Social Psychiatry and Psychiatric Epidemiology最新文献

Background: Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are frequently comorbid and are individually associated with increased risk of suicidal behavior. However, whether their comorbidity exacerbates this risk has not been adequately investigated.

Methods: Using a Swedish birth cohort (born 1970-1990; N = 799,203-858,983), we employed Aalen's linear hazards models to evaluate the risk of non-fatal suicide attempt (SA) as a function of registration for AUD and/or PTSD. Models were stratified by sex and considered the temporal ordering of AUD and PTSD. We adjusted for registrations of major depression (MD) and other key covariates.

Results: The overall incidence of SA ranged from 16.52 to 19.29 per 10,000 person-years (PY). In models adjusted for MD and other covariates, PTSD accounted for an additional 12.19-22.09 SA cases per 10,000 PY; the corresponding range for AUD was 43.24-80.04, and the difference in effect size across predictors was more pronounced where AUD preceded PTSD. Comorbidity exacerbated risk: The interaction between PTSD and AUD accounted for 71.13-179.41 additional SA cases per 10,000 PY. In secondary models, interactions between AUD and MD conferred additional SA risk (40.50-127.88 additional SA cases per 10,000 PY), while interactions between PTSD and MD were very weak and, in most cases, negative (-13.26-3.29).

Conclusions: PTSD and AUD are independently associated with SA, but risk is substantially exacerbated among comorbid individuals. While the total effect of these conditions on SA risk is overall comparable across sexes, females whose PTSD precedes AUD are particularly burdened by comorbidity.

Purpose: Social disconnection has been linked to adverse health outcomes, including higher risks of mental disorders. However, previous studies have primarily focused on depression, with limited exploration of other mental disorders and demographic variations. This study investigates the association between social disconnection and a range of subsequent mental disorders in a large, population-based cohort.

Methods: A cohort study was conducted using data from 162,483 participants of the Danish National Health Survey, linked to national health registers. Social disconnection was assessed through survey measures of loneliness, social isolation, and low social support. Incident cases of mental disorders were identified using hospital-based diagnoses and included in seven categories. Poisson regression was applied to estimate incidence rate ratios (IRRs) adjusted for demographics, country of birth, and socio-economic resources.

Results: Individuals who were socially disconnected had a higher incidence rate of mental disorders in all seven categories: substance use disorders, schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, neurotic and anxiety-related disorders, personality disorders, and a combined category of any aforementioned disorder. Loneliness overall showed the strongest associations (range of IRRs, 2.94 to 4.94) compared to social isolation (range of IRRs, 1.47 to 4.80) and low social support (range of IRRs, 1.32 to 2.82). While associations were generally similar across sexes, contrasting age trends were indicated for loneliness and social isolation.

Conclusion: Strong associations were consistently found between social disconnection and subsequent mental disorders, highlighting the potential for targeted public health interventions. Future research should investigate causal mechanisms and directional relations to refine prevention strategies.

Background: Loneliness is increasingly recognized as a global public health concern linked to adverse mental health outcomes. However, cross-national evidence on its distribution and association with depression and generalized anxiety is limited.

Methods: We analyzed data from the 2023-2024 Global Social Determinants of Health Survey, a cross-sectional, nationally representative survey of 7,997 adults across Brazil, France, India, Indonesia, Nigeria, the Philippines, Türkiye, and the United States. Depression and generalized anxiety were measured using PHQ-9 and GAD-7 screening tools, respectively, while loneliness was self-reported. Weighted bivariate and multivariate (logistic and Poisson regression) models were used to estimate associations between loneliness and mental health outcomes, adjusting for demographic factors.

Findings: Overall, 38.9% of respondents reported loneliness, 9.2% met criteria for depression, and 5.5% for generalized anxiety. Loneliness was more common among younger adults, women, individuals with lower income or education, unmarried individuals, and urban residents. In fully adjusted models, loneliness was associated with depression (OR 2.82 [95% CI: 2.25-3.54]) and generalized anxiety (OR 3.89 [95% CI 2.86-5.28]).

Interpretation: Loneliness is common and strongly associated with depression and generalized anxiety across diverse settings. These findings underscore the importance of integrating strategies that promote social connection into mental health policy and interventions. Future research should explore causal pathways.

Purpose: Racial discrimination is consistently linked with post-traumatic stress symptomatology. It is essential to identify adaptive coping strategies in order to disrupt racial disparities in mental health. Proactive coping with discrimination-efforts taken before or during an exposure in order to minimize its harmful effects-is a potential avenue to minimize race-based traumatic stress.

Methods: We tested proactive coping as a moderator of the association between everyday discrimination and race-based traumatic stress symptoms among 1,433 racially diverse U.S. young adults. We further disaggregated results to examine trends across Asian, Black, and Latiné respondents.

Results: In the full analytic sample, proactive coping appeared to exacerbate the link between everyday discrimination exposure and race-based traumatic stress symptoms. The race-stratified analyses suggest that this finding was driven by Black and Latiné young adults. In Asian respondents, there was no moderation nor a direct association of proactive coping.

Conclusion: The results suggest that proactive coping may reflect increased racial vigilance and self-monitoring-behaviors reflective of traumatic stress symptomatology. Future research must further disentangle anticipatory coping styles to understand their unique utility and identify means of promotion. Clinicians might prioritize using mindfulness- and acceptance-based therapeutic approaches with clients, to mitigate vigilance and avoidance of stressful race-related emotionality.

Background: Depression, loneliness and other psychological distress symptoms are common in the US; lifetime cumulative estimates and life course prospective persistence is under-studied. We use national data with repeated assessment to provide lifetime cumulative risk estimates for the US.

Methods: Longitudinal data from Monitoring the Future panel study on individuals (N = 421) followed from age 18 (in 1976-1978) to age 60 (in 2018-2020), with mean = 12.4 assessments (range 5-13). Psychological distress included three subscales: loneliness (2 items), low self-esteem (4 items), depressive symptoms (4 items).

Results: By age 60, 73.91% had [Formula: see text]1 period of high loneliness; 24.84% had 3+ periods of high loneliness. A total of 65.72% had [Formula: see text]1 period of low self-esteem. Most risk accumulated during early adulthood; 56.40% had high loneliness and 46.38% had low self-esteem by age 25/26. Those with high loneliness at age 18 had 3.72 (95% C.I. 2.09, 6.63) times the odds of high loneliness, 4.28 (95% C.I. 2.10, 8.71) times the odds of high depressive symptoms, and 2.61 (95% C.I. 1.47, 4.65) times the odds of low self-esteem at age 60. Associations were of similar magnitude for age 18 low self-esteem predicting age 60 distress.

Conclusion: By age 60, most US adults will have experienced at least 1 period of high loneliness or low self-esteem, and the majority of risk accumulates early in adulthood. Adolescent distress prospectively predicts later life distress, thus intervention and prevention efforts in adolescence are potentially critical for addressing late life mental health problems.

Background: Informal caregivers play a vital role in the long-term community care of individuals with severe mental disorders but often face substantial psychological challenges. China's national '686 Program' offers free or subsidized medical treatment, follow-up care, and community-based services for people with severe mental disorders on an equitable basis. However, limited evidence exists regarding the mental health status of informal caregivers within this program. This study aimed to assess the prevalence of high caregiver burden, depression, and anxiety, and to identify associated factors among informal caregivers enrolled in the '686 Program'.

Methods: A cross-sectional study was conducted in Hainan Province, China, involving 284 informal caregivers recruited through multistage sampling. Data were collected via structured, face-to-face, in-home interviews between May and September 2024. Caregiver burden, depression, and anxiety were assessed using the 12-item Zarit Burden Interview (ZBI-12), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Binary logistic regression analyses-together with prespecified stratified and sensitivity analyses-were conducted to identify independent predictors of each outcome.

Results: Among the 284 participants, 63.7% experienced high caregiver burden, 11.6% met criteria for clinically significant depression, and 17.6% for clinically significant anxiety. Multivariate analysis showed that higher PANSS scores and greater social disability (SDSS) in care recipients were the most consistent predictors across outcomes. Depression was independently associated with being female, having a parental relationship to the patient, and caring for individuals with greater functional impairment; longer illness duration (≥ 11 years) was linked to lower risk. Anxiety was more likely among female caregivers and those supporting patients with more severe symptoms. Diagnostic heterogeneity did not materially alter these associations in sensitivity analyses.

Conclusion: Informal caregivers under China's '686 Program' experience high rates of burden, depression, and anxiety. Key associated factors include patient symptom severity, caregiver gender, and the caregiving relationship. By focusing on caregivers within a national mental health initiative, this study provides evidence to inform caregiver support strategies both in China and in similar global contexts pursuing community-based mental health reforms. These findings highlight that structural equity in patient services alone is insufficient unless caregiver needs are explicitly incorporated into system design.

Purpose: How well the over 200,000 U.S. servicemembers who complete military service each year navigate the transition to civilian life may impact their later-life outcomes, with smoother transitions increasing resilience to later life stressors and leading to better long-term outcomes. The purpose of this study was to examine whether veterans who experience better military-to-civilian transitions are less vulnerable to poor mental health when faced with later stressors.

Methods: Data were drawn from a population-based sample of U.S. veterans (N = 9,566) who completed six biannual surveys on their health and well-being throughout the first three years following separation from military service (2016-2019), and another a year into the COVID-19 pandemic (2021). We examined veterans' vocational, financial, and social readjustment patterns using latent growth modeling and impacts on subsequent mental health using logistic regressions.

Results: The majority of veterans reported consistently high vocational and social well-being but low financial well-being during the initial transition from service, with approximately 15% reporting declining well-being in each domain. In turn, well-being trajectories predicted veterans' odds of experiencing probable mental health conditions (depression and anxiety) during the pandemic, even after accounting for background characteristics, prior mental health, and additional stressful/traumatic experiences. In contrast with those with consistently low well-being, those with initially low then increasing vocational, financial, and social well-being reported similar mental health as those with consistently high well-being.

Conclusions: These results underscore the importance of bolstering support for transitioning veterans and point to strategies that can be applied to improve their longer-term mental health.

Purpose: Agricultural producers face unique stressors that significantly impact mental health, including depressive symptoms, anxiety, and suicidal ideation. This study offers a novel application of the Stress Process Model (SPM) to examine how agriculture-related stress, social support, and resilience shape mental health outcomes among agricultural producers.

Methods: N = 525 Illinois farmers participated in mailed surveys, with data collected in two panels: June-August 2020 (N = 296) and March-May 2021 (N = 229). Participants completed the Perceived Stress Scale, Farm Stress Survey, Multidimensional Scale of Perceived Social Support, and Brief Resilient Coping Scale. Mental health outcomes were assessed, along with general health. Data was analyzed using structural equation modeling in R.

Results: Higher perceived and agricultural stress were linked to increased depressive symptoms, anxiety symptoms, and suicidal ideation. Social support reduced depressive symptoms (β = -0.121, p < .001) and suicidal ideation (β = -0.216, p < .001), mediating and moderating the relationship between stress and mental health. Resilience moderated the effects of stress, lowering depressive symptoms (β = -0.100, p = .001) and anxiety symptoms (β = -0.088, p < .001).

Conclusion: Findings highlight the importance of addressing occupational stress, enhancing social support, and promoting resilience to improve the health of agricultural producers. Interventions should target stress reduction and support systems based on the SPM framework.

Purpose: Physical illness describes long-term physical health conditions such as asthma, diabetes, and epilepsy. Mental or neurodevelopmental disorder (MND) that co-occurs with physical illness in childhood is associated with poorer outcomes for children and their families. There is a need for contemporary estimates of physical-MND burden to inform resource allocation and reduce occurrence. This descriptive study estimated the prevalence of morbidity status and compared prevalence of MNDs among children with or without physical illness.

Methods: Data come from the 2019 Canadian Health Survey on Children and Youth, a representative cross-sectional study conducted by Statistics Canada. Physical illnesses and MNDs were reported by the person most knowledgeable about the child.

Results: The sample included children aged 5 to 17 years (n = 33,715). In total, 49.5% of children had at least one physical illness and 17.9% had at least one MND. Physical-MND multimorbidity was reported for 9.8% of children. Among children with any physical illness, MNDs were present in 19.9%. Among children with no physical illness, the prevalence of MNDs was 14.1%. Differences in prevalence of MNDs across types of physical illnesses were small in magnitude (h=-0.02 to 0.35).

Conclusion: Findings show that childhood physical-MND multimorbidity is common, highlighting the need for screening of MNDs among Canadian children with physical illness. Integrated care models are necessary to comprehensively address the physical and MND health needs of children. These estimates of morbidity snapshot the time immediately prior to the COVID-19 pandemic and have critical utility as baselines for future post-COVID-19 studies.