Epidemiology and Psychiatric Sciences最新文献

Aims: While the cross-sectional relationship between internet gaming disorder (IGD) and depression is well-established, whether IGD predicts future depression remains debated, and the underlying mechanisms are not fully understood. This large-scale, three-wave longitudinal study aimed to clarify the predictive role of IGD in depression and explore the mediating effects of resilience and sleep distress.

Methods: A cohort of 41,215 middle school students from Zigong City was assessed at three time points: November 2021 (T1), November 2022 (T2) and November 2023 (T3). IGD, depression, sleep distress and resilience were measured using standardized questionnaires. Multiple logistic regression was used to examine the associations between baseline IGD and both concurrent and subsequent depression. Mediation analyses were conducted with T1 IGD as the predictor, T2 sleep distress and resilience as serial mediators and T3 depression as the outcome. To test the robustness of the findings, a series of sensitivity analyses were performed. Additionally, sex differences in the mediation pathways were explored.

Results: (1) IGD was independently associated with depression at baseline (T1: adjusted odds ratio [AOR] = 4.76, 95% confidence interval [CI]: 3.79-5.98, p < 0.001), 1 year later (T2: AOR = 1.42, 95% CI: 1.16-1.74, p < 0.001) and 2 years later (T3: AOR = 1.24, 95% CI: 1.01-1.53, p = 0.042); (2) A serial multiple mediation effect of sleep distress and resilience was identified in the relationship between IGD and depression. The mediation ratio was 60.7% in the unadjusted model and 33.3% in the fully adjusted model, accounting for baseline depression, sleep distress, resilience and other covariates. The robustness of our findings was supported by various sensitivity analyses; and (3) Sex differences were observed in the mediating roles of sleep distress and resilience, with the mediation ratio being higher in boys compared to girls.

Conclusions: IGD is a significant predictor of depression in adolescents, with resilience and sleep distress serving as key mediators. Early identification and targeted interventions for IGD may help prevent depression. Intervention strategies should prioritize enhancing resilience and improving sleep quality, particularly among boys at risk.

Aims: Prompt initial contact with a treatment provider is a critical first step in seeking help for a mental or substance use disorders (SUDs). The aim of the current study was to provide estimates of patterns and predictors of delay in making initial treatment contact based on the recently completed Australian National Survey of Mental Health and Wellbeing.

Methods: Data came a nationally representative epidemiological survey of n = 15,893 Australians. Measures included DSM-IV lifetime diagnoses of mood (MD), anxiety (AD) and SUDs; age of disorder onset; and age of first treatment contact. Correlates of treatment delay were examined.

Results: SUDs exhibited the lowest lifetime treatment rate (27%), compared to MD (94%) and ADs (85%). Individuals with AD experienced the longest delay in seeking treatment (Mdn = 11 years), followed by those with SUDs (Mdn = 8 years) and MDs (Mdn = 3 years). Females had higher odds of seeking treatment for MD and AD but lower odds for SUDs. Recent birth cohorts showed increased treatment seeking across disorders, and higher education was associated with increased treatment seeking for MD and AD. Age of onset, country of birth and co-occurring disorders had mixed associations with treatment seeking.

Conclusions: The study reveals stark disparities in treatment-seeking behaviour and delays across mental and substance use disorders, with a pronounced underutilization of services for SUDs. Additionally, attention should be directed towards early intervention for individuals with earlier symptom onset, those from earlier cohorts and those with co-occurring SUDs.

Aims: Digital peer support interventions have the potential to promote healthy lifestyles and better mental health. This systematic review and meta-analysis synthesizes evidence on the effectiveness of digital peer support interventions for enhancing physical and mental health in healthy individuals rather than those diagnosed with a clinical condition.

Methods: First, we evaluated the impact of digital peer support interventions on physical and mental health outcomes by attending to sources of peer support (informal, naturally occurring peer support; formal support from trained peers), effectiveness demonstrated through different study designs (pre-post comparison vs. well-controlled experimental conditions) and long-term effects of interventions. Second, we examined whether features of digital peer support interventions - specifically, dosage, uptake and platform affordances - moderated intervention effectiveness. Third, we considered moderating effects of individual differences (age and existing health conditions) and country.

Results: Using random-effects modelling, which included 47 studies with 76 effect sizes on physical health, and 73 studies with 118 effect sizes on mental health, we found a moderate effect of digital peer support in improving physical health (standardized mean difference (SMD) = 0.35, p < 0.001; 95% CI: 0.30-0.41) and a large effect in enhancing mental health (standardized mean difference(SMD) = 0.53, p < 0.001; 95% CI: 0.46-0.61), which were similar across ages and individuals with varying degree of existing health conditions. Different sources of peer support demonstrated similar effects on physical health, but informal, naturally occurring peer support was more effective in bolstering mental health than formal support from trained peers, producing large effects that were comparable to online professional support. Positive effects on physical health were sustained over follow-up assessments, but weakened for mental health over time. Greater dosages of intervention had decreased effectiveness, but uptake of intervention did not moderate the effects on health. Interventions delivered on platforms that afford greater interactivity (apps, social networking sites and video conferencing) were more effective than those with lower interactivity (forums, websites and emails). Digital peer support interventions had stronger effects on improving physical health in Western countries than Eastern countries, but stronger effects on improving mental health in Eastern than Western countries.

Conclusions: Our findings contribute to the nascent conceptual models of digital peer support, lend credence to digital peer support as a scalable preventive intervention with real-world benefits in bolstering individuals' physical and mental health and provide important insights into best practices.

Aims: The association between a pregnant mother's vitamin D status and depressive symptoms has yielded inconsistent results. It is possible that other factors play a role in this association, as depression can have multiple causes. Recognizing the significance of the husband's participation in antenatal care, this study aimed to examine whether the husband's involvement moderates the link between the mother's vitamin D status and depressive symptoms during pregnancy.

Methods: A total of 2983 Chinese married pregnant women, in their 25-35 weeks of pregnancy, completed questionnaires to assess their levels of depressive symptoms and the involvement of their husbands in their antenatal care appointments. Additionally, their serum levels of vitamin D were measured.

Results: After adjusting for maternal age, parity, and socio-economic status, the husband's involvement in antenatal care moderated the association between maternal vitamin D status and depressive symptoms during pregnancy (β = 2.03, p = 0.035). Specifically, when their husbands were not regularly present for antenatal care appointments, mothers with suboptimal vitamin D levels experienced more depressive symptoms than those with optimal levels. However, there were no noticeable differences in depressive symptoms between vitamin D groups for mothers whose husbands attended all antenatal care appointments.

Conclusions: Pregnant women who have suboptimal vitamin D levels and lack support from their spouses are most vulnerable to experiencing depression. It is crucial to holistically assess the social and physiological needs of expectant mothers to reduce their risk of antenatal depression.

In low- and middle-income countries, fewer than 1 in 10 people with mental health conditions are estimated to be accurately diagnosed in primary care. This is despite more than 90 countries providing mental health training for primary healthcare workers in the past two decades. The lack of accurate diagnoses is a major bottleneck to reducing the global mental health treatment gap. In this commentary, we argue that current research practices are insufficient to generate the evidence needed to improve diagnostic accuracy. Research studies commonly determine accurate diagnosis by relying on self-report tools such as the Patient Health Questionnaire-9. This is problematic because self-report tools often overestimate prevalence, primarily due to their high rates of false positives. Moreover, nearly all studies on detection focus solely on depression, not taking into account the spectrum of conditions on which primary healthcare workers are being trained. Single condition self-report tools fail to discriminate among different types of mental health conditions, leading to a heterogeneous group of conditions masked under a single scale. As an alternative path forward, we propose improving research on diagnostic accuracy to better evaluate the reach of mental health service delivery in primary care. We recommend evaluating multiple conditions, statistically adjusting prevalence estimates generated from self-report tools, and consistently using structured clinical interviews as a gold standard. We propose clinically meaningful detection as 'good-enough' diagnoses incorporating multiple conditions accounting for context, health system and types of interventions available. Clinically meaningful identification can be operationalized differently across settings based on what level of diagnostic specificity is needed to select from available treatments. Rethinking research strategies to evaluate accuracy of diagnosis is vital to improve training, supervision and delivery of mental health services around the world.

Aims: Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress.

Methods: MHC use was examined in 31,433 individuals aged 18-64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable.

Results: Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43-2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98-1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45-0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services.

Conclusions: Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.

Aims: The impact of social determinants of health (SDOH) on mental health is increasingly realized. A comprehensive study examining the associations of SDOH with mental health disorders has yet to be accomplished. This study evaluated the associations between five domains of SDOH and the SDOH summary score and mental health disorders in the United States.

Methods: We analyzed data from a diverse group of participants enrolled in the All of Us research programme, a research programme to gather data from one million people living in the United States, in a cross-sectional design. The primary exposure was SDOH based on Healthy People 2030: education access and quality, economic stability, healthcare access and quality, social and community context, and neighbourhood and built environment. A summary SDOH score was calculated by adding each adverse SDOH risk (any SDOH vs. no SDOH). Our primary outcomes were diagnoses of major depression (MD) (i.e., major depressive disorder, recurrent MD or MD in remission) and anxiety disorders (AD) (i.e., generalized AD and other anxiety-related disorders). Multiple logistic regression models were used to determine adjusted odd ratios (aORs) for MD and/or ADs after controlling for covariates.

Results: A total of 63,162 participants with MD were identified (22,277 [35.3%] age 50-64 years old; 41,876 [66.3%] female). A total of 77,624 participants with AD were identified (25,268 [32.6%] age 50-64 years old; 52,224 [67.3%] female). Factors associated with greater odds of MD and AD included having less than a college degree, annual household income less than 200% of federal poverty level, housing concerns, lack of transportation, food insecurity, and unsafe neighbourhoods. Having no health insurance was associated with lower odds of both MD and AD (aOR, 0.48; 95% confidence interval [CI], 0.46-0.51 and aOR, 0.44; 95% CI, 0.42-0.47, respectively). SDOH summary score was strongly associated with the likelihood of having MD and AD (aOR, 1.97; 95% CI, 1.89-2.06 and aOR, 1.69; 95% CI, 1.63-1.75, respectively).

Conclusions: This study found associations between all five domains of SDOH and the higher odds of having MD and/or AD. The strong correlations between the SDOH summary score and mental health disorders indicate a possible use of the summary score as a measure of risk of developing mental health disorders.

Peer Support Workers (PSWs) play a crucial role in recovery-oriented mental health services. They offer support and hope by sharing their personal experiences and recovery journeys. However, transitioning from voluntary self-help roles to paid positions within statutory systems is not merely a technical shift. This change creates inherent tensions and conflicts, stemming from the integration of a peer model within a medical framework. I refer to the interface between these models as the "Professional-Peer Paradox" (PPP). At its heart, this paradox questions whether and how PSWs can integrate a role that relies on self-disclosure of shared lived experiences within a system rooted in professional knowledge norms delivered unidirectionally to service recipients. Using a whole organizational approach, I propose leveraging the autonomy-supportive environment concept from self-determination theory (SDT; Deci & Ryan, 2000) to promote self-disclosure in mental health services. I highlight the complexities involved in Peer Support Workers' (PSWs) use of self-disclosure (lived experience) within statutory mental health (MH) services. I suggest that PSWs can better commit to their unique roles by structuring multiple peer roles with varying levels of self-disclosure and creating a culture that fosters peer practice. Overall, applying a SDT systems' framework to the practice of self-disclosure can enhance the occupational identity of PSWs, establishing their unique position within the spectrum of mental health professions globally.

Background: Childhood contact with social services is associated with a range of adverse mental health outcomes across the life course, yet there is limited evidence in relation to self-harm and suicidal or self-harm ideation.

Aims: Determine the association between all tiers of childhood contact with social services and presentation to an emergency department (ED) with self-harm or thoughts of suicide or self-harm (ideation) in young adulthood.

Methods: This retrospective cohort study linked population-wide administrative data on self-harm and ideation presentations recorded in the Northern Ireland Registry of Self-Harm (NIRSH) between 2012 and 2015 to primary care registrations and children's social care data. Multilevel logistic regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need; child in need and child in care) and ED-presenting self-harm or ideation in young adulthood.

Results: There were 253,495 individuals born 1985-1993 with full data, alive and resident in Northern Ireland during 2012-2015 (ages 18-30 years). Of all young adults that presented to EDs with self-harm or ideation, 40.9% had contact with social services in childhood. Young adults with a history of care had 10-fold increased odds of self-harm or ideation (OR = 10.49 [95% CI, 9.45-11.66]) relative to those with no contact. Even those assessed as not in need of any help or support in childhood were three times more likely to present with self-harm or ideation (OR = 3.45 [95% CI, 3.07-3.88]).

Conclusions: Understanding the magnitude of childhood adversity amongst adults that present to EDs with self-harm or ideation may inform clinicians' understanding and therapeutic decision-making. Whilst EDs provide an important setting in which to administer brief interventions, a multi-agency approach is required to reduce self-harm/ideation in young adults that had contact with social services in childhood.

Aims: Clinical high-risk for psychosis (CHR-P) states exhibit diverse clinical presentations, prompting a shift towards broader outcome assessments beyond psychosis manifestation. To elucidate more uniform clinical profiles and their trajectories, we investigated CHR-P profiles in a community sample.

Methods: Participants (N = 829; baseline age: 16-40 years) comprised individuals from a Swiss community sample who were followed up over roughly 3 years. latent class analysis was applied to CHR-P symptom data at baseline and follow-up, and classes were examined for demographic and clinical differences, as well as stability over time.

Results: Similar three-class solutions were yielded for both time points. Class 1 was mainly characterized by subtle, subjectively experienced disturbances in mental processes, including thinking, speech and perception (basic symptoms [BSs]). Class 2 was characterized by subthreshold positive psychotic symptoms (i.e., mild delusions or hallucinations) indicative of an ultra-high risk for psychosis. Class 3, the largest group (comprising over 90% of participants), exhibited the lowest probability of experiencing any psychosis-related symptoms (CHR-P symptoms). Classes 1 and 2 included more participants with functional impairment and psychiatric morbidity. Class 3 participants had a low probability of having functional deficits or mental disorders at both time points, suggesting that Class 3 was the healthiest group and that their mental health and functioning remained stable throughout the study period. While 91% of Baseline Class 3 participants remained in their class over time, most Baseline Classes 1 (74%) and Class 2 (88%) participants moved to Follow-up Class 3.

Conclusions: Despite some temporal fluctuations, CHR-P symptoms within community samples cluster into distinct subgroups, reflecting varying levels of symptom severity and risk profiles. This clustering highlights the largely distinct nature of BSs and attenuated positive symptoms within the community. The association of Classes 1 and 2 with Axis-I disorders and functional deficits emphasizes the clinical significance of CHR-P symptoms. These findings highlight the need for personalized preventive measures targeting specific risk profiles in community-based populations.