Review
The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression
- L. Mandelli, C. Petrelli, A. Serretti
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- Published online by Cambridge University Press:
- 13 June 2015, pp. 665-680
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Background
A large literature has long focused on the role of trauma in childhood and risk for psychological disorders in adulthood. Despite several studies performed, to date, it is not clear which weight have different childhood stressors specifically on the risk for depression in adult life. In the present study, we performed a meta-analysis of the literature in order to assess the effective role of childhood traumas as risk factor in the onset of depressive disorders in adults.
MethodsPreviously published papers investigating the exposure to childhood trauma and their association with depression in adult subjects were retrieved in literature through common databases. Meta-analysis was conducted by the RevMan software. The quality of studies was evaluated by an adapted version of the New-Ottawa Quality Assessment Scale; bias publication was evaluated by the Egger's test. Meta-regression analysis was employed to detect potential confounders and/or moderating variables. Finally, a sensitivity analysis was post-hoc performed to control for potential confounders.
ResultsEmotional abuse showed the strongest association with depression (OR = 2.78) followed by neglect (OR = 2.75) and sexual abuse (OR = 2.42). Significant associations were also found for domestic violence (OR = 2.06) and physical abuse (OR = 1.98). Nevertheless, in post-hoc analysis, emotional abuse and neglect showed the strongest associations with depression as compared to other kinds of child trauma.
ConclusionsThese findings support the role of neglect and emotional abuse as significantly associated to depression. Sexual/physical abuse or violence in family may be unspecific risk factors for mental disturbance. Other kind of trauma may play a less relevant role in risk of adult depression, though they should be not underestimated.
Original article
Internet Use, Facebook Intrusion, and Depression: Results of a Cross-Sectional Study
- A. Błachnio, A. Przepiórka, I. Pantic
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- Published online by Cambridge University Press:
- 08 May 2015, pp. 681-684
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Facebook has become a very popular social networking platform today, particularly among adolescents and young adults, profoundly changing the way they communicate and interact. However, some reports have indicated that excessive Facebook use might have detrimental effects on mental health and be associated with certain psychological problems. Because previous findings on the relationship between Facebook addiction and depression were not unambiguous, further investigation was required. The main objective of our study was to examine the potential associations between Internet use, depression, and Facebook intrusion. A total of 672 Facebook users took part in the cross-sectional study. The Facebook Intrusion Questionnaire and the Center for Epidemiologic Studies Depression Scale were used. For collecting the data, the snowball sampling procedure was used. We showed that depression can be a predictor of Facebook intrusion. Our results provides additional evidence that daily Internet use time in minutes, gender, and age are also predictors of Facebook intrusion: that Facebook intrusion can be predicted by being male, young age, and an extensive number of minutes spent online. On the basis of this study, it is possible to conclude that there are certain demographic – variables, such as age, gender, or time spent online – that may help in outlining the profile of a user who may be in danger of becoming addicted to Facebook. This piece of knowledge may serve for prevention purposes.
Review
The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis
- P. Cuijpers, E. Karyotaki, G. Andersson, J. Li, R. Mergl, U. Hegerl
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- Published online by Cambridge University Press:
- 11 July 2015, pp. 685-693
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Background
Randomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.
MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.
ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).
ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.
Original article
Autoantibodies are not Predictive Markers for the Development of Depressive Symptoms in a Population-Based Cohort of Older Adults
- R.A. Iseme, M. McEvoy, B. Kelly, L. Agnew, J. Attia, F.R. Walker, C. Oldmeadow, M. Boyle
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- Published online by Cambridge University Press:
- 15 July 2015, pp. 694-700
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Background
Autoantibodies have been implicated in the etiologic pathway of depressive disorders. Here, we determine the association between the presence of a panel of autoantibodies at baseline and change in depression symptom score over 5-year follow-up in a cohort of healthy elderly Australians.
MethodsSerum samples from 2049 randomly selected subjects enrolled in the Hunter Community Study (HCS) aged 55–85 years were assayed for a range of autoimmune markers (anti-nuclear autoantibodies, extractable nuclear antigen autoantibodies, anti-neutrophil cytoplasmic autoantibodies, thyroid peroxidase autoantibodies, tissue transglutaminase autoantibodies, anti-cardiolipin autoantibodies, rheumatoid factor and cyclic citrullinated peptide autoantibodies) at baseline. Depression symptom score was assessed using the Centre for Epidemiological Study (CES-D) scale at baseline and 5 years later.
ResultsAutoantibody prevalence varied amongst our sample with ANA being the most prevalent; positive in 16% and borderline in 36% of study population. No evidence for a relationship was found between change in CES-D score over time and any autoimmune marker. Statins and high cholesterol were significantly associated with change in CES-D score over time in univariate analysis; however, these were probably confounded since they failed to remain significant following multivariable analysis.
ConclusionsAutoantibodies were not associated with change in CES-D score over time. These findings point to an absence of autoimmune mechanisms in the general population or in moderate cases of depression.
Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach
- A. Gutiérrez-Zotes, J. Labad, R. Martín-Santos, L. García-Esteve, E. Gelabert, M. Jover, R. Guillamat, F. Mayoral, I. Gornemann, F. Canellas, M. Gratacós, M. Guitart, M. Roca, J. Costas, J. Luis Ivorra, R. Navinés, Y. de Diego-Otero, E. Vilella, J. Sanjuan
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- Published online by Cambridge University Press:
- 30 June 2015, pp. 701-708
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Background
Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks.
MethodsA total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression.
ResultsPassive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism.
ConclusionsEarly identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.
Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis
- S. Moritz, B. Cludius, B. Hottenrott, B.C. Schneider, K. Saathoff, A.K. Kuelz, J. Gallinat
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- Published online by Cambridge University Press:
- 07 July 2015, pp. 709-714
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Introduction
Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy.
MethodsA sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253).
ResultsNo changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses).
Discussion/conclusionThe study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.
Further Evidence of Depdc7 Dna Hypomethylation in Depression: a Study in Adult Twins
- A. Córdova-Palomera, M. Fatjó-Vilas, H. Palma-Gudiel, H. Blasco-Fontecilla, O. Kebir, L. Fañanás
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- Published online by Cambridge University Press:
- 04 May 2015, pp. 715-718
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Late and early stressful factors have widely been recognized to play a role in the aetiology of depression. Recent research indicates that such adverse environmental stimuli may alter gene expression in humans via epigenetic modifications. While epigenetic changes such as DNA methylation are likely involved in these processes, it is still unknown what specific genomic loci may be hyper- or hypo-methylated in depression. The association between depressive symptoms during the last 30 days (Brief Symptom Inventory [BSI]) and peripheral-blood DNA methylation levels at genomic loci previously reported as epigenetically altered in saliva and brain of depressive patients was evaluated in a community sample of 34 adult Caucasian MZ twins (17 pairs). Intrapair DNA methylation differences in an intron of DEPDC7 (chr11:33040743) were associated with intrapair differences in current depressive symptoms. Accordingly, a site-specific 10% DNA hypomethylation in a co-twin would correlate with a current depressive symptom score around 3.1 BSI points above the score of his/her less-depressed co-twin. These findings indicate that DEPDC7 hypomethylation in peripheral blood DNA may be associated with recent depressive symptomatology, in line with previous results.
Interaction Between Parental Psychosis and Early Motor Development and the Risk of Schizophrenia in a General Population Birth Cohort
- E. Keskinen, A. Marttila, R. Marttila, P.B. Jones, G.K. Murray, K. Moilanen, H. Koivumaa-Honkanen, P. Mäki, M. Isohanni, E. Jääskeläinen, J. Miettunen
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- Published online by Cambridge University Press:
- 09 June 2015, pp. 719-727
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Background
Delayed motor development in infancy and family history of psychosis are both associated with increased risk of schizophrenia, but their interaction is largely unstudied.
AimTo investigate the association of the age of achieving motor milestones and parental psychosis and their interaction in respect to risk of schizophrenia.
MethodsWe used data from the general population-based prospective Northern Finland Birth Cohort 1966 (n = 10,283). Developmental information of the cohort members was gathered during regular visits to Finnish child welfare clinics. Several registers were used to determine the diagnosis of schizophrenia among the cohort members and psychosis among the parents. Altogether 152 (1.5%) individuals had schizophrenia by the age of 46 years, with 23 (15.1%) of them having a parent with psychosis. Cox regression analysis was used in analyses.
ResultsParental psychosis was associated (P < 0.05) with later achievement of holding the head up, grabbing an object, and walking without support. In the parental psychosis group, the risk for schizophrenia was increased if holding the head up (hazard ratio [HR]: 2.46; degrees of freedom [df] = 1; 95% confidence interval [95% CI]: 1.07–5.66) and touching the thumb with the index finger (HR: 1.84; df = 1; 95% CI: 1.11–3.06) was later. In the group without parental psychosis, a delay in the following milestones increased the risk of schizophrenia: standing without support and walking without support. Parental psychosis had an interaction with delayed touching thumb with index finger (HR: 1.87; df = 1; 95% CI: 1.08–3.25) when risk of schizophrenia was investigated.
ConclusionsParental psychosis was associated with achieving motor milestones later in infancy, particularly the milestones that appear early in a child's life. Parental psychosis and touching the thumb with the index finger had a significant interaction on risk of schizophrenia. Genetic risk for psychosis may interact with delayed development to raise future risk of schizophrenia, or delayed development may be a marker of other risk processes that interact with genetic liability to cause later schizophrenia.
A National Network of Schizophrenia Expert Centres: an Innovative Tool to Bridge the Research-Practice Gap
- F. Schürhoff, G. Fond, F. Berna, E. Bulzacka, J. Vilain, D. Capdevielle, D. Misdrahi, M. Leboyer, P.-M. Llorca
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- Published online by Cambridge University Press:
- 10 June 2015, pp. 728-735
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Schizophrenia is probably the most severe psychiatric disorder with much suffering for the patients and huge costs for the society. Efforts to provide optimal care by general practitioners and psychiatrists are undermined by the complexity of the disorder and difficulties in applying clinical practice guidelines and new research findings to the spectrum of cases seen in day-to-day practice. An innovative model of assessment aimed at improving global care of people with schizophrenia provided by the French national network of schizophrenia expert centres is being described. Each centre has established strong links to local health services and provides support to clinicians in delivering personalized care plans. A common set of assessment tools has been adopted by the ten centres spread over the whole French territory. A web application, e-schizo© has been created to record data in a common computerized medical file. This network offers systematic, comprehensive, longitudinal, and multi-dimensional assessments of cases including a medical workup and an exhaustive neuropsychological evaluation. This strategy offers an effective way to transfer knowledge and share expertise. This network is a great opportunity to improve the global patient care and is conceived as being an infrastructure for research from observational cohort to translational research.
Clinical and Functional Outcome of Assertive Outreach for Patients With Schizophrenic Disorder: Results of a Quasi-Experimental Controlled Trial
- D. Kästner, D. Büchtemann, I. Warnke, J. Radisch, J. Baumgardt, S. Giersberg, K. Kopke, J. Moock, W. Kawohl, W. Rössler
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- Published online by Cambridge University Press:
- 21 May 2015, pp. 736-742
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Background
The majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter.
MethodWe conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n = 176) and controls (TAU, n = 142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS–II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models.
ResultsThe GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables – WHODAS–II and MARS – neither showed a stable temporal improvement nor a difference between groups.
ConclusionOur findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.
Non-Suicidal Self-Injury Among Dutch and Belgian Adolescents: Personality, Stress and Coping
- G. Kiekens, R. Bruffaerts, M.K. Nock, M. Van de Ven, C. Witteman, P. Mortier, K. Demyttenaere, L. Claes
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- Published online by Cambridge University Press:
- 07 August 2015, pp. 743-749
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Background
This study examines: (1) the prevalence of Non-Suicidal Self-Injury (NSSI) among Dutch and Belgian adolescents, (2) the associations between Big Five personality traits and NSSI engagement/versatility (i.e., number of NSSI methods), and (3) whether these associations are mediated by perceived stress and coping.
MethodsA total of 946 Flemish (46%) and Dutch (54%) non-institutionalized adolescents (Mean age = 15.52; SD = 1.34, 44% females) were surveyed. Measures included the NSSI subscale of the Self-Harm-Inventory, the Dutch Quick Big Five Personality questionnaire, the Perceived Stress Scale and the Utrecht Coping List for Adolescents. Examination of zero-order correlations was used to reveal associations, and hierarchical regression analysis was used to reveal potential mediators which were further examined within parallel mediation models by using a bootstrapping-corrected procedure.
ResultsLifetime prevalence of NSSI was 24.31%. Neuroticism; perceived stress; and distractive, avoidant, depressive, and emotional coping were positively associated with NSSI engagement, whereas Agreeableness, Conscientiousness; and active, social, and optimistic coping were negatively associated with NSSI engagement. Observed relationships between personality traits and NSSI engagement were consistently explained by perceived stress and depressive coping. A higher versatility of NSSI was not associated with any Big Five personality trait, but was associated with higher scores on perceived stress and depressive coping and with lower scores on active and optimistic coping.
ConclusionOur study suggests that a specific personality constellation is associated with NSSI engagement via high stress levels and a typical depressive reaction pattern to handle stressful life events.
Induced Abortions and Birth Outcomes of Women With a History of Severe Psychosocial Problems in Adolescence
- V. Lehti, M. Gissler, J. Suvisaari, M. Manninen
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- Published online by Cambridge University Press:
- 25 June 2015, pp. 750-755
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Objective
To increase knowledge on the reproductive health of women who have been placed in a residential school, a child welfare facility for adolescents with severe psychosocial problems.
MethodsAll women (n = 291) who lived in the Finnish residential schools on the last day of the years 1991, 1996, 2001 and 2006 were included in this study and compared with matched general population controls. Register-based information on induced abortions and births was collected until the end of the year 2011.
ResultsCompared to controls, women with a residential school history had more induced abortions. A higher proportion of their births took place when they were teenagers or even minors. They were more often single, smoked significantly more during pregnancy and had a higher risk of having a preterm birth or a baby with a low birth weight.
ConclusionsThe findings have implications for the planning of preventive and supportive interventions that aim to increase the well-being of women with a residential school history and their offspring.
Review
Are There Associations Between Early Emotional Trauma and Anxiety Disorders? Evidence from a Systematic Literature Review and Meta-Analysis
- V. Fernandes, F.L. Osório
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- Published online by Cambridge University Press:
- 08 July 2015, pp. 756-764
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Background
Previous studies indicate a possible association between early emotional trauma (EET) and the development of anxiety disorders (ADs) in adult life. However, no previous studies have compiled the findings of such studies and analyzed their statistical significance. Therefore, the objective of this study was to conduct a systematic literature review and meta-analysis to determine possible associations between EET and three ADs (panic, generalized anxiety, and social anxiety disorders).
MethodsA systematic search was conducted in PubMed, PsycInfo, and Scielo with no publication date limitations. A total of 2127 studies were found, 32 studies of which were selected for the systematic review and 13 studies of which were selected for the meta-analysis.
ResultsHigh prevalence rates of different EETs were observed among the individuals with ADs (median: 18%–45%). The results of the meta-analysis indicated that individuals with EETs were 1.9- to 3.6-fold more likely to develop ADs compared with a control group of healthy individuals. Emotional traumas were the main risk factor for social anxiety disorder. However, no specific associations were found for the other ADs.
ConclusionsEET is a risk factor for ADs, underscoring the importance of preventive measures to combat the development of these disorders. Moreover, the identification of EETs among patients with ADs is essential for implementing remedial measures to minimize the impact and damage arising from this association by decreasing the risk and severity of symptoms and to improve the response rate to treatment of ADs.
Original article
Emotional Regulation of Mental Pain as Moderator of Suicidal Ideation in Military Settings
- L. Shelef, E. Fruchter, A. Hassidim, G. Zalsman
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- Published online by Cambridge University Press:
- 29 June 2015, pp. 765-769
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Background
In the Israel Defense Forces (IDF) as well as in most armies throughout the world, the leading cause of death during peace-time is suicide. This study examines emotional regulation of mental pain as a contributor to suicidal ideation in soldiers.
MethodsOne hundred sixty-eight IDF soldiers (aged 18–21 years, 59% males) completed the following self-report questionnaires: Scale for Suicide Ideation (SSI); Orbach & Mikulincer Mental Pain Scale (OMMP); and Emotional Regulation of Mental Pain questionnaire. Participants were divided into 3 groups: soldiers who attempted suicide (AS group, n = 58), soldiers under treatment by a mental health professional and reporting no suicidal behavior (PT group, n = 58), and controls (C group, n = 50).
ResultsSuicide ideation, mental pain, and low emotional regulation were significantly higher in the suicidal group as compared to the two other groups (P < 0.001). Mental pain was significantly related to more suicide ideation in soldiers with low ability to regulate mental pain (P < .001 for the interaction).
ConclusionEmotional regulation of mental pain moderates the link between mental pain and suicide ideation. Soldiers with high mental pain and low regulation of mental pain exhibited higher suicidal ideation. These findings may assist in planning prevention programs in the army and similar settings.
Shifts in the Care for Patients Presenting in Primary Care With Anxiety; Stepped Collaborative Care Parameters From More than a Decade
- L.G. Gidding, M.G. Spigt, J.G. Maris, O. Herijgers, G.-J. Dinant
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- Published online by Cambridge University Press:
- 10 July 2015, pp. 770-777
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Background
The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically.
MethodsRetrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841–69,413 primary care patients.
ResultsSubstantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1–85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4–0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4–0.8]). More patients were referred to psychologists and psychiatrists.
ConclusionsWe found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels.
Gender Differences in Psychotropic Use Across Europe: Results From a Large Cross-Sectional, Population-Based Study
- A. Boyd, S. Van de Velde, M. Pivette, M. ten Have, S. Florescu, S. O’Neill, J.-M. Caldas-de-Almeida, G. Vilagut, J.M. Haro, J. Alonso, V. Kovess-Masféty
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- Published online by Cambridge University Press:
- 04 July 2015, pp. 778-788
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Background
In many epidemiological studies, women have been observed to consume psychotropic medication more often than men. However, the consistency of this relationship across Europe, with differences in mental health care (MHC) resources and reimbursement policies, is unknown.
MethodsQuestions on 12-month psychotropic use (antidepressants, benzodiazepines, antipsychotics, mood stabilizers) were asked to 34,204 respondents from 10 European countries of the EU-World Mental Health surveys. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria were used to determine 12-month prevalence of mood/anxiety disorders using the Composite International Diagnostic Interview (v3.0).
ResultsFor all participating countries, women were significantly more likely than men to use psychotropic medication within the previous 12 months (overall-OR = 2.04, 95% CI: 1.81–2.31). This relationship remained significant after adjusting for common sociodemographic factors (age, income level, employment status, education, marital status) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index). In multivariable gender-stratified risk-factor analysis, both women and men were more likely to have taken psychotropic medication with increasing age, decreasing income level, and mental health care use within the past 12 months, with no significant differences between genders. When only including participants with a mental disorder, gender differences overall were still significant with any 12-month mood disorder but not with any 12-month anxiety disorder, remaining so after adjusting for sociodemographic characteristics and country-level indicators.
ConclusionsWomen use psychotropic medication consistently more often than men, yet reasons for their use are similar between genders. These differences also appear to be contingent on the specific mental disorder.
Disability and Functional Burden of Disease Because of Mental in Comparison to Somatic Disorders in General Practice Patients
- M. Linden, U. Linden, U. Schwantes
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- Published online by Cambridge University Press:
- 26 May 2015, pp. 789-792
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Background
Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society.
MethodTo study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life.
ResultsPatients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62).
ConclusionMental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine.
Functional Disability and Quality of Life Decrements in Mental Disorders: Results From the Mental Health Module of the German Health Interview and Examination Survey for Adults (Degs1-Mh)
- Simon Mack, Frank Jacobi, Katja Beesdo-Baum, Anja Gerschler, Jens Strehle, Michael Höfler, Markus A. Busch, Ulrike Maske, Ulfert Hapke, Wolfgang Gaebel, Jürgen Zielasek, Wolfgang Maier, Hans-Ulrich Wittchen
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- Published online by Cambridge University Press:
- 10 July 2015, pp. 793-800
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Background
This paper provides nationally representative data on how current and past mental disorders are related to functional disability and health-related quality of life (QoL).
MethodsResults are based on a nationally representative sample (DEGS1-MH; n = 4483 aged 18–79). Respondents were examined by clinical interviewers with the DSM-IV Composite International Diagnostic Interview (DIA-X/M-CIDI). Functional disability, i.e. number of disability days in the past 4 weeks, and QoL, i.e. mental (MCS) and physical (PCS) component scale of the SF-36V2, were examined in subjects with 12-month mental disorders (= active cases [AC]) and compared to (a) subjects who never met diagnostic criteria (= unaffected individuals [UAI]), and (b) those with a history of mental disorders but not meeting the diagnostic criteria in the past 12 months (= non-active cases [NAC]; partially or fully remitted).
ResultsIn comparison to UAI (mean: 1.9), AC reveals a 2–3 fold disability days/month (5.4, P < .001) and a substantially reduced MCS (UAI: 52.1; AC: 43.3, P < .001). NAC had a similar number of disability days as UAI, but significantly reduced MCS scores (49.9; P < .001). Disability days and QoL decrements were highest in internalizing disorders including somatoform disorders and most pronounced in comorbid cases.
ConclusionsBy and large, findings of a previous study were confirmed and extended for this nationally representative German sample. 12-month mental disorders, particularly internalizing, including somatoform disorders, are associated with high levels of disability and increased health-related QoL decrements. Partial or complete remission of the mental disorders is associated with a normalization of the numbers of disability days.
Reported and Intended Behaviour Towards Those With Mental Health Problems in the Czech Republic and England
- P. Winkler, L. Csémy, M. Janoušková, K. Mladá, L. Bankovská Motlová, S. Evans-Lacko
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- Published online by Cambridge University Press:
- 22 June 2015, pp. 801-806
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This is one of the first studies, which compares the level of stigmatizing behaviour in countries that used to be on the opposite sides of the Iron Curtain. The aim was to identify the prevalence of reported and intended stigmatizing behaviour towards those with mental health problems in the Czech Republic and to compare these findings with the findings from England. The 8-item Reported and Intended Behaviour Scale (RIBS) was used to assess stigmatising behaviour among a representative sample of the Czech population (n = 1797). Results were compared with the findings of an analogous survey from England (n = 1720), which also used the RIBS. The extent of reported behaviour (i.e., past and present experiences with those with mental health problems) was lower in the Czech Republic than in England. While 12.7% of Czechs reported that they lived, 12.9% that they worked, and 15.3% that they were acquainted with someone who had mental health problems, the respective numbers for England were 18.5%, 26.3% and 32.5% (P < 0.001 in each of these items). On the other hand, the extent of intended stigmatizing behaviour towards those with mental health problems is considerably higher in the Czech Republic. Out of maximum 20 points attached to possible responses to the RIBS items 5–8, Czechs had a lower total score (x = 11.0, SD = 4.0) compared to English respondents (x = 16.1, SD = 3.6), indicating lower willingness to accept a person with mental health problems (P < 0.001). The prevalence of stigmatizing behaviour in the Czech Republic is worrying. Both, further research and evidence based anti-stigma interventions, should be pursued in order to better understand and decrease stigmatizing behaviour in the Czech Republic and possibly across the post-communist countries in Central and Eastern Europe.
Review
Systematic Review and Meta-Analysis of Prevalence Studies in Transsexualism
- J. Arcelus, W.P. Bouman, W. Van Den Noortgate, L. Claes, G. Witcomb, F. Fernandez-Aranda
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- Published online by Cambridge University Press:
- 26 May 2015, pp. 807-815
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Background
Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data.
MethodsDatabases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed.
ResultsThe overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years.
ConclusionsThe overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.