Education and income: which is more important for mental health?

STUDY OBJECTIVE: To assess which indicators of socioeconomic status are associated with an increased prevalence of common mental disorders. DESIGN: Cross sectional household survey. SETTING: Santiago, Chile. PARTICIPANTS: Random sample of adults aged 16-65 residing in private households. Main results: Less education (odds ratio 2.44, 95% confidence intervals 1.50 to 3.97), a recent income decrease (odds ratio 2.14, 1.70 to 2.70), and poor housing (odds ratio 1.53, 1.05 to 2.23), were the only socioeconomic status variables that remained significantly associated with an increased prevalence of common mental disorders after adjustments. The prevalence of common mental disorders was also higher among people with manual unskilled occupations, overcrowded housing, and lower per capita income but these associations disappeared after adjustment for other explanatory and confounding variables. CONCLUSIONS: There is a strong, inverse, and independent association between education and common mental disorders. However, income was not associated with the prevalence of common mental disorders, after adjusting for other socioeconomic variables. Similar results have been found in other Latin American studies but British studies tend to find the opposite, that income but not education is associated with common mental disorders. Understanding the impact of socioeconomic factors on mental health requires research in poor as well as rich countries.     

Psychotic symptoms in Kenya--prevalence, risk factors, and relationship with common mental disorders

There have been few epidemiological surveys to establish prevalence and associated risk factors of psychosis in Sub-Saharan Africa. This paper reports a population-based epidemiological survey in rural Kenya of the prevalence of psychotic symptoms and their relationship with demographic, socio-economic and other risk factors. A random sample of 2% of all adults living in Maseno, Kisumu District of Nyanza province, Kenya (50,000 population) were studied, aiming for a sample size of 1,000 people. The psychosis screening questionnaire was used to assess the prevalence of psychotic symptoms in the preceding twelve months. The response rate was 87.6%. The prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms in this sample size. Psychotic symptoms were evenly distributed across this relatively poor rural population and were significantly associated with presence of common mental disorders, and to a lesser extent with poor physical health and housing type. We conclude that single psychotic symptoms are relatively common in rural Kenya and rates are elevated in those with CMD, poor physical health and poor housing.     

Retirement and mental health: analysis of the Australian national survey of mental health and well-being

Nation-wide research on mental health problems amongst men and women during the transition from employment to retirement is limited. This study sought to explore the relationship between retirement and mental health across older adulthood, whilst considering age and known risk factors for mental disorders. Data were from the 1997 National Survey of Mental Health and Well-being, a cross-sectional survey of 10,641 Australian adults. The prevalence of depression and anxiety disorders was analysed in the sub-sample of men (n = 1928) and women (n = 2261) aged 45-74 years. Mental health was assessed using the Composite International Diagnostic Instrument. Additional measures were used to assess respondents' physical health, demographic and personal characteristics. The prevalence of common mental disorders diminished across increasing age groups of men and women. Women aged 55-59, 65-69, and 70-74 had significantly lower rates of mental disorders than those aged 45-49. In contrast, only men aged 65-69 and 70-74 demonstrated significantly lower prevalence compared with men aged 45-49. Amongst younger men, retirees were significantly more likely to have a common mental disorder relative to men still in the labour force; however, this was not the case for retired men of, or nearing, the traditional retirement age of 65. Men and women with poor physical health were also more likely to have a diagnosable mental disorder. The findings of this study indicate that, for men, the relationship between retirement and mental health varies with age. The poorer mental health of men who retire early is not explained by usual risk factors. Given current policy changes in many countries to curtail early retirement, these findings highlight the need to consider mental health, and its influencing factors, when encouraging continued employment amongst older adults.     

Patients’ Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS)

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.     

Women, poverty and common mental disorders in four restructuring societies.

BACKGROUND: Poverty and female gender have been found to be associated with depression and anxiety in developed countries. The rationale behind this paper was to bring together five epidemiological data sets from four low to middle income countries to examine whether key economic and development indicators such as income and poor education, and female gender, were associated with common mental disorders. METHOD: The paper is based on five datasets: three based on primary care attenders in Goa, India; Harare, Zimbabwe and Santiago, Chile; and two based on community samples in Pelotas, Brazil and Olinda, Brazil. All five studies estimated prevalence of common mental disorders along with variables to measure economic deprivation and education. FINDINGS: In all five studies, female gender, low education and poverty were strongly associated with common mental disorders. When income was divided into tertiles, with the lowest tertile as a reference value, there was a significant trend for reduced morbidity for the lower two tertiles. DISCUSSION: These findings have considerable implications since the rapid economic changes in all four societies have been associated with rising income disparity and economic inequality. Examples of population based prevention strategies based on increasing the proportion of those who complete schooling and on high-risk strategies such as providing loan facilities to the impoverished are potential outcomes of these findings. Development agencies who focus on women as a priority group have failed to recognize their unique vulnerability to common mental disorders and need to reorient their priorities accordingly.     

Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.     

Material standard of living,social class,and the prevalence of the common mental disorders in Great Britain

STUDY OBJECTIVE: To test the hypothesis that poor material standard of living is independently associated with the prevalence of the common mental disorders after adjusting for occupational social class, and to estimate the population impact of poor material standard of living on the prevalence of these disorders. DESIGN: Cross sectional survey. Prevalence of the common mental disorders was assessed using the General Health Questionnaire, a self administered measure of psychiatric morbidity. PARTICIPANTS: 9064 adults aged 16-75 living in private households in England, Wales, and Scotland. MAIN RESULTS: The common mental disorders were significantly associated with poor material standard of living, including low household income (OR 1.24, 95% CI 1.00, 1.54) and not saving from income (OR 1.29, 95% CI 1.15, 1.45), after adjusting for occupational social class and other potential confounders. An independent association was also found with occupational social class of the head of household among women, but not men, after adjusting for material standard of living. The adjusted population attributable fraction for poor material standard of living (using a five item index) was 24.0%. CONCLUSIONS: Like mortality and physical morbidity, common mental disorders are associated with a poor material standard of living, independent of occupational social class. These findings support the view that recent widening of inequalities in material standards of living in the United Kingdom pose a substantial threat to health.       

The Bambuí Cohort Study of Aging: methodology and health profile of participants at baseline

The cohort study was initiated in 1997 to investigate the incidence and predictors of health outcomes in an elderly population with low socio-economic level. The eligible population consisted of all 1,742 residents in Bambuí, Minas Gerais State, Brazil, aged 60 years and over (1,606 participated). During 10 years of follow-up, 641 participants died and 96 were lost, leading to 13,739 person-years of observation. The baseline health profile of participants revealed a double burden of diseases with high prevalence of chronic non-transmissible diseases and widespread Trypanosoma cruzi infection. The most common health condition was hypertension (61.5%), followed by chronic knee or hand symptoms (43.6%), common mental disorders (38.5%), T. cruzi infection (38.1%), and insomnia (36.7%). In general, the baseline prevalence of mental symptoms and cardiovascular diseases or risk factors was comparable to those found in populations in high income countries.     

The prevalence of common mental disorders in urban slums with displaced persons in Colombia]

OBJECTIVES: To investigate the prevalence of common mental disorders in groups with a high percentage of families who have been displaced by armed conflict and political instability and are living in urban slum areas on the outskirts of Sincelejo, a city in the department of Sucre, Colombia. METHODS: A cross-sectional study was conducted, with two-stage random cluster sampling, in slum neighborhoods of Sincelejo that contain a high percentage of displaced persons. A household survey of persons 18 years old or older was used to determine the presence of common mental disorders-psychosomatic disorders, anxiety, and depression-in the population studied. A score of 7 or more on the first 20 questions of the Self-Reporting Questionnaire (SRQ) of the World Health Organization was used to determine the presence of a common mental disorder. We searched for associations among the studied variables (age group, gender, type of health care card, and length of residence in the neighborhood) and among those variables and the score on the SRQ. The chi-square test was used, with statistical significance set at 0.05. Logistic regression was carried out with all the related variables. RESULTS: The prevalence of common mental disorders in the adult population of the neighborhoods studied was 27.2% (95% confidence interval (95% CI)=24.0% to 30.0%); 13.6% (95% CI=11.4% to 16.1%) of the population surveyed had problems with excessive alcohol consumption. There was an association between the prevalence of common mental disorders and the type of health care card used (odds ratio=1.66 for persons using the health care card for displaced persons versus persons using other types of health care cards). In addition, there was an association between the prevalence of common mental disorders and gender (OR=1.78 for women); this association remained after adjusting for other explanatory variables. CONCLUSIONS: Using the study criteria (type of health care card and length of time living in the slum area), it was difficult to separate the displaced persons from other persons living in the same slum areas, and thus to measure the prevalence of common mental disorders among just the displaced persons. The prevalence of common mental disorders in the urban population studied showed a statistical association with the type of health care card, which in turn determined the level of access to public health services. This association between the type of health care card held and the prevalence of common mental disorders is strong enough to justify providing mental health care services to persons who have the health care card for displaced persons.     

Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey.

The National Institute of Mental Health Epidemiologic Catchment Area Survey is a comprehensive, community-based survey of mental disorders and use of services by adults, ages 18 and older. Diagnoses are based on the criteria in the "Diagnostic and Statistical Manual of Mental Disorders," third edition, and were obtained in five communities in the United States through lay-interviewer administration of the National Institute of Mental Health Diagnostic Interview Schedule. Results from the survey provide the public health field with data on the prevalence and incidence of specific mental disorders in the community, unbiased by the treatment status of the sample. The population with disorders is estimated, and the survey findings that respond to some of the most common requests for information about the epidemiology of mental disorders in the United States are highlighted briefly. Based on the survey, it is estimated that one of every five persons in the United States suffers from a mental disorder in any 6-month period, and that one of every three persons suffers a disorder in his or her lifetime. Fewer than 20 percent of those with a recent mental disorder seek help for their problem, according to the survey. High rates of comorbid substance abuse and mental disorders were found, particularly among those who had sought treatment for their disorders.     

The prevalence of borderline personality disorder among individuals with obesity: a critical review of the literature

Through a MEDLINE and PsycLIT database search, all US studies relating to the prevalence of borderline personality disorder (BPD) among obese individuals were reviewed. The highest rates of BPD among these individuals were found in samples recruited from psychologically oriented settings (i.e., eating disorders program, mental health setting). Lowest rates were found among those seeking weight loss in non-psychological programs or those in primary care settings. Among those studies examining individuals with binge-eating disorder (BED), all indicated a higher-than-community prevalence of BPD. These data suggest that the prevalence of BPD appears increased among those obese individuals seeking psychological care or who have BED.     

Mental Health Needs of an Emerging Latino Community

Over the last decade, Baltimore has become a non-traditional sanctuary city, receiving an unprecedented influx of Latino immigrants, mostly from Central America’s Northern Triangle, who are often fleeing violence in their home countries. This study explored the nature and frequency of healthcare utilization for mental health problems among uninsured/uninsurable Latinos who received outpatient care between 2012 and 2015 through an academic hospital-affiliated program that covers primary and specialty services to uninsured patients without regard to documentation status. Encounters for mental health disorders were the most common category, accounting for 14.88% of all visits. Mood (78%) and anxiety disorders (16%) were the most prevalent mental health diagnoses. The most frequent reason to seek care was symptom, signs, and ill-defined conditions (37.47%), and within this subgroup, pain was the leading cause of seeking care (88%), which may indicate high rates of somatization of mental health distress. This study presents a unique opportunity to explore the burden and nature of mental health needs among a population for which healthcare information is rarely attainable and highlights the need for culturally competent screening mechanisms and interventions to address the stressors faced by emergent communities.

     

Impaired work functioning due to common mental disorders in nurses and allied health professionals: the Nurses Work Functioning Questionnaire

Purpose  

Common mental disorders (CMD) negatively affect work functioning. In the health service sector not only the prevalence of CMDs is high, but work functioning problems are associated with a risk of serious consequences for patients and healthcare providers. If work functioning problems due to CMDs are detected early, timely help can be provided. Therefore, the aim of this study is to develop a detection questionnaire for impaired work functioning due to CMDs in nurses and allied health professionals working in hospitals.     

Urbanization and mental health in developing countries

It is expected that the urban population in developing countries will double in the next 30 years. While urbanization is accompanied by health problems, population density can lower public health costs. Common mental disorders, such as anxiety, depression, insomnia, fatigue, irritability, and poor memory, account for 90% of all mental disorders, cause behavioral problems in offspring, and impede recovery from physical ailments. Those who suffer most from common mental disorders include women, those between 15 and 49 years old, and low-income populations. Strong links have been established between socioenvironmental factors and common mental disorders, and an urban environment has been associated with many possible risk factors for such disorders. Only a small percentage of people with mental disorders seek primary health care and even less receive secondary- or tertiary-level care. Common mental disorders place a large burden on primary health care services, however, but most of the patients suffering from mental disorders seek care for physical disorders that mask proper diagnosis and treatment. Thus, the World Health Organization advocates the introduction of mental health components in primary health care services in developing countries. In order to reach those who remain outside of the health care system, community-based interventions such as self-help groups or efforts to promote wider social changes or address poverty should be undertaken. Mental health in developing countries is gaining attention as the attendant loss in economic productivity of human capital has become apparent.     

The prevalence and correlates of hazardous drinking in industrial workers: a study from Goa,India

AIMS: This study aimed to describe the prevalence and associations of hazardous drinking in a male industrial worker population in India. METHODS: A total of 984 subjects from a randomly selected sample of 1013 workers from four industries in Goa, India, were recruited. Interviews included the 10-item Alcohol Use Disorders Identification Test (AUDIT) as an indicator of hazardous drinking and the 12-item General Health Questionnaire (GHQ12) as a measure of common mental disorders (CMDs). RESULTS: The prevalence of hazardous drinking, defined as an AUDIT score of more than 8 was 21%. There was a significant association with CMD (OR 2, P = 0.003). Hazardous drinking was significantly associated with severe health problems, such as head injuries and hospitalization, whereas CMD was found to be a confounder in its association with adverse economic outcomes. CONCLUSIONS: Hazardous drinking is common among male industrial workers in Goa. Interventions in the workplace must target both drinking problems and CMDs, since they often co-exist and are associated with different types of adverse outcomes.     

Self-reported history of physician-diagnosed asthma and common mental disorders among civil servants at a public university in Rio de Janeiro, Brazil: the Pró-Saúde study

This study investigates the association between history of asthma and common mental disorders among employees at a public university in the State of Rio de Janeiro, Brazil. Phase 1 cross-sectional data from a cohort study (the Pró-Saúde Study) were collected from 4,030 employees. Asthma was ascertained by self-reported medical diagnosis, and the occurrence of common mental disorders was based on the General Health Questionnaire (GHQ-12). Generalized linear models were used to calculate prevalence rates. Asthma prevalence was 11% (444), of whom 39.7% (176) presented common mental disorders. History of asthma was associated with higher income (p = 0.01) and female gender (p = 0.01). The analysis adjusted by gender, age, and per capita income revealed an association between asthma and common mental disorders (PR = 1.37; 95%CI: 1.22-1.55). Employees with less than 10 years since their asthma diagnosis showed a higher prevalence of common mental disorders (PR = 1.88; 95%CI: 1.32-2.70). These findings suggest that multidisciplinary teams should consider emotional aspects of asthma patients, especially those recently diagnosed.     

Trends in mental health inequalities in urban Canada

ObjectivesCanadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada’s largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time.MethodsSelf-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored.ResultsAt the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011–2015. Inequalities were present in 2001–2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001–2005 and decreased over time.ConclusionThe large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.     

Pediatric mental health problems and associated burden on families

Approximately 20% of children in the United States have mental health problems. The factors associated with childhood mental health problems and the associated burdens on families are not well understood. Therefore, our goals were to profile mental health problems in children to identify disparities, and to quantify and identify correlates of family burden. We used the National Survey of Children's Health, 2003 (n?=?85,116 children aged 3–17 years) for this analysis. The prevalence, unadjusted and adjusted odds ratios (AOR) of mental health problems and family burden were calculated for children by child-, family- and health systems-level characteristics. The prevalence of mental health problems among children aged 3–17 years was 18%. The odds of mental health problems were higher for boys, older children, children living in or near relative poverty, those covered by public insurance, children of mothers with fair or poor mental health, children living in homes without two parents, children without a personal doctor or nurse and children with unmet health care needs. Among families with children with mental health problems, 28% reported family burden. Correlates of family burden included white race, severity, older age, higher income, non-two-parent family structure and having a mother with mental health problems. In conclusion, childhood mental health problems are common, and disproportionally affect children with fewer family and health care resources. Families frequently report burden, especially if the mental health problem is moderate to severe, but the correlates of family burden are not the same correlates associated with mental health problems. Understanding those highest at risk for mental health problems and family burden will help assist clinicians and policy makers to ensure appropriate support systems for children and families.     

Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa

Globally, the poor are consistently at greater risk of suffering from depression and anxiety. Yet in resource-poor countries, mental health remains a neglected topic. This interdisciplinary study explored the potential for a poverty alleviation programme to contribute to breaking the vicious cycle between poverty and common mental disorders (CMD). Quantitatively, beneficiaries of a cash-transfer programme were found to have a lower risk of CMD. Qualitative interviews indicated that Child Support Grants acted as a psychological safety net, but that negative stereotypes of grant recipients could detract from the positive mental health outcomes of the grants. It was concluded that poverty alleviation programmes such as cash transfers could have both positive and negative impacts on mental health. In order to achieve mental health benefits for programme beneficiaries, aspects of programme design and implementation that promote mental health should be enhanced and aspects detrimental to mental health modified.