Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

     

Length of marriage and its effect on spousal concordance in kuwait

It was hypothesized that marriage duration affects physical and cultural homogamy and spousal concordance in Kuwaiti marriages. Westernization increased spousal correlations due to fewer arranged marriages and increased individual spousal choice. Spousal similarities for selected physical and cultural traits were also examined for couples married 15 years or less, 16 to 30 years, and 31 years and more. Consanguineous couples belong to the al‐Kandari, one of the largest and most important kindreds in Kuwait, who traditionally married kin and continue to do so. Six physical measurements and blood pressure were taken along with a sociocultural questionnaire to examine cultural preferences. In all, 242 couples (484 people) participated; 62 couples were in non‐consanguineous unions. It was hypotheised that in shorter‐duration unions spouses would be more alike for physical and cultural traits. For physical traits, results for stature, weight, the body mass index, and hip circumference are congruent with the hypothesis, whereas results for the triceps and subscapular skinfolds, waist circumference, and systolic and diastolic blood pressure are not. Overall, for some traits spouses are more alike than in previous generations, and specific aspects of similarity among long‐term spouses reflect historical and cultural phenomena. Am. J. Hum. Biol. 14:1–8, 2002. © 2002 Wiley‐Liss, Inc.     

Women's mental health in the Muslim world: cultural, religious, and social issues

In Arab communities, several cultural factors, derived mainly from the subordinate position of women, have been shown to affect the prevalence, clinical picture, health seeking behaviour, course and management of psychopathology in women. Women are definitely at a greater risk of developing mental disorders such as depressive, somatoform, anxious or eating disorders, as well as suicidal behaviors. Furthermore, mentally ill women are more stigmatized, have less access to care and suffer from a worse social outcome. This paper describes a series of culture-related risk factors such as education, work, sexuality, marriage, and infertility, which significantly contribute to triggering mental disorders in females, or to worsen their course and outcome. The authors recommend that mental health providers should play a critical role by addressing the cultural as well as psychological conditions that create and maintain threats to women's mental health.     

Self-perception of poor health and suicidal ideation in medical patients

OBJECTIVE: To determine the relationship between self-perceived health and suicidal ideation among patients in general internal medicine practice settings. METHOD: A representative sample of 4007 patients was assessed for current suicidal ideation, self-perception of health, current medical disorders and current mental disorders (major depression, generalized anxiety disorder, panic attacks and alcohol use disorder) with the PRIME-MD Patient Health Questionnaire. RESULTS: Patients with self-perception of poor health, compared with those who reported more favourable health perception, were significantly more likely to report current suicidal ideation (35.2% v. 8.3%; chi2 = 97.4, df = 1, P < 0.0001). Multivariate logistic regression analyses revealed that the perception of poor health was associated with a significantly increased risk of suicidal ideation (OR = 3.1, CI 1.9, 5.0), even after adjusting for sociodemographic characteristics, mental disorders and common physical illnesses. CONCLUSION: Self-perception of poor health is associated with a significantly increased risk of suicidal ideation among general medical patients, even in the absence of common mental and physical disorders. These findings add to a growing literature on the importance of self-perceived health in the treatment and outcomes of mental and physical well-being by documenting self-perceived poor health as a risk factor for suicidal ideation in medical patients.     

大学生社会支持与心理健康的关系

目的　本研究观察了社会支持对大学生心理健康的影响。方法　采用社会支持评定量表 ( SSRS)和 SCL-90分别测试 45 7名大学生。SCL-90的心理障碍筛查标准如下 :总分 >1 60或阳性项目数〉43项 ,或任何一个因子分〉2。结果　在所有受试中 ,SCL-90共筛查诊断为心理障碍 5 0名 ( 1 1 .0 % )。心理健康组的社会支持各因子分 ,均高于心理障碍组。结论　大多数学生保持心理健康。心理健康与社会关系和社会支持有密切关系。对于大学生的心理健康 ,不断的监测和提供适当的支持系统是相当重要的。     

Childhood family relationships,marital and work conflict,and mental health distress in Mexican immigrants

The present study examined the associations among childhood family relationships, adult conflict in marriage and work relationships, and mental health distress in Mexican immigrants. The sample consisted of 135 married Mexican immigrants recruited from an ESL program in Southern California. Structural equation modeling was used to test theoretical hypotheses. The model revealed that dysfunctional childhood family relationships predicted dissatisfaction and conflict in marital and work relationships. Conflict in marital relationships directly contributed to mental health distress, whereas conflict in work relationships had an indirect effect on mental health by impacting negatively on immigrants' marital relationships. The model also indicated that immigrants' socioeconomic status in Mexico was linked to work relationships conflict in the United States, which, in turn, had a detrimental effect on marital relationships and mental health distress. Furthermore, a significant pathway was found linking recency of migration and immigrants' resident status (legal vs. illegal) to conflict in marital relationships and mental health distress. Finally, social status risk factors significantly predicted mental health distress. Mexican immigrants who were older, of lower status, and female experienced a high level of psychological distress. The findings were discussed in terms of attachment and migration stress theory, and Latino cultural patterns. © 1998 John Wiley & Sons, Inc.     

The epidemiology of psychogenic disorders and consequences for prevention

After discussing social issues of epidemiologic research on neurotic, character and psychosomatic disorders, we outline the main results of a field cohort study on 600 representative adults of Mannheim, a West German industrial city. According to ICD 300-307 (WHO 8th revision) and to a quantitative case definition clinically based on the severity of the symptoms we find an overall case rate of 26% in which females prevail over men by a ratio of approximately 2:1 and the rate of lower social class members over that of higher ones. We then turned to conclusions of our research for matters of primary and secondary prevention. Concerning primary prevention of psychogenic diseases life circumstances during childhood proved to be relevant as predisposing variables and risk factors often indicating poor emotional relationships between the child and its caretakers. Furthermore, we deal with protective factors preserving mental and physical health in spite of heavy burdens during childhood. Turning to secondary prevention we examine risk factors in present life, the importance of the lay system, and the influence of life events as well as the true demand for psychotherapy.     

The effect of social roles on mental health: a matter of quantity or quality?

The effect of social roles (partner, parent, worker) on mental health may depend on the total number or the quality of the individual occupied social roles. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of the number and quality of occupied social roles on mental health over three years was examined among 2471 men and women aged 25-55 years without mental disorders at baseline. Mental health was assessed using 3-year change in the SF-36 mental health scale as well as using the 3-year incidence of anxiety and depressive disorders defined by DSM-III criteria. The quality of social roles was assessed by the GQSB (Groningen Questionnaire Social Behavior). The number of social roles had no significant effect on the risk of developing depressive and anxiety disorders, but particularly the partner-role had a significant positive effect on mental health (beta of mental health=1.19, p=0.01; HR of incident disorders=0.75, 95% CI:0.51-1.00, p=0.05). A good quality of each of the three social roles was associated with higher levels of mental health and lower risks of incident disorders over 3 years. More than the number of social roles, knowledge about social role quality might provide opportunities for prevention of depressive and anxiety disorders.     

Neural mechanisms of social risk for psychiatric disorders

Mental health and social life are intimately inter-related, as demonstrated by the frequent social deficits of psychiatric patients and the increased rate of psychiatric disorders in people exposed to social environmental adversity. Here, we review emerging evidence that combines epidemiology, social psychology and neuroscience to bring neural mechanisms of social risk factors for mental illness into focus. In doing so, we discuss existing evidence on the effects of common genetic risk factors in social neural pathways and outline the need for integrative approaches to identify the converging mechanisms of social environmental and genetic risk in brain.     

Non-random Mating and Convergence Over Time for Mental Health, Life Satisfaction, and Personality: The Nord-Trøndelag Health Study

Earlier studies have shown evidence for various sources of observed spousal similarity regarding different traits and characteristics. We explored the relative contribution of non-random mating and convergence to spouse similarity with respect to global mental health, life satisfaction, optimism, and type A personality. We used population-based data collected for the Nord-Trøndelag Health Study (1984–1986) and prospective registry information about when and with whom people entered into marriage/cohabitation between 1970 and 2000 for 19,599 married/cohabitating couples and 1,551 future couples that entered into marriage/cohabitation during the 16 years after data collection. Couples were categorized by interval between data collection and entry into marriage/cohabitation. Age-adjusted polychoric correlations calculated for each group were used as the dependent variables in non-linear, segmented regression analysis, with time since or until marriage/cohabitation as the independent variable. Initial correlations between partners-to-be were low to moderate, typically around one-half of the values estimated in existing couples, indicating both non-random mating and early convergence. There appeared to be moderate divergence during the first 20 years of marriage/cohabitation and moderate convergence during the rest of life.     

Prevention of mental disorders: Steps toward community interventions

Current social conditions present a mixture of progress in some areas, together with destruction and violence in others. These circumstances represent predisposing conditions for the occurrence of mental disorders. Tertiary and secondary prevention have proved insufficient to deal with such risk factors, whereas primary prevention appears to be a powerful tool. This article presents a community program for the prevention of mental disorders, based on the following premises: (a) certain environmental factors place one at risk for mental illness; (b) those factors reflect the joint action of physical and social environments; (c) they are historical; (d) mental disorder results from the interaction of two factors: personal vulnerability conditions and environmental risk factors; (e) communities are a means by which social groups can adapt to the demands posed by life; and (f) the action produced by community health programs' agents, reflects service delivery policies. Guidelines are provided for four stages of program development: Program Preparation, Indirect Interventions, Direct Interventions, and Program Assessment. © 1998 John Wiley & Sons, Inc.     

Spousal resemblance for history of major depressive episode in the previous year

BACKGROUND: There is discrepancy in findings on spousal concordance for major depression. Here we report the risk of depression and its determinants in spouses of persons with or without depression, taking into account several known risk factors for major depression. METHODS: A random sample of non-institutionalized Finnish individual aged 15-75 years was interviewed in the 1996 National Health Care Survey. The sample included 1708 male-female spouse pairs. Major depressive episode (MDE) during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Risk factors were assessed in the same interview. RESULTS: Factors associating with MDE were spouse's MDE, own alcohol intoxication at least once a week and own chronic medical conditions. In addition, there was a strong association between female's current smoking and male's MDE, independently of other risk factors and spousal MDE. The association of MDE with spouses's MDE was not affected by taking into account other assessed risk factors (own or spouse's). CONCLUSIONS: The results indicate elevated spouse concordance for MDE independent of the risk factors assessed in the present study.     

Cohabiting unions, repartnering and mental health

BACKGROUND: A considerable body of research has established that transitions out of marriage are generally deleterious for mental health and some have examined transitions out of cohabitation. In this study we depart from these established areas to investigate the effects of poor mental health on the duration and outcome of cohabitations and on the time to, and likelihood of, repartnering after both cohabitation and marriage. METHOD: Samples came from the British Household Panel Survey, 1991--2001. These were: (1) 447 cohabiting spells; (2) 5571 paired person-years during cohabitation; (3) 508 spells after cohabitation; (4) 1197 person-year observations within those spells; (5) 869 spells after marriage; and (6) 2736 person-year observations within those spells. Life tables, log-rank tests, multinomial logit and proportional hazard models were used. Mental health was measured by the 12-item General Health Questionnaire. RESULTS: Poor mental health increased the risk of dissolving a cohabiting union for both men and women. Poor mental health reduced the risk of repartnering after a cohabiting union but had no effect on the risk of repartnering after a marriage. Other factors such as past marital status, age and parental status also had significant effects. CONCLUSIONS: This study provides evidence that poor mental health during a cohabiting union increases the chances of that union dissolving instead of turning into marriage and poorer mental health immediately after a transition out of a cohabiting union is associated with reduced chances of repartnering.     

社会支持、心理控制感和心理健康的关系研究

目的 :为探讨社会支持、心理控制感对心理健康的影响 ,及社会支持与心理控制感之间的关系。方法 :采用社会支持、心理控制感及 3个心理健康评定量表对 2 72 3名成年被试者进行测量。结果 :社会支持和心理控制感对心理健康有重要影响 ,社会支持水平低下、外控心理倾向的人主观幸福度低 ,心理症状多 ,心理健康水平低 ;同时还发现 ,内外控制感对社会支持水平也产生影响 ,内在控制感强的人所获得的社会支持更多。结论 :提示社会支持和心理控制感都是影响心理健康水平的中介因素 ,研究这二个中介因素之间的关系对维护个体的心理健康 ,探讨心理障碍产生的心理机制都很有意义     

The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study

Mental health problems disproportionately affect women, particularly during childbearing years. We sought to estimate the prevalence of antepartum mental health problems and determine potential risk factors in a representative USA population. We examined data on 3,051 pregnant women from 11 panels of the 1996–2006 Medical Expenditure Panel Survey. Poor antepartum mental health was defined by self report of mental health conditions or symptoms or a mental health rating of “fair” or “poor.” Multivariate regression analyses modeled the odds of poor antepartum mental health; 7.8% of women reported poor antepartum mental health. A history of mental health problems increased the odds of poor antepartum mental health by a factor of 8.45 (95% CI, 6.01–11.88). Multivariate analyses were stratified by history of mental health problems. Significant factors among both groups included never being married and self-reported fair/poor health status. This study identifies key risk factors associated with antepartum mental health problems in a nationally representative sample of pregnant women. Women with low social support, in poor health, or with a history of poor mental health are at an increased risk of having antepartum mental health problems. Understanding these risk factors is critical to improve the long-term health of women and their children.     

The explanatory models of depression in low income countries: listening to women in India

INTRODUCTION: Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness. METHOD: We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking). RESULTS: 35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall "weakness" and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints. CONCLUSIONS: We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.     

Social Functioning and Suicide Risk in a Community Sample of Adolescents

Suicide is the second leading cause of death among young people. Both mental illness and social factors are associated with suicide in adolescents, and youth with mental disorders often experience social deficits, which may compound risk. The cumulative effects of mental disorders and social factors on suicidal ideation and behaviors (SIB) in adolescents have not previously been explored. Adolescents 13–18 years of age (N = 6,447; 49% female, 65% non-Hispanic White) participated in the National Comorbidity Survey Replication Adolescent Supplement. Adolescents were interviewed to assess mental health diagnoses, history of SIB, and relationship quality. Parents completed self-reports about adolescent mental health and family characteristics. Logistic regression estimated associations of friend, sibling, and family relationships with 12-month SIB and lifetime suicide attempt (SA); associations between relationships, SIB, and SA were compared across classes of mental disorders. Friendship negativity (odds ratio [OR] = 1.20, 95% confidence interval (CI) [1.04, 1.40]), and family conflict (OR = 1.26, 95% CI [1.13, 1.41]), were positively associated with SIB, beyond the risk conferred by mental disorders, particularly mood disorders (OR = 4.75, 95% CI [3.20, 7.05]). Friendship positivity (OR = 0.89, 95% CI [0.80, 0.99]); sibling relationship positivity (OR = 0.79, 95% CI [0.68, 0.91]); family cohesion (OR = 0.77, 95% CI [0.69, 0.87]); maternal care (OR = 0.76, 95% CI [0.69, 0.84]); and paternal care (OR = 0.68, 95% CI [0.59, 0.78]), were inversely associated with SIB. Sibling relationship positivity, family conflict, and paternal care were similarly associated with SA. Self-reported adolescent friend and family relationship characteristics are associated with SIB and SA beyond the risk conferred by mental disorders. This suggests that perceptions of friend and family relationships may be an appropriate target to reduce suicide risk among adolescents.     

我国大陆地区六部地方性精神卫生条例内容的评估

目的:了解我国大陆地区地方性精神卫生条例在内容上的不足,为精神卫生立法提供建议.方法:采用专题讨论的方法,对我国大陆地区六部地方精神卫生条例按照爯世界卫生组织有关精神卫生立法的检查清单爲进行评价.结果:按照世界卫生组织立法检查清单,六部地方性精神卫生条例彼此之间相差不大,六部地方性精神卫生条例在自愿入院、自愿治疗、非自愿入院、非自愿治疗、社区中的非自愿治疗、特殊治疗、监督调查机制、犯罪的精神障碍患者的处理、保护弱势群体、保护精神障碍患者的就业、住房权利、社会保障等方面的具体规定较少.结论:我国精神卫生立法需要在对非自愿就医的标准、批准机构、复核机构、实施步骤、期限等方面做出明确的规定;需要规定切实可行的审查、监督机制及司法救济途径;需要对精神障碍患者的就业、住房权利和社会保障制订具体的规定或实施细则.     

Mental health literacy: an impediment to the optimum treatment of major depression in the community

BACKGROUND: Mental health literacy refers to the knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This study examined the mental health literacy and experience of depression in a random and representative community population. METHODS: The experience of depression and mental health literacy of 3010 subjects from a random and representative population were determined on the basis of responses to the mood module of the PRIME-MD and questions about a vignette of a person with features of major depression. RESULTS: Those with major depression had significantly more personal experience of depression than those with other depressions and those who were not depressed, but there were few significant differences between the groups in terms of mental health literacy. Of those with major depression, 40% considered anti-depressants helpful, but 40% also considered they were harmful. CONCLUSIONS: There is a considerable impediment to the recognition and management of major depression and a need for further community education programs.     

Prevention of childhood anxiety disorders

Anxiety disorders represent one of the most common and debilitating forms of psychopathology in children. While empirical research, mental health funding, and mental health professionals continue to focus on the treatment rather than prevention of anxiety disorders in children, preliminary research presents an optimistic picture for preventative strategies in the future. Knowledge of the risk factors, protective factors, and treatment strategies associated with childhood anxiety disorders, in conjunction with theories regarding the methods, timing, levels, and targets of prevention, equip us well for effectively preventing childhood anxiety disorders in the future.