Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time.

Methods

Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD.

Results

Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82–0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84–0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02–1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07–1.2). Age-specific trends showed increased ADHD medication use among younger patients (14–24 years), and anxiolytic use predominated in those aged ≥ 65 years.

Conclusions

Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Purpose: There is a lack of comprehensive measurements and systematic evaluations of the depression in caregivers of patients with psychiatric disorders and the factors influencing them in China. This study aims to explore the relationship between family function and depression in caregivers of patients with schizophrenia at the individual, family, and social levels according to the ecological system theory and attachment theory.

Methods: In this study, multi-stage, stratified cluster sampling was adopted to sample caregivers of patients with schizophrenia as subjects from one to three counties of four counties in Yunnan, from September 2022 to March 2023. Collecting the current caregiver's demographic data, family functions, social support, care burden, depression and internalized stigma.

Results: The results of single-factor analysis show that age, education level, relationship with patients, and the degree of self-care of patients are the influencing factors of depression of people living with schizophrenia (p < 0.05). The scores of self-rating depression scale are higher for caregivers who have not received formal education, caregivers who cannot take care of themselves and the parents, spouses and children of patients. The results of Pearson correlation analysis show that depression is positively associated with internalized stigma and care burden, and negatively associated with social support and family function (p < 0.05). The results of multiple linear regression show that after controlling age, education level, the patient's self-care capacity, and relationship with patient, the internalized stigma (β = 0.184, p = 0.01) is positively correlated with depression. The mediation effect route of family function → social support → care burden → internalized stigma → depression was significant with 95% confidence interval [-0.150, -0.01], and the chained mediation effect was 5.904%.

Conclusions: To reduce the depression level in family caregivers of schizophrenia, apart from taking measures to improve the caregiver's family function, enhancing social support, decreasing care burden, and reducing internalized stigma are suggested.

Purpose

The current study examined associations of social and built features of neighborhood environments with psychological distress 6 years later and whether these associations were explained by stress and social factors, among Hispanic/Latino adults from the HCHS/SOL and SOL CASAS Ancillary Study.

Methods

In the SOL CASAS Ancillary Study, HCHS/SOL San Diego participants’ baseline (2008–2011) home addresses were geocoded, neighborhoods were defined using 800 m radial buffers, and variables representing neighborhood socioeconomic deprivation, social disorder, walkability, and greenness were created. Psychological distress (anxiety and depression symptoms) and proposed pathway variables chronic stress, social support, and family cohesion were assessed at HCHS/SOL Visit 2 (2014–2017).

Results

On average, the population (n = 2785) was 39.47 years old, 53.3% were women, and 92.3% were of Mexican heritage. In complex survey regression analyses that accounted for sociodemographic covariates, the complex sampling design, and sample weights, greater baseline neighborhood socioeconomic deprivation predicted lower family cohesion at Visit 2 (B = -0.99, 95% CI [-1.97, -0.06]). Path models showed indirect associations of baseline neighborhood socioeconomic deprivation with Visit 2 psychological distress through family cohesion (MacKinnon’s 95% CI depression [0.001, 0.026]; 3.9% of the variance accounted for; anxiety [0.00071, 0.019] 3.0% of the variance accounted for).

Conclusions

Among adults of mostly Mexican heritage from the San Diego, CA area, neighborhood deprivation indirectly predicted later psychological distress through family cohesion. No other effects of neighborhood variables were observed.

Purpose

There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally.

Methods

A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data.

Results

1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8–21.6%), anxiety was 56.4% (95% CI 35,9–75%), and depression was at 34.7% (95% CI 23.4–48.1%).

Conclusion

This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.

Background

Social participation as a protective factor against cognitive decline was one of the targets in the AgeWell.de study, a multi-domain interventional trial in a sample of older adults at increased risk for dementia. This study aimed to examine differential effects of the intervention and other influencing factors on social participation throughout the trial.

Methods

A longitudinal analysis of study data at the primary follow-up after 24 months (n = 819) was conducted. The Lubben Social Network Scale (LSNS-6) was used to assess quantitative aspects of social networks, and self-reported social activities were classified using a three-tiered categorical framework to capture qualitative aspects.

Results

A positive effect of the intervention was observed at the qualitative framework level, with an OR of 1.38 [95% CI: 1.05–1.82] for achieving or maintaining higher social participation at follow-up, while no effect could be detected on quantitative social network characteristics. Later phases of the Covid-19 pandemic showed a negative impact on the level of social participation at follow-up with an OR of 0.84 [95% CI: 0.75–0.95].

Conclusions

These findings suggest that by focusing on qualitative aspects of social participation as a component of dementia prevention, future interventions can promote enriched social interactions within established social networks.

Trial Registration

German Clinical Trials Register (DRKS) ID DRKS00013555.

Purpose: Community participation is believed to be positively associated with recovery experiences and quality of life for people with serious mental illnesses (PSMIs). However, the underlying mechanism remains unclear. This study examined the mediating effect of self-stigma on the relationship between community participation and personal recovery experiences and quality of life among PSMIs.

Methods: Structural equation modeling and mediation analyses were conducted based on a community sample of 315 PSMIs in Beijing, China, who were surveyed using the Community Participation Domains Measure, Internalized Stigma of Mental Illness, Recovery Assessment Scale, Quality of Life Scale, and a demographic questionnaire. Most were in their middle age. About half were married, and half were females. Most participants got disability certificates.

Results: The results indicate that community participation is directly associated with personal recovery of PSMIs (P < 0.01) and indirectly associated with personal recovery through the mediation of self-stigma (P < 0.01). Additionally, community participation does not have a direct effect on the quality of life of PSMIs but shows an indirect effect through the mediation of self-stigma (P < 0.01). The findings suggest that self-stigma mediates the relationship between community participation and both the subjective perception of recovery and quality of life.

Conclusion: The findings indicate that community participation for PSMIs should be enhanced. Tailored individual intervention services should be implemented to boost positive self-awareness and reduce self-stigma through active engagement in activities. Such participation has the potential to improve subjective experiences of recovery and overall quality of life.

Purpose

The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis.

Methods

We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables.

Results

One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5–524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5–945.0)) vs. (17.0 (IQR: 8.0–30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis.

Conclusions

Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.

Purpose: To explore the impact of unmet community service demands on loneliness among older adults.

Methods: Based on the longitudinal tracking data of CLHLS (2008-2018), latent growth curve model (LGCM) was used to describe the trajectory of loneliness among older adults. Panel regression was used to analyze the impact of unmet community service demands on loneliness, and latent classification analysis (LCA) was used to classify the older adults and analyze the differences in loneliness among different types of older adults.

Results: A total of 1445 older people participated in all four surveys, and 22.4% of them reported feeling lonely. From 2008 to 2018, there was a significant non-linear increase in loneliness, with average values of 1.77, 1.81, 1.83, and 1.96, respectively. The level of community service supply (1.31) was far from meeting the demand level (5.11). Unmet community service demands were associated with a higher prevalence of loneliness (β = 0.012, P = 0.003, 95% CI = [0.004, 0.020]). In addition, according to the demand difference for community services, older adults were classified into the comprehensive demand type (Type I) and the medical demand type (Type II). The loneliness of Type I older adults was significantly higher than that of Type II (P < 0.05).

Conclusions: With the passage of time, loneliness of older adults is showing an accelerating upward trend. Unmet community services can lead to enhanced loneliness among older adults, and the higher the demand for community services, the stronger the loneliness. The government should increase the supply of community services to meet the basic and socio-emotional needs of the older adults to reduce loneliness.

Background: Despite evidence suggesting that insecure attachment is a significant risk factor for Problematic Social Media Use (PSMU), there remains a lack of comprehensive studies exploring this relationship, and a unified understanding of its role has yet to be established.

Methods: We employed network analysis to construct an integrated model for examining the complex interrelations between negative emotions, trait and state attachment, motives, and PSMU across three platforms (i.e., WeChat, Sina Weibo, and TikTok), as well as for identifying potential mediating variables between attachment and PSMU. Data were collected from 685 young adults via online self-reported questionnaires.

Results: We found that negative emotions are positively correlated with insecure trait and state attachment but have a negligible direct relationship with PSMU. The conformity motive and state attachment security emerged as important central nodes when measured by strength, closeness, and betweenness. Moreover, attachment states and motives were found to be clustered. Such strong interrelationships were also evident between insecure attachment and PSMU, while trait attachment anxiety and avoidance were observed to be related to PSMU across various platforms.

Conclusions: Our findings promote a deeper understanding of the relationship between insecure attachment and PSMU from a cross-platform perspective and offer novel insights into the mechanisms underlying their co-occurrence, which may guide the development of effective interventions for healthier social media engagement.

Purpose: Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada.

Methods: The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis.

Results: An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics.

Conclusion: Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.