Incidence of post-traumatic stress disorder in adolescents: results of the Bremen Adolescent Study

The frequency and comorbidity of posttraumatic stress disorders (PTSD) were assessed together with the resultant psychosocial impairment in 1035 adolescents between the ages of 12 and 17 years. Posttraumatic stress disorder and other psychiatric disorders were coded on the basis of the DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview (CIDI). A total of 17 (1.6%) adolescents met the DSM-IV criteria for PTSD at some point in their life. Slightly more girls than boys met the criteria for the disorder, whose frequency increased with age. The lifetime prevalence of traumatic events is much higher still: 233 (22.5%) adolescents reported one or more traumatic events in their life. The types of traumatic events experienced by the greatest number of adolescents were: physical attack, injury, and serious accident. Boys experienced significantly more traumatic events than did girls. The occurrence of a traumatic event was mostly associated with hypervigilance and recurrent and intrusive psychological distress upon exposure to cues which symbolized the event itself or resembled an aspect thereof. PTSD occurred in highly frequent comorbidity with depressive disorders, somatoform disorders, and substance abuse. Over 90% of those with posttraumatic stress disorder were severely impaired in their daily life and activities. Despite the high-grade psychosocial impairment, only a small number sought professional help.     

The frequency of the psychiatric symptoms in the patients with dyspepsia at a university hospital

OBJECTIVE: According to the psychiatric hypothesis, the symptoms of dyspepsia may be due to depression, anxiety or a somatization disorder. We investigated the frequency of psychiatric symptoms in patients undergoing endoscopic procedures with dyspepsia, either with or without pathological findings, and compared this with control subjects without dyspeptic symptoms. METHODS: Ninety patients with dyspeptic symptoms and 90 control subjects participated in the study. Both the patients and the controls were asked to complete a questionnaire about socio-demographic characteristics, the Turkish version of the Spielberger State-Trait Anxiety Inventory (STAI) and the Symptom Check List-90 (SCL-90). In order for us to determine whether the criteria for any of the conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were met, the patients were asked to take part in the Structured Clinical Interview for DSM-IV disorders. RESULTS: Of the participants, 47.8% had a psychiatric disorder according to DSM-IV criteria, somatoform disorder (44.2%) being the most common. While 42.2% patients were determined to have a pathological finding using endoscopic evaluation, 57.8% had no findings. Together with the somatization and obsessive-compulsive disorder subscale scores, the total SCL-90 score and the mean trait anxiety score were statistically significantly higher in participants with no pathological findings. There were trends for anxiety (13.2% vs. 7.7%) and mood (2.6% vs. 0.0%) disorders to be more frequent in patients with pathological findings, while somatoform disorder+depressive disorder (17.3% vs. 5.2%) was more frequent in patients with no findings, although the differences were not statistically significant (Z=0.7, P>.05). The scores of state-trait anxiety, somatization, obsession-compulsion, depression, anxiety, phobic anxiety and psychotism subscales, and the total SCL-90 score were statistically significantly higher in those participants without a pathological finding than in the controls. CONCLUSIONS: Regarding the high frequency of psychiatric disorders in patients with dyspeptic symptoms, we think that such patients should be evaluated by two separate departments, gastroenterology and psychiatry.     

The prevalence of somatoform disorders among internal medical inpatients

OBJECTIVE: To find the prevalence of somatoform disorders (SDs) among internal medical inpatients and to study the comorbidity with other psychiatric disorders. METHODS: Of 392 eligible consecutive medical inpatients, 294 (75%) accepted to participate and, using a two-phase design, were assessed for ICD and DSM-IV somatoform diagnoses and for ICD-10 psychiatric diagnoses. RESULTS: A total of 18.1% (95% CI: 12.8-24.9%) of the patients fulfilled the diagnostic criteria for an ICD-10 disorder, and 20.2% (95% CI:14.7-27.2% ) for a DSM-IV SD. The prevalence of specified disorders revealed marked differences between the two diagnostic systems, e.g., concerning somatisation disorder (SD), which was more prevalent in the ICD-10 (5%) than in the DSM-IV (1.5%) equivalent. Quite the contrary was found in undifferentiated SD (0.7% in ICD-10 and 10% in DSM-IV). According to ICD-10 criteria, 3.5% had hypochondriasis, 2.6% a dissociative disorder, 3.2% a somatoform autonomic dysfunction, 1.5% had neurasthenia or persistent somatoform pain disorder, and 5% had an SD, unspecified. SDs were more prevalent among younger females. Thirty-six percent of the patients with SDs also had another psychiatric disorder, 11% a depression, and 25% an anxiety disorder. The physicians detected about 1/3 of the cases. CONCLUSION: Somatoform disorders were prevalent among internal medical inpatients especially among younger women.     

Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion

Purpose

To provide preliminary prevalence estimates of common DSM-IV (Diagnostic and Statistical Manual of Mental Disorders—4th Edition) disorders in a sample of Hong Kong Chinese adolescents.

Methods

541 Chinese adolescents were recruited from Grades 7, 8 and 9 of 28 mainstream high schools in Hong Kong (mean age=13.8 years; SD=1.2). The adolescents and their parents were separately administered the Youth and Parent versions of DISC-IV (Diagnostic Interview Schedule for Children-Version 4), respectively.

Results

Based upon both symptom and impairment criteria, as required by DSM-IV, the overall prevalence estimate of DSM-IV disorders in our sample of Chinese adolescents was 16.4%. Estimates for such individual disorders/diagnostic groupings as anxiety disorders, depressive disorders, attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders were 6.9, 1.3, 3.9, 6.8, 1.7, and 1.1%, respectively. These rates were largely compatible with those reported in previous studies with perhaps lower rates of generalized anxiety disorder (GAD), depressive disorders, CD, and substance use disorders, but a higher rate of ODD. The rate of ADHD was somewhat higher, but this might reflect the current DSM-IV diagnostic practice. The rate of anxiety disorders was not as high as predicted from some previous questionnaire surveys. The application of an impairment criterion had discernible impacts on prevalence estimates, greater on anxiety and substance use disorders, but smaller on depressive and disruptive behavior disorders. There was a lack of gender difference in rates of ODD and CD.

Discussion and conclusion

While the findings reported here are broadly compatible with those of other studies, there may be cross-cultural differences in rates of some individual disorders, e.g., GAD, depressive disorders, ODD, CD, and substance use disorders, as well as in gender difference regarding rates of ODD and CD. However, exact comparison between studies is confounded by methodological differences in sample characteristics, measures, and case definition. Standardization of methodology in epidemiological surveys should allow more precise identification of any within- or between-culture variations in prevalence estimation.     

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.     

Comorbidity of anxiety disorders in adolescents

We examined the comorbidity of anxiety disorders and their clinical consequences in adolescents. The 1,035 adolescents, aged 12 to 17 years old, were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. The comorbidity rate within the anxiety disorders was relatively low (14.1%). However, the comorbidity of anxiety disorders with other psychiatric disorders was high. Approximately half (51%) of the anxious adolescents had other psychiatric disorders. The most common comorbid pattern was that of anxiety and depressive disorders. Among those with both anxiety and depressive disorders, a majority of them (72%) had anxiety before that of depression. Anxious adolescents with comorbid disorders were significantly more psychologically distressed, as assessed using the SCL-90-R, and used more mental health services than adolescents with anxiety disorders only. The effect of comorbidity on mental health services utilization was stronger in males than females. The findings suggest the need to design intervention strategies to deal with cases with multiple disorders.     

Somatoform Disorders in Children and Adolescents: A Comparison with Other Internalizing Disorders

A chart review of children and adolescents attending a university-based psychiatric outpatient clinic over a 1-year period was done. Nineteen consecutive patients with somatoform disorders were compared with 26 consecutive patients with other internalizing disorders, i.e., depressive disorders and/or anxiety disorders without disruptive behavior problems. Mean age, sex distribution, cognitive level, and duration of symptoms were not different between groups. Self- and parent-reported levels of psychopathology, including depression, anxiety, suicidal ideation, and deliberate self-harm, differentiated between somatoform disorders and other internalizing disorders at the group level. Levels of adaptive functioning and functional somatic symptoms did not. High levels of medically unexplained symptoms should prompt the clinician for assessing depressive symptoms and anxiety. Findings also support the use of DSM-IV criteria in pediatric patients to differentiate somatoform disorders from other internalizing disorders.     

Diagnostic orphans: adolescents with alcohol symptom who do not qualify for DSM-IV abuse or dependence diagnoses.

OBJECTIVE: Little is known about the validity of the DSM-IV criteria for alcohol use disorders when applied to adolescents. This report describes a group of "diagnostic orphans," adolescents with one or two DSM-IV alcohol dependence symptoms who do not meet the DSM-IV criteria for alcohol abuse or alcohol dependence. METHOD: The study included 199 male and 173 female subjects aged 13-19 years. All subjects were regular drinkers, recruited from community sources and alcohol treatment programs. At baseline and at 1-year follow-up, DSM-IV alcohol use disorders were assessed with a version of the Structured Clinical Interview for DSM-III-R, modified for DSM-IV criteria. RESULTS: Diagnostic orphans represented 31% of the drinkers without an alcohol use disorder. The orphans were similar to the alcohol abusers and dissimilar to the other drinkers in alcohol and substance use patterns and in the course of alcohol problems over 1 year. CONCLUSIONS: The results indicate limitations of the DSM-IV criteria for alcohol use disorders when applied to adolescents. Diagnostic orphans should be considered separately from other drinkers in research and treatment efforts.     

Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments

OBJECTIVE: To present prevalence findings of DSM-IV somatoform symptoms, syndromes and disorders in a representative sample of adolescents and young adults. METHOD: Data come from the Early Developmental Stages of Psychopathology (EDSP) study, in which a total of 3021 respondents aged 14-24 years were assessed by the Munich-Composite International Diagnostic Interview. RESULTS: Although specific DSM-IV somatoform disorders were relatively rare with a lifetime rate of 2.7%, a considerably higher proportion of respondents met criteria for clinically significant somatoform syndromes as defined by the Somatic Symptom Index SSI4, 6 (lifetime: 1.7%), as well as the undifferentiated somatoform/dissociative syndrome USDS (lifetime: 9.1%), resulting in an overall prevalence rate of 12.6%. Somatoform conditions are often comorbid with other mental disorders and were found to be associated with remarkable impairments and disabilities. CONCLUSION: Somatoform disorders and syndromes in young adults are frequent, impairing and often associated with the development of other mental disorders.     

A controlled study of alexithymia in adolescent patients with persistent somatoform pain disorder.

OBJECTIVE: To study the differences in levels of alexithymia, depression, and anxiety between a sample of adolescents diagnosed with ICD-10 persistent somatoform pain disorder (defined by the DSM-IV as a pain disorder associated with psychological factors) and healthy adolescent control subjects. METHOD: Using the Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale, we investigated the point prevalence of alexithymia, anxiety, and depression among adolescents aged 12 to 17 years, with somatoform disorder, who were hospitalized in Kaunas Medical University Hospital, Lithuania (n =120), and a healthy control group (n = 60) of adolescents aged 12 to 17 years, who were randomly selected from 6 schools in Kaunas, Lithuania. RESULTS: The rate of alexithymia in adolescents with somatoform disorder was 59%, which was significantly higher than that in healthy control subjects (1%, P < 0.001). Similarly, the rate of anxiety was significantly higher in the patient group (62%), compared with control subjects (15%, P < 0.001). The rate of depression was low in both groups and did not differ significantly between groups. CONCLUSIONS: Adolescents with somatoform disorder have higher levels of alexithymia and anxiety than healthy adolescent control subjects, but adolescents with somatoform disorder and adolescent control subjects do not have significantly different levels of depression.     

Panic attack as a risk factor for severe psychopathology

OBJECTIVE: The purpose of the study was to examine the relationship between panic attack and the onset of specific mental disorders and severe psychopathology across the diagnostic spectrum among adolescents and young adults. METHOD: Data were drawn from the Early Developmental Stages of Psychopathology Study (N=3,021), a 5-year prospective longitudinal study of psychopathology among youths ages 14-24 years at baseline in the community. Multiple logistic regression analyses were used to examine the associations between panic attacks at baseline, comorbid mental disorders in adolescence, and the risk of mental disorders across the diagnostic spectrum at follow-up. RESULTS: The large majority of subjects with panic attacks at baseline developed at least one DSM-IV mental disorder at baseline (89.4% versus 52.8% of subjects without panic attacks). Subjects with panic attacks at baseline had significantly higher baseline levels of any anxiety disorder (54.6% versus 25.0%), any mood disorder (42.7% versus 15.5%), and any substance use disorder (60.4% versus 27.5%), compared to subjects without panic attacks at baseline. Preexisting panic attacks significantly increased the risk of onset of any anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, any substance use disorder, and any alcohol use disorder at follow-up in young adulthood, and these associations persisted after adjustment for all comorbid mental disorders assessed at baseline. More than one-third (37.6% versus 9.8%) of the subjects with panic attack at baseline met the criteria for at least three mental disorders at follow-up during young adulthood. CONCLUSIONS: Panic attacks are associated with significantly increased odds of mental disorders across the diagnostic spectrum among young persons and appear to be a risk factor for the onset of specific anxiety and substance use disorders. Investigation of key family, environmental, and individual factors associated with the onset of panic attacks, especially in youth, may be an important direction for future research.     

Lebenszeitprävalenz psychischer Störungen in der erwachsenen Allgemeinbevölkerung Ergebnisse der TACOS-Studie

The present paper reports lifetime prevalence rates of mental disorders in the 18- to 64-year-old general population of a northern German region. A representative random sample from registration office files of 4,075 individuals was examined in personal interviews using the fully standardized and computerised "Munich Composite International Diagnostic Interview" (M-CIDI). The response rate was 70.2%. Individuals were classified according to the DSM-IV. Substance use disorders were most frequent with 25.8% followed by anxiety (15.1%), somatoform (12.9%), affective (12.3%), and eating disorders (0.7%). Disorders other than substance use were more frequent in women and less frequent in men. A trend toward less psychiatric morbidity exists in individuals with higher educational level, higher income, and those who are married or reside in rural communities. Of all individuals affected by mental disorders, 42% fulfilled the criteria for at least one additional disorder. The results are discussed against the background of selected previous studies.     

Cognitive-behavioural therapy for patients with multiple somatoform symptoms--a randomised controlled trial in tertiary care

OBJECTIVE: (a) To evaluate the effect of a cognitive-behavioural inpatient treatment and (b) to analyse the differential efficacy of an additional ("soma") group management training of somatisation. METHODS: The final sample consisted of 191 patients with somatisation syndrome (patients with at least eight DSM-IV somatoform symptoms). Patients were randomly assigned to (I) "standard treatment + soma" or (II) "standard treatment + relaxation training." A waiting control group consisted of 34 patients. All patients were diagnosed with a structured clinical interview for DSM-IV and received an interview on medical consulting behaviour and questionnaires concerning somatoform symptoms, general psychopathology, subjective health status, and life satisfaction. RESULTS: Results show high impairment of the sample prior to treatment. At the 1-year follow-up, all outcome criteria were significantly reduced. The differential effect of the additional soma treatment was significant only for a reduction of visits to the doctor. Greatest longitudinal effect sizes were found for the reduction of somatoform symptoms. CONCLUSION: Considering the subjects' high initial impairment, the outcome results are encouraging. The specific effect on health care use highlights the socioeconomic relevance.     

Post-traumatic stress disorder

BACKGROUND: The study is aimed at investigating the influence of trauma type, pre-existing psychiatric disorders with an onset before trauma, and gender on post-traumatic stress disorder (PTSD). METHODS: Traumas, PTSD and psychiatric disorders were assessed in a representative sample of 4075 adults aged 18-64 years using the Composite International Diagnostic Interview. Pre-existing DSM-IV diagnoses of anxiety disorders, depressive disorders, somatoform disorders, alcohol abuse and dependence, nicotine dependence, gender, and the type of trauma were analysed with logistic regressions to estimate the influence of these factors on the risk for developing PTSD. RESULTS: The lifetime prevalence of exposure to any trauma did not vary by gender. The conditional probability of PTSD after exposure to trauma was higher in women (11.1% SE = 1.58) than men (2.9% SE = 0.83). Univariate analyses showed that pre-existing anxiety disorders, somatoform disorders and depressive disorders significantly increase the risk of PTSD. Multivariate analyses revealed that specific types of trauma, especially rape and sexual abuse, pre-existing anxiety disorders and somatoform disorders are predictors of an increased risk of PTSD, while gender and depressive disorder were not found to be independent risk factors. CONCLUSION: Women do not have a higher vulnerability for PTSD in general. However, especially sexually motivated violence and pre-existing anxiety disorders are the main reasons for higher prevalences of PTSD in women.     

Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

CONTEXT: Little is known about lifetime prevalence or age of onset of DSM-IV disorders. OBJECTIVE: To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. DESIGN AND SETTING: Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. PARTICIPANTS: Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. MAIN OUTCOME MEASURES: Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. RESULTS: Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. CONCLUSIONS: About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.     

Clinical utility of DSM-IV pain disorder.

The utility of DSM-IV criteria for pain disorder was investigated within a consecutive sample of 90 chronic pain patients aged between 18 and 65 years. In this sample, 65.6% (n = 59) fulfilled diagnostic criteria for DSM-IV pain disorder. Of the patients with DSM-IV pain disorder, 22% fulfilled additional criteria for depressive disorder, 6.8% for hypochondriasis, and 23.7% for any other DSM-IV diagnosis. Only 54.2% of the patients with DSM-IV pain disorder had no comorbid psychiatric disorder. When assessing somatoform symptoms without hierarchical guidelines, there is a great overlap between the symptomatology of pain disorder and other somatoform disorders. Of 59 patients with DSM-IV pain disorder, 93.2% also met criteria for DSM-IV undifferentiated somatoform disorder and 10.2% for DSM-IV somatization disorder. The mean number of somatoform symptoms was 17 in the total sample. Despite the presence or absence of a general medical condition, there was no significant difference between pain disorder associated with both psychological factors and a general medical condition (code 307.89) and pain disorder associated with psychological factors (code 307.80) with regard to the pain duration, intensity, and type and the level of disability and educational level. The formulation of a distinct psychiatric entity for pain conditions may improve the consideration of psychosocial factors in the pathogenesis and clinical cause of pain. However, with regard to our data, the distinctive validity of different subtypes of pain disorder as provided by DSM-IV awaits further clarification.     

Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area

We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.     

Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?

OBJECTIVE: DSM-III imposed a hierarchical relationship in the diagnosis of anxiety disorders in depressed patients, stipulating that anxiety disorders could not be diagnosed if their occurrence was limited to the course of a mood disorder. In the subsequent versions of the DSM this hierarchy was eliminated for all anxiety disorders except generalized anxiety disorder. The authors examined the validity of this remaining hierarchical relationship between mood and anxiety disorders. METHOD: Psychiatric outpatients with major depressive disorder (N=332) were evaluated with a semistructured diagnostic interview and completed paper-and-pencil questionnaires on presentation for treatment. To study the validity of the DSM-IV hierarchical relationship between generalized anxiety disorder and mood disorders, the authors made a diagnosis of modified generalized anxiety disorder for patients with major depressive disorder who met all the criteria for generalized anxiety disorder except for the exclusion criterion. The analyses compared the characteristics of three nonoverlapping groups of patients with DSM-IV major depressive disorder: 1) those with coexisting DSM-IV generalized anxiety disorder, 2) those with coexisting modified generalized anxiety disorder, and 3) those with neither DSM-IV nor modified generalized anxiety disorder. RESULTS: Compared to the depressed patients without generalized anxiety disorder, the depressed patients with DSM-IV and modified generalized anxiety disorder had higher levels of suicidal ideation; poorer social functioning; a greater frequency of other anxiety disorders, eating disorders, and somatoform disorders; higher scores on most subscales of a multidimensional self-report measure of DSM-IV axis I disorders; a greater level of pathological worry; and a higher morbid risk for generalized anxiety disorder in first-degree family members. The two generalized anxiety disorder groups did not differ from each other. CONCLUSIONS: The findings question the validity of the DSM-IV hierarchical relationship between major depressive disorder and generalized anxiety disorder and suggest that the exclusion criterion should be eliminated.     

Patterns of incidence and psychiatric risk factors for traumatic events

Individual differences are thought to influence the propensity for exposure to trauma and the subsequent development of post-traumatic stress disorder (PTSD) symptoms. Prior research has identified pre-existing mood disorders as one such individual risk factor for traumatic events as well as for PTSD. The present study reports the incidence of traumatic events (and PTSD) and examines psychiatric risk factors for trauma exposure in a prospective community sample. Data come from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24) in Munich, Germany. Respondent diagnoses (N = 2,548) at baseline and at follow-up 34-50 months later were considered. Psychiatric diagnoses at baseline were examined as predictors of qualifying trauma. Baseline prevalence of persons having experienced trauma meeting DSM-IV A1 and A2 criteria ('qualifying trauma') was 16.7%; during the follow-up period, 20.3% persons had experienced incident (new) qualifying traumata. The prevalence of PTSD, including subthreshold cases, at baseline was 5.6%; by the end of the follow-up period this had increased to 10.3%. Presence of an anxiety disorder at baseline predicted exposure to qualifying traumas during the follow-up period (adjusted ORs ranging from 1.36 for any trauma type to 3.00 for sexual trauma); this association was apparently due to an increased tendency to report events as being particularly horrific (meeting A2 criteria). In contrast, presence of illicit drug use predicted the onset of traumatic events (specifically assaultive and sexual trauma) meeting at least A1 criteria, suggesting an actual exposure to these types of traumatic events for this class of disorders. In this prospective study of urban adolescents and young adults, certain classes of pre-existing psychiatric disorders (most notably anxiety disorders and illicit drug use disorders) were associated with increased risk for qualifying traumatic events. The mechanisms by which premorbid psychiatric disorders promote exposure to traumatic events are unknown. Better understanding of these pathways may lead to novel strategies for primary and secondary prevention of PTSD.     

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.