Social Psychiatry and Psychiatric Epidemiology最新文献

Background: Patients with schizophrenia (SCZ) and bipolar disorder (BD) face higher risks of premature mortality from both natural (e.g., cardiovascular disease) and unnatural causes (e.g., suicide). Notwithstanding these findings, the impact of general health screening participation on mortality outcomes in this population remains underexplored.

Methods: Using the Korean National Health Insurance Database, this retrospective cohort study included 120,308 patients with SCZ and 147,221 patients with BD patients aged ≥ 20 years, newly diagnosed between 2007 and 2018. The primary exposure was participation in the national health screening program. Time-dependent Cox proportional hazards models, adjusted for demographic and clinical covariates, were used to assess associations between screening participation and all-cause, cardiovascular (CVD), and suicide mortality.

Results: Standardized mortality ratios were 4.67 for SCZ and 2.93 for BD compared to the general population. Screening rates were lower than the general population and varied by age, sex, income, and psychiatric comorbidity. Screening participation was associated with lower mortality hazards across all outcomes. Adjusted hazard ratios for all-cause, CVD, and suicide mortality were 0.63, 0.56, and 0.82 for SCZ, and 0.56, 0.43, and 0.75 for BD. Lower hazards of CVD mortality were most pronounced in those aged ≥ 40 years, while lower hazards of suicide were most notable in those < 40.

Discussion: Participation in national health screenings is associated with significantly lower mortality hazards among individuals with SCZ and BD. Integrating physical health assessments into psychiatric care and improving screening participation may help reduce mortality and health disparities in this population.

Purpose: We aimed to take a detailed approach to examine difference in the extent and nature of IPV victimisation and their association with PTSD, depression, and anxiety.

Methods: 100 community-dwelling IPV victim-survivors and 59 controls in Melbourne completed a series of questionnaires on IPV, adverse childhood experiences (ACEs), brain injury, resilience, PTSD, depression, and anxiety. Prevalence of PTSD, depression, and anxiety in victim-survivors were compared to controls using chi-square tests. Then we used logistic regressions to examine differences in the nature and extent of IPV victimisation and their association with PTSD, depression, and anxiety.

Results: We found an increased prevalence of probable PTSD (52.3% versus 1.7%), depression (47.6% versus 5.1%) and anxiety (53.3% versus 9.5%) in community-dwelling victim-survivors compared to controls. More lifetime IPV experiences, increased number of IPV relationships, less time since the most recent IPV relationship, experiences of sexual IPV, increased ACEs, and lower resilience were factors significantly associated with PTSD, depression, and/or anxiety among victim-survivors.

Conclusion: Overall, victim-survivors had an increased prevalence of adverse mental health outcomes. We found that several IPV experiences, ACEs, and resilience were significantly associated with the odds of probable PTSD, depression, and anxiety. Underscoring the complexity of IPV experiences and the need for trauma-informed care.

Purpose: This study examines the associations between childhood parental death and parental substance-related problems and DSM-5 substance use disorders (SUDs), suicide attempt, and mental health discorders (mood, anxiety, post truamatic stress) in adulthood..

Methods: Using data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309), we compared four mutually exclusive groups who experienced the following before age 18: parental death and no parental substance use problems; parental substance use problems and no parental death; both parental death and parental substance use problems; and neither parental death nor substance use problems. We examined differences in adverse childhood experiences (ACEs), suicidality, and six DSM-5 SUD and mental health disorders. Parental death and parental substance-related problems were treated as exposures rather than included in the ACEs measure.

Results: Parentally-bereaved individuals who experienced parental substance-related problems reported significantly greater number of ACEs (M = 5.34) compared to all other groups. Parentally-bereaved individuals who experienced parental substance-related problems had greater odds of a suicide attempt and all six DSM-5 SUD and mental health disorder outcomes (aOR range = 2.06-3.59) compared to parentally-bereaved individuals without parental substance-related problems. They also had greater odds of a suicide attempt and four DSM-5 SUD and mental health disorders (aOR range = 1.19-1.46) compared to those who experienced parental substance use problems and no parental death. Some differences were attenuated in models adjusting for ACEs; however, differences remained for six of the seven outcomes.

Conclusion: Individuals who experienced parental death and parental substance-related problems have increased risk for suicidality, DSM-5 SUD, and mental health disorders which may warrant additional trauma-informed mental health care in bereavement services.

Purpose: Adolescence is a sensitive period for the emergence of subclinical psychotic experiences, including paranoid ideation. Understanding their developmental course in relation to common mental health difficulties such as anxiety, is important for clarifying etiological processes and potential progression to clinical psychosis. This study longitudinally examined the possible bidirectional relationship between anxiety and paranoia assessed in a Virtual Reality setting in adolescents aged 12 to 18 and the role of childhood threat experiences, as part of the EMBRACE study.

Methods: Data were collected in two waves, 18 months apart at baseline. State paranoia was assessed using the State Social Paranoia Scale (SSPS) in two distinct Virtual Reality (VR) environments. Anxiety was measured with the Revised Children's Anxiety and Depression Scale (RCADS25), while childhood threat exposure was evaluated using the Juvenile Victimization Questionnaire (JVQ). Linear and multiple regression analyses were conducted to examine associations and moderation effects.

Results: At baseline, 120 adolescents participated, of whom 97 completed both waves. State paranoia in a school canteen VR environment at baseline significantly predicted state paranoia in a VR bar environment 18 months later (β = 0.45, SE = 0.10, p < 0.001). Similarly, anxiety at baseline strongly predicted anxiety at follow-up (β = 0.46, SE = 0.10, p < 0.001), but no associations were found between state paranoia and anxiety over time in either direction. Childhood threat exposure moderated the relationship between baseline state paranoia and anxiety at follow-up (β = -0.17, SE = 0.06, p = 0.009), with adolescents experiencing higher state paranoia and threat exposure at baseline showing lower anxiety at follow-up. In contrast, the interaction between Wave 1 anxiety and Wave 1 childhood threat exposure in predicting follow-up state paranoia was non-significant (β = -0.17, SE = 0.11, p = .117).

Conclusion: VR can capture subtle paranoid ideation in ecologically valid, dynamic social interactions that are consistent over time and across different VR environments. The developmental trajectories of paranoia and anxiety may diverge depending on childhood threat exposure, highlighting the role of early adversity in shaping their interplay.

Purpose: Precariousness, which refers to experiencing a high level of insecurity and instability in life, manifests in multiple life dimensions and can give rise to mental health issues. Associations with mental health are potentially influenced by migration background. In this study, we examine the associations between precariousness in different life dimensions and depressed mood among individuals with and without migration background.

Methods: We included 22,039 participants from the baseline measurement of the HELIUS (HEalthy LIfe in an Urban Setting) study, representing the six largest ethnic groups in Amsterdam. We used 13 indicators of precariousness in five life dimensions (employment, financial, housing, cultural and social), 9 assessed through a self-report questionnaire and 4 from neighborhood-level data. Depressed mood was classified as > 9 on the Patient Health Questionnaire (PHQ-9, Dutch version). Network models were applied, stratified by migration background.

Results: In total, 14.6% experienced depressed mood. Among those who experienced precariousness in at least four dimensions, the corresponding number was 22.1% to 46%, depending on the specific dimensions of precariousness that were experienced. Associations between depressed mood and indicators of precariousness were similar for those with and without a migration background. Depressed mood was associated with marginal work or unemployment, social satisfaction, social frequency, income inadequacy, discrimination, and financial difficulties, and additionally with lost friendship and health literacy among those with a migration background.

Conclusion: Individuals with and without depressed mood differ markedly in their experience of precariousness, but associations are mostly consistent between those with and without a migration background.

Background: Alcohol Use Disorder (AUD) is a major global contributor to disability and mortality, significantly adding to the overall disease burden. It is particularly prevalent among individuals with severe mental illnesses (SMI), such as bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD), and is often accompanied by comorbid psychiatric conditions that further exacerbate its effects. Due to impairments in memory, cognitive control, mood regulation, impulsivity, and emotional stability, individuals with mental health disorders-including schizophrenia and mood disorders-are at an increased risk of developing AUD. This review aims to determine the pooled prevalence of AUD and identify its associated factors among individuals with severe mental illness in Africa.

Methods: Primary studies were systematically retrieved from PubMed/MEDLINE, Scopus, African Journals Online, PsycINFO, EMBASE, CINAHL, and the Cochrane Library. This review included twenty original research articles that examined the prevalence of Alcohol Use Disorder (AUD) among individuals with severe mental illness in Africa. Data extraction and article evaluation were independently performed by two reviewers to ensure accuracy and minimize bias. All studies included in the meta-analysis underwent a rigorous quality assessment, and only those with a score of 5 or higher on the evaluation criteria were incorporated into the final analysis. Given the heterogeneity among the included studies, a random-effects meta-analysis was employed, and potential publication bias was evaluated using Egger's weighted regression test, funnel plots, and trim-and-fill plots. The review protocol was prospectively registered with PROSPERO (ID: CRD42024535636).

Results: This review included 20 primary studies encompassing a total of 7,540 participants. The pooled prevalence of Alcohol Use Disorder (AUD) among individuals with severe mental illness (SMI) was 33.26% (95% CI: 26.41-40.12). Factors significantly associated with AUD included male sex (OR = 3.45; 95% CI: 2.13-5.59), younger adults (OR = 3.12; 95% CI: 1.92-5.08), participants reporting current cigarette use (OR = 4.80; 95% CI: 3.03-7.69), and a family history of alcohol use (OR = 3.25; 95% CI: 2.82-4.65).

Conclusion: This review reveals that Alcohol Use Disorder is highly prevalent among individuals with severe mental illness in Africa. The findings indicate that being male, younger adults, participants reporting current cigarette use, or having a family history of alcohol use significantly increases the risk of AUD. These results emphasize the importance of incorporating targeted screening, early intervention, and integrated treatment approaches into mental health services to effectively address and reduce the impact of AUD within this population.

Background: The prevalence of common mental disorders (CMDs) in South Asia is higher among women than men. Reasons include lower socioeconomic status and greater exposure to social, economic and environmental disadvantage. Economic determinants are important, modifiable risk factors for CMDs.

Aims: This systematic review aimed to evaluate the evidence for impacts of economic interventions on women's well-being and CMD outcomes in South Asia.

Method: We searched for peer-reviewed quantitative research studies in eight databases (3ie, EconLit, Embase Classic, Embase, Global Health, J-PAL, Medline, APA PsychInfo, Scopus) and studies included in relevant systematic reviews of economic interventions which measured CMDs and well-beingamong female participants in South Asia. We assessed the risk of bias of included studies using the Joanna Briggs Institute checklist. Following data extraction, we synthesised our findings through narrative synthesis.

Results: We identified eight eligible studies evaluating five types of economic intervention: microfinance, employment, conditional cash transfers, self-help groups (SHGs) and economic empowerment programmes. Studies were conducted in Afghanistan (n = 1), Bangladesh (n = 2) and India (n = 5). Approximately 60% of studies reported statistically significant associations between receipt of economic interventions and improved CMD symptoms or well-being among female participants. Risk of bias was moderate and study designs were heterogeneous. Attention to gendered risks of economic interventions in countries with strong patriarchal norms was limited.

Conclusion: The limited published evidence suggests that economic interventions can have positive impacts on CMDs and well-being among women in South Asia. However, methodological limitations and lack of geographical representation mean that further research is needed to evaluate the risks and benefits of economic interventions for diverse women in South Asia.

Purpose: The mental health treatment gap is an important issue for young people in the East Mediterranean Region as financial constraints and cultural factors continue to play a limiting role. This paper examined predictors and barriers for help-seeking for mental health problems in children and adolescents in Lebanon.

Methods: The Psychopathology in Children and Adolescents in Lebanon Study, a nationally-representative household sample of n = 1,517 youth aged 5-17 years, was used. Parents and adolescents completed several self-reported mental health questionnaires, and a demographic information sheet. Potential barriers to care utilization assessed included: (i) discomfort in discussing mental health, (ii) stigmatization, (iii) distrust in effectiveness of mental healthcare, (iv) costs, (v) unavailability of nearby services. Regression models were conducted to examine the correlates of help-seeking for psychiatric disorders.

Results: Of the n = 498 youth with a positive screen for a psychiatric disorder, only n = 25 (5.0%) reported ever receiving professional mental healthcare services. Male gender, receiving school accommodation, higher parent-reported hyperactivity and depression were associated with help-seeking after adjustment for other variables. For children with a positive screen who had not sought help, the most often endorsed barriers were costs (22.3% major barrier) and unavailability of nearby services (16.1% major barrier).

Conclusion: This study showed that costs and unavailability of nearby services were the biggest barriers to help-seeking among children and adolescents in Lebanon, underscoring the importance of incorporating mental health in public health policies and budget allocation in the East Mediterranean Region.