Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose: To determine the co-occurrence and temporal trajectories between gambling disorder (GD) and other psychiatric diagnoses in the Finnish population.

Methods: Data were retrieved from two healthcare registers covering primary and specialized care, including 5,172 individuals aged 18 or over (3,720 males, 1,452 females) with diagnosed GD (ICD-10 code F63.0). We also retrieved information on all other psychiatric diagnosis dates (codes F00-99) between 1996 and 2024 for every individual, alongside their official sex, year of birth, and whether GD was a primary, secondary, or long-term diagnosis. Linear mixed modelling (LMM) was used to analyse longitudinal data on multiple diagnosis occurrences.

Results: Mood, anxiety, and substance use disorders (SUDs) had the highest co-occurrence with GD both preceding and following its diagnosis, indicating bidirectional comorbidity patterns. The most common comorbid categories included unipolar depression, phobic anxiety disorders, alcohol use disorder, and bipolar disorder. Mood disorder comorbidity was especially prominent among women, and SUD comorbidity among men. Most psychiatric diagnoses occurred 112 to 2,697 days before GD (LMM p-values 0.38 - <0.001, marginal and conditional R² = 0.13 and 0.47, respectively). Comorbid diagnoses after GD were, on average, temporally closer to GD onset than diagnoses before GD.Diagnosis occurrences were significantly more frequent among individuals with GD than among psychiatric controls in most diagnostic categories.

Conclusions: There were distinct and sex-specific temporal trajectories between GD and other psychiatric diagnoses, with mood-, anxiety-, and SUDs showing the strongest and most reciprocal associations. Social and health care professionals should screen for GD among those seeking treatment for these disorders, particularly given the increased suicide risk.

Given the established detrimental effect of poverty in early life on later cognition, understanding the mechanisms underlying this relationship is important to design interventions to mitigate such inequities. However, eliminating inequities may not be enough. It is likely that poverty in early life is also associated with reduced qualification and job opportunities, in which case the benefit of healthy cognitive development could be mitigated or even neutralized. We referred to this potential effect of early poverty on both the development and expression as the double-burden hypothesis (DBH). This study systematically reviews the literature on the mechanisms by which childhood poverty can affect cognitive outcomes later in life and includes original studies that either quantified the role of mediators of the effect of early-life socioeconomic position (SEP) on cognition or that assessed whether early SEP modifies the relationship between later IQ and income. Of the 27 articles selected, all studied mediation and consistently identified educational attainment and adult SEP as key mediators. However, much of the available evidence is limited by retrospective measures, confounding, and selection bias. This suggests that while direct effects of childhood poverty might exist, most of its impact on later-life cognition operates through modifiable mechanisms. Reinforcing the importance of interventions that target early-life environments to reduce the long-term impacts of childhood poverty. Further studies with robust methods are needed to confirm these findings and provide more reliable estimates. Moreover, the present review shows that effect modification is an underexplored route to further develop effective, equitable interventions.

Purpose: This study investigates predictors of internalising symptoms among adolescents aged 16 to 19 years in a high-risk context in South Africa. Specifically, it explores early childhood (antenatal to 18 months postpartum), and early adolescent (13 to 14 years) predictors of internalising symptoms measured during later adolescence (16-19 years), aiming to identify key factors influencing mental health outcomes in this vulnerable population.

Methods: Utilising a unique 18-year longitudinal dataset, we included a total of 314 adolescent participants from South Africa in the analysis and employed an adaptive elastic net regularised regression to analyse the effects of 18 predictors from early childhood and early adolescence on internalising symptoms at ages 16 to 19 years. The broadband scale for "internalising" from the Youth Self Report (ages 11-18) was used as the outcome measure. Data collected at five time points across three phases of the longitudinal study were included in the analysis.

Results: Key predictors of internalising symptoms were female sex (β=-4.30; 95% CI [-4.42;4.19]). Early childhood predictors with significant associations were maternal depression (β = 1.70; 95% CI [1.56;1.84]) and caregiver employment (β=-0.37; 95% CI [-0.46;-0.29]). In early adolescence, significant predictors included informal house type (β = 0.82; 95% CI [0.71;0.93]), caregiver alcohol use (β = 0.74; 95% CI [0.67;0.81]), exposure to violence (β = 0.73; 95% CI [0.67;0.78]), friend support (β=-0.61; 95% CI [-0.67;-0.55]), food insecurity (β = 0.51; 95% CI [0.46;0.56]), family support (β=-0.33; 95% CI [-0.37;-0.29]), and self-esteem (β=-0.33; 95% CI [-0.37;-0.29]).

Conclusion: This study identifies key predictors of internalising symptoms in adolescents from high-risk context, focusing on caregiver variables and social connections. Maternal / Primary cargiver depression and caregiver unemployment in early childhood have lasting effects, highlighting the need for early intervention. In early adolescence, factors such as social environment and caregiver stability are crucial. These insights can inform targeted interventions and policies to support adolescent mental health in high-risk contexts.

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.

Purpose: Early intervention can improve mental health outcomes for people living with serious mental illness (SMI). Understanding what factors influence patients' health help-seeking decisions are important in low and middle-income countries (LMICs) where resources and outcomes are poor, particularly in slums, to help inform targeted intervention approaches.

Methods: A concurrent triangulation mixed methods study conducted in Dhaka, Bangladesh, using a quantitative pathway to care questionnaire with individuals from a local slum (Korail) attending the National Institute for Mental Health (NIMH), a specialised hospital for mental health services. Qualitative interviews were conducted with people with SMI and family caregivers living in Korail.

Results: 28,896 patients attended NIMH between 24th September 2022 and 25th September 2023 and only 0.11% (n = 33) came from the Korail slum. 46% had previously seen a faith or traditional healer. Qualitative interviews with people with SMI and caregivers in Korail showed that spiritual possession was among several perceived causes of SMI. Participants also percieved pharmacological treatment as expensive and potentially harmful. However participants also reported a lack of knowledge about specialist mental health facilities and spending considerable funds and resources on healers and private medical providers in the hope of cure.

Conclusions: Help-seeking among families living in slums in Dhaka is pluralistic, with complex influences on treatment choice. Understanding help-seeking behaviour and care pathways is crucial to design an equitable health system and improve access to effective mental health care.