Social Psychiatry and Psychiatric Epidemiology最新文献

Purpose: Peer victimisation, often a serious childhood stressor, has been associated with poor cognitive outcomes. The current study sought to uncover whether peer victimisation is associated with poor cognitive functioning in childhood via inflammation.

Methods: Data from 4583 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Path analysis was conducted to determine whether inflammation, measured using IL-6 and CRP levels (age 9), mediates the effects of peer victimisation (age 8), even after controlling for other stressors, on multiple cognitive outcomes, including working memory (age 10), reading (accuracy, speed, and comprehension) (age 9), spelling (age 9), response inhibition (age 10), attentional control (age 11), and selective attention (age 11).

Results: IL-6 and CRP partially mediated the effects of peer victimisation on working memory, reading accuracy, and selective attention. IL-6 partially mediated the effect of peer victimisation on reading comprehension, while CRP partially mediated the effect of peer victimisation on reading speed. All effects were small. Inflammation did not mediate the effects of peer victimisation on spelling, response inhibition or attentional control.

Conclusion: Peer victimisation may impact on some aspects of children's cognitive functioning via inflammation. The cognitive outcome specificity observed warrants further research.

Purpose: Comorbidity between mental disorders and somatic diseases exacerbates health outcomes and contributes to premature mortality. However, differences in this comorbidity among immigrant groups compared to the majority population are unclear. This study aims to examine disparities in the risk relationship between common mental disorders (CMDs) and somatic diseases among the majority population (Norwegians) and various immigrant groups.

Methods: This national register study uses information from 3 142 925 residents aged 18+on diagnosed CMDs and selected somatic diseases for years 2008-2016. Poisson regression models were used to study the association between CMD and somatic diseases (i.e., cardiovascular diseases (CVDs), endocrine and metabolic diseases, cancer, and infectious diseases). Differences in risk between Norwegians and immigrant groups were investigated by introducing interaction terms between CMD and immigrant background.

Results: Individuals with CMDs had a higher risk for all somatic diseases compared to those without, regardless of immigrant status. Immigrant groups varied in comorbidity, with those without CMDs showing similar or lower risk compared to Norwegians. However, immigrants with CMDs from non-Western countries (i.e., Eastern Europe, sub-Saharan Africa, South Asia) had a significantly higher probability of developing CVD, hypertension, and diabetes mellitus than Norwegians with CMDs. Additionally, SSA immigrants with CMDs also had a higher risk for viral hepatitis.

Conclusion: Findings suggest that immigrant groups experience varying degrees of comorbidity, which underscores the need for tailored healthcare interventions to address these disparities effectively.

Purpose: To estimate the association between regional level income inequality (a relative measure of socioeconomic disparity) and deaths of despair and assess whether this association is moderated by age, gender, racialized minority status, and income.

Methods: Data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) study were used. A cohort of Canadian adults (n = 19,436,790) within 288 CDs were followed from May 2006 to December 2019. Multilevel Cox-proportional hazard regression was used to estimate the association between income inequality and time to deaths attributed to suicide, drug overdose, and alcohol.

Results: In models adjusted for confounders, income inequality was associated with time to death due to alcohol (HR = 1.14; 95% CI: 1.05, 1.25), drug overdose (HR = 1.19; 95% CI: 1.06, 1.33), and deaths of despair (HR = 1.05; 95% CI: 1.00, 1.11). Significant interactions were primarily observed in cases of deaths attributed to drug overdose. The association between income inequality and the hazards for drug overdose deaths was stronger for individuals aged 40-49 (HR = 1.71; 95% CI: 1.24, 2.37), males (HR = 1.69; 95% CI: 1.22, 2.35), from low-income households (HR = 1.69; 95% CI: 1.22, 2.35), self identified as White (HR = 1.69; 95% CI: 1.22, 2.35) and those living in low-income areas (HR = 1.69; 95% CI: 1.22, 2.35).

Conclusion: Income inequality is associated with high risk of deaths of despair. Additionally, this association is significantly moderated by age, gender, racialized minority status and income at the household and area levels. As such, our findings suggest the need to address income inequality in interventions for reducing deaths of despair among Canadian adults.

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.

Purpose: Relatively little epidemiological evidence on psychosis from diverse settings in the Global South exists, where many people with untreated psychosis seek help outside of formal health service settings. Here, we report a preliminary mapping study of formal and informal community resources within a catchment area in South Africa that established an infrastructure that could be used to detect a representative sample of individuals with untreated psychosis.

Methods: PSYMAP-ZN is a 3-year study of incidence, clinical presentation and associated risk factors for untreated psychosis in Msunduzi Municipality in South Africa. We conducted a preliminary mapping study of the region in which we aimed to document all potential providers of care (gatekeepers) in both formal (health services) and informal (folk) sectors, with the purpose of enrolling them in a collaborative case surveillance system. We drew on official sources, local knowledge from key stakeholders and utilised snowballing techniques.

Results: We established a surveillance system which included (a) all secondary mental health and primary care services (b) the majority of informal providers (including traditional health practitioners, religious institutions) and (c) a wide range of key informants.

Conclusion: Expanding the global knowledge base on psychosis to diverse settings in the Global South requires a surveillance and case-detection method that includes (in addition to formal health settings) informal settings and local key informant knowledge in the community. This preliminary 'mapping' process established a platform for the ongoing PSYMAP study of untreated psychosis in South Africa.

Purpose: We assessed the association between number of adverse childhood experiences (ACEs) and depression among adults and explored the association by race/ethnicity.

Methods: We used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) among 127,577 adult respondents (≥ 18 years old). The exposure was the number of ACEs classified as zero, one, two-three, and ≥ four. The outcome was a self-reported history of depression diagnosis (yes/no). Weighted multivariable logistic regression models examined the association between ACEs and depression stratified by race/ethnicity. Each model was adjusted for age, gender, smoking status, income, education, marital status, and body mass index.

Results: In this sample, 36%, 23%, 21%, and 20% reported having experienced zero, one, two-three, and ≥ four ACEs, respectively. Depression was reported by 19% of survey respondents. There was a significant interaction between the number of ACEs and race/ethnicity, and depression (p = 0.0003), thus, analyses were stratified by race/ethnicity. Respondents who experienced ≥ 4 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR = 4.07; 95% CI: 3.55, 4.65), non-Hispanic Blacks (aOR = 3.96, 95% CI: 2.68, 5.86), or Hispanics (aOR = 7.73; 95% CI: 4.48, 13.35). Respondents with 2-3 ACEs had higher odds of reporting depression: non-Hispanic Whites (aOR: 2.41, 95% CI. 2.11- 2.76), non-Hispanic Blacks (aOR: 1.94, 95% CI. 1.19- 3.17), and Hispanics (aOR: 2.86, 95% CI. 1.64- 4.98).

Conclusion: We found that individuals with two or more ACEs were more likely to report a depression diagnosis, irrespective of race/ethnicity. This finding highlights the need to monitor individuals with an increasing number of ACEs for depression.

Aims: It is purported that tertiary students are at greater risk for poor mental health outcomes in comparison with their non-tertiary peers and those not in education, although the evidence for this is mixed. This paper examines the mental health differences between tertiary and non-tertiary students, and those not enrolled in study, and then examines the changes in mental health in the years prior to, during and post the COVID-19 pandemic.

Methods: Participants were from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, a longitudinal household panel survey. For this study, N = 21,385 participants provided at least one observation on the relevant education and mental health measures between 2017 and 2023. Mental Health was operationalised with the four mental health subscales from the Short Form-36 and included the MHI-5, a measure of psychological distress, Vitality, Social Functioning, and Role Emotion subscales.

Results: Over the study period, there were no differences in levels of Vitality or Social Functioning between education status. Those enrolled in undergraduate programs reported lower MHI-5 (b = -1.17 (SE = 0.38); P = .011) and Role Emotional (b = -2.49 (SE = 0.79); P = .010) scores, but these differences were substantively smaller than the differences reported between age, employment and sex. There were substantive changes in all mental health outcomes with the onset of COVID, particularly for Role Emotion. Two-way interactions between education and time were reported for the MHI, Vitality and Social Functioning subscales with those enrolled in undergraduate and postgraduate reporting slightly larger declines.

Conclusions: In comparison with the magnitude of differences between sex, employment and age groups, there was only weak evidence for differences between education levels. There was weak evidence for changes in mental health between education levels over the study period. Stabilisation in more recent years suggest some adaptation to the COVID-19 pandemic.

Purpose: Although previous studies have considered loneliness as a mediator of the relationship between prodromal psychotic symptoms and impaired social functioning, there is lack of consensus regarding directionality of effects. We tested two competing hypotheses: Prodromal psychotic symptoms lead to deficits in social functioning via loneliness, vs. social functioning deficits lead to amplification of prodromal psychotic symptoms via loneliness.

Methods: We implemented a longitudinal mediational design measuring variables (social functioning, loneliness and prodromal symptoms) at three time points over 6 to 8 months (N = 276) in a sample of British undergraduate students. We tested four longitudinal mediation path models across the three time points, controlling for age, gender and ethnicity.

Results: Longitudinal mediational analyses suggest that both baseline prodromal symptoms and baseline distress about prodromal symptoms lead to small-to-moderate (standardized indirect effects = - 0.02) impairments in social functioning 6 to 8 months later via loneliness. However, baseline impairments in social functioning did not augment prodromal symptoms or symptom distress 6 to 8 months later.

Conclusion: The results suggest that prodromal psychotic symptoms and distress about symptoms lead to impairments in social functioning via loneliness but not vice versa. These results suggest the need for preventative strategies to target loneliness which could prevent subsequent exacerbation of social functioning deficits. Future studies need to examine loneliness as a mechanism in the relationship between prodromal psychotic symptoms and social functioning across cultures, age groups, and over longer time periods.

Purpose: Mental health disparities in sexual minority adolescents have emerged as public health concerns worldwide. This study aimed to investigate the prevalence of sexual minorities and its association with mental health problems among Chinese adolescents, and explored sex difference and the role of social support in the foregoing associations.

Methods: A total of 66,812 adolescents were included from eight provinces via a multi-stage, stratified cluster, random sampling method in 2021. Sampling weights were used to estimate the prevalence, and propensity score-weighted multivariable logistic regression models were conducted in the analyses. Stratified analyses by sex and social support were also conducted.

Results: Of the total sample, the mean (SD) age was 14.9 (1.8) years, with 33,206 boys (52.4%) and 33,721 girls (47.6%). The weighted prevalence of adolescents who identified as heterosexual, homosexual, bisexual and unsure was 80.4%, 2.0%, 9.1% and 8.5%, respectively. Compared with heterosexual, homosexual adolescents were associated with higher odds of depressive symptoms (propensity score-weighted [PSW] adjusted odds ratio [AOR], 2.64; 95% CI, 2.17-3.22), anxiety symptoms (PSW AOR, 1.88; 95% CI, 1.55-2.29), non-suicidal self-injury (PSW AOR, 1.83, 95% CI, 1.55-2.17), suicidal ideation (PSW AOR, 2.34; 95% CI, 1.98-2.77), and suicidal attempt (PSW AOR, 2.39, 95% CI, 1.93-2.98). Sex-stratified analyses showed stronger associations between sexual minority status and most mental health problems for boys than for girls. Sexual minority adolescents with low social support were associated with poorer mental health compared to those with high social support.

Conclusion: Homosexual and bisexual adolescents experienced poorer mental health status than their heterosexual peers, with homosexual adolescents showing slightly stronger associations with mental health risks than bisexual adolescents. More support from family, school and society are recommended to improve the well-being of sexual minority adolescents.