Despite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data ...on these topics are presented from the National Comorbidity Survey Replication (NCS-R).
The NCS-R is a nationally representative household survey fielded in 2001-2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.
The estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose-response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.
Social phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.
Despite significant advances in the study of obsessive-compulsive disorder (OCD), important questions remain about the disorder's public health significance, appropriate diagnostic classification, ...and clinical heterogeneity. These issues were explored using data from the National Comorbidity Survey Replication, a nationally representative survey of US adults. A subsample of 2073 respondents was assessed for lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) OCD. More than one quarter of respondents reported experiencing obsessions or compulsions at some time in their lives. While conditional probability of OCD was strongly associated with the number of obsessions and compulsions reported, only small proportions of respondents met full DSM-IV criteria for lifetime (2.3%) or 12-month (1.2%) OCD. OCD is associated with substantial comorbidity, not only with anxiety and mood disorders but also with impulse-control and substance use disorders. Severity of OCD, assessed by an adapted version of the Yale-Brown Obsessive Compulsive Scale, is associated with poor insight, high comorbidity, high role impairment, and high probability of seeking treatment. The high prevalence of subthreshold OCD symptoms may help explain past inconsistencies in prevalence estimates across surveys and suggests that the public health burden of OCD may be greater than its low prevalence implies. Evidence of a preponderance of early onset cases in men, high comorbidity with a wide range of disorders, and reliable associations between disorder severity and key outcomes may have implications for how OCD is classified in DSM-V.
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. ...Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed ...at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.
Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.
Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).
Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.
The present article describes the basic therapeutic techniques used in the cognitive-behavioral therapy (CBT) of generalized anxiety disorders and reviews the methodological characteristics and ...outcomes of 13 controlled clinical trials. The studies in general display rigorous methodology, and their outcomes are quite consistent. CBT has been shown to yield clinical improvements in both anxiety and depression that are superior to no treatment and nonspecific control conditions (and at times to either cognitive therapy alone or behavioral therapy alone) at both posttherapy and follow-up. CBT is also associated with low dropout rates, maintained long-term improvements, and the largest within-group and between-group effect sizes relative to all other comparison conditions.
Background Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and ...fatalities. This paper describes a systematic, data-driven, injury prevention–decision making process to rank potential injury prevention targets. Methods Medical surveillance and safety report data on injuries for 2004 were reviewed. Nonfatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified. Results Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls. Conclusions A systematic approach to injury prevention–decision making supports the DoD's goal of ensuring a healthy, fit force. The methodology described here advances this capability. Immediate follow-up efforts should employ both medical and safety data sets to identify and monitor injury prevention priorities.
Recent research has revealed that a large number of highly worried individuals do not qualify for a diagnosis of generalized anxiety disorder (GAD). This raises the intriguing question of why some ...high worriers are more impaired and distressed by their worrying than others, particularly when the severity of their worry is the same. The present investigation sought to address this question by examining whether GAD and non-GAD high worriers differ in their actual worry experiences, their subjective appraisals of worry experiences, or both experiences and appraisals of worry. GAD and non-GAD worriers, selected for matching levels of trait worry severity, completed an attention-focus task with thought sampling before and after a brief worry induction. They also completed questionnaires assessing their experiences during and after the worry induction, as well as their general beliefs about worry. GAD worriers experienced less control over negative intrusive thoughts immediately after worrying, reported greater somatic hyperarousal following worry, and endorsed several negative beliefs about worry more strongly than their worry-matched controls. Results suggest that GAD is associated with unique experiences and appraisals that distinguish it from other forms of severe worry.
A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk ...factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries.
Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85,052). Prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria.
Lifetime prevalence estimates for GAD lasting 1 month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1-2 months, 3-5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting >or=12 months was the most severe, persistently symptomatic and impaired subgroup.
In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.
Despite growing recognition of substantial interpersonal impairment among many war‐zone veterans with posttraumatic stress disorder (PTSD), little is known about the association between PTSD ...symptomatology and veterans' relationships with their children. This study examined the differential pattern of associations between the symptom clusters of PTSD and the perceived father–child relationships of 66 male Vietnam veterans. Analyses revealed that only the emotional numbing cluster was significantly related to perceived quality of all relationship domains. The association between emotional numbing and perceived relationship quality remained significant in regression analyses even after controlling for fathers' family‐of‐origin stressors, combat exposure, depression, and substance abuse. Findings suggest that emotional numbing may be the component of PTSD most closely linked to interpersonal impairment in war‐zone veterans.
Objective: Although empirical investigations have established a relationship between childhood sexual abuse and numerous long-term consequences, surprisingly little research has addressed the ...possible effects of childhood victimization on the later child-rearing practices of adult survivors. The present study examined hypothesized predictors of three parenting styles among adult survivors of sexual abuse as compared with adult children of alcoholic parents.
Method: Forty-five clinical outpatients completed a questionnaire battery assessing experiences of childhood abuse, current economic and social resources, and parenting attitudes and practices. The child-rearing practices of participants were compared with those reported by a community sample of 717 mothers. Additional analyses examined the extent to which sexual abuse and its adult sequelae predicted the parenting behaviors reported by the present sample.
Results: Both sexual abuse survivors and children of alcoholics reported significantly higher rates of permissive parenting practices than mothers in the community sample. Multiple regression analyses further revealed unique relationships between sexual abuse and parenting, over and above the variance explained by physical abuse, current socioeconomic status, and the experience of growing up in an alcoholic home. Mothers’ sexual abuse severity, social support satisfaction, and dysfunctional parenting attitudes moderated several of these relationships.
Conclusions: The present findings suggest that sexual abuse and its adult sequelae may have negative consequences for the parenting practices of survivors, particularly for survivors’ ability to providetheir children with appropriate structure, consistent discipline, and clear behavioral expectations. Implications for the psychosocial development of survivors’ children are discussed.
Objectif: Bien que la recherche empirique ait établi une relation entre les abus sexuels connus dans l’enfance et de nombreuses conséquences à long terme, on est surpris de constater que l’on se soit peu penché sur les effets possibles de la victimisation de l’enfant sur les pratiques éducatives des adultes qui ont survécu (“survivors”). Cette étude examine l’hypothèse de la prédiction de trois styles éducatifs chez les adultes ayant survécu aux abus sexuels comparés aux adultes ayant été enfants de parents alcooliques.
Méthode: 44 patientes d’une consultation externe ont rempli une batterie de questionnaires destinés à évaluer leur expérience d’enfant abusé sexuellement, leurs ressources sociales et économiques courantes, ainsi que leurs attitudes et leurs pratiques en tant que parents. Les participantes furent comparées quant à leur façon d’élever leurs enfants avec un échantillon communautaire de 717 mères. Des analyses supplémentaires ont examiné jusqu’où les abus sexuels et leurs séquelles pouvaient prédire les comportements parentaux dont faisait état l’échantillon mentionné.
Résultats: A la fois les parents “survivants” des abus sexuels et les enfants d’alcooliques ont fait état de taux significativement plus élevés de comportements parentaux permissifs que les mères de l’échantillon communautaire. Les analyses par régression multiple ont révélé par la suite une relation particulière entre les abus sexuels subis et la parentalité, bien au-dessus de la variance expliquée par les abus sexuels, par le statut socio-économique courant ainsi que par l’expérience d’avoir grandi dans un famille alcolique. La gravité des abus sexuels subis par les mères, le soutien social rencontré ainsi que les attitudes parentales dysfonctionnelles ont modéré plusieurs de ces relations.
Conclusions: Les résultats actuels sugèrent que les abus sexuels et leurs séquelles chez l’adulte peuvent entrainer des conséquences sur les pratiques des adultes survivants, particulièrement en ce qui concerne la capacité à élever leurs enfants de façon structurée, avec une discipline cohérente ainsi qu’avec des attentes claires concernant leur comportement. Les implications au sujet du développement des enfants de ces parents sont discutées.
Objetivo: Aunque la investigación empı́rica ha establecido una relación entre el abuso sexual infantil y múltiples consecuencias a largo plazo, sorprendentemente hay poca investigación que aborde los posibles efectos de la victimización infantil en las prácticas de crianza infantil de esos niños/as en el estado adulto. Este estudio analizó un conjunto de posibles predictores de tres estilos de “paternidad/maternidad” entre sujetos adultos que habı́an sufrido abuso sexual en su infancia y sujetos adultos hijos de padres/madres alcohólicos.
Método: Cuarenta y cinco pacientes psiquiátricos ambulatorios completaron una baterı́a de cuestionarios que evaluaban sus experiencias de abuso sexual infantil, sus recursos económicos y sociales actuales, y sus actitudes y conductas como padres/madres. Se compararon las prácticas de crianza infantil de los participantes en el estudio con las prácticas de crianza de una muestra comunitaria de 717 madres. Otros análisis examinaron la medida en la cual el abuso sexual en la infancia y sus secuelas en la madurez predecı́an las conductas de estos adultos hacia sus hijos/as.
Resultados: Tanto los adultos abusados sexualmente en su infancia como los adultos hijos de alcohólicos informaron tener una tasa significativamente más alta de conductas parentales permisivas que las madres de la muestra comunitaria. Los análisis de regresión múltiple mostraron además la existencia de relaciones únicas entre el abuso sexual infantil y las prácticas de crianza en el estado adulto, más allá de la varianza explicada por el maltrato fı́sico, el estatus socioeconómico actual, y la experiencia de crecer en un hogar alcohólico. La severidad del abuso sexual, la satisfacción con el soporte social, y las actitudes parentales disfuncionales de las madres moderaban algunas de estas relaciones.
Conclusiones: Estos resultados sugieren que el abuso sexual y sus secuelas en la madurez pueden tener consecuencias negativas en las conductas parentales de los adultos, especialmente en la capacidad de los adultos para proporcionar a sus hijos un marco de referencia apropiado, una disciplina consistente, y expectativas claras respecto a su conducta. Se comentan las implicaciones para el desarrollo psicosocial de los hijos de estos adultos.
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