conventional measures of SES, suggests that some aspects of social changes which are strongly associated with mental health have not been fully captured by those conventional measures. Some scholars have argued that income inequality and social polarization can heighten an individual’s sense of relative deprivation, resulting in frustration, anger and resentment. Our data suggest that how much one believes he/she has compared to others is more relevant than how much one actually has in understanding mental health problems in contemporary Korea. These findings may offer some lessons for the countries experiencing similar economic and social changes. Further research is needed to better understand how subjective social status is formed and what mechanisms underlie the strong link between subjective social status and mental health problems. Jihyung Hong, Jong-Hyun Yi Department of Healthcare Management, College of Social Science, Gachon University, Seongnam, South Korea; Department of Business Administration, College of Business and Economics, Gachon University, Seongnam, South Korea
{"title":"Nonsuicidal self‐injury in men: a serious problem that has been overlooked for too long","authors":"N. Kimbrel, P. Calhoun, J. Beckham","doi":"10.1002/wps.20358","DOIUrl":"https://doi.org/10.1002/wps.20358","url":null,"abstract":"conventional measures of SES, suggests that some aspects of social changes which are strongly associated with mental health have not been fully captured by those conventional measures. Some scholars have argued that income inequality and social polarization can heighten an individual’s sense of relative deprivation, resulting in frustration, anger and resentment. Our data suggest that how much one believes he/she has compared to others is more relevant than how much one actually has in understanding mental health problems in contemporary Korea. These findings may offer some lessons for the countries experiencing similar economic and social changes. Further research is needed to better understand how subjective social status is formed and what mechanisms underlie the strong link between subjective social status and mental health problems. Jihyung Hong, Jong-Hyun Yi Department of Healthcare Management, College of Social Science, Gachon University, Seongnam, South Korea; Department of Business Administration, College of Business and Economics, Gachon University, Seongnam, South Korea","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47777112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
3. Hiday VA, Swartz MS, Swanson JW et al. Psychiatr Serv 1999;50:62-8. 4. Lehman AF, Linn LS. Am J Psychiatry 1984;141:271-4. 5. Walsh E, Moran P, Scott C et al. Br J Psychiatry 2003;183:233-8. 6. Silver E, Arseneault L, Langley J et al. Am J Public Health 2005;95:2015-21. 7. Maniglio R. Acta Psychiatr Scand 2009;119:180-91. 8. Latalova K, Kamaradova D, Prasko J. Neuropsychiatr Dis Treat 2014;10: 1925-39. 9. Tsai AC, Weiser SD, Dilworth SE et al. Am J Epidemiol 2015;181:817-26. 10. Khalifeh H, Johnson S, Howard LM et al. Br J Psychiatry 2015;206:275-82.
{"title":"The long‐term impact of bullying victimization on mental health","authors":"L. Arseneault","doi":"10.1002/wps.20399","DOIUrl":"https://doi.org/10.1002/wps.20399","url":null,"abstract":"3. Hiday VA, Swartz MS, Swanson JW et al. Psychiatr Serv 1999;50:62-8. 4. Lehman AF, Linn LS. Am J Psychiatry 1984;141:271-4. 5. Walsh E, Moran P, Scott C et al. Br J Psychiatry 2003;183:233-8. 6. Silver E, Arseneault L, Langley J et al. Am J Public Health 2005;95:2015-21. 7. Maniglio R. Acta Psychiatr Scand 2009;119:180-91. 8. Latalova K, Kamaradova D, Prasko J. Neuropsychiatr Dis Treat 2014;10: 1925-39. 9. Tsai AC, Weiser SD, Dilworth SE et al. Am J Epidemiol 2015;181:817-26. 10. Khalifeh H, Johnson S, Howard LM et al. Br J Psychiatry 2015;206:275-82.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43748129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is well recognized that individuals with severe mental illness show high rates of suicide and also various physical illnesses which contribute to reduced longevity. This is a major public health challenge in the 21st century. Drugs and alcohol consumption and tobacco use further add to the increased rates of morbidity and mortality. The delays in helpseeking, whether it is for physical illness or psychiatric illness, and the underdiagnosis due to stigma and other factors contribute further to this disparity. Liu et al provide a model based on a multilevel approach at individual, health care systems and social determinant levels to cope with the excess mortality among mentally ill people. We believe that it is a relevant proposal in the framework of modern medicine. At the individual level, although early recognition of physical comorbidity and early interventions are effective strategies to reduce mortality, it is also relevant to explore what people seek help for and where they seek it from. In fact, culture and explanatory models will guide people to the sources of help, especially those which are easily available and accessible. Explanations of distress and symptoms (explanatory models) will vary across cultures and communities and also be related to educational and socioeconomic status. Health care systems need to be geographically and emotionally available and accessible for people affected by mental illness, so that they can seek help early. Some of the physical comorbidity may not be recognized by clinicians and on occasion the responsibility for managing physical illness may be left to primary care physicians or specialists who in turn may not recognize mental illness or due to stigma may not intervene early enough. This might be due, in the West at least, to a somewhat rigid division between mental health and physical health services. For centuries, the mind-body dualism attributable to Descartes’ dogma has affected clinical practice and has increased the dichotomy between psychiatric and physical health care services. This dualism may well have contributed to stigma against mental illness, the mentally ill and the psychiatric services. Furthermore, if physicians are not very good at identifying psychiatric disorders or carrying out mental state examinations, psychiatrists are often not very good at identifying and managing physical illnesses either. When interventions have taken place in partnerships between services, physical health of patients with severe mental illness has been shown to improve. At a social level, explanatory models of disease do not only vary across cultures and communities. They may also differ between the patients, their families and their carers, who may interpret these experiences on the basis of physical or psychosocial factors. More industrialized societies are likely to have psychological, medical or social causative factors as explanations, whereas more traditional societies may hold supra-natural and nat
{"title":"Mind and body: physical health needs of individuals with mental illness in the 21st century","authors":"D. Bhugra, A. Ventriglio","doi":"10.1002/wps.20381","DOIUrl":"https://doi.org/10.1002/wps.20381","url":null,"abstract":"It is well recognized that individuals with severe mental illness show high rates of suicide and also various physical illnesses which contribute to reduced longevity. This is a major public health challenge in the 21st century. Drugs and alcohol consumption and tobacco use further add to the increased rates of morbidity and mortality. The delays in helpseeking, whether it is for physical illness or psychiatric illness, and the underdiagnosis due to stigma and other factors contribute further to this disparity. Liu et al provide a model based on a multilevel approach at individual, health care systems and social determinant levels to cope with the excess mortality among mentally ill people. We believe that it is a relevant proposal in the framework of modern medicine. At the individual level, although early recognition of physical comorbidity and early interventions are effective strategies to reduce mortality, it is also relevant to explore what people seek help for and where they seek it from. In fact, culture and explanatory models will guide people to the sources of help, especially those which are easily available and accessible. Explanations of distress and symptoms (explanatory models) will vary across cultures and communities and also be related to educational and socioeconomic status. Health care systems need to be geographically and emotionally available and accessible for people affected by mental illness, so that they can seek help early. Some of the physical comorbidity may not be recognized by clinicians and on occasion the responsibility for managing physical illness may be left to primary care physicians or specialists who in turn may not recognize mental illness or due to stigma may not intervene early enough. This might be due, in the West at least, to a somewhat rigid division between mental health and physical health services. For centuries, the mind-body dualism attributable to Descartes’ dogma has affected clinical practice and has increased the dichotomy between psychiatric and physical health care services. This dualism may well have contributed to stigma against mental illness, the mentally ill and the psychiatric services. Furthermore, if physicians are not very good at identifying psychiatric disorders or carrying out mental state examinations, psychiatrists are often not very good at identifying and managing physical illnesses either. When interventions have taken place in partnerships between services, physical health of patients with severe mental illness has been shown to improve. At a social level, explanatory models of disease do not only vary across cultures and communities. They may also differ between the patients, their families and their carers, who may interpret these experiences on the basis of physical or psychosocial factors. More industrialized societies are likely to have psychological, medical or social causative factors as explanations, whereas more traditional societies may hold supra-natural and nat","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41735586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irritability can be defined as increased proneness to anger, relative to peers. Clinically, it manifests as developmentally inappropriate temper outbursts and sullen, grouchy mood; thus, it includes both behavioral and mood components. Related constructs are mood dysregulation, which is broader than irritability, and aggression, which encompasses only behavioral manifestations. Anger proneness has a defined developmental trajectory, peaking in the preschool period and declining thereafter, with a modest increase during adolescence. Irritability is a common reason for mental health evaluation in children, and pediatric irritability is associated with both concurrent and future impairment. In the 1990s, American researchers suggested that pediatric bipolar disorder does not present with distinct manic episodes as in adults, but instead with severe, chronic irritability. However, post-hoc analyses of epidemiological studies found associations between pediatric irritability and risk for subsequent anxiety and depression, but not for bipolar disorder. Similarly, in studies comparing the two dimensions of oppositional defiant disorder (ODD) (i.e., irritability and headstrong behavior), irritability predicts subsequent anxiety and depression, while headstrong behavior predicts attention-deficit/hyperactivity disorder (ADHD) and conduct disorder. Thus, the diagnosis of bipolar disorder should be reserved for youth (and adults) with distinct manic episodes, rather than chronic irritability. Genetically informative studies link irritability and depression. Twin studies document that longitudinal associations between irritability and both anxiety and depression have a genetic component. These studies also find that the heritability of irritability is approximately 40-60%, similar to anxiety or unipolar depression. Irritability is a diagnostic criterion for multiple disorders in youth, including anxiety disorders, major depressive disorder, and ODD. It is also common in youth with ADHD, bipolar disorder, conduct disorder, and autism. However, for children and adolescents, the validity and clinical utility of a diagnostic category characterized primarily by irritability remains an important and unanswered question. Historically, that category has been ODD, which is conceptualized as a disruptive behavior disorder. However, ODD consists of two dimensions, only one of which, irritability, has genetically mediated longitudinal associations with depression and anxiety. Also, severe irritability has significant cross-sectional associations with anxiety disorders. These considerations call into question the appropriateness of combining irritable and headstrong features into one disorder, and of categorizing a diagnosis characterized primarily by irritability as an externalizing, disruptive behavior disorder, rather than as a mood disorder. Given these complexities, it is not surprising that DSM-5 and ICD-11 take different approaches to diagnosing youth whose primar
{"title":"Irritability in children: what we know and what we need to learn","authors":"E. Leibenluft","doi":"10.1002/wps.20397","DOIUrl":"https://doi.org/10.1002/wps.20397","url":null,"abstract":"Irritability can be defined as increased proneness to anger, relative to peers. Clinically, it manifests as developmentally inappropriate temper outbursts and sullen, grouchy mood; thus, it includes both behavioral and mood components. Related constructs are mood dysregulation, which is broader than irritability, and aggression, which encompasses only behavioral manifestations. Anger proneness has a defined developmental trajectory, peaking in the preschool period and declining thereafter, with a modest increase during adolescence. Irritability is a common reason for mental health evaluation in children, and pediatric irritability is associated with both concurrent and future impairment. In the 1990s, American researchers suggested that pediatric bipolar disorder does not present with distinct manic episodes as in adults, but instead with severe, chronic irritability. However, post-hoc analyses of epidemiological studies found associations between pediatric irritability and risk for subsequent anxiety and depression, but not for bipolar disorder. Similarly, in studies comparing the two dimensions of oppositional defiant disorder (ODD) (i.e., irritability and headstrong behavior), irritability predicts subsequent anxiety and depression, while headstrong behavior predicts attention-deficit/hyperactivity disorder (ADHD) and conduct disorder. Thus, the diagnosis of bipolar disorder should be reserved for youth (and adults) with distinct manic episodes, rather than chronic irritability. Genetically informative studies link irritability and depression. Twin studies document that longitudinal associations between irritability and both anxiety and depression have a genetic component. These studies also find that the heritability of irritability is approximately 40-60%, similar to anxiety or unipolar depression. Irritability is a diagnostic criterion for multiple disorders in youth, including anxiety disorders, major depressive disorder, and ODD. It is also common in youth with ADHD, bipolar disorder, conduct disorder, and autism. However, for children and adolescents, the validity and clinical utility of a diagnostic category characterized primarily by irritability remains an important and unanswered question. Historically, that category has been ODD, which is conceptualized as a disruptive behavior disorder. However, ODD consists of two dimensions, only one of which, irritability, has genetically mediated longitudinal associations with depression and anxiety. Also, severe irritability has significant cross-sectional associations with anxiety disorders. These considerations call into question the appropriateness of combining irritable and headstrong features into one disorder, and of categorizing a diagnosis characterized primarily by irritability as an externalizing, disruptive behavior disorder, rather than as a mood disorder. Given these complexities, it is not surprising that DSM-5 and ICD-11 take different approaches to diagnosing youth whose primar","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48777504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Galling, A. Roldán, K. Hagi, L. Rietschel, F. Walyzada, Wei Zheng, Xiao‐Lan Cao, Y. Xiang, M. Zink, J. Kane, J. Nielsen, S. Leucht, C. Correll
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta‐analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co‐primary outcomes were total symptom reduction and study‐defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=–0.53, 95% CI: −0.87 to −0.19, p=0.002). However, superiority was only apparent in open‐label and low‐quality trials (both p<0.001), but not in double‐blind and high‐quality ones (p=0.120 and 0.226, respectively). Study‐defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N=938, risk ratio = 1.19, 95% CI: 0.99 to 1.42, p=0.061), being clearly non‐significant in double‐blind and high‐quality studies (both p=0.990). Findings were replicated in clozapine and non‐clozapine augmentation studies. No differences emerged regarding all‐cause/specific‐cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N=931, SMD=–0.38, 95% CI: −0.63 to −0.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N=532, SMD=–0.41, 95% CI: −0.79 to −0.03, p=0.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p=0.028), but more prolactin elevation (p=0.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p=0.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double‐blind/high‐quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.
{"title":"Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta‐analysis and meta‐regression analysis","authors":"B. Galling, A. Roldán, K. Hagi, L. Rietschel, F. Walyzada, Wei Zheng, Xiao‐Lan Cao, Y. Xiang, M. Zink, J. Kane, J. Nielsen, S. Leucht, C. Correll","doi":"10.1002/wps.20387","DOIUrl":"https://doi.org/10.1002/wps.20387","url":null,"abstract":"Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta‐analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co‐primary outcomes were total symptom reduction and study‐defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=–0.53, 95% CI: −0.87 to −0.19, p=0.002). However, superiority was only apparent in open‐label and low‐quality trials (both p<0.001), but not in double‐blind and high‐quality ones (p=0.120 and 0.226, respectively). Study‐defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N=938, risk ratio = 1.19, 95% CI: 0.99 to 1.42, p=0.061), being clearly non‐significant in double‐blind and high‐quality studies (both p=0.990). Findings were replicated in clozapine and non‐clozapine augmentation studies. No differences emerged regarding all‐cause/specific‐cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N=931, SMD=–0.38, 95% CI: −0.63 to −0.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N=532, SMD=–0.41, 95% CI: −0.79 to −0.03, p=0.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p=0.028), but more prolactin elevation (p=0.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p=0.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double‐blind/high‐quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48173067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
South Korea has witnessed an unprecedented rise in suicide rates following the 1997 Asian financial crisis. Unfortunately, the rate has not decreased and still remains the highest among the 34 countries which are part of the Organization for Economic Co-operation and Development (OECD). Several researchers have suggested that, in high-income countries, it is no longer the absolute level of one’s socioeconomic status (SES) that is most important for health, but rather inequality or a sense of inequality. A number of studies have been undertaken to examine the relationship of inequality (at the country level) or a sense of inequality (at the individual level) to health. Some of these studies have focused on subjective SES, which measures one’s perception of his/her own position in the social hierarchy. We aimed to examine how both objective and subjective SES are related to mental health problems (suicidal ideation, depressive symptoms and psychological distress) in South Korea, using data from the 2013 Korea Health Panel survey. Subjective SES was measured using the MacArthur scale, a 10rung ladder on which individuals indicate their perceived standing in the social hierarchy. The assessment of suicidal ideation and depression was based on self-report (“yes” versus “no” in the past 12 months). Psychological distress in the past month was assessed using the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K). A score 2.4 was defined as “severe stress”. Of the 16,313 respondents aged 19 years or older, the 14,432 who had no missing data were included in this analysis. All data were weighted to represent the structure of the Korean population. Of the 14,432 participants, 5.4% and 7.2% had suicidal ideation and depression, respectively, in the past 12 months, and 13.6% had severe psychological distress in the past month. A clear social gradient was found in the prevalence of these mental health problems, especially when SES was measured subjectively (subjective SES) rather than objectively (income quintile) (p<0.001). Notably, this pattern was more apparent in the case of severe psychological distress. Of those with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), nearly one in three (29.6%) reported the experience of severe psychological distress in the past month, while only 7.2% reported the same experience among those with the highest subjective SES (i.e., a rating 5). The equivalent rates were 19.3% in the lowest income quintile and 10.2% in the highest income quintile. The associations with subjective SES appeared to far outweigh those with conventional measures of SES when considering both in logistic regression models. Subjective SES was the only factor that was consistently associated with any type of mental health problems. For instance, compared to the respondents with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), those with higher subjective SES were much less likely to rep
{"title":"The relationship of subjective social status to mental health in South Korean adults","authors":"Jihyung Hong, Jonghan Yi","doi":"10.1002/wps.20357","DOIUrl":"https://doi.org/10.1002/wps.20357","url":null,"abstract":"South Korea has witnessed an unprecedented rise in suicide rates following the 1997 Asian financial crisis. Unfortunately, the rate has not decreased and still remains the highest among the 34 countries which are part of the Organization for Economic Co-operation and Development (OECD). Several researchers have suggested that, in high-income countries, it is no longer the absolute level of one’s socioeconomic status (SES) that is most important for health, but rather inequality or a sense of inequality. A number of studies have been undertaken to examine the relationship of inequality (at the country level) or a sense of inequality (at the individual level) to health. Some of these studies have focused on subjective SES, which measures one’s perception of his/her own position in the social hierarchy. We aimed to examine how both objective and subjective SES are related to mental health problems (suicidal ideation, depressive symptoms and psychological distress) in South Korea, using data from the 2013 Korea Health Panel survey. Subjective SES was measured using the MacArthur scale, a 10rung ladder on which individuals indicate their perceived standing in the social hierarchy. The assessment of suicidal ideation and depression was based on self-report (“yes” versus “no” in the past 12 months). Psychological distress in the past month was assessed using the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K). A score 2.4 was defined as “severe stress”. Of the 16,313 respondents aged 19 years or older, the 14,432 who had no missing data were included in this analysis. All data were weighted to represent the structure of the Korean population. Of the 14,432 participants, 5.4% and 7.2% had suicidal ideation and depression, respectively, in the past 12 months, and 13.6% had severe psychological distress in the past month. A clear social gradient was found in the prevalence of these mental health problems, especially when SES was measured subjectively (subjective SES) rather than objectively (income quintile) (p<0.001). Notably, this pattern was more apparent in the case of severe psychological distress. Of those with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), nearly one in three (29.6%) reported the experience of severe psychological distress in the past month, while only 7.2% reported the same experience among those with the highest subjective SES (i.e., a rating 5). The equivalent rates were 19.3% in the lowest income quintile and 10.2% in the highest income quintile. The associations with subjective SES appeared to far outweigh those with conventional measures of SES when considering both in logistic regression models. Subjective SES was the only factor that was consistently associated with any type of mental health problems. For instance, compared to the respondents with the lowest subjective SES (i.e., a rating of 1 on the 10-rung ladder), those with higher subjective SES were much less likely to rep","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41856300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
top of the political agenda, so that patients with severe mental illness get the best services they need, deserve and will utilize. It is imperative that psychiatrists take the lead in identifying the physical health needs of persons with severe mental illness as well as in orienting the public mental health agenda to ensure that cultural norms and values are taken into account when developing and delivering integrated care at all levels. They must work with stakeholders, including service users and their families groups, to ensure that integrated care and services are sensitive to patients’ needs.
{"title":"Excess mortality in severe mental disorder: the need for an integrated approach","authors":"G. Ivbijaro","doi":"10.1002/wps.20382","DOIUrl":"https://doi.org/10.1002/wps.20382","url":null,"abstract":"top of the political agenda, so that patients with severe mental illness get the best services they need, deserve and will utilize. It is imperative that psychiatrists take the lead in identifying the physical health needs of persons with severe mental illness as well as in orienting the public mental health agenda to ensure that cultural norms and values are taken into account when developing and delivering integrated care at all levels. They must work with stakeholders, including service users and their families groups, to ensure that integrated care and services are sensitive to patients’ needs.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46122553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Molero, M. Martínez-González, M. Ruíz-Canela, F. Lahortiga, A. Sánchez-Villegas, A. Perez-Cornago, A. Gea
ANCOVA analysis, which included age and education as covariates. The model also remained significant in a follow-up analysis in which participants who identified as AfricanAmerican (N515) were excluded. Carriers of the 5HTTLPR-S’ allele had increased PTSD symptoms compared to individuals homozygous for the L’ allele (IES mean score: L’L’547.3 6 5.3, S559.8 6 4.1). For DISC1, individuals homozygous for the T allele had increased PTSD symptoms compared to A carriers (A545.3 6 2.8, TT561.9 6 7.2). In ANCOVA analysis of symptom sub-factors, 5-HTTLPR and DISC1 selectively influenced intrusion and hypervigilance symptoms, but did not affect avoidance symptoms. PTSD symptom severity (total IES scores) increased by an average of 40% with each risk genotype (none538.4, one5 54.5, two565.6). These data support prior observations of 5-HTTLPR effects on PTSD symptoms in military veterans. Although 5-HTTLPR has been identified as a potential contributor to PTSD susceptibility in civilian-based populations, its effect may be less robust in those populations, due to lower overall level of trauma exposure. The effects of 5-HTTLPR on PTSD in military veterans after deployment to a war zone may be more robust because of a universal and constant exposure to threat, military training, and/or separation from family and home social support. In addition to 5-HTTLPR, genetic variation in DISC1, a gene associated with susceptibility to multiple mental disorders, was found to contribute to PTSD symptom severity. Possessing both DISC1 and 5-HTTLPR risk genotypes resulted in a 1.7fold increase in PTSD symptoms. Although this is the first report of DISC1 S704C TT allele as a risk factor for PTSD, the finding is not surprising, considering that this allele has been identified as a risk factor for major depression. DISC1 variants interfere with a protein complex important for organelle transport and in tethering of mitochondria, interfering with dendritic development and reducing densities of dendritic spines in the frontal cortex, paralleling our recent report of spine density reductions in the frontal cortex in PTSD. This study was powered to screen for candidate genes with relatively large effect sizes on PTSD symptoms in combat veterans, which may be different from sets of genes affecting PTSD in civilian populations. Study of the serotonin system in PTSD is motivated in large part by the therapeutic utility of serotonin uptake inhibitors to treat symptoms of PTSD. Our data provide additional impetus for continued study of this system in PTSD pharmacotherapy. In addition, antipsychotics such as risperidone have been shown to reverse DISC1-related behavioral deficits and pathophysiology in animal models, suggesting the possibility that such agents could be re-examined for use as alternative pharmacotherapies for PTSD. Keith A. Young, Sandra B. Morissette, Robert Jamroz, Eric C. Meyer, Matthew S. Stanford, Li Wan, Nathan A. Kimbrel Central Texas Veterans Health Care System,
ANCOVA分析，包括年龄和教育作为协变量。在排除非裔美国人(N515)的随访分析中，该模型仍然具有重要意义。5HTTLPR-S’等位基因携带者与L’等位基因纯合子个体相比，PTSD症状增加(IES平均评分:L’L 547.3 6 5.3, S559.8 6 4.1)。对于DISC1，与A携带者相比，T等位基因纯合的个体PTSD症状增加(A545.3 6 2.8, TT561.9 6 7.2)。在ANCOVA分析症状亚因素中，5-HTTLPR和DISC1选择性地影响侵入和超警觉症状，但不影响回避症状。每种风险基因型的PTSD症状严重程度(IES总分)平均增加40%(非538.4，一54.5，二565.6)。这些数据支持了先前关于5-HTTLPR对退伍军人PTSD症状影响的观察。尽管5-HTTLPR已被确定为平民人群中创伤后应激障碍易感性的潜在因素，但由于总体创伤暴露水平较低，它在这些人群中的作用可能不那么明显。5-HTTLPR对部署到战区的退伍军人创伤后应激障碍的影响可能更强，因为他们普遍和持续地暴露于威胁、军事训练和/或与家人和家庭社会支持分离。除了5-HTTLPR外，研究还发现，与多种精神障碍易感性相关的基因DISC1的遗传变异与PTSD症状的严重程度有关。同时拥有DISC1和5-HTTLPR风险基因型导致PTSD症状增加1.7倍。虽然这是DISC1 S704C TT等位基因作为PTSD危险因素的首次报道，但考虑到该等位基因已被确定为重度抑郁症的危险因素，这一发现并不令人惊讶。DISC1变异干扰一种对细胞器运输和线粒体拴系很重要的蛋白质复合物，干扰树突发育并降低额叶皮质树突棘的密度，这与我们最近报道的PTSD患者额叶皮质脊柱密度降低的情况相似。本研究旨在筛选对退伍军人创伤后应激障碍症状有较大影响的候选基因，这可能与影响平民人群创伤后应激障碍的一系列基因不同。研究创伤后应激障碍中的血清素系统在很大程度上是由血清素摄取抑制剂治疗创伤后应激障碍症状的治疗效用所推动的。我们的数据为该系统在PTSD药物治疗中的持续研究提供了额外的动力。此外，在动物模型中，利培酮等抗精神病药物已被证明可以逆转disc1相关的行为缺陷和病理生理，这表明这些药物可能会被重新研究作为创伤后应激障碍的替代药物疗法。Keith A. Young, Sandra B. Morissette, Robert Jamroz, Eric C. Meyer, Matthew S. Stanford, Li Wan, Nathan A. Kimbrel中央德州退伍军人医疗保健系统，坦普尔，德克萨斯州，美国;退伍军人事务部visn17退伍军人归国研究卓越中心，美国德克萨斯州韦科;美国德州坦普尔市德州农工大学健康科学中心精神病学与行为科学系;德克萨斯大学圣安东尼奥分校，美国德克萨斯州圣安东尼奥;希望与康复中心，休斯顿，德克萨斯州，美国;达勒姆退伍军人事务医疗中心，美国北卡罗来纳州达勒姆;VA中大西洋精神疾病研究、教育和临床中心，达勒姆，北卡罗来纳州，美国;杜克大学医学中心，美国北卡罗来纳州达勒姆
{"title":"Cardiovascular risk and incidence of depression in young and older adults: evidence from the SUN cohort study","authors":"P. Molero, M. Martínez-González, M. Ruíz-Canela, F. Lahortiga, A. Sánchez-Villegas, A. Perez-Cornago, A. Gea","doi":"10.1002/wps.20390","DOIUrl":"https://doi.org/10.1002/wps.20390","url":null,"abstract":"ANCOVA analysis, which included age and education as covariates. The model also remained significant in a follow-up analysis in which participants who identified as AfricanAmerican (N515) were excluded. Carriers of the 5HTTLPR-S’ allele had increased PTSD symptoms compared to individuals homozygous for the L’ allele (IES mean score: L’L’547.3 6 5.3, S559.8 6 4.1). For DISC1, individuals homozygous for the T allele had increased PTSD symptoms compared to A carriers (A545.3 6 2.8, TT561.9 6 7.2). In ANCOVA analysis of symptom sub-factors, 5-HTTLPR and DISC1 selectively influenced intrusion and hypervigilance symptoms, but did not affect avoidance symptoms. PTSD symptom severity (total IES scores) increased by an average of 40% with each risk genotype (none538.4, one5 54.5, two565.6). These data support prior observations of 5-HTTLPR effects on PTSD symptoms in military veterans. Although 5-HTTLPR has been identified as a potential contributor to PTSD susceptibility in civilian-based populations, its effect may be less robust in those populations, due to lower overall level of trauma exposure. The effects of 5-HTTLPR on PTSD in military veterans after deployment to a war zone may be more robust because of a universal and constant exposure to threat, military training, and/or separation from family and home social support. In addition to 5-HTTLPR, genetic variation in DISC1, a gene associated with susceptibility to multiple mental disorders, was found to contribute to PTSD symptom severity. Possessing both DISC1 and 5-HTTLPR risk genotypes resulted in a 1.7fold increase in PTSD symptoms. Although this is the first report of DISC1 S704C TT allele as a risk factor for PTSD, the finding is not surprising, considering that this allele has been identified as a risk factor for major depression. DISC1 variants interfere with a protein complex important for organelle transport and in tethering of mitochondria, interfering with dendritic development and reducing densities of dendritic spines in the frontal cortex, paralleling our recent report of spine density reductions in the frontal cortex in PTSD. This study was powered to screen for candidate genes with relatively large effect sizes on PTSD symptoms in combat veterans, which may be different from sets of genes affecting PTSD in civilian populations. Study of the serotonin system in PTSD is motivated in large part by the therapeutic utility of serotonin uptake inhibitors to treat symptoms of PTSD. Our data provide additional impetus for continued study of this system in PTSD pharmacotherapy. In addition, antipsychotics such as risperidone have been shown to reverse DISC1-related behavioral deficits and pathophysiology in animal models, suggesting the possibility that such agents could be re-examined for use as alternative pharmacotherapies for PTSD. Keith A. Young, Sandra B. Morissette, Robert Jamroz, Eric C. Meyer, Matthew S. Stanford, Li Wan, Nathan A. Kimbrel Central Texas Veterans Health Care System, ","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42701745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physical health of people with severe mental disorders: leave no one behind.","authors":"Shekhar Saxena, Mario Maj","doi":"10.1002/wps.20403","DOIUrl":"10.1002/wps.20403","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":"1-2"},"PeriodicalIF":60.5,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49047440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nancy H Liu, Gail L Daumit, Tarun Dua, Ralph Aquila, Fiona Charlson, Pim Cuijpers, Benjamin Druss, Kenn Dudek, Melvyn Freeman, Chiyo Fujii, Wolfgang Gaebel, Ulrich Hegerl, Itzhak Levav, Thomas Munk Laursen, Hong Ma, Mario Maj, Maria Elena Medina-Mora, Merete Nordentoft, Dorairaj Prabhakaran, Karen Pratt, Martin Prince, Thara Rangaswamy, David Shiers, Ezra Susser, Graham Thornicroft, Kristian Wahlbeck, Abe Fekadu Wassie, Harvey Whiteford, Shekhar Saxena
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
{"title":"Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas.","authors":"Nancy H Liu, Gail L Daumit, Tarun Dua, Ralph Aquila, Fiona Charlson, Pim Cuijpers, Benjamin Druss, Kenn Dudek, Melvyn Freeman, Chiyo Fujii, Wolfgang Gaebel, Ulrich Hegerl, Itzhak Levav, Thomas Munk Laursen, Hong Ma, Mario Maj, Maria Elena Medina-Mora, Merete Nordentoft, Dorairaj Prabhakaran, Karen Pratt, Martin Prince, Thara Rangaswamy, David Shiers, Ezra Susser, Graham Thornicroft, Kristian Wahlbeck, Abe Fekadu Wassie, Harvey Whiteford, Shekhar Saxena","doi":"10.1002/wps.20384","DOIUrl":"10.1002/wps.20384","url":null,"abstract":"<p><p>Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":"30-40"},"PeriodicalIF":60.5,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46665407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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