Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose: Postpartum depression (PPD) is a complex condition that can have negative outcomes for mothers, children, and their families and may affect mothers' quality of life (QoL(. This study examined the impact of PPD symptoms (PPDs) on QoL among mothers in the first year postpartum, with a particular focus on vulnerable populations, specifically Arab women, and comparing them with Jewish mothers in Israel.

Methods: For this cross-sectional study, we recruited 601 mothers (478 Jewish, 123 Arab), up to 12 months postpartum. The questionnaire battery included the Edinburgh Postnatal Depression Scale (EPDS) and the WHOQoL-BREF Assessment (QoL). Elevated PPD symptoms were defined as EPDS ≥ 13. Statistical analysis included bivariate associations and multiple linear regression to identify factors associated with QoL, adjusted for sociodemographic and obstetric variables.

Results: The prevalence of PPDs in this sample was 23.8%, with 21% among Jewish and 33% among Arab mothers. PPDs were significantly associated with QoL, with higher EPDS scores correlating with lower QoL scores. Ethnicity also showed a significant association with QoL, with Arab mothers reporting lower QoL. Additionally, low income, unemployed mothers, and those experiencing obstetric complications reported significantly lower QoL.

Conclusion: These findings highlight the importance of early screening, diagnosis, and treatment of PPD to improve postpartum QoL. The observed disparities underscore the need for culturally tailored interventions to address ethnic differences. Future research should develop targeted strategies addressing psychological and socioeconomic factors in vulnerable populations effected by PPD.

Purpose: Food insecurity is increasingly linked with disordered eating. However, studies have not yet explored impacts of childhood food insecurity on disordered eating in adolescence. This study examined the links between patterns of childhood food insecurity and adolescent disordered eating.

Methods: Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort in the UK (6,723 participants; 55.7% girls). Food insecurity was reported by mothers from pregnancy to age 7. Disordered eating was reported by adolescents at ages 14, 16, and 18.

Results: Most participants experienced no food insecurity throughout childhood (n = 5,801, 77.9%), followed by low food insecurity (n = 416, 12.4%), time-limited food insecurity (n = 292, 6.0%), and persistent food insecurity (n = 214, 3.7%). At age 14 adolescents in the time-limited food insecurity group had higher odds of binge eating (OR = 1.63, p = .040), and those in the persistent food insecurity group had higher odds of compensatory behaviours compared those in the no food insecurity group (OR = 1.72, p = .025). No significant associations were observed with disordered eating at age 16. At age 18 adolescents in the time-limited food insecurity group compared to the no food insecurity group had higher odds of compensatory behaviours (OR = 1.68, p = .041).

Conclusions: Findings showed that childhood food insecurity was linked with higher odds of disordered eating in adolescence. Interestingly, associations were observed for those experiencing either time-limited or persistent food insecurity, highlighting the potential impact of early childhood experiences.

Purpose: The death of a loved one is one of life's most ubiquitous events that can increase risk of mental health difficulties. Bereavement support is one of the few factors influencing grief-related mental health outcomes that can be modified after bereavement. This study sought to determine the proportion of bereaved people that want and receive support from different sources following a bereavement, and the bereavement and mental health-related factors associated with wanting and receiving bereavement support.

Methods: Data was derived from a cross-sectional survey of bereaved adults (n = 1170) living in Ontario, Canada.

Results: Over a third of the sample (38.9%; n = 455) reported wanting support in coping with their loss. These individuals exhibited distinct loss-related characteristics and reported higher levels of anxiety, depression, and prolonged grief symptoms. Most of these individuals received support and a small number of participants who didn't want support received it regardless. The most common sources of support were family members, friends, and other bereaved individuals, and these sources were generally found to be helpful. Those who accessed multiple types of support were those with the highest levels of anxiety, depression, and prolonged grief symptoms.

Conclusion: Most individuals wanting support after a loss can access it and find it beneficial. The desire for support is closely tied to psychological distress, highlighting the need to prioritize formal support for those in distress and rely on existing social networks for those who are not. Such an approach embodies an 'assets-based' bereavement model, enhancing community capacity for effective support provision.

Background: Many young people with first episode psychosis (FEP) experience challenges in key areas of social inclusion, including housing, finances, employment or education, and social relationships. However, there is diversity in these challenges, and it is unclear how social inclusion relates to potentially modifiable treatment factors such as social cognition. Here we aimed to identify distinct social inclusion profiles using cluster analysis and examine their associations with social cognition and other clinical factors.

Methods: 145 young people (aged 15-25) who had experienced a FEP completed assessments of demographics, clinical symptomology, social inclusion, functioning, quality of life (QoL), and social cognition. K-means cluster analyses identified social inclusion subgroups. Kruskal-Wallis and Wilcoxon rank-sum post-hoc tests were used to compare subgroups on psychosocial factors and multinomial regression models were used to examine whether social cognition was associated with the subgroups, controlling for clinical factors.

Results: Three clusters emerged: low inclusion/low participation (LI-LP), moderate inclusion/low participation (MI-LP), and high inclusion/high participation (HI-HP). Social cognition was not associated with subgroup membership. LI-LP had greater depressive and less expressive negative symptoms than both other subgroups, and more severe motivation/pleasure negative symptoms than HI-HP.

Conclusion: Distinct FEP subgroups with varying subjective and objective social inclusion, shaped by external psychosocial and clinical factors were revealed. The findings highlight the need for holistic and personalised care to improve social inclusion for individuals with FEP and suggest that targeting depressive and motivational negative symptoms may be potential avenues to achieve this.

Objective: To examine patterns of recent service use to predict non-fatal suicidal events shortly following emergency department (ED) visits for mental health.

Methods: For this retrospective cohort study, we used Optum electronic health record data from 2,445,597 ED mental health episodes (2015-2022) for persons aged ≥ 10 years. We then constructed a series of logistic regression models to evaluate how six permutations of characterizing prior 180-day mental health service use predicted acute non-fatal suicidal events within 180 days of ED discharge beyond demographic characteristics and ED mental health diagnoses. Model performance was assessed by area under the receiver operating curve (AUC).

Results: Overall, 7.2% (n = 176,000) of episodes resulted in an acute suicidal event within 180 days. Model performance improved from demographic characteristics and ED mental health diagnoses (AUC = 0.76) when past 180-day service use variables were added, but with minimal differences between a binary variable of any mental health service use compared to monthly counts, weighted slopes, or interactions (AUC's 0.78-0.82). The final model containing demographics, ED mental diagnosis, and past 180-day service use yielded an AUC of 0.83. The most predictive past service use variables were any inpatient or ED event for self-harm or suicide ideation (OR = 5.45, 95% CI = 5.37, 5.54) and any ED mental health visit (OR = 1.87, 95% CI = 1.84, 1.90).

Conclusions: As part of evaluating suicide risk in ED settings, information about recent acute care for mental health, suicidal ideation, or self-harm use significantly contributes to the short-term prediction of non-fatal suicidal events.

Purpose: Previous prospective findings of elevated risk of depression following exposure to stressful work in terms of effort-reward imbalance (ERI) were based on a single exposure measurement. With this study, we set out to analyse longitudinal associations of single and twofold exposure measurement with depression among middle-aged employees.

Methods: Data were derived from the first two waves (2011 and 2014) of the prospective lidA cohort study in Germany, including 3,104 middle-aged employed men and women. Participants with depression at baseline were excluded. Work stress (effort-reward ER) ratio and work-related over-commitment (WOC) and depression (Beck's Depression Inventory) were assessed at both waves. Time-invariant (birth year, sex, education) and time-varying covariates (employment, control, physical health) were adjusted for. Multiple logistic regression analyses were conducted to estimate the odds of depression for single or twofold high exposure, and generalized estimation equations (GEE) to analyze mean associations between moderate and high exposure and outcome over both waves.

Results: 5.9% of male and 9.8% of female participants experienced depression during the observation period. Cases were more frequent among those scoring high on work stress measures, those with poor physical health and part-time work. In the fully adjusted GEE model, the estimated risk ratio of depression was 1.60 (95%-CI: 1.05; 2.44) for moderate and 2.49 (1.67; 3.71) for high exposure to ERI work stress on average over time. Similar effects were observed for WOC.

Conclusion: Elevated risk ratios of depression were observed in associations with moderate and high exposure to stressful work (ERI) over time.

Purpose: Psychiatric disorder is a well-established risk factor for homelessness, and homelessness amplifies social, physical, and mental health risks. Yet, little is known about the extent and nature of diagnostic delays, including the duration of untreated psychosis (DUP), among homeless individuals with schizophrenia. This study aimed to address that gap by examining DUP, diagnostic delays, illness trajectories, psychopathology, and substance use in this population.

Methods: We conducted an exploratory cross-sectional study of 35 homeless individuals with schizophrenia, using in-depth psychosocial interviews, standardized psychopathological assessments, and social functioning scales, incl. the Positive and Negative Syndrome Scale (PANSS) and the Examination of Anomalous Self-Experience (EASE).

Results: The sample (mean age 32.6 years; 82.9% male) included 17 patients with paranoid schizophrenia and 10 with disorganized (hebephrenic) schizophrenia; 54% had a comorbid substance use disorder (SUD). The mean DUP was 15.5 years, with an average 6.7-year delay between first psychiatric contact and formal non-substance induced psychosis diagnosis. Patients with SUD showed shorter DUP compared to those without. Psychopathological measurements - including a mean PANSS score of 71.7 and a mean EASE score of 21.3 - were comparable to other schizophrenia samples, with no major differences between patients with or without SUD.

Conclusion: Our findings indicate that the extraordinarily long DUP and diagnostic delays in this homeless sample are not explained by substance use, symptom profile, or schizophrenia subtype but point to systemic barriers in recognizing and managing severe mental illness. There is an urgent need to improve psychiatric services for homeless individuals with schizophrenia.

Purpose: Given the prevalence and diversity of eating issues among adolescents, understanding the epidemiological aspects of orthorexia nervosa (ON) in this demographic, along with identifying associated clinical factors, sociodemographic traits, eating habits and parental attitudes, holds paramount importance both clinically and scientifically. This study aimed to ascertain the prevalence of ON among Turkish high school adolescents aged 14-18 and explore potential correlates of this clinical condition.

Method: In the initial phase, 1784 adolescents completed the Data Form, Orthorexia Nervosa Inventory (ONI) and Parent Style Scale (PSS), while their parents filled out the the parental version of the revised Child Anxiety and Depression Scale (RCADS). Subsequently, clinical interview and The Kiddie-Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (KD-SADS-PL) were conducted with 9 adolescents with high risk for ON to assess comorbidities.

Results: The study revealed ON prevalence of 0.5%, with 0.3% in boys and 0.6% in girls. Rural residency, dietary supplement use, and pet ownership correlated with higher ONI scores (p = 0.022, p = 0.002, p = 0.042 respectively). OCD and panic disorder symptoms (B = 0.307, p < 0.001 and B = 0.165, p = 0.018 respectively), increased BMI, and anxiety scores were associated with elevated ONI scores. Authoritarian parenting was significantly related to ONI total scores (B = 1.69, p = 0.018).

Conclusion: This study significantly contributes to the literature by delineating the prevalence of ON in adolescents, identifying associated risk factors, elucidating psychopathological associations of orthorexic symptoms, and identifying the relationship between parenting styles and ON. Such insights into the factors influencing ON can aid in demystifying its nature.

Introduction: Night eating syndrome (NES) involves hyperphagia and nocturnal ingestion, causing significant distress and impairment. Despite its impact, NES is poorly understood and underdiagnosed both in clinical and community settings. Prevalence rates vary, highlighting the need for further research in community samples.

Purpose: To assess NES prevalence in a community sample and its relationship with sleep disturbances, eating patterns, and psychopathology.

Method: A total of 746 participants (ages 21-51), including 377 men (50.5%), were recruited through a large Israeli online platform. Participants completed self-report demographic data and questionnaires assessing NES, sleep disturbances, eating patterns, and psychopathology.

Results: The prevalence of NES (night eating questionnaire/NEQ: score > 25, score > 21) was 8.8% and 18.2%, respectively. No significant differences in NES prevalence were found between genders or age groups in most of the variables. There were no significant differences between the NES and non-NES groups in terms of BMI, age, or gender. However, significant differences were found in sleep disturbances (PSQI total), depression, and anxiety. The NES group was significantly associated with higher levels of fat and carbohydrate consumption during the evening and night.

Conclusion: The NES prevalence among study participants was relatively higher than among previous community samples worldwide, despite participants having a BMI within the normal range. The higher prevalence, along with the significant associations with lower sleep quality, higher levels of anxiety and depression, and increased fat and carbohydrate consumption, underscore the need for greater emphasis on the diagnosis, treatment, and prevention of NES in the community beyond cultural differences.

Background: Evaluating the decision-making capacity of individuals with Severe Mental Disorder (SMD) is essential for compliance with the 2006 Convention on the Rights of People with Disabilities. In Spain, capacity was historically determined through judicial procedures, resulting in partial or total capacity modification (CM). The abolition of this procedure in 2021 has left a gap in addressing the needs of this population, creating challenges under the new legal framework.

Aim: The RECAPACITA project studied the clinical, neuropsychological, and functional profiles of individuals with SMD and CM, focusing on differences between partial (pCM) and total (tCM) modifications.

Methods: A cross-sectional study was conducted with 77 adult patients with SMD and CM (47 tCM, 30 pCM) from the Parc Sanitari Sant Joan de Déu mental health network (Spain). Sociodemographic, clinical, functional, and neuropsychological data were collected, along with an independent assessment of mental capacity.

Results: Around 87% of sample had a schizophrenia spectrum disorder; pCM patients presented more substance-related and personality disorders as a secondary diagnosis. While no statistically significant differences were observed between groups, clinically, tCM group presents greater clinical alteration, lower insight, sustained attention, coding capacity, processing speed and resistance to interference compared to pCM group. tCM group had worse social functioning, and lower scores in reasoning and appreciation when assessing mental capacity.

Conclusions: Individuals with tCM show greater clinical impairment and higher support needs compared to those with pCM. With the practical and legal abolition of tCM, it is essential to ensure that these individuals' persistent challenges are adequately addressed, as their needs remain significant despite the disappearance of this legal category.