Epidemiology and Psychiatric Sciences最新文献

Aims: About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA).

Methods: In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD.

Results: Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7-0.9) at 6 weeks to 5.5% (5.3-5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14-3.85]), preterm delivery (1.47 [1.30-1.66]), PCOS (1.37 [1.09-1.72]), hyperemesis gravidarum (1.32 [1.11-1.57]), gestational hypertension (1.30 [1.03-1.66]) and postpartum haemorrhage (1.29 [0.91-1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD.

Conclusions: The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA's private sector. Identified risk factors could inform targeted PPD screening strategies.

Aims: The aim of the article is to undertake the first economic analysis exploring the costs of illness (COIs) and factors affecting COIs in people living with mental disorders using individual patient-level data across five countries with different national income levels. This is done by investigating diagnosis-related and sociodemographic factors for country-specific medical and psychosocial service use in these high, lower-middle and low-income countries.

Methods: Using data from the Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) study, a pragmatic randomized controlled trial, costs for medical and psychosocial services have been estimated over 6 months in 615 people with severe mental illness from Germany (n = 171), Uganda (n = 138), Tanzania (n = 110), India (n = 93) and Israel (n = 103). The primary economic analysis included (1) total COI expressed in 2021 international dollars and (2) proportional cost-type expenditures. Generalized linear regression models were also used to estimate the impact of psychiatric diagnosis, social disability, age and gender on the total COI.

Results: Of the 615 participants (mean [SD] age 38.3 [11.2] years; 335 [54.5%] women), the total 6-month COI ranged from $311.48 [±547.47] in Tanzania to $10,493.19 [±13324.10] in Germany. High-income Germany and low-income Uganda both concentrated >70% of COIs on inpatient care. High-income Israel had the most balanced COI, with the lowest mean share (15.40%) on inpatient care, compared with community (35.12%) and primary care (33.01%). Female gender was associated with lower COI (e^b = 0.215; p = 0.000) in Tanzania, while in India diagnosis of depression was associated with lower costs than schizophrenia (e^b = 0.363; p = 0.017). Health of the Nation Outcome Scale scores (social disability) were not significantly associated with COIs in any country. In Tanzania, the total mean COI increased by 3.6% for every additional year of age. Compared to Germany, mean COIs were significantly lower by 90%, 99% and 86% in Uganda, Tanzania and India, respectively, and by 50% in Israel, although this difference was not significant.

Conclusions: National income is correlated with the total COI in people living with mental disorders but is a poor predictor of the sector-specific distribution of these expenditures.

Aims: Existing evidence on the association between combined lifestyle and depressive symptoms is limited to the general population and is lacking in individuals with subthreshold depression, a high-risk group for depressive disorders. Furthermore, it remains unclear whether an overall healthy lifestyle can mitigate the association between childhood trauma (CT) and depressive symptoms, even in the general population. We aimed to explore the associations of combined lifestyle, and its interaction with CT, with depressive symptoms and their subtypes (i.e. cognitive-affective and somatic symptoms) among adults with subthreshold depression.

Methods: This dynamic cohort was initiated in Shenzhen, China in 2019, including adults aged 18-65 years with the Patient Health Questionnaire-9 (PHQ-9) score of ≥ 5 but not diagnosed with depressive disorders at baseline. CT (present or absent) was assessed with the Childhood Trauma Questionnaire-Short Form. Combined lifestyle, including no current drinking, no current smoking, regular physical exercise, optimal sleep duration and no obesity, was categorized into 0-2, 3 and 4-5 healthy lifestyles. Depressive symptoms were assessed using the PHQ-9 during follow-up. This cohort was followed every 6 months, and as of March 2023, had been followed for 3.5 years.

Findings: This study included 2298 participants (mean [SD] age, 40.3 [11.1] years; 37.7% male). After fully adjusting for confounders, compared with 0-2 healthy lifestyles, 3 (β coefficient, -0.619 [95% CI, -0.943, -0.294]) and 4-5 (β coefficient, -0.986 [95% CI, -1.302, -0.671]) healthy lifestyles were associated with milder depressive symptoms during follow-up. There exists a significant synergistic interaction between a healthy lifestyle and the absence of CT. The CT-stratified analysis showed that compared with 0-2 healthy lifestyles, 3 healthy lifestyles were associated with milder depressive symptoms in participants with CT, but not in those without CT, and 4-5 healthy lifestyles were associated with milder depressive symptoms in both participants with and without CT, with a stronger association in those with CT. The lifestyle-stratified analysis showed that CT was associated with more severe depressive symptoms in participants with 0-2 healthy lifestyles, but not in those with 3 or 4-5 healthy lifestyles. Cognitive-affective and somatic symptoms showed similar results.

Conclusions: In this 3.5-year longitudinal study of adults with subthreshold depression, an overall healthy lifestyle was associated with subsequent milder depressive symptoms and their subtypes, with a stronger association in adults with CT than those without CT. Moreover, an overall healthy lifestyle mitigated the association of CT with depressive symptoms and their subtypes.

Aims: Understanding patterns and predictors of elevated psychological distress (EPD) among humanitarian migrants compared to the host population is critical for designing effective mental health interventions. However, existing research presents conflicting findings on the prevalence of EPD. This study examined EPD prevalence and associated factors in humanitarian migrants and Australian-born adults using large population-level datasets.

Methods: Kessler 6 scores (range 6-30) were dichotomised, and scores above 19 were defined as EPD and indicative of probable serious mental illness. Comparative 1:2 matched analysis used humanitarian migrant data from the Building a New Life in Australia and Australian-born comparators from the National Health Survey. Each humanitarian migrant was matched by age, sex and location with two Australian-born residents. Modified Poisson regression identified predictors of EPD in both groups.

Results: EPD was higher among humanitarian migrants (17.2%, 95% CI: 15.5, 18.9) compared to Australian-born (14.5%, 95% CI: 13.3, 15.6), with an adjusted relative risk (aRR) with 95% confidence intervals (1.16%, 95% CI: 1.11, 1.21) after adjusting for key factors. In both groups, females had a higher aRR than males, with similar effect sizes: 1.06 (95% CI: 1.04, 1.08) among Australian-born and 1.04 (95% CI: 1.02, 1.07) among humanitarian migrants. The impact of age on distress was more pronounced in Australian-born individuals: compared to the 65+ age group, the youngest group (18-24 years) had an aRR of 1.36 (95% CI: 1.28, 1.43) for Australian-born and 1.19 (95% CI: 1.12, 1.27) for humanitarian migrants. Compared to excellent health, poor and fair self-rated health condition had an aRR of 2.13 (95% CI: 2.03, 2.26) and 1.69 (95% CI: 1.61, 1.79), respectively, for humanitarian migrants and 1.94 (95% CI: 1.82, 2.05) and 1.48 (95% CI: 1.43, 1.56), respectively, for Australian born. Australian-born individuals in the lowest-income quintile had higher distress (aRR: 1.11 [95% CI: 1.06-1.15]) compared to the highest-income quintile, with no significant income effect for humanitarian migrants. In both groups, females with poorer self-rated health had higher aRRs than females reporting excellent health.

Conclusions: Although distress prevalence was higher in the humanitarian migrants, age and sex differences followed similar patterns in both groups. Income level was a factor in Australian-born adults but not in humanitarian migrants. Clinically, this highlights the need for culturally sensitive and group-specific mental health support. From a policy perspective, the use of matching methodology from large, separate datasets offers a valuable model for generating actionable insights, supporting the development of targeted and equitable mental health programmes.

Aims: Little is known about the effects of both financial hardship and people's perception of it on mental health. This study aimed to evaluate the effect of perceived financial hardship on individuals' depressive symptoms across several strata of objective financial situations.

Methods: We used data from a four-wave French national population-based cohort (N = 14,236, 2020-2022) to assess the relationship between depressive symptoms and perceived financial hardship. Multi-state models (MSM) were used on a three-level scale for depressive symptom severity based on the Patient Health Questionnaire (PHQ-9). Analyses were stratified by household income to study the interaction with the objective financial situation.

Results: We showed a link between perceived financial hardship and the onset and deterioration of depressive symptoms in subsequent waves, with effect sizes ranging from HR = 1.29 (0.87-1.90) to 2.23 (1.66-2.98). This association was stronger in the high-income population. There was no significant link between perceived financial hardship and the improvement of depressive symptomatology.

Conclusions: This study confirms that perceived financial hardship is linked to the onset and deterioration of depressive symptoms. Furthermore, it suggests a stronger effect in high-income households, which could mean that the experience of financial hardship and the objective financial situation interact in their effect on mental health.

Aims: First-year postpartum depression is a common mental health problem among first-time mothers. A younger age of pregnancy often compounds the challenge due to underlying factors such as poverty and limited educational achievement. This study aimed to examine the minimal number of interpersonal supporters during pregnancy associated with lower levels of postpartum depressive symptoms among first-time mothers.

Methods: We obtained data from the population-based Mother-Infant/Newborn Tokyo Cohort (MINT cohort) in four municipalities in Tokyo on 429 first-time mothers who responded to two waves of surveys (early pregnancy and one month postpartum). They completed self-report measures of interpersonal support using one item from the Social Support Questionnaire and depressive symptoms using the Edinburgh Postnatal Depression Scale. Segmented regression analyses were conducted to determine the threshold at which the strength of the association changed between the number of interpersonal supporters and postpartum depressive symptoms, with adjustment for depressive symptoms in pregnancy. This analysis was also conducted with the sample stratified into young mothers (≤ 25 years) and older mothers (≥ 26 years).

Results: In the overall sample, postpartum depressive symptoms were found to be lower among individuals with more than 3.0 supportive individuals (prepartum). Among young mothers, this threshold was higher, with lower symptom levels observed among those with at least 5.3 supporters. Only 22.9% of young first-time mothers had this level of interpersonal support, compared to 54.8% of all first-time mothers.

Conclusions: Our results suggest that having four or more interpersonal supporters in early pregnancy is associated with lower levels of postpartum depressive symptoms among first-time mothers. Additionally, among young mothers, having six or more supporters was associated with lower postpartum depressive symptoms. These findings suggest that tailored strategies to increase supporters around first-time pregnant women might be beneficial depending on their age.

Aims: This study aims to examine the different aspects of socio-economic status (SES) patterns in mental health from adolescence into adulthood by investigating the mean, prevalence, cumulative incidence and trajectories of several mental health measures, including depressive symptoms, mental disorder diagnosis and medication use. The different aspects of SES are investigated through the measures of subjective social status (SSS) in school, SSS in society, income and parental educational level.

Methods: Individuals born in 1989 were followed from 2004 to 2021 with surveys at ages 15, 18, 21, 28 and 32 years, supplied with yearly register data. The mean level of depressive symptoms, yearly prevalence of medication use and cumulative incidence of mental disorder diagnosis were calculated for each SES group (low, middle and high) across each measure. Group-Based Trajectory Modelling (GBTM) was used to identify depressive symptom trajectories and logistic regressions were used to analyse the relative odds ratios (ROR) of membership to the different trajectory groups by characteristics.

Results: Individuals with low SES at age 15 years across all SES measures showed higher mean depressive symptoms, prevalence of medication use and cumulative incidence of mental disorder diagnosis through adolescence and adulthood (age 15-32 years). Four depressive symptom trajectories were identified: low stable, moderate stable, decreasing and increasing trajectories. Being female, receiving medication or a mental disorder diagnosis in early adulthood and during the study period, having low SSS in school, parents not living together, being bullied, lacking support from teachers or classmates, lower levels of parents' support or higher school pressure resulted in higher RORs of membership to the other trajectory groups compared to the low stable trajectory, while having high SSS in society resulted in a lower ROR.

Conclusions: This is the first study to detect the role of social support in relation to depressive symptom trajectories. While individuals with low social status consistently experienced more negative mental health outcomes than those with middle and high social status in the study period (age 15-32 years), low SSS showed the strongest associations. This indicates that SSS may capture vulnerable individuals not identified by traditional SES. Being female, having low SES, low social support, and other mental health outcomes were associated with higher odds of being in trajectories with more depressive symptoms. Preventive initiatives should therefore target individuals with such characteristics. It is worth exploring whether adolescents with increasing depressive symptoms could benefit from increased social support.