Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose: This report provides the results of a task-shared approach for integrating care for perinatal depression (PND) within primary maternal and child healthcare (PMCH), including the factors that may facilitate or impede the process.

Methods: This hybrid implementation-effectiveness study guided by the Replicating Effective Programmes framework was conducted in 27 PMCH clinics in Ibadan, Nigeria. The primary implementation outcome was change in the identification rates of PND by primary health care workers (PHCW) while the primary effectiveness outcome was the difference in symptom remission (EPDS score ≤ 5) 6 months postpartum. Outcome measures were compared between two cohorts of pregnant women, one recruited before and the other after training PHCW to identify and treat PND. Barriers and facilitators were explored in qualitative interviews.

Results: Identification of PND improved from 1.4% before to 17.4% after training; post-training rate was significantly higher in clinics where PHCW routinely screened using the 2-item patient health questionnaire (24.8%) compared to non-screening clinics (5.6%). At 6-months postpartum, 60% of cohort one experienced remission from depression, compared to 56.5% cohort two [OR-0.9 (95%CI-0.6, 1.3) p = 0.58]. Identified facilitators for successful integration included existence of policy specifying mental health as a component of PHC, use of screening to aid identification and supportive supervision, while barriers included language and cultural attitudes towards mental health and human resource constraints. PHCW were able to make adaptations to address these barriers.

Conclusions: Successful implementation of task-shared care for perinatal depression requires addressing staff shortages and adopting strategies that can improve identification by non-specialist providers.

Trial registration: This study was retrospectively registered 03 Dec 2019. https://doi.org/10.1186/ISRCTN94230307 .

Purpose: Social psychiatry considers the ways in which mental disorders are shaped by particular social environments. This paper outlines a cultural-ecosocial approach that emphasizes the ways in which cultural meaning and practices mediate the effects of the social determinants of mental health on the mechanisms of illness, disorder, and disease.

Methods: Selective review of literature and conceptual synthesis.

Results: "The social" in psychiatry stands for the structures and dynamics of groups of people interacting on multiple scales from the intimate sphere of couple and family to neighbourhoods, communities, societies, nations, and transnational or global networks. These interactions create social contexts, niches, forms of belonging, identities, institutions, and larger systems that influence the causes, expression, course, and outcome of mental disorders. Characterizing these systems requires theory that considers the ways in which social systems constitute dynamical systems that configure material, energetic, and informational flows that give rise to human experience. Unpacking the health consequences of these local and extended systems requires an interdisciplinary approach that considers: (1) the social psychological, psychophysiological, and sociophysiological processes that mediate the impact of the environment on body, mind, and person; (2) the interactional dynamics of social systems that give rise to structural adversity and inequity as well as resilience; and (3) the recursive effects of self-understanding, agency and subjectivity.

Conclusions: In the cultural-ecosocial view, "the social" is shorthand for interactional processes that constitute material and symbolic structures that provide cultural affordances, constraints, and challenges as well as resources for healing, recovery, and adaptation.

Purpose: Gun violence traumatizes communities and places a heavy burden on the mental health of those exposed. This ecological study examines the association between gun violence exposure and suicide mortality rates in US counties for the period 1999-2020 at various urbanicity levels.

Methods: A Bayesian hierarchical Gamma-Poisson model with state random effects was employed to model the age-adjusted suicide mortality rates which adjusted for sex ratio, urbanicity, social vulnerability, gun ownership, culture of honor, and exposure spillovers from neighbouring counties.

Results: Results indicate a small significant positive association between gun violence and suicide mortality rates. Urbanicity levels do not appear to modify this association, although the association may be slightly smaller for large urban metros.

Conclusions: Gun violence exposure may be positively associated with suicide mortality in US counties.

Purpose: Epidemiological studies investigating the mental health impacts of microaggressions in the trans population have tended to have methodological limitations, including a lack of validated measures, raising concerns about the validity of their findings. To address this evidence gap, we investigated the associations between microaggressions and poor mental health (depression; anxiety; non-suicidal self-harm [NSSH]; suicidal thoughts; suicide attempt) amongst trans people.

Methods: We conducted a cross-sectional survey of 787 trans adults in the UK, measuring mental health and exposure to microaggressions using the Gender Identity Microaggressions Scale (GIMS). Using univariable and multivariable linear and logistic regression models we tested for an association of microaggressions with depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), lifetime NSSH, lifetime suicidal thoughts, and lifetime suicide attempt.

Results: Of the 787 participants, 574 (73%) provided complete data. Microaggressions were a common experience, affecting 97.6% of participants over their lifetime. In adjusted analyses, using sociodemographic and clinical variables, increased microaggression scores were associated with increased depressive symptoms (adjusted coefficient: 1.86 (95%CI = 1.35 to 2.36)), anxiety symptoms (adjusted coefficient: 1.57 (95%CI = 1.09 -2.05)) and with increased odds of NSSH (Odds Ratio [OR]_adj 1.83 (95%CI = 1.45 -2.30)), suicidal thoughts (OR_adj 2.18, (95%CI = 1.52 -3.13)), and suicide attempt (OR_adj, 1.59, (95%CI = 1.32 -1.92)). In exploratory analyses different GIMS subscales were associated with these various outcomes.

Conclusions: There was evidence of associations between microaggressions and adverse mental health outcomes, as well as to support specific microaggressions being associated with specific outcomes, emphasizing the importance of public health interventions that target microaggressions directed at trans adults. Longitudinal studies are needed to investigate the temporality of the associations between microaggressions and mental health outcomes.

Purpose: To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning.

Methods: This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age.

Results: 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vs n = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vs n = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vs n = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vs n = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vs n = 205 females, 28.2%; p < 0.001).

Conclusion: These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.

Purpose: Persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of post-SSRI sexual dysfunction (PSSD), an iatrogenic syndrome characterized by enduring sexual dysfunction following the discontinuation of some antidepressants. We aimed to estimate the frequency of PPTGH among past users of psychiatric treatments, particularly antidepressants.

Methods: We used a subsample of UnACoRN, a US/Canada survey of sexual and gender minority youth aged 15 to 29. We included participants with a history of psychiatric drug use. We excluded individuals with genital surgeries or without sexual experience. The analysis involved chi-square tests for initial group comparisons, post hoc tests for multiple comparisons, and logistic regression among those who had stopped taking medication. We exponentiated the regression to estimate the odds of PPTGH by drug type, adjusting for age, sex-assigned-at-birth, hormone treatment, and depression severity in three nested models.

Results: 574 of 2179 survey participants reported genital hypoesthesia. They were older and more likely to report male sex assignment at birth, hormonal therapy history, and psychiatric drug history. The frequency of PPTGH among antidepressant users was 13.2% (93/707) compared to 0.9% (1/102) among users of other medications; adjusted odds ratio: 14.2 (95% CI: 2.92 to 257).

Conclusion: Antidepressant discontinuation is strongly associated with PPTGH in the US and Canada where SSRI/SNRI medications account for 80% of antidepressant prescriptions. We call for standardized international warnings and transparent, informed consent. Future research should expand upon our efforts to estimate the risk of PSSD by including all the proposed diagnostic criteria, including documentation of temporal changes in PSSD-related symptoms before and after treatment (≥3 months).

Purpose: Combatants and veterans are at risk of developing post traumatic stress symptoms (PTSS). The long-term responses to traumatic events are variable and can be classified into distinct PTSS trajectories. In this prospective study, we evaluated PTSS trajectories among combat veterans during the initial year after discharge from military service. Subsequently, we analyzed how combat exposure and PMIEs contributed to these trajectories.

Methods: Our study encompassed 374 combat veterans who participated in a five-year prospective study, with four waves of measurements, T1 - one year before enlistment, T2 - one month prior to discharge from military service (July 2021), and then again at six months (T3 - February 2022) and twelve months after discharge (T4, July-August 2022) .

Results: The utilization of Latent Profile Analysis (LPA) revealed a diverse array of PTSS trajectories. Predominantly, a resilient trajectory emerged as the most frequently observed (69.3%), with 'delayed onset'(13.6%), 'improving'(9.9%) and 'chronic'(6.1%) trajectories following in order. Importantly, multinominal regression analysis indicated that combat exposure and PMIE-betrayal contributed to alignment with symptomatic trajectories.

Conclusions: This study represents the first of its kind to establish longitudinal, time-dependent associations between PMIEs and PTSS trajectories. These results emphasize the critical importance of ongoing screening and the development of tailored interventions for combat veterans.

Purpose: To evaluate the associations and interaction between sexual violence perpetration and victimization on suicide attempts using a large representative sample of adolescents from South Korea.

Methods: Based on data from 515,247 adolescents aged 12-18 years from the Korea Youth Risk Behavior Web-Based Survey (2006-2012), a nationally representative repeated cross-sectional survey, we obtained self-reports of suicide attempts over the past year and of lifetime sexual violence perpetration and victimization. Using complex survey weights, weighted logistic regression models were employed to estimate the odds ratios (ORs). The interaction analyses were conducted on both additive and multiplicative scales. All analyses were conducted separately for boys and girls.

Results: Lifetime prevalence of sexual violence perpetration were 1.3% for boys and 0.4% for girls, and about 40% of those perpetrating sexual violence were also victims. After adjusting for several covariates, sexual violence perpetration was independently associated with suicide attempts in boys (OR_adjusted for boys 1.80 [95% confidence intervals: 1.53, 2.11]), whereas in girls, the association was only marginally significant (OR_adjusted for girls 1.27 [1.00, 1.63]). We found the negative multiplicative and additive interaction between the sexual violence perpetration and victimization on suicide attempts for both boys and girls (the ratio of ORs 0.30 [0.23, 0.39] for boys and 0.20 [0.12, 0.31] for girls; relative excess risk due to interaction - 1.20 [-1.91, - 0.50] for boys and - 2.33 [-3.00, - 1.66] for girls).

Conclusion: Sexual violence perpetration and victimization were independently and interactively associated with suicide attempts in adolescents, with a sub-additive interaction found between these two variables. Public mental health services and policies should recognize the importance of actively involving adolescents who had sexually perpetrated others as key intervention targets.