Early-life adversity-induced long-term epigenetic programming associated with early onset of chronic physical aggression: Studies in humans and animals

Objectives: To examine whether chronic physical aggression (CPA) in adulthood can be epigenetically programmed early in life due to exposure to early-life adversity.

Methods: Literature search of public databases such as PubMed/MEDLINE and Scopus.

Results: Children/adolescents susceptible for CPA and exposed to early-life abuse fail to efficiently cope with stress that in turn results in the development of CPA later in life. This phenomenon was observed in humans and animal models of aggression. The susceptibility to aggression is a complex trait that is regulated by the interaction between environmental and genetic factors. Epigenetic mechanisms mediate this interaction. Subjects exposed to stress early in life exhibited long-term epigenetic programming that can influence their behaviour in adulthood. This programming affects expression of many genes not only in the brain but also in other systems such as neuroendocrine and immune.

Conclusions: The propensity to adult CPA behaviour in subjects experienced to early-life adversity is mediated by epigenetic programming that involves long-term systemic epigenetic alterations in a whole genome.     

Prenatal famine exposure and mental health in later midlife

Objectives: Maternal malnutrition during pregnancy may have long-lasting effects on offspring's mental health. We investigate the effect of prenatal exposure to the Dutch famine (mid November 1944 to late April 1945) on mental health in later mid-life.

Methods: Data are from the Netherlands Kinship Panel Study (n = 642). We use difference-in-difference analyses to compare mental health in later midlife (measured with the MHI-5 index) across three cohorts (‘pre-famine cohort’, ‘famine cohort’, ‘post-famine cohort’) and across two regions (famine affected cities vs. rest of the country).

Results: In the affected cities, we find poorer mental health for the famine cohort than for the pre-famine and post-famine cohorts. In the non-affected rest of the country, no significant mental health differences between birth cohorts were found. The mental health differences between birth cohorts differ significantly between the affected cities and the rest of the Netherlands.

Conclusion: Our analyses link prenatal famine exposure to poorer mental health in later midlife. This suggests that in utero malnutrition has a long-lasting detrimental effect on mental health.     

Background,experience of abuse,and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample

Purpose: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents.

Materials and methods: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze.

Results: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care.

Conclusions: Even where the protective factor ‘senior educational attainment’ is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.     

Associations of health insurance coverage,mental health problems,and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities.

Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use.

Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use.

Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.     

Mental health knowledge and training needs among direct care workers: a mixed methods study

Objectives: Direct care providers (DCWs) spend the most time with clients in the home, and as such, play an integral role in identifying mental health problems. However, DCWs receive little preparation in mental health and there is little research regarding their role in the mental health care of clients. The purpose of this study was to explore DCWs’ knowledge, attitudes, and experiences of caring for clients with mental health problems from the perspectives of DCWs and key administrators (KAs).

Method: Mixed method design. Structured interviews were conducted with DCWs. Focus groups were conducted with KAs.

Results: Twenty-nine DCWs and 12 KAs took part in the study. Loneliness and memory problems in clients were the most prevalent challenges identified by DCWs. DCWs’ self-reported mental health knowledge was mid to high across all domains, although they had many misconceptions about mental health and aging. Helpful strategies in working with clients included communication skills, rapport-building, behavioral, cognitive, emotion-regulation, and making use of external resources. KAs noted individual differences in DCWs’ mental health knowledge and indicated that mental health issues were often viewed by DCWs as dispositional problems or a normal part of aging. KAs viewed DCWs’ greatest challenges as personalizing difficult client behaviors, lack of knowledge about how to manage specific behaviors, and difficulties managing their own emotions towards clients.

Conclusion: Data from this study suggest important areas for DCW development. However, system issues that affect DCWs such as workload, resources, mental health stigma, and diverse client populations should be addressed concurrently.     

Impact of a culturally adapted behavioural family psychoeducational programme in patients with schizophrenia in Egypt

Objective: To study the effect of a culturally adapted, structured family intervention on symptom severity, medication attitudes and knowledge, social functioning and quality of life in patients with schizophrenia.

Methods: Thirty subjects with schizophrenia were selected to receive 14 sessions of a culturally adapted behavioural family psychoeducational programme (BFPEP). Another 30 subjects received standard treatment as usual (STU) for 6 months. Pre- and post-intervention outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory 10-item scale (DAI-10), Quality of Life Scale (QLS) and Social Functioning Questionnaire (SFQ).

Results: There was a no significant difference between BFPEP and STU at baseline on all measures. There was a significant difference (p?<?.05) between pre- and post-treatment scores for BFPEP on all measures, a significant difference (p?<?.05) between pre- and post-treatment scores for STU on all measures (favouring pre-treatment scores) and a significant difference (p?<?.05) favouring BFPEP over STU on all measures post-treatment.

Conclusions: These results demonstrate the feasibility and effectiveness of implementing family therapy psychoeducational interventions in different cultural settings, with relatively minor modifications. This may have implications for mental health policy makers to make available such programmes for patients and mental health professionals.     

Addressing organizational barriers to continuity of care in the Danish mental health system – a comparative analysis of 14 national intervention projects

Background: Continuity of mental health care is central to improve the conditions of people with enduring mental disorders. In Denmark, several government-funded projects on the improvement of continuity of mental health care have been initiated since 2009.

Aim: The aim of this study was to investigate how national intervention projects on continuity of mental health care have addressed major barriers for continuity of care and extract general learning points from the projects on the improvement of continuity of care.

Method: The study was designed as a thematic document analysis of external evaluations of 14 major national projects on the improvement of continuity of routine mental health care from 2009 to 2017. The data material was processed through thematic coding and comparative analysis.

Results: The analysis was organized around four main barriers for continuity: Lack of models for collaboration, different professional cultures and methods, lack of channels of communication, and intersectoral differences in management, economy, and legislation. The first three barriers were addressed in a predominant part of the projects through development of collaborative models, common tools and communication systems. The latter structural barrier was not addressed in any of the projects.

Conclusion: There is an ongoing need to address barriers for continuity of mental health care. So far, there has been a much larger focus on organizational, cultural and communicational aspects of continuity than on structural aspects. The study calls for an increased focus on how changes in existing managerial, economic and legislative structures can improve continuity of care.     

French translation and validation of a fragile X syndrome screening checklist

Background: Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability among men. This syndrome is frequently underdiagnosed in adults. The aim of this study was to develop and validate a French translation of the screening checklist Fragiele-X screeningslijst.

Method: The validation sample for the translated checklist included 22 pairs of men between the ages of 18 and 52, matched by age and degree of intellectual impairment.

Results: The translated checklist achieved coefficients of 0.92 for internal consistency, 0.90 for test-retest reliability and 0.65 for inter-rater reliability. These psychometric properties are commensurate with those of the original checklist.

Conclusion: Therefore, the translated checklist developed in this study can be considered a valid screening instrument for the detection of FXS in men with intellectual disabilities.

Abbreviations: FXS: fragile X syndrome; FMR1: fragile X mental retardation 1 (gene)     

Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms

Objectives: This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS.

Methods: Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the ‘How Well Doctors Communicate’ composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used.

Results: CSDS are associated with greater odds of having ‘poor’ perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand.

Conclusion: Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients’ unique needs and communication preferences to ensure receipt of quality care.     

Effects of aging on the myelination of the optic nerve in rats

Aim of the study: Cognitive decline due to aging is most probably the result of changes in the white matter in the central nervous system (CNS) and/or demyelination.

Material and methods: We used electron microscopic analysis of the morphological changes in aging rats’ optic nerves as an easily accessible part of the CNS.

Results: Several age changes were observed in aging rats (36?months) vs. young adult rats (6?months), namely degeneration of axons, decreased packing density and morphological alterations of myelination, including the ballooning of some myelin sheaths, separation of myelin lamellae and degenerative changes in the oligodendrocytes population.

Conclusion: Cognitive decline related to aging may occur in part due to the disturbed myelination of axons in CNS white matter.     

Perceived discrimination and mental health among older African Americans: the role of psychological well-being

Objectives: Examine the effect of perceived discrimination (both racial and non-racial) on the mental health of older African Americans and explore the buffering role of psychological well-being (purpose in life and self-acceptance).

Methods: Using an older African American subsample from the National Health Measurement Study (n = 397), multiple regression model by gender was used to estimate the effects of two types of discrimination (every day and lifetime) on SF-36 mental component and mediating role of two concepts of psychological well-being.

Results: With no gender difference on the everyday discrimination, older men experienced more lifetime discrimination than older women. The older men's model found that the depressive symptomology was significantly explained by only everyday discrimination and mediated by self-acceptance. The older women's model was significant, with everyday discrimination and both self-acceptance and purpose in life emerging as mediating variables.

Discussion: The prevalence of institutional lifetime discrimination for older African American men is consistent with previous research. Inconsistency with past research indicated that only everyday discrimination is statistically associated with depressive symptoms. Considering the buffering role of psychological well-being served for mental health problems, practitioners need to emphasize these factors when providing services to older African Americans. Equally important, they must address racial discrimination in mental health care settings.     

Mental health care providers talk about their experiences preventing suicide in people with substance use disorders in South Africa: implications for clinical practice

Objective: This study explored mental health care providers’ experiences of preventing suicide in people with substance use disorders and their perceptions of factors related to clinical practice that contributed to these experiences.

Methods: In-depth, semistructured interviews were conducted with 18 mental health care providers working in South Africa. Thematic analysis was used to analyse the data inductively with Atlas.ti software.

Results: Participants described feeling hopeless, helpless, powerless and guilty and needed to debrief from their experiences of preventing suicide. They perceived their experiences to be related to the difficulties of treating substance use disorders, the difficulties of assessing and managing suicide risk and how treating substance use might increase suicide risk.

Conclusions: The ways in which mental health care providers think about suicide and make sense of their experiences affects their perceived abilities to prevent suicide. Educating mental health care providers to transcend the limitations of risk factor approaches to suicide prevention and utilise evidence-based strategies for treating substance use disorders and associated problems, may be important to empower them and make them feel competent in suicide prevention. Empowering people with substance use disorders may help prevent suicide and may require collaboration between mental health care providers and allied professionals.     

Effects of stimulus-related variables on mental states recognition in Huntington’s disease

Background: Cognitive abnormalities in Huntington’s Disease (HD) can involve the specific impairment of the social perspective taking as well as difficulties in recognizing others’ mental state many years before the onset of motor symptoms.

Aims: At the scope of assessing how the difficulties in mental state recognition might be an HD early sign before motor symptoms appear, our study was aimed to investigate how the recognition of others’ mental states in HD subjects is moderated by different stimulus related features (gender, difficulty (low, medium, high), and valence (positive, negative, neutral) of the mental states that are to be recognized).

Methods: Subjects with premanifest (n?=?20) and manifest (n?=?40) HD performed the revised ‘Reading the Mind in the Eyes Test’ and were compared with age-matched healthy controls (HC, 40 subjects per cohort).

Results: Our results highlight an early impairment in mental state recognition preceding manifest HD symptoms and a deterioration of these abilities with HD progression. Moreover, we found in HD premanifest subjects an impairment concerning the recognition of negative and neutral mental states, as well as of mental states with moderate recognition difficulty. Finally, we found that participant gender did not influence the performance in recognizing others’ mental states, while all participants recognized mental states displayed by females more accurately than those displayed by males.

Conclusions: We conclude that difficulties in the recognition of complex mental states can be considered as an early sign of HD, before evident behavioral manifestations, and peculiar features of the stimulus influence it.     

A Note on the “One Case per Stagger Position” Character of Common Multiple-Baseline Intervention Designs

Purpose: To overcome the constraint of common multiple-baseline designs that only one case per stagger position is permitted.

Methods: Three alternative strategies for assigning more than one case to each stagger position are examined.

Results: The three recommended strategies achieve the objective while maintaining the study’s internal and statistical-conclusion validities.

Conclusions: ExPRT, a freely available Excel-based randomization-test package, can be used to assist in both the design and statistical analysis associated with each of the strategies.     

Assertive community treatment versus standard treatment for severely mentally ill patients in Denmark: a quasi-experimental trial

Background: The future of assertive community treatment is uncertain, and studies have questioned whether it continues to provide a more effective treatment model for severely mentally ill patients in a modern mental health context. Studies conducted in new settings can contribute to the debate.

Methods: This Danish study compares treatment from assertive community treatment with treatment by standard community mental health teams, using a non-blinded quasi-experimental multi-center trial. Outcomes included contact with mental health services, days of admission, days of involuntary admission, number of outpatient contacts, adherence to antipsychotic medication, social functioning, user satisfaction, and psychopathology.

Results: A total of 366 patients receiving treatment from assertive community treatment (n?=?213) or continuation of care from community mental health teams (n?=?153) were included in the trial. Assertive community treatment was significantly better in sustaining contact with patients. At 2-year follow-up, 16 (8%) of patients receiving assertive community treatment versus 22(14%) receiving care from standard treatment had lost contact with treatment. Patients who received assertive community treatment had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction. No differences in days of involuntary admission and psychopathology were found.

Conclusions: The results suggest that a high fidelity assertive community treatment may be a valuable tool to strengthen contact between severely mentally ill patients and the treatment staff and may contribute to improving outcomes in a modern Danish mental health context.     

The influence of social support and perceived stress on response time inconsistency

Objectives: Lack of social support and high levels of stress represent potentially modifiable risk factors for cognitive aging. In this study we examined the relationships between these two risk factors and response time inconsistency (RTI), or trial-to-trial variability in choice response time tasks. RTI is an early indicator of declining cognitive health, and examining the influence of modifiable psychosocial risk factors on RTI is important for understanding and promoting cognitive health during adulthood and old age.

Methods: Using data from a community sample study (n = 317; M_age = 49, range = 19–83), we examined the effects of social support, including size of network and satisfaction with support, global perceived stress, and their interactions on RTI.

Results: Neither size of network nor satisfaction with support was associated with RTI independent of perceived stress. Stress was positively associated with increased RTI on all tasks, independent of social support. Perceived stress did not interact with either dimension of social support to predict RTI, and perceived stress effects were invariant across age and sex.

Conclusion: Perceived stress, but not social support, may be a unique and modifiable risk factor for normal and pathological cognitive aging. Discussion focuses on the importance of perceived stress and its impact on RTI in supporting cognitive health in adulthood and old age.     

Identifying modifiable factors associated with health optimism in older adults

Objective: Despite the documented importance of health optimism for enhancing health outcomes, very little work has been done to examine who experiences health optimism and under what conditions. The present study sought to identify modifiable factors associated with health optimism that could constitute the focus of future intervention efforts designed to promote health optimism among older people.

Design: Participants were 453 (44% males) community-based Western Australians aged 60+ years (M = 70.39 years, SD = 6.06). Participants completed questionnaires to assess sociodemographic characteristics and provided information relating to physical and psychological health status.

Results: Almost a quarter of participants (24%; n = 108) were classified as health optimists. Results from a multivariate regression analysis found quality of life, psychological well-being, and age to be directly and positively associated with health optimism. A subsequent path analytic model found depression (negatively) and self-efficacy (positively) to be indirectly associated with health optimism via both psychological well-being and quality of life.

Conclusion: These findings extend the limited evidence on health optimism in older adults by identifying various modifiable factors that may constitute potential areas of focus for future interventions designed to enhance health outcomes via the fostering of health optimism.     

Flourishing despite a cancer diagnosis: factors associated with complete mental health in a nationally-representative sample of cancer patients aged 50 years and older

Objectives: This study investigated the association between cancer and complete mental health (CMH). CMH includes optimal functioning as well as the absence of psychopathology.

Methods: Secondary data analyses of the nationally representative 2012 Canadian Community Health Survey-Mental Health. This study used bivariate and logistic regression analyses to estimate the odds ratios of CMH among community dwellers aged 50 and older with current cancer (n?=?438), previous cancer (n?=?1,174) and no cancer history (n?=?9,279). CMH had three elements: (1) absence of mental illness, addictions and suicidal thoughts in the past year; (2) almost daily happiness or life satisfaction in the past month; (3) psychosocial well-being. Control variables included socio-demographics, health behaviours, current physical health and lifetime history of mental illness and childhood maltreatment.

Results: Adults aged 50 and over with current cancer had a much lower prevalence of CMH (66.1%) than those with previous cancer (77.5%) and those with no cancer history (76.8%). After adjusting for 17 variables, the odds of CMH among those with current cancer remained substantially lower (OR = 0.63; 95% CI = 0.49–0.79) than those without cancer. Among those who had ever had cancer, the odds of CMH were higher for female, white, married, and older respondents, as well as those with higher socioeconomic status, and no history of childhood physical abuse, substance abuse, depression or anxiety disorder.

Conclusions: Those with former cancer have comparable odds of CMH to those with no cancer history, suggesting a high level of resilience among cancer survivors.     

Geographical proximity and depressive symptoms among adult child caregivers: social support as a moderator

Objectives: This study examined whether geographical proximity is a predictor of depressive symptoms, and whether family and friend support can moderate the relationship between geographical proximity and depressive symptoms.

Method: A survey of 557 adult child primary caregivers was conducted in Shanghai, China in 2013. Geographical proximity was measured as a categorical variable: coresidence, short distance (less than 30 minutes’ travel time), and long distance (more than 30 minutes’ travel time). Family and friend support were assessed using the Multidimensional Scale of Perceived Social Support. Depressive symptoms were evaluated using the Center on Epidemiologic Studies Depression Scale. Multiple regression analyses and interaction terms were used to test the moderating roles of family and friend support.

Results: Adult child caregivers who live more than 30 minutes away from care recipients experienced higher depressive symptoms than coresiding caregivers (β = .114, p < .01). Family support (β = ?.408, p < .05) and friend support (β = ?.235, p < .05) were protective factors that lessened depressive symptoms for long-distance adult child caregivers.

Conclusion: This study adds spatial dimension to caregiving literature and extends stress process theory. These findings have important implications for service planning and social support for adult child caregivers.