cycle. The effects of the menstrual cycle phase and/or the estradiol level on the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) scores were calculated by means of regression analyses.
ResultsSignificant improvement in psychotic, but not depressive, symptoms was observed during the luteal phase, compared with other days of the menstrual cycle.
ConclusionsThe present findings indicate that estradiol may have specific antipsychotic-like effects on the symptoms of schizophrenia. Thus further investigation into the therapeutic effect of estrogen may be worthwhile.
Delusional ideation and manic symptoms in potential future emigrants in Uganda
- PATRIC LUNDBERG, ELIZABETH CANTOR-GRAAE, MAUREEN KAHIMA, PER-OLOF ÖSTERGREN
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- Published online by Cambridge University Press:
- 06 December 2006, pp. 505-512
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Background. The cause of increased schizophrenia rates among immigrants in Europe is unknown. This study explores psychotic features in persons aspiring and actively planning to emigrate, prior to their potential emigration.
Method. Potential future emigrants and controls in Kampala (Uganda) were screened for delusional ideation and manic symptoms, using the Peters et al. Delusions Inventory (PDI) and mania items from the Composite International Diagnostic Interview (CIDI).
Results. Aspirations regarding emigration were associated with increased delusional ideation compared with controls (p=0·01), whereas active plans regarding emigration were not. Neither aspiring nor actively planning to emigrate was associated with increased manic symptoms. Subjects with increased delusional ideation also had increased manic symptoms (p<0·001).
Conclusions. Although some aspects of delusional ideation might include thoughts concerning emigration, practical circumstances (e.g. visa requirements, travel costs) probably prevent emigration of the psychosis-prone in many settings.
Research Article
Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation
- AART H. SCHENE, MAARTEN W. J. KOETER, MARTIJN J. KIKKERT, JAN A. SWINKELS, PAUL McCRONE
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- Published online by Cambridge University Press:
- 20 November 2006, pp. 351-362
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Background. Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU).
Method. Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months.
Results. The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75·5% probability of being more cost-effective than TAU alone.
Conclusion. Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.
Original Article
Shell shock: an outcome study of a First World War ‘PIE’ unit
- EDGAR JONES, ADAM THOMAS, STEPHEN IRONSIDE
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- Published online by Cambridge University Press:
- 09 November 2006, pp. 215-223
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Background. ‘Forward psychiatry’ was introduced by the French Army in 1915 to stem the loss of troops to base hospitals. Also known by the acronym PIE (proximity to the battle, immediacy of treatment and expectancy of recovery, including return to duty), it was subsequently used by the British and Americans in both World Wars. The US Army used PIE techniques in Korea and Vietnam. Although widely accepted as an effective intervention, forward psychiatry is not amenable to random-controlled trials and only one controlled outcome study has been conducted.
Method. All 3580 soldiers with shell shock admitted to 4 Stationary Hospital between January and November 1917 were recorded. Unit details, military experience, length of stay and outcomes were analysed. Soldiers were categorized into combat, combat-support and non-combatant groups. Admissions were correlated with military operations to compare the impact of defensive and offensive phases of warfare.
Results. Rates of admission for shell shock rose significantly during offensives when physical casualties escalated. Combat troops were disproportionately represented. Over 50% of admissions had less than 9 months service in France and 21% broke down within 3 months of going overseas. Less than 20% returned directly to combat units, most going to other hospitals, convalescent depots or base duties.
Conclusions. Forward psychiatry was not effective in returning combat troops to fighting units but, by allocating soldiers to support roles, it prevented discharge from the armed forces. Uncertainties remain about relapses, including other routes that servicemen used to escape from a combat zone.
Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa)
- CYNTHIA M. BULIK, ANN VON HOLLE, ROBERT HAMER, CECILIE KNOPH BERG, LEILA TORGERSEN, PER MAGNUS, CAMILLA STOLTENBERG, ANNA MARIA SIEGA-RIZ, PATRICK SULLIVAN, TED REICHBORN-KJENNERUD
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- Published online by Cambridge University Press:
- 10 May 2007, pp. 1109-1118
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Background
We explored the course of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health.
MethodA total of 41 157 pregnant women, enrolled at approximately 18 weeks' gestation, had valid data from the Norwegian Medical Birth Registry. We collected questionnaire-based diagnostic information on broadly defined anorexia nervosa (AN), and bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). EDNOS subtypes included binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P). We explored rates of remission, continuation and incidence of BN, BED and EDNOS-P during pregnancy.
ResultsPrepregnancy prevalence estimates were 0·1% for AN, 0·7% for BN, 3·5% for BED and 0·1% for EDNOS-P. During early pregnancy, estimates were 0·2% (BN), 4·8% (BED) and 0·1% (EDNOS-P). Proportions of individuals remitting during pregnancy were 78% (EDNOS-P), 40% (BN purging), 39% (BED), 34% (BN any type) and 29% (BN non-purging type). Additional individuals with BN achieved partial remission. Incident BN and EDNOS-P during pregnancy were rare. For BED, the incidence rate was 1·1 per 1000 person-weeks, equating to 711 new cases of BED during pregnancy. Incident BED was associated with indices of lower socio-economic status.
ConclusionsPregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for the new onset of broadly defined BED, especially in economically disadvantaged individuals. Vigilance by health-care professionals for continuation and emergence of eating disorders in pregnancy is warranted.
Random-mood interpretation of determinants for major depression
- KIRSTEN I. KAPTEIN, PETER De JONGE, JAKOB KORF, JAN SPIJKER, RON De GRAAF, SIEBREN Y. VAN DER WERF
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- Published online by Cambridge University Press:
- 05 July 2007, pp. 1261-1271
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Background
It has recently been proposed that major depression disorder (MDD) may, in a heterogeneous population-based cohort, be interpreted in terms of a random-mood model. Mood fluctuations are thought to result from stressors that occur randomly in time. We have investigated whether this concept also holds for more homogeneous groups, defined by known determinants for MDD, and whether the model's parameters, susceptibility (Z) and relaxation time (T), may be evaluated and used to differentiate between subcohorts.
MethodFrom a large epidemiological survey, the Netherlands Mental Health Survey and Incidence Study (NEMESIS), data on the duration of MDD were obtained for subcohorts, based on gender, severity of depression, recurrence and co-morbidity with dysthymia, anxiety and somatic disorder, and were compared with random-mood simulation calculations.
ResultsSusceptibility, Z, is empirically found to be proportional to incidence and may be identified with a risk ratio. A second scaling rule states the proportionality of mean duration with the product of Z and T. This Z–T classification proves to be more sensitive than conventional significance tests. Notably for men/women and for co-morbid anxiety, differences are seen that have previously gone unnoticed.
ConclusionsDepression may be conceptualized as a disorder resulting from random-mood fluctuations, the response to which is influenced by a large variety of determinants or risk factors. The model's parameters can be evaluated and may be used in differentiating between risk factor-defined subgroups.
Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model
- AUDREY COUGNARD, MACHTELD MARCELIS, INEZ MYIN-GERMEYS, RON DE GRAAF, WILMA VOLLEBERGH, LYDIA KRABBENDAM, ROSELIND LIEB, HANS-ULRICH WITTCHEN, CÉCILE HENQUET, JANNEKE SPAUWEN, JIM VAN OS
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- Published online by Cambridge University Press:
- 09 February 2007, pp. 513-527
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Background. Research suggests that low-grade psychotic experiences in the general population are a common but transitory developmental phenomenon. Using two independent general population samples, the hypothesis was examined that common, non-clinical developmental expression of psychosis may become abnormally persistent when synergistically combined with developmental exposures that may impact on behavioural and neurotransmitter sensitization such as cannabis, trauma and urbanicity.
Method. The amount of synergism was estimated from the additive statistical interaction between baseline cannabis use, childhood trauma and urbanicity on the one hand, and baseline psychotic experiences on the other, in predicting 3-year follow-up psychotic experiences, using data from two large, longitudinal, random population samples from the Netherlands [The Netherlands Mental Health Survey and Incidence Study (NEMESIS)] and Germany [The Early Developmental Stages of Psychopathology (EDSP) study].
Results. The 3-year persistence rates of psychotic experiences were low at 26% in NEMESIS and 31% in EDSP. However, persistence rates were progressively higher with greater baseline number of environmental exposures in predicting follow-up psychotic experiences (χ2=6·9, df=1, p=0·009 in NEMESIS and χ2=4·2, df=1, p=0·04 in EDSP). Between 21% and 83% (NEMESIS) and 29% and 51% (EDSP) of the subjects exposed to both environmental exposures and psychotic experiences at baseline had persistence of psychotic experiences at follow-up because of the synergistic action of the two factors.
Conclusion. The findings suggest that environmental risks for psychosis act additively, and that the level of environmental risk combines synergistically with non-clinical developmental expression of psychosis to cause abnormal persistence and, eventually, need for care.
Clinical presentation of postnatal and non-postnatal depressive episodes
- CARLY COOPER, LISA JONES, EMMA DUNN, LIZ FORTY, SAYEED HAQUE, FEMI OYEBODE, NICK CRADDOCK, IAN JONES
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- Published online by Cambridge University Press:
- 12 March 2007, pp. 1273-1280
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Background
The relationship of postnatal (postpartum) depression (PND) to episodes of depression occurring at other times is not well understood. Despite a number of studies of clinical presentation, there is little consistency in the literature. We have undertaken within- and between-individual comparisons of the clinical presentation of postnatal (PN) and non-postnatal (NPN) depressive episodes in women with recurrent depression.
MethodIn a sample of well-characterized, parous women meeting DSM-IV and ICD-10 criteria for recurrent major depressive disorder, the clinical presentation of episodes of major depression with onset within 4 weeks of giving birth (PND group, n=50) were compared with (i) the non-postnatal episodes of women with PND, and (ii) episodes of major depression in parous women who had not experienced episodes of mood disorder in relation to childbirth (NPND group, n=132). In addition, the non-postnatal episodes of the PND group of women were compared with the depressive episodes of the NPND group.
ResultsThe small number of differences found between PN and NPN depressive episodes, such as reduced early morning wakening in postnatal episodes, are likely to be explicable by the context of having a new baby rather than by any difference in the nature of the underlying depression.
ConclusionsThe results do not point to substantial differences in clinical presentation between episodes of major depression occurring in relation to childbirth and at other times. Other avenues of research are therefore required to demonstrate a specific relationship between childbirth and depression.
Life trajectories and burden of adversity: mapping the developmental profiles of suicide mortality
- MONIQUE SÉGUIN, ALAIN LESAGE, GUSTAVO TURECKI, MÉLANIE BOUCHARD, NADIA CHAWKY, NANCY TREMBLAY, FRANCE DAIGLE, ANDRÉE GUY
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- Published online by Cambridge University Press:
- 18 June 2007, pp. 1575-1583
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Background
Little is known about differential suicide profiles across the life trajectory. This study introduces the life-course method in suicide research with the aim of refining the longitudinal and cumulative assessment of psychosocial factors by quantifying accumulation of burden over time in order to delineate distinctive pathways of completed suicide.
MethodThe psychological autopsy method was used to obtain third-party information on consecutive suicides. Life-history calendar analysis served to arrive at an adversity score per 5-year segment that was then cluster-analysed and correlated to define victim profiles.
ResultsTwo distinct life trajectories emerged: (1) individuals who experienced childhood traumas, developmental adversity and little protection were more likely to present concurrent psychiatric and Axis II disorders; and (2) individuals who experienced less adversity but seemed more reactive to later major difficulties.
ConclusionsThe life calendar approach presented here in suicide research adds to the identification of life events, distal and recent, previously associated with suicide. It also quantifies the burden of adversity over the life course, defining two distinct profiles that could benefit from distinct targeted preventive intervention.
The clinical significance criterion in DSM-IV post-traumatic stress disorder
- NAOMI BRESLAU, GERMAN F. ALVARADO
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- Published online by Cambridge University Press:
- 20 April 2007, pp. 1437-1444
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Background
The DSM-IV definition of post-traumatic stress disorder (PTSD) requires that the syndrome cause clinically significant distress or impairment. The impact of the clinical significance criterion on the lifetime prevalence of PTSD among civilian victims of traumatic events has not been evaluated.
MethodData from two community-based samples were examined, the 1996 Detroit Area Survey of Trauma (n=2181) and the Mid-Atlantic Urban Youth Study (n=1698). The World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to ascertain DSM-IV PTSD.
ResultsThe inclusion of the clinical significance criterion in DSM-IV reduces the conditional probability of PTSD given exposure to trauma by approximately 30%. Cases with clinically significant syndrome showed more pervasive and persistent disturbance and an excess in impaired activity days.
ConclusionsThe consistency of the findings between the two studies strengthens the evidence on the impact of the clinical significance criterion in the diagnosis of PTSD, and the construct validity of its measurement. There is a need for greater research effort on the definition and measurement of the clinical significance criterion.
Suicide in current psychiatric in-patients: a case-control study The National Confidential Inquiry into Suicide and Homicide
- ISABELLE M. HUNT, NAVNEET KAPUR, ROGER WEBB, JO ROBINSON, JAMES BURNS, PAULINE TURNBULL, JENNY SHAW, LOUIS APPLEBY
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- Published online by Cambridge University Press:
- 19 February 2007, pp. 831-837
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Background. Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide.
Method. We conducted a national population-based case-control study of people who died by suicide between 1 April 1999 and 31 December 2000 while in psychiatric in-patient care in England. Cases were 222 adult mental health in-patients who died by suicide matched on date of death with 222 living controls.
Results. Nearly a quarter of suicides took place within the first week of admission; most of these died on the ward or after absconding. After the first week, however, most suicides occurred away from the ward, the majority of patients having left the ward with staff agreement. Previous deliberate self-harm, recent adverse life events, symptoms of mental illness at last contact with staff and a co-morbid psychiatric disorder were associated with increased risk for suicide. Being off the ward without staff agreement was a particularly strong predictor. Those patients who were detained for compulsory treatment were less likely to die by suicide. Independent predictors of in-patient suicide were male sex, a primary diagnosis of affective disorder and a history of self-harm. Being unemployed or on long-term sick leave appeared to be independently protective.
Conclusion. Prevention of in-patient suicide should emphasize adequate treatment of affective disorder, vigilance in the first week of admission and regular risk assessments during recovery and prior to granting leave. Use of compulsory treatment may reduce risk.
Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China
- SING LEE, ADLEY TSANG, MING-YUAN ZHANG, YUE-QIN HUANG, YAN-LING HE, ZHAO-RUI LIU, YU-CUN SHEN, RONALD C. KESSLER
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- Published online by Cambridge University Press:
- 12 October 2006, pp. 61-71
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Background. This is the first study to examine variation across cohorts in lifetime risk of DSM-IV mental disorders in metropolitan China.
Method. Face-to-face household interviews of 2633 adults in Beijing and 2568 adults in Shanghai were conducted from November 2001 to February 2002 using a multi-stage household probability sampling method. The Chinese World Mental Health (WMH) Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used for assessment.
Results. Lifetime prevalence of any disorder was 13·2%. Alcohol abuse (4·7%), major depressive disorder (3·5%), and specific phobia (2·6%) were the most common disorders. The median age of onset was later for mood (43 years) than anxiety (17 years) and substance use (25 years) disorders. Compared to observed lifetime prevalence, the projected lifetime risk as of age 75 years increased by 106% for major depressive disorder (7·2%), and was uniformly higher for all disorders. Relative odds of any lifetime disorder were 4·7 in the most recent cohorts (ages 18–34) compared to the eldest cohorts (ages [ges ]65).
Conclusions. The findings of this cross-sectional study tally with the view that rapid socioeconomic changes may bring about increasing incidence of mental disorders in China. However, prospective longitudinal studies are needed to confirm if the increase is real. Because of the huge size of the Chinese population, any increase in projected lifetime risk of mental disorders represents an enormous increase in the number of affected individuals.
A cluster randomized controlled trial to assess the effectiveness of an intervention to educate students about depression
- ROWENA K. MERRITT, JONATHAN R. PRICE, JILL MOLLISON, JOHN R. GEDDES
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- Published online by Cambridge University Press:
- 23 October 2006, pp. 363-372
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Background. Depression is an important cause of disability worldwide, with many people experiencing their first depressive episode before the age of 18. University students are particularly vulnerable to depression. Depression can be treated successfully in most patients. However, for treatment to be successful, depressed people need to recognize their symptoms as illness, present to medical care, and be aware that effective treatment is available. A thoughtful health campaign might therefore increase the likelihood of successful treatment.
Method. A cluster randomized controlled trial was conducted to determine the effectiveness of an educational intervention. A total of 3313 undergraduate students participated in the study. The intervention consisted of postcards and posters on depression and its treatment. The primary outcome was student awareness that depression can be treated effectively. Secondary outcomes included the proportion of students reading the postcards, recognition of symptoms and knowledge of treatments.
Results. The postcards were read by 69% of students. Less than half of participants reported that depression could be treated effectively, and there was no evidence of a difference between the intervention and control groups [341 (49·1%) v. 379 (49·7%), difference −0·7, p=0·8, 95% confidence interval (CI) −5·1 to 3·7]. However, intervention group participants were more likely than control group participants to recognize depressive symptoms and to report that antidepressants are not addictive.
Conclusions. Many university students lack knowledge about depression and its treatment. Simple and cheap media, such as postcards and posters, might help to improve awareness in areas where current knowledge is low.
Is dissociative amnesia a culture-bound syndrome? Findings from a survey of historical literature
- HARRISON G. POPE, MICHAEL B. POLIAKOFF, MICHAEL P. PARKER, MATTHEW BOYNES, JAMES I. HUDSON
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- Published online by Cambridge University Press:
- 07 December 2006, pp. 225-233
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Background. Natural human psychological phenomena, such as depression, anxiety, delusions, hallucinations and dementia, are documented across the ages in both fictional and non-fictional works. We asked whether ‘dissociative amnesia’ was similarly documented throughout history.
Method. We advertised in three languages on more than 30 Internet web sites and discussion groups, and also in print, offering US$1000 to the first individual who could find a case of dissociative amnesia for a traumatic event in any fictional or non-fictional work before 1800.
Results. Our search generated more than 100 replies; it produced numerous examples of ordinary forgetfulness, infantile amnesia and biological amnesia throughout works in English, other European languages, Latin, Greek, Arabic, Sanskrit and Chinese before 1800, but no descriptions of individuals showing dissociative amnesia for a traumatic event.
Conclusions. If dissociative amnesia for traumatic events were a natural psychological phenomenon, an innate capacity of the brain, then throughout the millennia before 1800, individuals would presumably have witnessed such cases and portrayed them in non-fictional works or in fictional characters. The absence of cases before 1800 cannot reasonably be explained by arguing that our ancestors understood or described psychological phenomena so differently as to make them unrecognizable to modern readers because spontaneous complete amnesia for a major traumatic event, in an otherwise lucid individual, is so graphic that it would be recognizable even through a dense veil of cultural interpretation. Therefore, it appears that dissociative amnesia is not a natural neuropsychological phenomenon, but instead a culture-bound syndrome, dating from the nineteenth century.