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Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report
- Alan E. Kazdin, Chi-Shin Wu, Irving Hwang, Victor Puac-Polanco, Nancy A. Sampson, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Corina Benjet, José-Miguel Caldas-de-Almeida, Giovanni de Girolamo, Peter de Jonge, Silvia Florescu, Oye Gureje, Josep M. Haro, Meredith G. Harris, Elie G. Karam, Georges Karam, Viviane Kovess-Masfety, Sing Lee, John J. McGrath, Fernando Navarro-Mateu, Daisuke Nishi, Bibilola D. Oladeji, José Posada-Villa, Dan J. Stein, T. Bedirhan Üstün, Daniel V. Vigo, Zahari Zarkov, Alan M. Zaslavsky, Ronald C. Kessler, the WHO World Mental Health Survey collaborators
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- Journal:
- Psychological Medicine / Volume 53 / Issue 4 / March 2023
- Published online by Cambridge University Press:
- 23 September 2021, pp. 1583-1591
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Background
The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.
MethodsFace-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.
Results3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.
ConclusionADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
Quality of life and exercise performance in unoperated children with anomalous aortic origin of a coronary artery from the opposite sinus of valsalva
- Alan C. Sing, Stephen Tsaur, Stephen M. Paridon, Julie A. Brothers
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- Journal:
- Cardiology in the Young / Volume 27 / Issue 5 / July 2017
- Published online by Cambridge University Press:
- 26 September 2016, pp. 895-904
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Background
Anomalous aortic origin of a coronary artery is a congenital cardiac condition that can be associated with increased risk of sudden death. To date, quality of life and exercise performance have not been evaluated in patients with this condition who do not undergo surgical repair.
MethodsWe carried out a cross-sectional analysis of patients with unoperated anomalous aortic origin of a coronary artery at our institution from 1 January, 2000 to 31 January, 2016. We prospectively assessed quality of life using standardised questionnaires. Medical records were reviewed for clinical and exercise stress test data. Statistical analyses were performed using Student’s t-tests and Spearman’s correlation coefficients.
ResultsIn total, 56 families completed the questionnaires. The average age at enrolment was 14.7±6 years. The majority were male (n=44, 78.6%) and had interarterial anomalous right coronary artery (n=38, 67.9%). Patients had normal quality of life on the PedsQL 4.0 Report, Child Health Questionnaire Child Form 87, and SF-36v2. Their parents had normal quality of life on the PedsQL 4.0 Parent Report, but parents of exercise-restricted patients had decreased Physical Functioning, General Health Perception, Emotional Impact on Parent, and Physical Summary scores (p<0.001–0.048) on the Child Health Questionnaire Parent Form 50.
ConclusionsPatients with unoperated anomalous aortic origin of a coronary artery appear to have normal quality of life, but parents of exercise-restricted patients have decreased general health and emotional and physical quality of life scores. Improved counselling of families may be beneficial in this group. Future studies with more patients should evaluate quality of life and exercise performance over time.
Contributors
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- By Núria Duran Adroher, Sergio Aguilar-Gaxiola, Jordi Alonso, Ali Obaid Al-Hamzawi, Laura Helena Andrade, Matthias C. Angermeyer, James Anthony, Corina Benjet, Guilherme Borges, Joshua Breslau, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Huibert Burger, José Miguel Caldas de Almeida, Graça Cardoso, Somnath Chatterji, Wai Tat Chiu, Giovanni de Girolamo, Ron de Graaf, Peter de Jonge, Koen Demyttenaere, John Fayyad, Alize J. Ferrari, Silvia Florescu, Anne M. Gadermann, Meyer Glantz, Jen Green, Michael J. Gruber, Oye Gureje, Josep Maria Haro, Yanling He, Steven G. Heeringa, Hristo Hinkov, Chiyi Hu, Yueqin Huang, Irving Hwang, Robert Jin, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Lola Kola, Viviane Kovess-Masféty, Michael C. Lane, Carmen Lara, William LeBlanc, Sing Lee, Jean-Pierre Lépine, Daphna Levinson, Zhaorui Liu, Gustavo Loera, Herbert Marschinger, Katie A. McLaughlin, Maria Elena Medina-Mora, Elizabeth Miller, Samuel D. Murphy, Aimee Nasser Karam, Matthew K. Nock, Mark A. Oakley Browne, Siobhan O’Neill, Johan Ormel, Beth-Ellen Pennell, Maria V. Petukhova, José Posada-Villa, Rajesh Sagar, Mohammad Salih Khalaf, Nancy A. Sampson, Kathleen Saunders, Michael Schoenbaum, Kate M. Scott, Soraya Seedat, Victoria Shahly, Dan J. Stein, Hisateru Tachimori, Nezar Ismet Taib, Adley Tsang, T. Bedirhan Üstün, Maria Carmen Viana, Gemma Vilagut, Michael R. Von Korff, J. Elisabeth Wells, Harvey A. Whiteford, David R. Williams, Ben Wu, Miguel Xavier, Alan M. Zaslavsky
- Edited by Jordi Alonso, Universitat Pompeu Fabra, Barcelona, Somnath Chatterji, World Health Organization, Geneva, Yanling He
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- Book:
- The Burdens of Mental Disorders
- Print publication:
- 09 May 2013, pp ix-xii
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Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys
- Ronald C. Kessler, Katie A. McLaughlin, Jennifer Greif Green, Michael J. Gruber, Nancy A. Sampson, Alan M. Zaslavsky, Sergio Aguilar-Gaxiola, Ali Obaid Alhamzawi, Jordi Alonso, Matthias Angermeyer, Corina Benjet, Evelyn Bromet, Somnath Chatterji, Giovanni de Girolamo, Koen Demyttenaere, John Fayyad, Silvia Florescu, Gilad Gal, Oye Gureje, Josep Maria Haro, Chi-yi Hu, Elie G. Karam, Norito Kawakami, Sing Lee, Jean-Pierre Lépine, Johan Ormel, José Posada-Villa, Rajesh Sagar, Adley Tsang, T. Bedirhan Üstün, Svetlozar Vassilev, Maria Carmen Viana, David R. Williams
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- Journal:
- The British Journal of Psychiatry / Volume 197 / Issue 5 / November 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 378-385
- Print publication:
- November 2010
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Background
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
AimsTo examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.
MethodNationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
ResultsChildhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
ConclusionsChildhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
- Daphna Levinson, Matthew D. Lakoma, Maria Petukhova, Michael Schoenbaum, Alan M. Zaslavsky, Matthias Angermeyer, Guilherme Borges, Ronny Bruffaerts, Giovanni de Girolamo, Ron de Graaf, Oye Gureje, Josep Maria Haro, Chiyi Hu, Aimee N. Karam, Norito Kawakami, Sing Lee, Jean-Pierre Lepine, Mark Oakley Browne, Michail Okoliyski, José Posada-Villa, Rajesh Sagar, Maria Carmen Viana, David R. Williams, Ronald C. Kessler
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- Journal:
- The British Journal of Psychiatry / Volume 197 / Issue 2 / August 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 114-121
- Print publication:
- August 2010
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Background
Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries.
AimsTo examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys.
MethodThe WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated.
ResultsRespondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (χ2(9) = 5.5–8.1, P = 0.52–0.79). These losses are equivalent to 0.3–0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations.
ConclusionsThese results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.
The transfer of 15N from urea to lysine in the human infant
- D. Joe Millward, Terrance Forrester, Eric Ah-Sing, Nana Yeboah, Neil Gibson, Asha Badaloo, M. Boyne, M. Reade, C. Persaud, Alan Jackson
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- Journal:
- British Journal of Nutrition / Volume 83 / Issue 5 / May 2000
- Published online by Cambridge University Press:
- 09 March 2007, pp. 505-512
- Print publication:
- May 2000
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To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.To explore the nutritional significance of urea hydrolysis for human subjects, male infants being treated for severe undernutrition were given oral doses of 10 mg [15N15N]urea every 3 h for 36 h, on admission, during rapid growth and after repletion with either moderate or generous intakes of protein. Urea hydrolysis was calculated from the 15N enrichment of urinary urea, and where possible, lysine, alanine, glycine and histidine were isolated from urine by preparative ion-exchange chromatography for measurement of 15N enrichment. Sufficient N was obtained for 15N enrichment of lysine to be measured on fifteen occasions from six children. Urea hydrolysis accounted for half of all urea production with 130 (sd 85) mg N/kg hydrolysed per d, most of which appeared to be utilized in synthetic pathways. Of the samples analysed successfully, nine samples of lysine were enriched with 15N (mean atom percent excess 0·0102, range 0·0017–0·0208) with relative enrichment ratios with respect to lysine of 1·63 (range 0·18–3·15), 1·96 (range 0·7–3·73) and 0·9 (range 0·4–1·8) for glycine, alanine and histidine respectively. Enriched samples were identified at each treatment phase and 68 % of the variation in lysine enrichment was explained by the variation in urea enrichment with 54 % explained by the overall rate of delivery of 15N to the lower gastrointestinal tract. The results indicate a minimum of 4·7 mg lysine per kg body weight made available by de novo synthesis with the more likely value an order of magnitude higher. Thus, urea hydrolysis can improve the quality of the dietary protein supply by enabling an increased supply of lysine and other indispensable amino acids.
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