Social Psychiatry and Psychiatric Epidemiology最新文献

Background: This bibliometric study scrutinizes the thematic evolution of research on stigma and discrimination in mental disorders, covering a span of five decades. It reflects on the shifting paradigms within the stigma-focused mental health research community from 1974 to 2024.

Methods: A comprehensive bibliometric analysis was employed using the Bibliometrix R package and VOSviewer software, analyzing 1,892 articles from databases like Scopus, Web of Science, PubMed Central, and APA PsycInfo. Adherence to PRIBA guidelines ensured a holistic representation of the evolving research narrative.

Results: The analysis outlined three distinct periods: the Genesis Period (1974 - 2007), focusing on foundational concepts of mental disorders and stigma; the Growth Period (2008 - 2015), which experienced a broadening into themes of discrimination and diagnostic refinement; and the Rapid Growth Period (2016 - 2024), characterized by a surge in research on child mental disorders and the impacts of posttraumatic stress disorder. Network analyses highlighted significant journals, key authors, and international collaborations that have shaped this field.

Conclusions: The study maps a significant transformation in stigma-focused mental health research themes over fifty years, highlighting the growing complexity and the need for ongoing research into stigma and discrimination. It calls for interdisciplinary approaches to tackle these enduring challenges effectively.

Background: Mental illness remains a significant global public health concern, yet it is largely manageable through psychotropic medications and psychotherapy. However, non-adherence to prescribed psychotropic medications is a major barrier to effective treatment and long-term symptom control. This challenge compromises clinical outcomes, increases relapse rates, and places a burden on healthcare systems. Understanding the extent and contributing factors of medication non-adherence is essential for designing targeted interventions at both clinical and community levels. This study aims to assess the prevalence of psychotropic medication non-adherence and identify its determinants among adult psychiatric patients in Ethiopia.

Methods: An institution-based cross-sectional study was carried out between November 1 to November 30, 2024, among adult psychiatric outpatients who were diagnosed according to DSM-5-TR criteria and were receiving psychotropic treatment. Participants were selected using a consecutive sampling technique. Medication non-adherence was assessed using the 10-item Medication Adherence Rating Scale (MARS). Data were collected through face-to-face interviews and review of medical records. Bi-variable and multivariable binary logistic regression analyses were performed to identify associated factors, with statistical significance set at p-value < 0.05.

Results: Out of a total of 418 participants, the prevalence of psychotropic medication non-adherence was 44.7% (95% CI: 40.0-50.0). Factors significantly associated with non-adherence included experiencing medication side effects (AOR = 4.67, 95% CI: 2.68-8.16), Lack of enrollment in the Community-Based Health Insurance scheme (AOR = 2.41, 95% CI: 1.06-5.5), current substance use (AOR = 6.71, 95% CI: 2.01-22.36), presence of comorbid medical illness (AOR = 5.42, 95% CI: 1.79-16.4), and perceived stigma (AOR = 3.63, 95% CI: 1.91-6.87).

Conclusion: Nearly half of the adult psychiatric outpatients in this study were non-adherent to psychotropic medications. Key factors associated with non-adherence included medication side effects, Lack of enrollment in the Community-Based Health Insurance scheme, current substance use, comorbid medical conditions, and perceived stigma. These findings highlight the need for integrated interventions addressing both clinical and psychosocial barriers to improve medication adherence and treatment outcomes among psychiatric patients in Ethiopia. Targeted strategies should be implemented at both healthcare facility and community levels.

Purpose: Post-traumatic stress disorder (PTSD) and dissociation are common responses to trauma, especially interpersonal and betrayal trauma. Dissociation has been proposed to be a core concept in understanding PTSD. However, little is known about the bidirectional relationship between dissociation and ICD-11 complex PTSD (CPTSD) symptoms. This study examined the relationship between classical PTSD, disturbances in self-organization (DSO), and dissociative symptoms across two culturally different samples.

Methods: Participants from Western and South Asian countries completed validated measures of PTSD, DSO, and dissociation two times, approximately six months apart.

Results: Across the Western (N = 101) and South Asian (N = 160) samples, at baseline, 71.7% to 84.2% of participants with probable CPTSD exhibited co-occurring dissociative symptoms, while 70.0% to 72.3% of participants with dissociative symptoms had probable PTSD or CPTSD. Dissociative symptoms were less common in participants with probable PTSD (20.0% to 28.6%). In addition, dissociative symptoms predicted subsequent levels of classical PTSD symptoms across the two samples (β = 0.241 to 0.246, p < .01). The predictive role of dissociative symptoms on DSO symptoms was only observed in the South Asian sample (β = 0.231, p = .011). Neither PTSD nor DSO symptoms predicted dissociative symptoms in both samples.

Conclusion: This study provides updated and cross-cultural data showing that dissociation is associated with an increase in PTSD symptoms over time, though its association with DSO symptoms is less clear. Assessment, prevention, and treatment of PTSD should take dissociative symptoms into consideration.

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.