Do Current Measures of Polygenic Risk for Mental Disorders Contribute to Population Variance in Mental Health?

The polygenic risk score (PRS) allows for quantification of the relative contributions of genes and environment in population-based studies of mental health. We analyzed the impact of transdiagnostic schizophrenia PRS and measures of familial and environmental risk on the level of and change in general mental health (Short-Form-36 mental health) in the Netherlands Mental Health Survey and Incidence Study-2 general population sample, interviewed 4 times over a period of 9 years, yielding 8901 observations in 2380 individuals. Schizophrenia PRS, family history, somatic pain, and a range of environmental risks and social circumstances were included in the regression model of level of and change in mental health. We calculated the relative contribution of each (group of) risk factor(s) to the variance in (change in) mental health. In the combined model, familial and environmental factors explained around 17% of the variance in mental health, of which around 5% was explained by age and sex, 30% by social circumstances, 16% by pain, 22% by environmental risk factors, 24% by family history, and 3% by PRS for schizophrenia (PRS-SZ). Results were similar, but attenuated, for the model of mental health change over time. Childhood trauma and gap between actual and desired social status explained most of the variance. PRS for bipolar disorder, cross-disorder, and depression explained less variance in mental health than PRS-SZ. Polygenic risk for mental suffering, derived from significance-testing in massive samples, lacks impact in analyses focusing on prediction in a general population epidemiological setting. Social-environmental circumstances, particularly childhood trauma and perceived status gap, drive most of the attributable variation in population mental health.     

Risk and protective factors for psychological distress among adolescents: a family study in the Nord-Trøndelag Health Study

Purpose  

The study aimed to investigate potential adolescent and parental psychosocial risk and protective factors for psychological distress among adolescents and, in addition, to examine potential gender and age differences in the effects of risk factors on adolescent psychological distress.     

Are Mental Health,Family and Childhood Adversity,Substance Use and Conduct Problems Risk Factors for Offending in Autism?

Journal of Autism and Developmental Disorders - Mental health difficulties, family and childhood adversity factors, substance use and conduct problems have all been linked to offending behaviour in...     

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

Objective

Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents'' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide.

Methods

We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients'' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed.

Results

Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation.

Conclusion

Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.     

Mental Health in the Oregon Health Plan: Fragmentation or Integration?

The Oregon Health Plan was implemented in 1994 with a 50% expansion of Medicaid enrollment to include some of the working poor. Over 75% of Oregon Medicaid clients are now enrolled in health maintenance organizations (HMOs). Outpatient chemical dependency services have been capitated since May 1995. Capitated mental health services have been provided for the 25% of eligibles who live in demonstration counties since January 1995. Expansion and capitation appear to have been achieved without major trauma. More challenging has been the attempted integration of public sector behavioral health services with private sector health plans. Stakeholders interviewed for this study were especially concerned about the long-term impact on Medicaid clients with chronic mental illness. Strong leadership and clear policies regarding the mixture of public, private nonprofit, and private for profit entities are necessary if the state is to achieve its aim of integration without fragmenting a system of care for people with severe mental illness.     

Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men’s Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior

Background

Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM.

Purpose

We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex.

Methods

Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners).

Results

Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex.

Conclusions

We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors—maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.

     

Risk the Change or Change the Risk? The Nonlinear Effect of Job Insecurity on Task Performance

Job insecurity has been recognized for its negative effect on employee performance. Nevertheless, this study argues that, under the threat of job insecurity, employees may also be likely to seek to reduce the threat by proactively crafting their tasks and improving performance. Drawing from the perspective of Vroom’s expectancy theory, it is proposed that, only when job security is at moderate level will employees expect it as possible to make such a change to respond to the situation. Accordingly, a curvilinear mediated model is developed that links job insecurity and task performance indirectly through task crafting, and a two-waved time-lagged survey involving 328 employees was conducted to test the model. The results showed that job insecurity had an inverted U-shaped relationship with task crafting and that this relationship was moderated by strengths-based psychological climate, a measure of how employees feel their strengths are appreciated in the organization. In this sense, strengths-based psychological climate can enhance the positive relationship between job insecurity and task crafting. Overall, the finding suggests that job insecurity may not always be detrimental. Thus, there will be significant managerial implications in creating favorable conditions for increased task performance.     

Declining Transition Rate in Ultra High Risk (Prodromal) Services: Dilution or Reduction of Risk?

There is growing interest in the prodromal stage of psychotic disorders, with many services now providing care for these "ultra high risk" (UHR) individuals. However, a reduction in the rate of transition to psychosis has been suspected over the last few years. This has implications for the use of interventions in this population and for the validity of research findings. This study examined the transition rate in one UHR service, the Personal Assessment and Crisis Evaluation Clinic, over the years 1995-2000 and investigated possible causes for the transition rate reduction. There was evidence for a declining transition rate, with each successive year showing a rate 0.80 times that of the preceding year. Functioning and symptom level were not responsible for the change. The decreased transition rate was partly explained by a reduction in the duration of symptoms of patients prior to receiving help. That is, UHR individuals are being detected and provided with care earlier than in the past. Thus, the decline in transition rate may be due to treatment being more effective at this very early stage of illness or it may be due to finding more false positives who were never at risk of psychosis, ie, a "dilution" effect. Given that it is not possible to distinguish between these alternatives at least phenotypically at present, perhaps it is time to rethink the role and practice of UHR clinics. Patients presenting to them need help. It may be that we need to aim to prevent a range of target syndromes.     

Worth the Risk? Relationship of Incentives to Risk and Benefit Perceptions and Willingness to Participate in Schizophrenia Research

Objective: Providing incentives for research participation is widely practiced but minimally studied. In schizophrenia research, questions about capacity to consent and potential vulnerability may raise concerns when offering incentives for participation. Despite empirical attention focused on consent and decision-making capacity in schizophrenia, the issue of incentives has been essentially ignored. We examined willingness to participate in research, in relation to perceived risks and benefits, among people with schizophrenia and schizoaffective disorder. Method: Forty-six people with schizophrenia or schizoaffective disorder rated perceived risks and benefits of 5 hypothetical research vignettes. They also indicated whether they would be willing to participate at each of 5 incentive levels (including no compensation). Cognition was assessed with Mattis Dementia Rating Scale. Results: Ratings of risk and potential personal benefit were inversely correlated. For all scenarios, significant correlations were found between perceived risk and willingness to participate for greater compensation. Conversely, lower perceived likelihood of benefit was associated with a higher compensation threshold for participation in each scenario. Even at the highest proffered payment level for each scenario, however, a substantial proportion of respondents were not willing to participate. Risk assessment and willingness to participate (at all levels of compensation) were not associated with demographic variables or cognitive status. Conclusions: Determining whether incentives impede voluntarism remains an important task for empirical ethics research. Assessing potential research participants’ understanding and perceptions of risks, benefits, and alternatives to participation will help ensure that informed consent fulfills its mission—embodying the ethical principle of respect for persons.     

Towards Promoting Youth Mental Health in Aotearoa/New Zealand: Holistic ‘Houses’ of Health

A study of the literature on mental health promotion suggests that to a far greater extent than ‘physical’ health concerns, mental health seems to be dominated by the illness focus of established clinical perspectives and practices. In Aotearoa/New Zealand this leaves little in the way of conceptual space or fiscal resources for the development of new preventative possibilities of population-oriented measures focused on enhancing social and physical environments. Outflanking this unfortunate impasse, indigenous Maori and Samoan (Pacific) conceptual frameworks for health offer holistic theoretical foundations upon which we can work for health through positive development. This paper examines these frameworks and the youth development paradigm to draw out parameters of what might count as healthy youth development in this country.