Mental disorders and asthma in the community

OBJECTIVE: To determine the association between asthma and mental disorders among adults in the community. SETTING: Germany. PARTICIPANTS: Representative sample of the general population aged 18 to 65 years. MAIN OUTCOME MEASURES: Diagnoses of current (the past 4 weeks) and lifetime asthma were based on physician diagnosis; current and lifetime DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS: Current severe asthma (the past 4 weeks) was associated with a significantly increased likelihood of any anxiety disorder (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.35-5.18), specific phobia (OR, 4.78; 95% CI, 2.35-4.05), panic disorder (OR, 4.61; 95% CI, 1.09-9.4), and panic attacks (OR, 4.12; 95% CI, 1.32-12.8). Lifetime severe asthma was associated with the increased likelihood of any anxiety disorder (OR, 2.09; 1.3-3.36), panic disorder (OR, 2.61; 95% CI, 1.29-5.25), panic attacks (OR, 2.84; 95% CI, 1.66, 4.89), social phobia (OR, 3.28; 95% CI, 1.42, 7.59), specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). CONCLUSIONS: To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders. Longitudinal studies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms.     

Obesity and mental disorders in the adult general population

OBJECTIVE: The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education). METHODS: A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater. RESULTS: Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05). CONCLUSION: Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.     

Associations of mood and anxiety disorders with obesity: comparisons by ethnicity

Objective

The aim of this study is to compare the associations of mood and anxiety disorders (12 months and past diagnosis) with obesity among ethnically diverse adults.

Methods

Data from Caucasians, African American, and Latinos in the National Comorbidity Survey Replication (NCS-R), National Latino and Asian American Study (NLAAS), and National Study of American Life (NSAL) were analyzed (n = 17,445). Multivariate logistic regression models tested the associations between 12 month and past diagnosis of mood and anxiety disorders with obesity (body mass index ≥ 30 kg/m²).

Results

Approximately 52% of the sample was female and 24% obese. Among Caucasians, 12-month mood disorder (OR = 1.30, 95% CI = 1.05, 1.62), past diagnosis of mood disorder (OR = 1.37, 95% CI = 1.11, 1.69) and 12-month anxiety disorder (OR = 1.40, 95% CI = 1.02, 1.68) were associated with greater likelihood of obesity. Among African Americans, past year anxiety disorder (OR = 1.63, 95% CI = 0.92, 1.67) was associated with greater likelihood of obesity, and a trend toward an association between 12 month mood disorder (OR = 1.24, 95% CI = 0.92, 1.67) and obesity was observed. Similarly among Latinos, past year anxiety disorder (OR = 1.45, 95% CI = 1.00, 1.99) was associated with greater likelihood of obesity, and a trend toward an association between 12-month mood disorder (OR = 1.26, 95% CI = 0.94, 2.01) was observed. Tests of statistical interaction to assess heterogeneity of the associations of mood and anxiety disorders with obesity, comparing African Americans and Latinos to Caucasians, suggest differences in the association of past diagnosis of mood disorder with obesity (P < .10 for both groups).

Conclusions

Results suggest similar associations between 12-month mood and anxiety disorders with obesity across groups.     

Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

BACKGROUND: It has been suggested that homosexuality is associated with psychiatric morbidity. This study examined differences between heterosexually and homosexually active subjects in 12-month and lifetime prevalence of DSM-III-R mood, anxiety, and substance use disorders in a representative sample of the Dutch population (N = 7076; aged 18-64 years). METHODS: Data were collected in face-to-face interviews, using the Composite International Diagnostic Interview. Classification as heterosexual or homosexual was based on reported sexual behavior in the preceding year. Five thousand nine hundred ninety-eight (84.8%) of the total sample could be classified: 2.8% of 2878 men and 1.4% of 3120 women had had same-sex partners. Differences in prevalence rates were tested by logistic regression analyses, controlling for demographics. RESULTS: Psychiatric disorders were more prevalent among homosexually active people compared with heterosexually active people. Homosexual men had a higher 12-month prevalence of mood disorders (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) than heterosexual men. Homosexual women had a higher 12-month prevalence of substance use disorders (OR = 4.05; 95% CI = 1.56-10.47) than heterosexual women. Lifetime prevalence rates reflect identical differences, except for mood disorders, which were more frequently observed in homosexual than in heterosexual women (OR = 2.41; 95% CI = 1.26-4.63). The proportion of persons with 1 or more diagnoses differed only between homosexual and heterosexual women (lifetime OR = 2.61; 95% CI = 1. 31-5.19). More homosexual than heterosexual persons had 2 or more disorders during their lifetimes (homosexual men: OR = 2.70; 95% CI = 1.66-4.41; homosexual women: OR = 2.09; 95% CI = 1.07-4.09). CONCLUSION: The findings support the assumption that people with same-sex sexual behavior are at greater risk for psychiatric disorders.     

Obesity and associated complications in patients with severe mental illnesses: a cross-sectional survey

BACKGROUND: This naturalistic cross-sectional survey of patients with severe mental illnesses explores the association between important variables and obesity, extreme obesity, diabetes mellitus type 2, hypertension, and hyperlipidemia in the clinical environment. METHOD: Weight and height were obtained from 560 patients with severe mental illnesses (including DSM-IV schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder) at central Kentucky inpatient and outpatient facilities to estimate their body mass index (BMI). Chart diagnoses of diabetes mellitus, hypertension, and hyperlipidemia were obtained. RESULTS: When comparing the patients with severe mental illnesses with Kentucky adults from the general population, the odds ratio (OR) of obesity (BMI > or = 30 kg/m(2)) was 2.6 (95% confidence interval [CI] = 2.2 to 3.0), and the OR of diabetes mellitus was 2.9 (95% CI = 2.3 to 3.6). Female gender, African American race, early start of psychiatric medication, and long psychiatric medication duration were significantly associated with obesity. Current alcohol and nicotine use exhibited significant ORs of obesity lower than 1, particularly in males. Obesity was closely associated with hypertension, type 2 diabetes mellitus, and hyperlipidemia. These complications were closely associated with each other and may indicate a further progression of obesity after aging. CONCLUSIONS: These results suggest a complex pattern of variables that may influence the development of obesity and its complications in patients with severe mental illnesses, but they need replication. The major factors associated with obesity appear to be a long-term illness or treatment duration and substance use. The former may be more important in females, while the latter may be more important in males. Clinical diagnoses (schizophrenic or mood disorders) or current treatment did not appear to be fundamental factors.     

Racial/ethnic differences in 12-month prevalence and persistence of mood,anxiety, and substance use disorders: Variation by nativity and socioeconomic status

BackgroundDespite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders.MethodData were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence.ResultsNon-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels.ConclusionNativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.     

The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample

Objective

To investigate the association between mood and anxiety disorders and vascular diseases after controlling for vascular disease risk factors.

Methods

Using a nationally representative sample of adults (N=5692) from the National Comorbidity Survey-Replication (NCS-R), participants with mood disorders were hierarchically classified as having any lifetime history of mania, hypomania, or major depression. Anxiety disorders were also assessed. The reference group consisted of those without mental disorders. Vascular disease was determined by self-reported history of heart disease, heart attack, or stroke on the NCS-R survey. Vascular risk factors included diabetes, high blood pressure, and obesity.

Results

In multivariate logistic regression models that controlled for obesity, high blood pressure, smoking and diabetes, vascular disease was associated with bipolar disorder in women [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.63-4.80], and major depressive disorder in men (OR 1.85, 95% CI 1.17-2.92). Controlling for anxiety disorders reduced the associations in both men and women, and in fact, anxiety disorders were more strongly associated with vascular diseases in men, whereas bipolar disorder continued to be an important correlate of vascular disease in women.

Conclusion

These findings demonstrate the importance of evaluation of sex differences, mood disorder subtype and co-occurring anxiety disorders in assessing the association between mood disorders and vascular diseases. Future research should investigate potential biologic mechanisms for these associations in order to define potential targets for intervention.     

Obesity and the three‐year longitudinal course of bipolar disorder

Goldstein BI, Liu S‐Min, Schaffer A, Sala R, Blanco C. Obesity and the three‐year longitudinal course of bipolar disorder.
Bipolar Disord 2013: 00: 000–000. © 2013 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: Despite substantial cross‐sectional evidence that obesity is associated with an increased medical and psychiatric burden in bipolar disorder (BD), few longitudinal studies have examined this topic. Methods: Subjects with BD (n = 1600) who completed both Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were included. Analyses examined the association between obesity at Wave 1, and the subsequent course of BD, and of psychiatric and medical comorbidities, between Wave 1 and Wave 2. Results: BD subjects with obesity (n = 506; 29.43%), compared to BD subjects without obesity (n = 1094; 70.57%) were significantly more likely to have a major depressive episode and to receive counseling for depression during follow‐up, more likely to report a lifetime suicide attempt, and less likely to develop new‐onset alcohol use disorders. These differences were no longer significant, however, after controlling for baseline demographic variables. No significant differences in new episodes or treatment of mania/hypomania were observed. After controlling for demographic variables, obese subjects remained significantly more likely to report any new‐onset medical condition [odds ratio (OR) = 2.32, 95% confidence interval (CI): 1.63–3.30], new‐onset hypertension (OR = 1.81, 95% CI: 1.16–2.82) and arthritis (OR = 1.64, 95% CI: 1.07–2.52). Obese subjects were significantly more likely to report physician‐diagnosed diabetes (OR = 6.98, 95% CI: 4.27–11.40) and hyperlipidemia (OR = 2.32, 95% CI: 1.63–3.30) (assessed in Wave 2 only). The incidence of heart attacks was doubled among obese subjects, although this difference was not statistically significant. Conclusions: The association between obesity and increased prospective depressive burden appears to be explained by baseline demographic variables. By contrast, obesity independently predicts the accumulation of medical conditions among adults with BD. Treatment of obesity could potentially mitigate the psychiatric and medical burden of BD.     

Anxiety disorders moderate the association between externalizing problems and substance use disorders: Data from the National Comorbidity Survey-Revised

Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6–8.1), alcohol dependence (OR: 7.6, CI: 5.9–9.6), substance abuse (OR: 9.9, CI: 8.1–12.2), and substance dependence (OR: 13.1, CI: 9.6–17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4–15.5). Individuals who met diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.     

Mental disorder and threats made by noninstitutionalized people with weapons in the national comorbidity survey replication

Controversy exists as to whether mental disorders are associated with a higher risk of violent behavior. Data from the nationally-representative National Comorbidity Survey Replication was examined. Multiple logistic regression was used to determine whether mood, anxiety, impulse control, and substance use disorders were associated with a higher rate of potentially violent behavior as assessed by threatening others with a gun or other weapon. After adjusting for sociodemographic factors, an association was found between mood, anxiety, impulse control, and substance use disorders and the rate of threatening others. A significant association was found between threats made against others with a gun and both substance use disorders (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI] 1.62-3.20) and impulse control disorders (AOR 2.67; 95% CI 1.95-3.66). Threats made against others with any other type of weapon were significantly associated with any anxiety (AOR 1.76; 95% CI 1.34-2.31), substance (AOR 2.63; 95% CI 1.87-3.71), or impulse control disorder (AOR 2.49; 95% CI 1.96-3.18). Of the disorders studied, social phobia, specific phobia, and impulse control disorders seemed to have their onset before the act of threatening others with weapons. This finding was also true for those who had attempted suicide. Further research is needed to determine whether treatment of mental disorders decreases the risk of violence in this population.     

Clinical and prognostic characteristics associated with addictive comorbidity in hospitalized psychiatric patients

The aims of this study were to estimate: 1) the prevalence of substance use disorder, 2) the social and clinical characteristics associated to such a comorbid disorder in patients hospitalised in psychiatry. METHOD: Patients consecutively hospitalised for a non-addictive disorder were included in the present survey. A standardised method was used to collect information on clinical and social characteristics. DSM IV diagnoses, including those of substance use, were made using a structured diagnostic interview and all available clinical and historical informations collected during the hospital stay. RESULTS: We have included 127 patients fulfilling the diagnostic criteria for affective disorders (n = 61), non-affective psychotic disorder (schizophrenia, schizoaffective disorder, delusional disorder, other psychotic disorders, n = 50) and personality disorder (n = 16). Among these patients, 11.8% presented with a current abuse/dependence to alcohol (lifetime prevalence: 25.2%), 11% to cannabis (lifetime prevalence: 22.8%). The lifetime prevalence for any other substance disorder was 2.4%. The subjects presenting with an abuse/dependence to alcohol had a higher rate of psychiatric hospitalisation (OR = 2.9; 95% CI 1.0-8.1; p = 0.04) and had more frequently a history of attempted suicide (OR = 2.6; 95% CI 1.0-6.5; p = 0.04). The cannabis misuse was associated with medication noncompliance (OR = 3.1; 95% CI 1.1-9.1; p = 0.04) and more frequent penal problems (OR = 15.0; 95% CI 2.9-78.7; p = 0.001). CONCLUSION: Cannabis and alcohol misuse have a negative, but different, impact on social adaptation and clinical outcome in subjects with psychiatric disorder. These results confirm the necessity to systematically assess this type of comorbid disorder and to distinguish the different substances.     

The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study

Purpose

To examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups.

Methods

Data of 21,030 persons (18–70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m²) and waist circumference (cm)] and depressed mood (PHQ-9 score?≥?10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models.

Results

Obesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI?≥?30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR)?=?1.72; 95% Confidence intervals (CI) 1.24–2.40, and OR?=?1.86; 95% CI 1.38–2.50], respectively, and African Surinamese (OR?=?1.60; 95% CI 1.29–1.98 and OR?=?1.59; 95% CI 1.27–2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern.

Conclusion

Obesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.

     

Associations between depressive symptoms and obesity during puberty

BACKGROUND: Adolescent depression has been shown to be associated with later development of obesity. The purpose of this study was to examine the association between depressive symptoms and obesity with progressive pubertal development. METHODS: We conducted an analysis of the association between depressive symptoms and obesity using data from a cross-sectional study of 3101 youth aged 11-17 years. Logistic regression analyses were used to control for maternal education level, race and age. Analyses were stratified by pubertal status and sex to examine how the relationship between depressive symptoms and obesity varies with pubertal development. RESULTS: Depressive symptoms increased with pubertal development for both boys and girls, but the increase was larger for girls. Obesity prevalence was similar for all categories of pubertal development in boys and girls. After controlling for age, pubertal development, parental education and race, an association was noted between depressive symptoms and obesity among both males and females. Youth above the 90th percentile in the depressive symptom score had two times the odds of being obese [males: odds ratio (OR)=1.95, 95% confidence interval (95% CI)=1.19-3.18; females: OR=2.17, 95% CI=1.25-3.77]. With the exception of males in late puberty (OR=0.91, 95% CI=0.29-2.87), the magnitude of this association between depressive symptoms and obesity was similar for all levels of pubertal development, with no apparent increase in later puberty among girls. CONCLUSION: Depressive symptoms and obesity were associated during adolescence, and this association did not increase with advancing pubertal development.     

The association between arthritis and psychiatric disorders; results from a longitudinal population-based study

Background

To disentangle cross-sectionally and longitudinally the relationship between arthritis and psychiatric disorders, and to examine the relationship between age and incidence of (1) any psychiatric disorder among respondents with and without arthritis and (2) arthritis among respondents with and without any psychiatric disorder.

Methods

Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a nationally representative household survey with repeated measurements in 1996, 1997 and 1999. Self-report was used to ascertain arthritis. Psychiatric and substance use disorders were diagnosed with the WHO Composite International Diagnostic Interview.

Results

Regarding the cross-sectional results, it was found that the strength of the association of arthritis with mood and anxiety disorders was similar [odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09-1.99 and OR=1.42, 95% CI=1.11-1.81, respectively]. The longitudinal results showed that preexisting arthritis elevated the risk of developing any mood disorder (OR=1.94, 95% CI=1.23-3.07), whereas having any mood or any anxiety disorder did not predict new-onset arthritis. The incidence of any psychiatric disorder was significantly higher among younger persons (<45 years) with arthritis, compared to others in the same age category without arthritis.

Conclusions

Arthritis is associated with psychiatric disorders. The temporal relationship points to one direction: arthritis predicts new onset of psychiatric disorder (mood disorder) instead of the reverse. Especially younger people (<45 years) with arthritis are at risk of developing a psychiatric disorder. Screening and simultaneous treatment of comorbid mood disorder and arthritis are recommended as part of routine in primary care.     

Internalizing disorder in adopted versus non-adopted adults: A NESARC based study

The objective of the study consisted of comparing lifetime prevalence rates and odds ratios of anxiety, mood, and psychotic disorders in adopted-versus-non-adopted people in a nationally representative sample. The data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime internalizing psychiatric disorders in adopted (n = 378) versus non-adopted (n = 42,503) individuals. Adoptees and non-adoptees were compared to estimate the odds of lifetime internalizing disorders using logistic regression analyses. Adoptees had higher prevalence rates of several lifetime mood and anxiety disorders compared with non-adoptees, with a 1.61-fold increase (95% CI 1.29–2.02) in the odds of any mood disorder and a 1.49-fold increase (95% CI 1.18–1.89) in the odds of any anxiety disorder compared with non-adoptees. Regarding specific mood and anxiety disorders, adoptees had increased odds of major depressive disorder, bipolar I disorder, panic disorder without agoraphobia, specific phobia, and generalized anxiety disorder. Disorders not differing between adoptees and non-adoptees included dysthymia, bipolar II disorder, panic disorder with agoraphobia, social phobia, and psychotic disorder. One adoption-specific risk factor was associated with lifetime mood disorder (i.e., Asian/Pacific Island). In conclusion, adoptees in a large sample from the general population had higher rates of mood and anxiety disorders compared to non-adoptees.     

Is sexual orientation related to mental health problems and suicidality in young people?

BACKGROUND: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. METHODS: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty-eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. RESULTS: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). CONCLUSIONS: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.     

Family history of suicidal behavior and mood disorders in probands with mood disorders

OBJECTIVE: First-degree relatives of persons with mood disorder who attempt suicide are at greater risk for mood disorders and attempted or completed suicide. This study examined the shared and distinctive factors associated with familial mood disorders and familial suicidal behavior. METHOD: First-degree relatives' history of DSM-IV-defined mood disorder and suicidal behavior was recorded for 457 mood disorder probands, of whom 81% were inpatients and 62% were female. Probands' lifetime severity of aggression and impulsivity were rated, and probands' reports of childhood physical or sexual abuse, suicide attempts, and age at onset of mood disorder were recorded. Univariate and multivariate analyses were carried out to identify predictors of suicidal acts in first-degree relatives. RESULTS: A total of 23.2% of the probands with mood disorder who had attempted suicide had a first-degree relative with a history of suicidal behavior, compared with 13.2% of the probands with mood disorder who had not attempted suicide (odds ratio=1.99, 95% CI=1.21-3.26). Thirty percent (30.8%) of the first-degree relatives with a diagnosis of mood disorder also manifested suicidal behavior, compared with 6.6% of the first-degree relatives with no mood disorder diagnosis (odds ratio=6.25, 95% CI=3.44-11.35). Probands with and without a history of suicide attempts did not differ in the incidence of mood disorder in first-degree relatives (50.6% versus 48.1%). Rates of reported childhood abuse and severity of lifetime aggression were higher in probands with a family history of suicidal behavior. Earlier age at onset of mood disorder in probands was associated with greater lifetime severity of aggression and higher rates of reported childhood abuse, mood disorder in first-degree relatives, and suicidal behavior in first-degree relatives. CONCLUSIONS: Risk for suicidal behavior in families of probands with mood disorders appears related to early onset of mood disorders, aggressive/impulsive traits, and reported childhood abuse in probands. Studies of such clinical features in at-risk relatives are under way to determine the relative transmission of these clinical features.     

Obesity, abdominal obesity and Alzheimer disease

BACKGROUND/AIMS: Obesity has a strong association with vascular and metabolic diseases, which have been linked with Alzheimer disease (AD). While recent studies have reported an association between mid-life obesity and dementia, the role of later-life obesity is less clear. This study investigated the relation between AD, obesity and abdominal obesity at later-life in a case-control study. METHODS: Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Height and weight [from which body mass index (BMI) was calculated] and hip and waist circumferences (from which waist-hip ratio was calculated) were measured. Participants were classified according to their BMI as: underweight (BMI <20.0 kg/m2); normal weight (BMI 20.0-24.9 kg/m2); overweight (BMI 25-29.9 kg/m2), or obese (BMI > or = 30 kg/m2). They were classified as abdominally obese if their waist-hip ratio was >0.9 (men) or >0.8 (women). RESULTS: AD was associated with obesity [OR 9.5, 95% CI 2.4-37.3, p = 0.001], underweight (OR 5.4, CI 0.9-33.7, p = 0.07) and abdominal obesity (OR 2.5, CI 1.1-5.7, p = 0.027) using logistic regression analyses adjusted for age, sex and location. The inclusion of metabolic risk factors in the model increased the ORs for obesity (OR 12.6, CI 2.8-56.5, p = 0.001) and underweight (OR 7.9, CI 1.0-66.3, p = 0.056). CONCLUSION: AD may be associated with obesity, underweight and abdominal obesity at later life. Larger prospective studies are required to investigate this further.     

Sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorders in British Columbia,Canada

Purpose

This study aimed at determining to what extent sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorder diagnosis in British Columbia (BC), Canada, using a population-based survey.

Methods

This analysis was based on the cross-sectional 2013–2014 Canadian Community Health Survey. The sample was restricted to respondents in BC with valid responses to the survey items considered. A multivariable logistic model, where the behavioral HIV risk score exposure was nested into the sexual minority status modifier, estimated the odds of having a prevalent mood or an anxiety disorder. The behavioral HIV risk score (0, 1, 2, ≥ 3) included the following five measures: (1) age at first intercourse < 14 years, (2) condom use during last intercourse, (3) history of sexually transmitted infections, (5) number of sexual partners in the past 12 months (< 4, ≥ 4), and substance use in the past 12 months.

Results

Of the weighted sample (2,521,252), 97% (95% confidence interval (CI) 97–98) were heterosexual, while 3% (95% CI 2–3) were lesbian, gay, and bisexual (LGB). The prevalence of a mood or anxiety disorder diagnosis was 12% (95% CI 11–13). For every 1-level increment in the behavioral HIV risk score, the adjusted odds ratio of having a prevalent mood or anxiety disorder diagnosis was 1.29 (95% CI 1.03–1.54) for heterosexual respondents and 2.37 (95% CI 1.84–2.90) for LGB respondents.

Conclusion

Sexual minority status modified the relationship between HIV risk behavior and prevalent mood or anxiety disorders, with a stronger association among LGB respondents. Healthcare providers should prioritize integrated care that addresses the intersectionality between sexual risk, substance use, and mood or anxiety disorders.