Social Psychiatry and Psychiatric Epidemiology最新文献

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.

Purpose: The COVID-19 pandemic has brought negative impacts on young adults' mental health. The present study aimed to examine the transition of psychological distress classes in young adults after the pandemic and the associated factors.

Methods: A total of 577 young adults (mean age = 25.9 years, SD = 4.4) in Hong Kong participated in a longitudinal online survey on mental health in 2022 and 2023. The participants completed the 10-item Chinese Health Questionnaire and self-constructed items on COVID-19 distress, financial distress, and social distress. Latent class analysis was used to classify the participants into latent classes of psychological distress. Latent transition analysis was conducted with measurement invariance to examine the transition amongst the latent classes from 2022 to 2023 and the associations with changes in the stressors.

Results: The data supported three latent classes of psychological distress. A third of the participants belonged to the High-distress class with elevated symptoms and its prevalence decreased from 34.3% to 27.8% over one year. 40.9% and 10.0% of the Moderate-distress and High-distress classes transitioned to the Low-distress class after the pandemic, respectively. Financial distress (OR = 3.14, 95% CI = 1.17-8.41) and social distress (OR = 3.25, 95% CI = 1.70-6.21) was significantly linked to higher odds of transitioning from the Low-distress to High-distress class. Increased social distress was associated with decreased odds (OR = 0.57, 95% CI = 0.39-0.84) of improvement from the High-distress to Moderate-distress class.

Conclusion: The findings suggest an overall reduction in psychological distress among young adults after the pandemic. Increases in financial and social distresses after COVID-19 showed significant effects on worsening psychological distress.

Background: It is not known if there are differences in antipsychotic initiation between migrants and native-born individuals diagnosed with non-affective psychotic disorder. This study aimed to determine (1) potential differences in initiation rate and type of first antipsychotic medication between refugees, non-refugee migrants, second-generation migrants, and Swedish-born young adults with incident non-affective psychosis and (2) which sociodemographic and clinical factors are associated with initiation.

Methods: This register-based cohort included 12,960 adults aged 18-35 years, residing in Sweden during 2007-2018, with an incident diagnosis of a non-affective psychotic disorder in inpatient or specialised outpatient care. Sociodemographic and clinical factors associated with antipsychotic initiation were determined using modified Poisson regression models yielding Relative Risk, RRs, and 95% Confidence Intervals, CI.

Results: Initiation of antipsychotic use was slightly less common among refugees (65.6%) compared to non-refugee migrants (70.2%), second-generation migrants (71.0%), and Swedish-born individuals (71.1%). However, after adjustment for sociodemographic and clinical factors, there was no difference in initiation rates between refugees and Swedish-born individuals (adjusted RR 0.96; 95% CI 0.92-1.00). Olanzapine was most common initial antipsychotic in all groups. However, compared to the Swedish-born, refugees (1.47; 1.10-1.97), non-refugee migrants (1.70; 1.26-2.27) and second-generation migrants (1.43; 1.05-1.97) were more likely to initiate the use with long-acting injectable antipsychotics, and also with first-generation antipsychotics, particularly haloperidol. Sociodemographic factors associated with initiation were similar among refugees and Swedish-born individuals, including younger age, higher education and inpatient care.

Conclusion: Our finding that migrants were more likely to initiate long-acting antipsychotics suggests that clinical teams anticipate medication non-adherence among migrants.

Purpose: Although current interventions have proven effective for improving outcomes for individuals with psychotic disorders, this population continues to encounter challenges and health disparities. Recently, researchers have investigated how social determinants of health influence the incidence and outcomes of psychotic disorders. In particular, neighborhood deprivation (i.e., a composite index capturing the social, material, and environmental challenges of a particular area relative to the broader area [1]), has been investigated in numerous studies on psychotic disorders but research has yet to consolidate and quantify its significance. The current meta-analysis assesses neighborhood deprivation and its relationship to psychotic disorder incidence and symptoms.

Methods: Articles published prior to April 1, 2024 were identified via two bibliographic databases: PubMed and PsycINFO. The literature search yielded 17 studies consisting of 59,719 cases for the meta-analysis investigating the relation between neighborhood deprivation and psychotic disorder incidence. Six studies of 2,790 cases were included in the meta-analysis assessing the relation between neighborhood deprivation and psychotic disorder symptoms.

Results: There was a robust relation between psychotic disorder incidence and neighborhood deprivation, such that as neighborhood deprivation within an area increased so too did the incidence. There was no evidence of a substantial relationship between neighborhood deprivation and psychotic disorder symptoms.

Conclusions: The results of this study identified a social determinant of health that has high relevance to the incidence of psychotic disorders. Findings underscore the need to develop multi-level interventions to address neighborhood deprivation and reduce resource inequalities across geographical locations.

Purpose: The hypothesis that health status disparities exist because of high levels of social disadvantages, the Social Determinants of Health - Health Disparities (SDOH-HD) hypothesis by Ramírez García [1], was investigated among adults (N = 1,833) attending SARS-CoV-2 testing events at 71 community sites.

Methods: A Multilevel Structural Equation Model (CFI = 1.0, SRMRs ≤ 0.03), with cross-sectional self-reported data, operationalized health status with latent individual level and latent community site level variables. At the individual level, health variables met full or partial metric equivalence between participants who answered the survey in Spanish versus in English (CFIs = 0.99, SRMRs ≤ 0.03).

Results: Consistent with the SDOH-HD, high food insecurity and/or low levels of education among Latinxs putatively mediated (abs = 0.01 to 0.08, ps < 0.05) worse individual level general health (Within Level Model R² = 0.10, p <.05) or worse individual level psychological distress (Within Level Model R² = 0.11, p <.05) compared to non-Latinx Whites. However, three SDOH - unemployment, housing instability, and discrimination - did not support the SDOH-HD. Community site level SDOH - social vulnerability, and minority status indices - were not significantly related to site level health status, but site level psychological distress was lower in rural than in urban sites (γ = - 0.39, p <.05).

Conclusion: Taken together, the results delineate that equitable implementation of food security and education interventions may mitigate health status Latinx disparities. The SDOH-HD was partially supported, underscoring the need to investigate further these and additional SDOH-HD pathways.

Purpose: Victimisation is associated with psychotic experiences (PEs) across the psychosis continuum, yet contextual factors possibly influencing outcomes have been neglected. Building on the Unusual Experiences Enquiry study (UNIQUE) showing higher childhood trauma but lower discrimination in individuals with PEs without a need-for-care, compared to those with a need-for-care, this study utilized a novel instrument to examine victimisation-related contextual factors.

Methods: Individuals from the UNIQUE study with persistent PEs with (clinical, n = 82) and without (non-clinical, n = 92) a need-for-care, and a control group without PEs (n = 83), completed the Victimisation Experiences Schedule (VES). This multidimensional instrument, comprising items from validated measures, assesses interpersonal traumas and discriminatory experiences, alongside contextual factors: impact, powerlessness, social support, age, duration, frequency, victim-perpetrator relationships, and reasons for discrimination.

Results: There were no differences in lifetime interpersonal traumas between the clinical and non-clinical groups, with the latter reporting slightly more than controls. The clinical group experienced more lifetime perceived discrimination than the other groups. No differences emerged in impact and powerlessness at the time of victimisation; however, the clinical group reported lower positive social support and higher current impact and powerlessness for both types of victimisation. Discrimination occurred earlier and lasted longer in the clinical group than the other groups, often attributed to mental health and race/ethnicity, likely reflecting a higher proportion of racially minoritized individuals.

Conclusion: The results suggest an interplay between risk and protective factors around victimisation that may shape outcomes, highlighting the importance of assessing contextual factors of victimisation using comprehensive tools like the VES.

Purpose: Epidemiologic studies of hikikomori, a form of prolonged social withdrawal, are limited. This study aimed to look for indicators in a European country of a problem first detected in Japan, estimating the prevalence of hikikomori risk and examining the relationship between hikikomori risk and sociodemographic factors, health status, and health services use.

Methods: Data from the European Health Interview Survey collected in 2019 were used, consisting of a nationally representative sample (unweighted N = 45,962; weighted N = 52,012,922.578) of persons aged 15-75 years and over in Italy. Difficulty in going out not due to medical illnesses/functional limitations or chronic illnesses was considered a proxy condition for hikikomori, i.e., hikikomori risk. Hikikomori risk was further differentiated based on difficulty in social participation.

Results: The overall prevalence of hikikomori risk was 1.7% (95%CI: 1.6-1.9) corresponding to a weighted count of 866,743 persons. This was comprised of a 0.7% prevalence of hikikomori risk with no difficulty in social participation (95%CI: 0.6-0.8%; weighted n = 343,920), 0.9% prevalence of hikikomori with difficulty in social participation (95%CI: 0.8-1.0%; weighted n = 445,165) and 0.1% prevalence of hikikomori risk with no interest for social participation (95%CI: 0.1-0.2%; weighted n = 77,657). Low vitality and mental health index, low social support, high depressive symptoms, and difficulty accessing mental health services were significantly associated with hikikomori risk.

Conclusion: The prevalence of individuals at risk for hikikomori is on par with many psychiatric disorders. Given the prevalence and functional impairment faced by individuals at risk for hikikomori, they represent a group worthy of the attention of public health experts and other stakeholders in the health arena and beyond.

Purpose: This study examined how pre-existing early-life adversity (ELA) and current social support interacted with COVID-specific pandemic stressors in relation to risk of psychiatric disorders in a nationally-representative sample of Canadian adults.

Methods: Participants (n = 9,409) were from the Mental Health and Access to Care Survey, a cross-sectional survey of Canadian adults during later stages of the COVID pandemic (March to July 2022). Measures included pandemic stressors (Statistics Canada), ELA (Childhood Experiences of Violence Questionnaire), social support (Social Provisions Scale), and past 12-month psychiatric problems (WHO-CIDI). Statistical analyses included two-step logistic regression models adjusted for covariates and weighted for complex survey design.

Results: Higher odds of psychiatric problems were predicted by ELA (aOR = 1.24 [1.15-1.35]-aOR = 1.53 [1.39-1.69] across psychiatric disorders) and pandemic stress (aOR = 1.18 [1.12-1.25]-aOR = 1.32 [1.26-1.39] across psychiatric disorders). Significant interactions between ELA and pandemic stress for depression (aOR = 0.96 [0.93-0.98]) suggested an attenuated effect of pandemic stress at higher levels of ELA. Social support was associated with reduced psychiatric problems (aOR = 0.88 [0.86-0.91]-aOR = 0.97 [0.94-0.99]), while pandemic stress was associated with increased psychiatric problems (aOR = 1.20 [1.15-1.26]-aOR = 1.33 [1.27-1.40]). An interaction between social support and pandemic stress for suicidality (aOR = 1.02 [1.01-1.03]) indicated that higher levels of social support were associated with increased odds of suicidality in the presence of pandemic stress, though the effect was small and of questionable clinical significance.

Conclusion: ELA and pandemic stress increased psychiatric disorder likelihood, while social support was protective. However, interactions indicate nuanced relationships in mental health risk during the pandemic.

Background: The COVID-19 pandemic after isolation removal increased stigmatizing attitudes and anxiety, but there is a lack of studies analyzing the relationship between stigmatizing attitudes and anxiety symptoms after isolation lifting. This study aimed to explore the complex relationship between the SARS-CoV-2 stigma and anxiety symptoms in patients with SARS-CoV-2 and healthy populations.

Methods: We conducted a cross-sectional survey in which 1,730 university students reported COVID-19 stigmatizing attitudes and anxiety symptoms. These included university students who were either infected or uninfected individuals. We estimated the complex relationship between stigmatizing attitudes and anxiety symptoms using network analysis methods.

Results: During the COVID-19 pandemic, stigmatizing attitudes and anxiety observed in the infected group were 32.86% and 28.28%, respectively, and in the uninfected group were 34.64% and 22.79%, respectively. Network analysis showed that A2 (Uncontrollable worry) had the strongest expected influence centrality and S1 (Stereotype) had the strongest bridge expected influence centrality; network comparative analysis of the infected and uninfected groups revealed a significant difference in the expected influence centrality for S1; and directed acyclic graph analysis showed that node A2 had the highest priority.

Conclusion: We recommend developing appropriate strategies for safeguards, such as the dissemination of relevant knowledge to at-risk populations, to cope with stigmatizing attitudes and anxiety symptoms among university students.