Abstract Background The aim is to report the individual and joint effects of a range of chronic childhood adversities on the first onset of a broad range of psychiatric disorders, and to evaluate ...their impact at different stages of the life course in a representative sample of the Mexican population. Method The data is from the Mexican National Comorbidity Survey (M-NCS), a stratified, multistage area probability sample of persons aged 18–65. The WHO World Mental Health Composite International Diagnostic Interview (WMH-CIDI) measured 12 childhood adversities, 20 psychiatric disorders and ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Results In bivariate models, all adversities (except economic adversity and parental death) were significant predictors of psychopathology; however in multivariate models which correct for the clustering of adversities, family dysfunction and abuse adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined (mood, anxiety, substance use and externalizing), and for the most part, over all three life course stages (childhood, adolescence and adulthood). The effect of the number of adversities was nonlinear such that although the odds of disorder onset increased with increasing numbers of adversities, the odds increased at a decreasing rate. Conclusions Childhood family dysfunction and abuse is a strong predictor of the onset of psychopathology throughout the life course, consistent with evidence for the enduring effects of chronic stress on brain structures involved in many psychiatric disorders and with stress-sensitization models of psychopathology.
It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how ...generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.
To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.
Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.
Lifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.
Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs 95% CIs from 1.2 1.1-1.3 to 2.0 1.4-2.8). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.
These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.
...mental health services should be scaled up as an essential component of universal health coverage and should be fully integrated into the global response to other health priorities, including ...non-communicable diseases, maternal and child health, and HIV/AIDS. ...barriers and threats to mental health need to be addressed; these include the lack of awareness of the value of mental health in social and economic development, the lack of attention to mental health promotion and protection across sectors, the severe demand-side constraints for mental health care caused by stigma and discrimination, and the increasing threats to mental health due to global challenges such as climate change and growing inequality. ...mental health needs to be protected by public policies and developmental efforts; these intersectoral actions should be undertaken by each country's leaders to engage a wide range of stakeholders within and beyond health, including sectors in education, workplaces, social welfare, gender empowerment, child and youth services, criminal justice and development, and humanitarian assistance. ...investments in research and innovation should grow and harness novel approaches from diverse disciplines such as genomics, neuroscience, health services research, clinical sciences, and social sciences, both for implementation research on scaling up mental health interventions and for discovery research to advance understanding of causes and mechanisms of mental disorders and develop effective interventions to prevent and treat them.
Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a ...large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries.
Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior.
Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80).
Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors.
Background
Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic ...irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’s (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder DMDD) and from ICD‐10’s (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD‐11 classification of chronic irritability and oppositionality as compared to the ICD‐10 and DSM‐5 approaches.
Methods
Clinicians (N = 196) from 48 countries participated in an Internet‐based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.
Results
Compared to ICD‐10 and DSM‐5, ICD‐11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM‐5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.
Conclusions
The formulation of irritability and oppositionality put forth in ICD‐11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.
Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these ...goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that is aligned with the Sustainable Development Goals, to use this framework to systematically review evidence regarding these social determinants, and to identify potential mechanisms and targets for interventions. We did a systematic review of reviews using a conceptual framework comprising demographic, economic, neighbourhood, environmental events, and social and culture domains. We included 289 articles in the final Review. This study sheds new light on how the Sustainable Development Goals are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders.
Background: Because the epidemiologic data available for adolescents from the developing world is scarce, the objective is to estimate the prevalence and severity of psychiatric disorders among ...Mexico City adolescents, the socio‐demographic correlates associated with these disorders and service utilization patterns.
Methods: This is a multistage probability survey of adolescents aged 12 to 17 residing in Mexico City. Participants were administered the computer‐assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design of the survey.
Results: One in every eleven adolescents has suffered a serious mental disorder, one in five a disorder of moderate severity and one in ten a mild disorder. The majority did not receive treatment. The anxiety disorders were the most prevalent but least severe disorders. The most severe disorders were more likely to receive treatment. The most consistent socio‐demographic correlates of mental illness were sex, dropping out of school, and burden unusual at the adolescent stage, such as having had a child, being married or being employed. Parental education was associated with treatment utilization.
Conclusions: These high prevalence estimates coupled with low service utilization rates suggest that a greater priority should be given to adolescent mental health in Mexico and to public health policy that both expands the availability of mental health services directed at the adolescent population and reduces barriers to the utilization of existing services.
•In the Americas, structural barriers to treatment are more common in LMICs than HICs.•43% of those that did not access treatment did not perceive treatment need.•Severity is correlated to higher ...structural but lower attitudinal barriers.•There are few country-specific variations in the region, mostly from Argentina.
Mental health treatment is scarce and little resources are invested in reducing the wide treatment gap that exists in the Americas. The regional barriers are unknown. We describe the barriers for not seeking treatment among those with mental and substance use disorders from six (four low- and middle-income and two high-income) countries from the Americas. Regional socio-demographic and clinical correlates are assessed.
Respondents (n = 4648) from seven World Mental Health surveys carried out in Argentina, Brazil, Colombia, Mexico, Peru, and the United States, who met diagnostic criteria for a 12-month mental disorder, measured with the Composite International Diagnostic Interview, and who did not access treatment, were asked about treatment need and, among those with need, structural and attitudinal barriers. Country-specific deviations from regional estimates were evaluated through logistic models.
In the Americas, 43% of those that did not access treatment did not perceive treatment need, while the rest reported structural and attitudinal barriers. Overall, 27% reported structural barriers, and 95% attitudinal barriers. The most frequent attitudinal barrier was to want to handle it on their own (69.4%). Being female and having higher severity of disorders were significant correlates of greater perceived structural and lower attitudinal barriers, with few country-specific variations.
Only six countries in the Americas are represented; the cross-sectional nature of the survey precludes any causal interpretation.
Awareness of disorder or treatment need in various forms is one of the main barriers reported in the Americas and it specially affects persons with severe disorders.
PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We ...assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries. This was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, greater than or equal to18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness. After exclusions, 19,457 MSM were included in this analysis. In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was minimally associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no such association was observed in Mexico or Peru. Having more than a high school education, high income, daily use of geosocial networking (GSN) applications, and substance use were associated with PrEP awareness. Higher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that PrEP awareness could be strengthened with further prevention efforts. In the remaining countries, results were non-conclusive between risk and awareness. Interventions to increase PrEP awareness are paramount to increase PrEP willingness and uptake and in turn prevent new HIV infections. Social media platforms could play an important role to achieve this goal.
Background
Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12‐month DSM‐IV ...(where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment.
Methods
Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM‐IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM‐IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM‐5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for “problems with emotions, nerves, mental health, or use of alcohol or drugs.” Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits).
Results
Of 51,547 respondents (response = 71.3%), 9.8% had a 12‐month DSM‐IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12‐month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries.
Conclusions
Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
PDF
