Social Psychiatry and Psychiatric Epidemiology最新文献

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.

Background: People with psychotic disorders have greater mortality rates following cancer diagnosis, compared to people without psychotic disorders. Prior examinations of the effect of psychotic disorders on survival following cancer diagnosis mediated by stage at diagnosis and treatment disparities did not accommodate for multiple mediators and post-exposure confounding. The present study sought to estimate analogues of the natural indirect effects of having NAPD on mortality following cancer diagnosis, mediated through stage at diagnosis and time to treatment initiation.

Methods: We identified cases of cancer diagnosed between 1995 and 2019 among people with non-affective psychotic disorders (NAPD) and a comparison group without NAPD, constructed using Ontario health administrative data. Death from any cause was identified using register data. Inverse probability of treatment weighted Cox models were used to estimate the effect of NAPD on mortality following cancer diagnosis mediated by stage at diagnosis and time to treatment initiation, adjusting for relevant confounders.

Results: The analytic sample included 3,643 people with NAPD and 15,174 people without NAPD who developed cancer. People with NAPD had a 66% greater adjusted hazard of all-cause mortality than people without NAPD (95%CI = 1.55,1.78). The HR estimate for the indirect effect mediated through stage at diagnosis was 1.09 (95%CI = 1.05,1.13) and HR estimate for the indirect effect mediated through time to treatment initiation was 1.00 (95%CI = 0.96,1.04).

Conclusions: Our findings suggest that a relatively small proportion of the effect of NAPD on mortality is mediated by stage at diagnosis, while time to treatment initiation does not mediate that effect. This excess risk is potentially mediated by other patient, provider, and system-related factors in cancer care.

Purpose: The 2010 Affordable Care Act (ACA) expanded access to depression screening and care. However, changes in unmet need for depression treatment and public mental health equity following ACA implementation remain understudied.

Methods: Data from 3,522 respondents to the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020 were used to examine changes in clinically significant depression symptoms that received neither with pharmacologic nor behavioral health treatment. Modified Poisson regression models were used to estimate the association between time period (post-ACA, 2013-2020 vs. pre-ACA, 2005-2010) and unmet need for depression treatment, both overall and stratified by socio-demographic and health care-related variables.

Results: Unmet need for depression treatment decreased from 56% in 2005-10 to 47% in 2013-20, with no significant differences by socio-demographic characteristics. After adjusting for covariates, this corresponded to a 14% reduction in unmet need post- vs. pre-ACA (prevalence ratio (PR) 0.86; CI 0.79,0.95). Only those reporting Medicare vs. another type of insurance coverage experienced a significant decrease in unmet need for depression treatment (PR 0.77; CI 0.60,0.99). A similar decrease in unmet need was observed regardless of having a regular point of care or not, but only detected among those who had used health care services in the prior year (PR 0.80; CI 0.70,0.92) vs. those who had not (PR 1.13; CI 0.92,1.37).

Conclusion: Unmet need for depression treatment decreased after ACA implementation but remains common. Reductions in barriers to primary care visits and universal screening policies may further decrease unmet need for depression treatment.

Background: Grief, a universally experienced response to death of a loved one, carries distinct emotional and behavioral dimensions. This study examines the psychometric properties and factorial validity of the Arabic adaptation of the Inventory of Complicated Grief (ICG), along with mediation pathways between emotional distress (anxiety, depression, and stress) and grief dimensions, moderated by resilience, life satisfaction, and religiosity.

Method: Data were collected from a sample of 423 Arabic-speaking adults residing in Libya and affected by the Libyan wars, ranging in age from 18 to 52 years (M = 29.93, SD = 6.73) RESULTS: Confirmatory factor analysis revealed a two-factor structure, cognitive/emotional symptoms. Convergent validity showed significant positive correlations between ICG scores and measures of psychological distress (anxiety, r = .24; depression, r = .22). Discriminant validity was confirmed through negligible associations with resilience (r = -.25) and satisfaction with life (r = -.12). Mediation analyses identified resilience as a significant mediator in pathways from distress to grief symptoms (anxiety to cognitive/emotional symptoms via resilience, estimate = .13, p = .023). Satisfaction with life and religiosity displayed limited indirect effects, underscoring the dominant role of resilience.

Conclusion: These findings reinforce the suitability of the Arabic ICG as a reliable tool for assessing grief in Arabic-speaking populations, while highlighting the protective role of resilience in grief management. Implications extend to culturally sensitive interventions and resilience-building therapeutic approaches.

Background: Mass psychogenic illness (MPI), also known as mass hysteria, is a phenomenon where a group of individuals exhibit similar symptoms without any identifiable organic cause. MPI outbreaks in school settings can lead to significant disruptions and psychological distress among students. This systematic review aimed to identify and characterize the factors contributing to the initiation and progression of MPI outbreaks in schools through an analysis of the existing literature.

Methods: A comprehensive search was conducted in electronic databases, including Cochrane Library, PubMed, Embase, and Web of Science to identify relevant articles published in English. Studies were screened based on predefined inclusion and exclusion criteria. Moreover, grey literature search, hand searching, and backward/forward citation searching were performed. Data extraction was performed using a standardized form to collect information on outbreak characteristics, contributing factors, and symptom patterns.

Results: Nineteen studies were included. We identified 10 distinct factors associated with MPI outbreaks in schools, including (1) the spread of rumors and misinformation, (2) community pressure and persistent rumor dissemination, (3) lack of attention to mental disorders, (4) anxiety due to pseudo causation, (5) negative perception of the authorities, (6) the presence of psychological stressors, (7) media coverage and public anxiety, (8) physical proximity and perceived threat, (9) social media influence, and (10) psychological vulnerability. These factors were found to act as causal triggers or exacerbating elements, leading to the initiation and amplification of MPI outbreaks.

Conclusion: This study highlights the complex nature of MPI outbreaks in school settings and emphasizes the importance of understanding the social and psychological factors that contribute to their occurrence and spread. The identified factors can serve as valuable indicators for schools and health authorities to effectively manage and support students during such incidents. Further research is needed to explore the interplay of these factors in different cultural and educational contexts and to develop targeted interventions for the prevention and mitigation of MPI outbreaks in schools.

Purpose: Postpartum depression symptoms (PPDS) and postpartum anxiety symptoms (PPAS) are a major global public health issue, especially in low-resource settings. This study aimed to determine the prevalence of PPDS and PPAS in Benin, Sub-Saharan Africa, at one year postpartum and to identify associated risk and protective factors.

Methods: Pregnant women were recruited for a longitudinal mother-child cohort in the Allada District of Benin, and a cross-sectional analysis was performed on data collected at one-year postpartum. Maternal depression and anxiety symptoms were assessed one year postpartum using the Edinburgh Postnatal Depression Scale (EPDS)-validated in Benin and translated into Fon-and its anxiety subscale (EPDS-3 A). Cut-off scores for high depressive and anxiety symptoms were ≥ 13 and ≥ 6, respectively. Potential risk and protective factors including maternal, child characteristics, socioeconomic status, and social support were analyzed using multivariable-adjusted logistic regression models.

Results: At one year postpartum, 13% of 742 mothers had PPDS, and 21% PPAS. Risk factors for PPDS included recent alcohol consumption (previous three months) (aOR = 1.88; 95%CI: 1.17-3.02) and food insecurity (aOR = 4.47; 95%CI: 1.29-17.4), while partner cohabitation reduced PPDS odds (aOR = 0.45; 95%CI: 0.26-0.80). PPAS risk factors included recent alcohol consumption (aOR = 2.17; 95%CI: 1.44-3.28) and regular child care support from 3 + childcare providers (aOR = 2.91; 95%CI: 1.50-5.68). Protective factors for PPAS included the minority Aizo ethnicity (aOR = 0.58; 95%CI: 0.36-0.93) and living in an individual house (aOR = 0.45; 95%CI: 0.24-0.85).

Conclusion: This study sheds light on the prevalence of PPDS and PPAS at one year postpartum in the Beninese context, as well as associated factors. Findings underscore the importance of establishing postpartum psychological follow-up and targeted strategies to support maternal mental health in low-resource settings, addressing both socioeconomic vulnerabilities and social support structures.

Purpose: Suicide rates are high among older adults, yet research on risk factors associated with suicide in this age group remain largely unexplored. This study aims to examine the relationship between suicide and sociodemographic characteristics among individuals aged 60 and older.

Methods: We utilized data from Norwegian national registries, identifying individuals aged 60 and older who died by suicide between 2005 and 2019 (n = 2060, 70.7% males), and used a case-control design. To examine the relationships between suicide and sociodemographic factors, we used descriptive analyses and conditional multivariate logistic regression analyses, stratified by sex and age categories.

Results: Among individuals aged 60 to 69, risk factors for suicide included receiving a disability pension (odds ratio (OR) = 2.79 males, OR = 7.71 females), having mixed income sources (OR = 1.79 males, OR = 3.70 females), living alone (OR = 2.49 males, OR = 2.46 females), and living in urban areas, which was associated with an increased risk for females (OR = 1.85). Among males, living alone was also a significant risk factor for suicide in the 70 to 79 age group (OR = 1.85), and those aged 80 and above (OR = 2.16). Living in rural areas reduced risk for females aged 80 and above (OR = 0.05).

Conclusion: This first register-based study of suicide in older adults in Norway highlights that living arrangements, urbanization level, and income source are significant risk factors for suicide among older adults. Interventions to improve social connectedness, with a focus on the urban-rural divide, could potentially reduce suicide risk. Sex and age categories should be considered in future research and when implementing preventive measures.