Social Psychiatry and Psychiatric Epidemiology最新文献

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.

Purpose: This study examines how different forms of social isolation, such as living alone, lack of community engagement, and unemployment, are associated with mental health in mid-life (ages 42-46), a life stage often overlooked when examining the impacts of social isolation.

Methods: Using longitudinal data (1999-2016) from two British birth cohort studies: 1970 British Cohort Study N = 16,585 and the 1958 National Child Development Study N = 15,806, this study investigated whether different forms of isolation have independent effects, contribute to cumulative risk, or interact additively or multiplicatively.

Results: Effects varied by isolation type and mental health outcomes. Being out of employment was linked to higher psychological distress and lower life satisfaction and self-rated health, while living alone was only associated with lower life satisfaction. Limited contact with friends and relatives and a lack of community engagement were associated with lower life satisfaction and self-rated health. Greater social isolation corresponded to increased psychological distress, lower life satisfaction, and poorer self-rated health, demonstrating cumulative risk. Effects appeared additive rather than multiplicative. No consistent sex or cohort differences were observed.

Conclusion: The study underscores the need to examine both separate and combined effects of social isolation across the complete mental health state. Isolation in its various forms was detrimental for mental health in mid-life and was most consistently linked to lower life satisfaction. Efforts to reduce isolation and its negative mental health impacts must recognise the complexity of these experiences.

Background: Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality. Traditionally linked to high-income regions, its recognition is growing in low- and middle-income countries. This study analyzes the global, regional, and national burden of anorexia nervosa from 1990 to 2021 using GBD 2021 data and offers projections to 2040.

Methods: Data on the prevalence, years lived with disability (YLDs), and age-standardized rates of anorexia nervosa were obtained from the GBD 2021 study, covering 204 countries and regions. The study used various statistical methods, including the Assessment of Health Inequalities, Frontier Analyses, Temporal Trend Analysis and Bayesian Age-Period-Cohort (BAPC) model, to analyze trends, regional disparities, and forecast future disease burden. Results were stratified by Socio-Demographic Index (SDI) regions, age, and gender.

Results: From 1990 to 2021, the global prevalence of anorexia nervosa increased by 38.79%, with YLDs rising by 38.57%. High-SDI regions consistently showed the highest burden of the disorder, with significant increases in both prevalence and YLD rates. In contrast, low-SDI regions exhibited lower burdens, likely reflecting underreporting and diagnostic challenges. Female populations continued to bear a higher burden than males, although the prevalence of anorexia nervosa among males has steadily increased. Forecasts to 2040 predict continued increases in disease burden, particularly among females.

Conclusions: Anorexia nervosa's global burden has risen, especially in high-SDI regions. The increasing prevalence, particularly among females, underscores the need for targeted public health interventions, early diagnosis, and culturally appropriate treatments. Projections show continued growth in the disorder's burden.

Purpose: To estimate how social disparities in child psychiatric symptoms might change following hypothetical interventions targeting sports, outdoor play, and screen time at age 10.

Methods: We used data from 9,778 children of the Generation R Study, a prospective population-based cohort in Rotterdam, the Netherlands. Social inequality variables included sex, maternal education, and migration background. Primary caregivers filled out the validated Child Behavior Checklist to report on children's internalizing and externalizing symptoms at the age of 13. The hypothetical interventions (i.e., outdoor play, sports participation, and screen time) were parent-reported at age 10. We used sequential G-estimation to estimate the inequality with and without the hypothetical intervention.

Results: Children with migration backgrounds (46.3%) and low maternal education (53.3%) were associated with relatively more internalizing and externalizing symptoms than peers, with disparities of 0.125 and 0.177 standard deviations, respectively. Girls had more internalizing symptoms (0.106 SD), while boys had more externalizing symptoms (0.154 SD). Increasing sports participation reduced disparities in internalizing symptoms linked to maternal education (β = -0.014; 95% CI: -0.024, -0.003), while outdoor play and screen time interventions showed limited effects. None of the hypothetical interventions led to a statistically significant reduction in social disparities in externalizing symptoms.

Conclusions: This study underscores the persistence of sex, cultural, and socioeconomic disparities in youth mental health. While sports participation showed a potential effect in reducing disparities in internalizing symptoms, its impact on externalizing symptoms and other interventions was negligible. Future efforts should focus on identifying more effective strategies for addressing these disparities.