Epidemiology and Psychiatric Sciences最新文献

Aims: Reducing stigma and discrimination has been a priority in many national mental health policies for decades. Focusing efforts requires us to understand where this has the greatest impact on people with mental health problems. In 2024, we conducted a nationally representative survey that aimed to assess the burden of discrimination (as a product of frequency and impacts of experiences). Secondary aims were to quantify the types of discrimination experienced in different life domains and the sociodemographic and mental health problem characteristics of those experiencing higher burden.

Methods: Online surveys were completed by 6032 members of the general Australian community aged 18 years and over. The survey was carried out by the survey company The Social Research Centre, using their Life in Australia™ probability-based panel. Those who reported a mental health problem or scored high on the Kessler 6 measure of psychological distress (n = 2613) were asked about the past 12-month frequency and impact of their experiences of discrimination in a broad range of settings, including family, friends, workplaces and health services. The data were initially analysed using percent frequencies and 95% confidence intervals. A burden score was calculated for each domain, incorporating frequency and impact among those who reported discrimination experiences.

Results: Overall, discrimination in social life was the most common (43.6% [95% CI 41.2, 45.9]), followed by discrimination from family (41.4% [95% CI 39.1, 43.7]) or in making or keeping friends (41.0% [95% CI 38.7, 43.3]). However, the highest burden was from discrimination in finding or keeping a job, in dating/intimate relationships, in housing (including renting or public housing) and in obtaining welfare benefits or disability pensions. The most common type of discrimination experience in the workplace and among friends, family and partners was of people lacking understanding of the impact of the person's mental health problem. People aged 35-64 years were more likely than those aged 18-34 years to report higher burden in multiple domains; people with depression or attention-deficit/hyperactivity disorder also reported burden in more domains than people with anxiety or severe mental health conditions. Overall, 67.7% (95% CI 65.5, 69.9) agreed that stigma and discrimination was worse than the mental health problem itself.

Conclusions: Our study suggests that reducing the frequency and impact of discrimination in workplaces, welfare benefits and housing should be key targets for policy and practice. Improving the capacity of people in workplaces and intimate partners, families and friendship groups to better understand the impacts of mental health problems on individuals should also be a priority.

Aims: Generalized anxiety disorder (GAD) is characterized by persistent worry and physical symptoms, with prevalence estimates ranging from 0.8% to 8%. Researchers utilize various tools, such as standardized diagnostic interviews and self-report questionnaires, to estimate GAD prevalence in population-level studies. However, the diagnostic accuracy of these tools varies greatly. This scoping review aimed to identify the tools used for GAD prevalence estimation and assess the extent to which diagnostic tool accuracy is reported.

Methods: A systematic search was conducted in MEDLINE, Embase and PsycINFO using MeSH terms and keywords related to GAD prevalence. No date restrictions were applied. Studies were eligible if they used nationally or regionally representative samples and defined GAD based on DSM-5, ICD-11 or older case definitions. Studies focusing solely on specific sub-groups were excluded. Data extraction included study characteristics, diagnostic tools and reporting of test accuracy.

Results: A total of 537 studies were initially identified, with 48 meeting inclusion criteria, published between 1994 and 2024. Most studies were conducted in Europe (43.75%) and employed cross-sectional designs (92%). Structured diagnostic interviews were the most commonly used tool (77.08%), although self-report questionnaires gained popularity after 2005. Among the included studies, 62.5% reported test accuracy, often addressing validity and reliability.

Conclusions: Despite the widespread use of diagnostic tools in prevalence studies, test accuracy is not consistently reported, which may impact the reliability of prevalence estimates. The variability in agreement between self-report questionnaires and structured diagnostic interviews highlights the need for transparent reporting of test characteristics to improve the validity of GAD prevalence assessments across populations.

Aims: To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.

Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.

Results: We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of -1.40, 95% confidence interval: -2.15 to -0.66, P < 0.001, low-quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.

Conclusions: Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.

Aims: While breast cancer is rare in men, its incidence is rising, prompting more research into the mental health impacts of the disease in male patients. Anxiety, depression and sleep disorders are well-documented in women with breast cancer, but the effects on men are not as well understood, underscoring a need for gender-specific analysis.

Methods: This retrospective cohort study used data from the Health Insurance Review & Assessment Service from 2009 to 2017, examining patients diagnosed with ductal carcinoma in situ or invasive breast cancer. A propensity score matching at a 5:1 ratio resulted in a sample size of 280 men and 1,400 women for analysis. The study assessed the cumulative incidence of anxiety, depression and sleep disorders, along with potential risk factors for these conditions.

Results: Out of 75,936 breast cancer patients, 0.4% (281) were men. Women exhibited a significantly higher incidence of mental health conditions compared to men (p = 0.017), particularly in terms of anxiety. However, there were no significant gender differences in the incidence of depression or sleep disorders. Women demonstrated a higher risk of developing anxiety disorders (hazard ratio: 1.498, 95% CI: 1.057-2.123, p = 0.023). After adjusting for confounders, gender differences in depression and sleep disorders were not statistically significant.

Conclusions: Women with breast cancer experience higher rates of anxiety disorders, while depression and sleep disorders show no gender disparity. These findings suggest that mental health care approaches should be adapted to better support men with breast cancer and address their unique mental health needs.

Aims: The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.

Methods: This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.

Results: Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28-0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23-0.42; good: OR: 0.13, 95% CI: 0.09-0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11-0.76; frequently: OR: 0.15, 95% CI: 0.05-0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34-0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19-0.42) were significant for urban practitioners.

Conclusions: Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban-rural disparities.

Background: Although often associated with ageing, disability is becoming increasingly prevalent among young adults. While disability can pose a substantial psychological burden for young adults on critical pathways to establish the foundations for their future, the mental health risks faced by this population remain underexplored.

Aims: This study aimed to (1) assess the association between disability - including its presence, severity and type - and the risk of depressive and anxiety disorders, and (2) examine whether this association varies across sociodemographic factors, health behaviours and comorbidities in a young adult population.

Methods: We conducted a population-based cohort study using linked data from the National Disability Registry and the National Health Insurance Database of South Korea. A total of 6,058,290 individuals aged 20-39 years who underwent health check-ups between 2009 and 2012 were followed through 2022. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for depressive and anxiety disorders.

Results: Individuals with disabilities had significantly higher risks of depressive (aHR: 1.58, 95% CI: 1.55-1.60) and anxiety disorders (aHR: 1.50, 95% CI: 1.42-1.59). Increased risks were consistently observed across various disability types with the highest risk observed for mental health-related disabilities in depression (aHR: 4.98, 95% CI 4.62-5.37) and epilepsy-related disabilities in anxiety disorders (aHR: 12.05, 95% CI 8.73-16.63). Subgroup analyses revealed stronger associations among individuals in their 20s, low-income groups, non-smokers and those abstaining from alcohol, compared to their respective counterparts.

Conclusions: Young adults with disabilities, a population that has been relatively overlooked in policy discussions, warrant greater policy attention in relation to their mental health.

Aims: Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.

Methods: We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.

Results: In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15-1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99-1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15-2.09, fully adjusted model). The results further demonstrated an exposure-response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.

Conclusions: Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.

Aims: Loneliness is a global public health concern that has been widely associated with a variety of mental health impairments. Two dimensions of loneliness have been differentiated, that is, social loneliness (the perceived absence or inadequacy of a broader social network) and emotional loneliness (the perceived absence of a close, intimate relationship or emotional support from a significant person). The present study aimed to test the hypothesis that both dimensions of loneliness are differentially associated with mental health outcomes.

Methods: Altogether, 3275 individuals (aged 45.2 ± 15.7 years, 47.9% men), enrolled from the general population, were assessed at two waves spanning 6 to 7 months. Social and emotional loneliness were quantified using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was assessed with the six-item Lubben Social Network Scale, depressive symptoms with the Patient Health Questionnaire-9, generalised anxiety with the Generalised Anxiety Disorder-7, social anxiety with the Social Interaction Anxiety Scale, and paranoid ideation with the Revised Green et al. Paranoid Thoughts Scale. The data were analysed using a cross-lagged panel network model. Covariates included age, gender, education, employment status, place of residence, monthly income, the history of psychiatric treatment and substance use.

Results: Both dimensions of loneliness were bidirectionally associated and were found to have the highest overall weight of outcoming network connections. Emotional loneliness was bidirectionally and positively associated with all measures of mental health. In turn, social loneliness predicted higher levels of social anxiety but was not associated with other mental health outcomes. It was bidirectionally associated with social isolation.

Conclusions: The findings imply the relevance of differentiating social and emotional dimensions of loneliness in the assessment of its underlying mechanisms and consequences for mental health. Emotional loneliness might show a greater importance in the development of psychopathological symptoms compared to its social dimension.

Aims: Having a child with a psychiatric diagnosis is associated with parents' greater risk of subsequent mental disorders but no immediate change in their annual labour market metrics. This discrepancy could be explained by shorter absences from work. We examined first-time psychiatric sickness absences in parents whose children have psychiatric diagnoses.

Methods: Using several linked nationwide Finnish registers, in this cohort study we examined time to first psychiatric sickness absence in parents whose children were born in 2001-2012 (early-childhood-onset diagnoses) or 2005-2016 (late-childhood-onset diagnoses). Exposure was having a child with a psychiatric diagnosis. Follow-up started when the parent's eldest turned 1 (early-childhood-onset diagnoses) or 5 (late-childhood-onset diagnoses) and ended at psychiatric sickness absence, emigration, 68th birthday, death, or 31 December 2020, whichever occurred first.

Results: The 2001-2012 and 2005-2016 cohorts included 357 135 and 397 874 parents followed for 3.31 and 3.70 million person-years. Having a diagnosed child was associated with greater risk of psychiatric sickness absence in all except men whose children had substance use or psychotic disorder diagnoses. Time-varying analyses showed the greatest associations for women (HR: 4.92; 95% CI: 3.97-6.10) and men (HR: 2.48; 95% CI: 1.61-3.80) within 6 months of a child's eating disorder diagnosis.

Conclusions: Parents of children with psychiatric diagnoses may be at a greater risk of a psychiatric sickness absence. Associations differed by child's diagnosis, parent's gender and time since diagnosis.