Social Psychiatry and Psychiatric Epidemiology最新文献

Background and objectives: Bipolar Disorders affect 2% of the world population and ranks as the sixth leading cause of disability. Barriers such as lack of insight and limited access to healthcare result in a significant disease burden. These barriers can be mitigated by technology-delivered interventions such as ecological momentary interventions, which provide personalized, real-time treatments based on ecological momentary assessments of relevant variables. This review aimed to assess the effectiveness of ecological momentary interventions in bipolar disorder.

Methods: We conducted searches across Medline, Scopus, CENTRAL, psychINFO and ProQuest without applying any filter through December 30, 2023. Two authors screened results to eliminate irrelevant and duplicate studies, and the remaining studies were independently reviewed. Data were extracted, transformed into a common rubric, and analyzed for treatment effects using Review Manager 5.

Findings: We analyzed 14 studies, encompassing 1776 patients with bipolar disorder. Interventions were mostly based on psychoeducation and cognitive behavioral therapy. EMI had small to moderate effects on quality of life (SMD = 0.24; 95% CI = 0.04-0.44, P = 0.02; I² = 47%), medication adherence (SMD = 0.21; 95% CI = 0.03-0.39, P = 0.02; I² = 0%), and affective episodes (HR = 0.75; 95% CI = 0.57-0.98, P = 0.04; I² = 0%).

Conclusion: Ecological momentary intervention is a novel area of research in behavioral science. The results of this systematic review based on the available literature suggest that these interventions could be beneficial for patients with bipolar disorder.

Background: Sleep duration and physical activity have been associated with internalizing problems. However, genetic confounding and measurement error may introduce bias. We assessed genetic confounding in the associations of modifiable lifestyle with internalizing problems using device-based and questionnaire assessments to estimate shared genetic risk across different assessments in adolescents.

Methods: In this preregistered study in the Adolescents Brain Cognitive Development cohort, we included European adolescents with both self-reported and device-based sleep duration (N = 2283) and moderate/vigorous physical activity (MVPA, days/week, N = 2772). We used the Brief Problem Monitor to assess self-reported internalizing problem scores. Genetic sensitivity analyses were conducted to assess genetic confounding by combining polygenic scores and molecular-based heritability of internalizing problems.

Results: Longer sleep duration was associated with lower internalizing problems using both self-reported (-0.15-SD, SE = 0.02-SD) and objective (-0.10-SD, SE = 0.02-SD) assessments. More frequent MVPA was associated with lower internalizing problems using both self-reported (-0.09-SD, SE = 0.02-SD) and device-based (-0.06-SD, SE = 0.02-SD) assessments. Substantial genetic confounding (81%) was found between self-reported sleep duration and internalizing problems, predominantly among boys. No clear evidence of genetic confounding was found in the associations of device-based sleep duration or either measures of MVPA with internalizing problems.

Conclusion: The observed negative relationship between reported child sleep duration and internalizing problems may be partly due to genetic confounding, particularly among boys. This genetic influence likely captured reporting measurement error of shared method variance. The impact of adolescent sleep duration on internalizing problems may be overestimated by self-reports, especially among boys, whereas associations of physical activity were not genetically confounded.

Purpose: Psychological distress (PD) affects health and healthcare utilization. This study uses a novel, comprehensive social determinants of health (SDOH) risk score to examine the association between cumulative social disadvantage and PD in a large, nationally representative sample from the National Health Interview Survey (NHIS).

Methods: Data from the 2013 to 2017 NHIS was employed, including 124,361 adults aged ≥ 18 years. The Kessler 6 scale was used to assess PD. We measured SDOH across five domains: economic stability, education, healthcare system, neighborhood, and food security. An SDOH aggregate score was calculated, representing the cumulative number of individual unfavorable SDOH. Multivariable models were utilized to examine the association between SDOH score quartiles and PD.

Results: A total of 124,361 adults (mean [SD] age 50.2 [18.1] years; 67,035 women [53.9%]) were included in the analysis. In models fully adjusted for age, sex, ethnicity, region, cardiovascular risk factors, atherosclerotic cardiovascular diseases, and comorbidities, participants in the highest quartile of adverse SDOH burden (Q4) were associated with higher odds of moderate PD (OR, 3.67; 95% CI, 3.42-3.93) and severe PD (OR, 15.23; 95% CI, 11.97-19.36), respectively, than those in Q1. At nearly each quartile, a higher prevalence rate of PD was observed among females, middle-aged, and non-Hispanic White adults compared to their counterparts.

Conclusions: In a large, nationally representative sample of US adults, adverse SDOH was associated with increased PD. Assessing and mitigating the multifaceted adverse SDOH could serve as a strategy to help identify individuals with PD and improve existing PD prevention frameworks.

Background: People living with schizophrenia face disproportionate risk of HIV, yet HIV testing remains low. Differential testing rates and engagement in care may be impacted by compounding social marginalization, partly linked to structural barriers. Grounded in intersectionality, we set out to identify the riskiest intersectional positions for HIV testing and engagement in HIV care in the United States.

Methods: We created a retrospective cohort of people living with schizophrenia and matched controls, using 2012 national Medicaid claims data. We coded intersectional positions based on schizophrenia diagnosis, race/ethnicity, sex, and age. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) models to assess intersectional effects for two outcomes, HIV testing and retention in HIV care (RIC) defined as ≥2 CD4 or HIV viral load tests ≥90 days apart.

Results: Of 777,887 patients in the testing cohort, 7.7% tested for HIV; 39% of the 17,913 patients in the RIC cohort were retained in care. In MAIHDA models without fixed effects, intersectional positions explained 12.7% of the variance in HIV testing and 7.4% of the variance in RIC. In final models including fixed and random effects, intersectional positions accounted for 1.4% of the variance in HIV testing and 0.8% of the variance in RIC. Older Black men with schizophrenia had lower-than-expected RIC prevalence in final models.

Conclusion: Intersectional MAIHDA models can identify both vulnerable and resilient intersectional positions. The antagonistic intersectional effects for older Black men with schizophrenia highlight the need for targeted interventions to address structural barriers.

Purpose: We assessed the association between number of adverse childhood experiences (ACEs) and depression among adults and explored the association by race/ethnicity.

Methods: We used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) among 127,577 adult respondents (≥ 18 years old). The exposure was the number of ACEs classified as zero, one, two-three, and ≥ four. The outcome was a self-reported history of depression diagnosis (yes/no). Weighted multivariable logistic regression models examined the association between ACEs and depression stratified by race/ethnicity. Each model was adjusted for age, gender, smoking status, income, education, marital status, and body mass index.

Results: In this sample, 36%, 23%, 21%, and 20% reported having experienced zero, one, two-three, and ≥ four ACEs, respectively. Depression was reported by 19% of survey respondents. There was a significant interaction between the number of ACEs and race/ethnicity, and depression (p = 0.0003), thus, analyses were stratified by race/ethnicity. Respondents who experienced ≥ 4 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR = 4.07; 95% CI: 3.55, 4.65), non-Hispanic Blacks (aOR = 3.96, 95% CI: 2.68, 5.86), or Hispanics (aOR = 7.73; 95% CI: 4.48, 13.35). Respondents with 2-3 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR: 2.41, 95% CI. 2.11- 2.76), non-Hispanic Blacks (aOR: 1.94, 95% CI. 1.19- 3.17), and Hispanics (aOR: 2.86, 95% CI. 1.64- 4.98).

Conclusion: We found that individuals with two or more ACEs were more likely to report a depression diagnosis, irrespective of race/ethnicity. This finding highlights the need to monitor individuals with an increasing number of ACEs for depression.

Introduction: Holocaust survivors were exposed to extreme trauma. More than half a million survivors immigrated to Israel over the years, as well as immigrants who didn't suffer the atrocities of the holocaust. Trauma and immigration are both risk factors for mental disorders.

Aim: To describe differences in hospitalization characteristics and to determine whether there are differences in illness severity between mentally ill Holocaust Survivor Immigrants (HSI), non-Holocaust immigrants (NHI), and Native Israelis (NI).

Methods: An unidentified list of hospitalized psychiatric patients was extracted from the Israel psychiatric case registry according to the following criteria: Jewish patients who were born in Europe or Israel before 1944 and were admitted to a psychiatric ward between 1945 and 2010. 30,539 records were divided into three groups: Holocaust Survivor Immigrants, Native Israelis, and Non-Holocaust Immigrants.

Results: The number of first hospitalizations after age 70 is significantly higher at the HSI and NHI compared to NI. A significantly higher rate of suicide attempts was observed among HSI (13.8%), compared with the NI (11.8%) and NHI (9.7%). The odds for severe mental illness were significantly higher among HSI and NHI compared to NI by 84% and 66% among patients with psychotic disorders, twofold higher, and higher by 37% among patients with affective disorders, and threefold and 2.5 times higher among patients with anxiety.

Conclusions: Exposure to the Holocaust trauma has an effect on patterns of psychiatric hospitalizations and the severity of Holocaust survivors' psychiatric illness. Immigration is an independent risk factor for severe mental illness, although its influence was less pronounced than direct Holocaust exposure. Exposure to severe trauma such as war during childhood has long-term effects on the course and severity of mental illnesses.

Background: This study examines whether adherence to the Mediterranean diet (MD), alone and combined with physical activity (MedEx), is associated with cognitive decline and dementia incidence, with socioeconomic status (SES) as a potential modifier.

Methods: We included 8,568 subjects (mean age 72.3 ± 9.6 years, 52.4% female) from three pooled Italian population-based studies. MD adherence was assessed using the Panagiotakos algorithm. We analyzed the association of MD and MedEx adherence, both continuously and categorized in tertiles, with cognitive decline and incident dementia using Cox regression. SES modification was examined through interaction analysis and SES-stratified models.

Results: Cognitive decline occurred in 38.1% of participants but was not associated with MD adherence. In SES-stratified analysis, among high SES individuals, each 2-point increase in MD adherence reduced cognitive decline risk by 14%, and high MD adherence was associated with a 48% reduction (HR 0.52, 95%CI 0.31-0.90). In this group, medium MedEx adherence reduced cognitive decline risk by 77% (HR 0.23, 95%CI 0.07-0.83). No significant association was found between MD/MedEx adherence and incident dementia (4.2%), regardless of SES.

Discussion: SES may modify the relationship between MD and cognitive decline, with greater benefits observed in higher SES groups. Further studies, particularly in vulnerable populations, are needed to inform tailored preventive strategies for cognitive decline.

Purpose: We examined courses of distress in US veterans before, during, and after the COVID-19 pandemic and the impact of demographic and environmental characteristics on patterns of distress.

Methods: We used survey data (n = 1064; M_age = 38.85, 49.1% female) from the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study. Using data from three time points (pre-pandemic, peri-pandemic, and post-pandemic), participants were classified into one of five groups based on whether they met clinical cut-offs for depression, generalized anxiety, and/or PTSD at a given time point. We then examined demographic and environmental correlates of group membership and used relative importance analyses to identify the strongest correlates of group membership.

Results: For female and younger veterans, distress increased from pre-pandemic to peri-pandemic, decreased from peri-pandemic to post-pandemic, and then returned to pre-pandemic levels two years later. For male and older veterans, there was no change in distress from pre-pandemic to peri-pandemic, an increase in distress from peri-pandemic to post-pandemic, then a return to pre-pandemic distress levels. Most participants were classified as Resistant (60.1%), followed by Persistent (20.5%), Remitted (7.6%), Exacerbated (6.4%), and Resilient (5.5%). Income, community danger, neighborhood cohesion, and post-pandemic related distress were the strongest correlates of persistent distress, the most vulnerable group.

Conclusion: Overall, veterans were resilient in response to the pandemic. However, findings suggest that female and younger veterans were disproportionately impacted. The relationships we identified between environmental factors and persistent distress underscore the need for interventions that address both individual and structural factors that impact distress.

Purpose: Improving population mental health will require greater investment in prevention, yet the level of community support for such efforts is unclear. This study aimed to examine the Australian public's attitudes about the prevention of mental health problems (e.g. depression and anxiety conditions).

Methods: A probability-based panel provider recruited 6,142 Australians aged 16-75 + to complete an online survey. Survey items were developed to assess attitudes about prevention of physical and mental health problems, and support for government action on prevention of mental health problems. Data were weighted to be representative of the Australian adult population.

Results: 80.9% of respondents rated mental health as a top Australian government priority to prevent health problems. 14.6% of respondents thought that mental health problems were not preventable, 24.3% were not sure, and 61% agreed they were preventable, with younger adults being more positive. 79.5% of respondents agreed that the Australian government should play a role in preventing mental health problems in the population and 64.7% thought mental health funding should be spent equally on prevention and treatment. The most important age groups to focus on were adolescence and young adulthood and the most important areas were healthy housing, mental health promotion in schools, and reducing socioeconomic inequality.

Conclusion: There was strong support for prevention of mental health problems as a government priority to improve the health of Australians. Findings can inform where prevention literacy efforts should focus and where government investment in prevention should be targeted to align with community expectations.

Purpose: Previous studies document the clustering of major psychiatric disorders (MPDs) - schizophrenia, bipolar disorder, depression, and anxiety - among siblings. Few studies have, however, examined whether MPDs during childhood and early adulthood are associated with siblings' future socioeconomic status (SES).

Methods: This cohort study included 57,537 full siblings, 4653 paternal, and 5053 maternal half-siblings of individuals with MPDs (affected probands) born in Finland between 1970 and 1990. We defined the reference groups as identical types of siblings of individuals without an MPD diagnosis (unaffected probands) and followed both siblings of the affected and unaffected probands until December 31, 2020. MPDs diagnosed among the affected probands at ages 5-25 was obtained from the Finnish Care Register. Their siblings' SES was measured based on employment status, annual disposable income, and educational achievement. Logistic regression, median regression, and generalized estimating equations (GEE) were used to estimate the associations.

Results: Compared to the siblings of the unaffected probands, the odds of unemployment at the end of follow-up were 35% higher (95% CI: 1.31-1.39) in full siblings of affected probands with an MPD. Full siblings of affected probands were also more likely not to achieve a higher education level (aOR: 1.28, 95% CI 1.24-1.31). The median annual disposable income was 1255.9 EUR lower (95% CI: -1385.6, -1126.3) in full siblings of affected probands. Similar but weaker associations were observed in maternal and paternal half-siblings. Results from GEE models using repeated measurements of income and unemployment were similar.

Conclusion: Our findings suggest that the socioeconomic consequences associated with MPDs extend to siblings.