The counterfactual or potential outcome model has become increasingly standard for causal inference in epidemiological and medical studies.
This paper provides an overview on the counterfactual and ...related approaches. A variety of conceptual as well as practical issues when estimating causal effects are reviewed. These include causal interactions, imperfect experiments, adjustment for confounding, time-varying exposures, competing risks and the probability of causation. It is argued that the counterfactual model of causal effects captures the main aspects of causality in health sciences and relates to many statistical procedures.
Counterfactuals are the basis of causal inference in medicine and epidemiology. Nevertheless, the estimation of counterfactual differences pose several difficulties, primarily in observational studies. These problems, however, reflect fundamental barriers only when learning from observations, and this does not invalidate the counterfactual concept.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed ...to conduct a systematic review and meta‐analysis on the association between CM and treatment outcome in psychotic disorders.
Methods
Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment.
Results
Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = 1.08, 2.10). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples.
Conclusions
Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta‐analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
Beesdo‐Baum K, Knappe S, Fehm L, Höfler M, Lieb R, Hofmann SG, Wittchen H‐U. The natural course of social anxiety disorder among adolescents and young adults.
Objective: To examine the natural ...course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long‐term outcomes.
Method: A community sample of N = 3021 subjects aged 14–24 was followed‐up over 10 years using the DSM‐IV/M‐CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow‐up.
Results: SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow‐up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow‐up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co‐occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and – less impressively – diagnostic stability.
Conclusion: A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.
Abstract Background Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is ...associated with more rapid transitions to SUD. Objective To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use. Methods N = 3021 community subjects aged 14–24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results (1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs. Conclusion Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.
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•Magnetic resonance microscopy with 2 micrometer resolution in one dimension.•Probe head for precise sample alignment with respect to static field gradient.•Compensation of ...experimental imperfections by stepwise sample movement.
Magnetic resonance microscopy (MRM) is a valuable tool for spatially resolved studies. While it is desirable to address voxels in the general case, it is sufficient to resolve slices of the sample in many cases of practical importance, e.g., for layered structures or at planar surfaces. We demonstrate that use of high static field gradients of 73 T/m in combination with a specially designed probe head enable MRM with an ultrahigh resolution of ∼2 μm in one dimension. The key feature of the built probe head is a precise computer controlled adjustment of the sample position and orientation, which allows for an accurate alignment of the samples with respect to the gradient of the magnetic field. Since slice-wise scanning of extended samples with this high spatial resolution is time-consuming, we introduce a methodology to reduce the experimental time significantly. Unlike the usual approach, which involves elaborate hardware and software correction, experimental imperfections are removed by stepwise moving the sample in our case. We demonstrate the capabilities of high-resolution 1D MRM for a solid sample with a layered structure and a liquid droplet on a planar solid substrate.
Dementia is from an economic perspective a main challenge for economies worldwide because of increasing costs. Since there is no cure in sight, prevention seems the most promising approach for ...reducing health care cost due to Dementia. On the contrary, approximately 40% of dementias is attributable to modifiable risk factors and first studies showed that multidomain interventions may be effective for preventing dementia. Considering the increasing economic burden, for many health administrations worldwide, cost-effectiveness plays a mayor role. This scoping review wants to bring evidence to the question if prevention for people at risk may be cost-effective. Therefore, the four databases Medline (via Pubmed), CINHAL (via EBSCO), Business Source Complete (via EBSCo), and the Health Economic Evaluation database (HEED) were used to conduct a scoping review using PICO and a systematic search string. 3,629 studies were identified and seven met all inclusion criteria. The included studies showed clear cost-effectiveness for most multidomain interventions. The gained QALYs at mean were 0.08 (SD=0.08) and the intervention average costs 472.20 EUR per Person (SD=74.06 EUR). The Incremental Cost-Effectiveness Ratios varied between -80,427.97 and 104,189.82 EUR per QALY. The three core results are (i) prevention programs focusing on people at risk may be cost-effective and cost-efficient, (ii) multimodal prevention reveal cost saving potential, when the people at risk are defined well, (iii prevention in middle-aged cohorts may be also cost-effective if life-style related risk factors are addressed.
There are inconclusive findings regarding whether danger and loss events differentially predict the onset of anxiety and depression.
A community sample of adolescents and young adults (n = 2304, age ...14-24 years at baseline) was prospectively followed up in up to four assessments over 10 years. Incident anxiety and depressive disorders were assessed at each wave using the DSM-IV/M-CIDI. Life events (including danger, loss and respectively mixed events) were assessed at baseline using the Munich Event List (MEL). Logistic regressions were used to reveal associations between event types at baseline and incident disorders at follow-up.
Loss events merely predicted incident 'pure' depression odds ratio (OR) 2.4 per standard deviation, 95% confidence interval (CI) 1.5-3.9, p < 0.001 whereas danger events predicted incident 'pure' anxiety (OR 2.3, 95% CI 1.1-4.6, p = 0.023) and 'pure' depression (OR 2.5, 95% CI 1.7-3.5, p < 0.001). Mixed events predicted incident 'pure' anxiety (OR 2.9, 95% CI 1.5-5.7, p = 0.002), 'pure' depression (OR 2.4, 95% CI 1.6-3.4, p < 0.001) and their co-morbidity (OR 3.6, 95% CI 1.8-7.0, p < 0.001).
Our results provide further evidence for differential effects of danger, loss and respectively mixed events on incident anxiety, depression and their co-morbidity. Since most loss events referred to death/separation from significant others, particularly interpersonal loss appears to be highly specific in predicting depression.
Objective
Depressive episodes are typically the initial presentation of bipolar disorder. The evidence as to whether depressive episodes occurring in persons who later convert to bipolar disorder are ...symptomatically distinct from episodes of unipolar depression remains controversial. As there are crucial differences in the therapeutic management, symptom profiles indicating subsequent bipolar conversion may aid in appropriate treatment.
Method
A representative community sample of originally N = 3021 adolescents and young adults aged 14–24 years at baseline was assessed up to four times over 10 years. Assessment of symptoms was conducted by clinically trained interviewers using the standardized M‐CIDI. Symptom profiles of depressive episodes were compared via logistic regression between subjects that subsequently developed (hypo‐)manic episodes (n = 35) or remained unipolar depressive (n = 659).
Results
Initial depression amongst prospective converters was characterized by significantly increased suicidality (odds ratio, OR = 2.31), higher rates of feelings of worthlessness and excessive guilt (OR = 2.52), complete loss of pleasure (OR = 2.53) and diurnal variation (OR = 4.30). No differences were found for hyperphagia, hypersomnia and psychomotor alterations.
Conclusion
Findings suggest that the symptom profile of initial depressive episodes may be useful in the identification of subjects with an elevated risk for the subsequent conversion to bipolar disorder.
Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military ...personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders.
1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples.
Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1-0.6; NS: OR: 0.2, 95% CI: 0.1-0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3-0.6; NS: OR: 0.5, 95% CI: 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4-5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3-8.0) were observed in DS with high combat exposure compared with civilians.
Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.
Objective
The role of behavioral inhibition (BI) and parenting for an unfavorable emotional trauma response (DSM‐IV criterion A2) and post‐traumatic stress disorder (PTSD) development is unclear.
...Method
A community sample of adolescents and young adults (aged 14–24) was followed up over 10 years (N = 2378). Traumatic events, criterion A2, and PTSD (according to DSM‐IV‐TR) were assessed using the M‐CIDI. BI and parenting were assessed using the Retrospective Self‐Report of Inhibition and the Questionnaire of Recalled Parenting Rearing Behavior. Multiple logistic regressions adjusted for sex, age, and number of traumata were used to examine associations of BI as well as maternal and paternal overprotection, rejection, and reduced emotional warmth with (i) criterion A2 in those with trauma (N = 1794) and (ii) subsequent PTSD in those with criterion A2 (N = 1160).
Results
Behavioral inhibition (BI; odds ratio, OR = 1.32) and paternal overprotection (OR = 1.27) predicted criterion A2 in those with trauma, while only BI (OR = 1.53) predicted subsequent PTSD. BI and paternal emotional warmth interacted on subsequent PTSD (OR = 1.32), that is, BI only predicted PTSD in those with low paternal emotional warmth.
Conclusion
Our findings suggest that BI and adverse parenting increase the risk of an unfavorable emotional trauma response and subsequent PTSD. Paternal emotional warmth buffers the association between BI and PTSD development.
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