Prevalence and socioeconomic aspects of epilepsy in the Croatian county of Sibenik-Knin: community-based survey

The aim of the survey was to estimate the prevalence rate of epilepsy, as well as seizure types, frequency, etiology, and comorbidity, by gender, age, and socioeconomic status among people with epilepsy in the Croatian county of Sibenik-Knin. The survey revealed that of 112,871 inhabitants, 1228 were identified as having active epilepsy. The crude prevalence rate for Sibenik-Knin County was 10.9 per 1000 inhabitants. Prevalence rates (per 1000) by age and gender were: 6.9 (ages 0-19); 10.6 (ages 20-59); 15.1 (ages 60+), 10.1 (females), and 11.7 (males). A significant number of subjects had different comorbid disorders. Although the literature suggests that Dalmatia is a region with a low prevalence of epilepsy, our results showed that Sibenik-Knin County has a higher prevalence of epilepsy than expected for European populations. The most common comorbid disorders, such as mental retardation, psychotic episodes, and substance addiction, highly influence socioeconomic status and quality of life.     

Geographical distribution of insanity in America: evidence for an urban factor

The geographic distribution of insanity and schizophrenia in the United States is examined for 9 separate years between 1880 and 1963. A concentration of these conditions in Northeastern and Pacific Coast States was remarkably consistent over the 83 years. States with a high prevalence rate had approximately three times more insanity and schizophrenia than those with a low prevalence rate. There is a direct regional correlation of insanity/schizophrenia with urbanization, which is consistent with previous studies. There is also a direct regional correlation of schizophrenia with socioeconomic status, which contradicts previous studies carried out in large cities in which the schizophrenic rates were inversely correlated with socioeconomic status. The apparent discrepancy can be explained by postulating that the direct regional correlations are due to correlations of urbanization and socioeconomic status (cities have higher mean incomes than rural areas) whereas, within a particular city, schizophrenia is more prevalent among lower socioeconomic groups because of drift and other factors. Social, stress and crowding, genetic, and biological factors are discussed as possible explanations for the urban factor associated with insanity/schizophrenia.     

Educational level and hospital use in mental disorders A population-based study

This population-based study presents socioeconomic differences in psychiatric inpatient care by diagnosis. Inpatient care among the Finnish population aged 25–64. years was studied using data from the Finnish National Hospital Discharge Register. All major mental disorders in the ICD-9 were included in the study. The socioeconomic status of individual patients was defined by years of education in the population census. Discharge rates, first–time admission rates and hospitalization risk were usually 2- to 4-fold higher in the low educational group compared with the highly educated population. The socioeconomic gradient was steepest for schizophrenia. No gradient was observed for major affective disorders. However, bipolar disorder was most common in the highest educational category. For most conditions, the socioeconomic gradient among women was lower than among men. In Finland hospitalization was more common among low than high socioeconomic groups for most mental disorders and most indicators of inpatient care. Most of these differences are fairly consistent with previous data on socioeconomic gradients in the prevalence of mental disorders.     

Elder abuse and neglect in two different socioeconomic districts in Izmir, Turkey

OBJECTIVE: To determine and compare the prevalence and risk factors of elder abuse in elderly population in two different districts in Izmir, Turkey. METHODS: This cross-sectional study involved 497 subjects selected by cluster sampling. RESULTS: The prevalence of physical and financial abuse among the elderly in the district of low socioeconomic status was 1.5% and 2.5%, respectively, while among the elderly in the district of high socioeconomic status, it was 2% and 0.3%, respectively. However, the prevalence of elder neglect in the two districts was 27.4% and 11.2%, respectively. Prevalence of neglect was associated with infrequent contact with relatives, little or no income, and fewer years of education among the elderly in the low socioeconomic district. In the high socioeconomic district, neglect was associated with fewer years in education, poor health status and having chronic status. CONCLUSION: The prevalence of abuse among the elderly living in the two different districts was low. However, nearly one-fifth of elderly people were exposed to neglect.     

Prevalence estimations of attention-deficit/hyperactivity disorder: differential diagnoses and comorbidities in a Colombian sample

The aim of this article was to analyze the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) in Colombian "Paisa" children and adolescents. A randomized sample of 4- to 17-year-old children and adolescents--176 males and 154 females--was selected from schools in Manizales, Colombia. The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview, medical histories revision, and neurological or psychiatric evaluations. Several rating scales and a neuropsychological assessment were administered in order to confirm the diagnosis. Children with Full Scale Intelligence Quotient (FSIQ) between 71 and 84 were recorded as having Borderline Intellectual Functioning (BIF), and those with a history of mild motor retardation, and/or Performance Intelligence Quotient (PIQ) lower than 71, were recorded as having a Developmental Coordination disorder (DCD), after confirmation by neurological and neuropsychological examinations. BIF and DCD children were excluded from the ADHD group. Total prevalence of ADHD adjusted by sex was 16.4% (males 19.8% and females 12.3%). Prevalence of clean ADHD cases was 11.5%, distributed as follows: combined type, 6.4%; inattentive, 4.8%; and hyperactive-impulsive, 0.3%. Distribution by sex was as follows: males, 14.8%; and females, 7.7%; with an odds ratio of 2.1 (95% CI: 1-4.5, chi 2 = 4.0, p < .05). Clean prevalence of ADHD adjusted by equal sex distribution was 11.3%. Prevalence of BIF was 5.8%, DCD 3.0%, and mild mental retardation 3.9%. Prevalence of ADHD did not show differences by socioeconomic status (SES), in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES.     

PREVALENCE ESTIMATIONS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: DIFFERENTIAL DIAGNOSES AND COMORBIDITIES IN A COLOMBIAN SAMPLE

The aim of this article was to analyze the prevalence of Attention Deficit/ Hyperactivity Disorder (ADHD) in Colombian Paisa children and adolescents. A randomized sample of 4- to 17-year-old children and adolescents--176 males and 154 females--was selected from schools in Manizales, Colombia. The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview, medical histories revision, and neurological or psychiatric evaluations. Several rating scales and a neuropsychological assessment were administered in order to confirm the diagnosis. Children with Full Scale Intelligence Quotient (FSIQ) between 71 and 84 were recorded as having Borderline Intellectual Functioning (BIF), and those with a history of mild motor retardation, and/or Performance Intelligence Quotient (PIQ) lower than 71, were recorded as having a Developmental Coordination disorder (DCD), after confirmation by neurological and neuropsychological examinations. BIF and DCD children were excluded from the ADHD group. Total prevalence of ADHD adjusted by sex was 16.4% (males 19.8% and females 12.3%). Prevalence of clean ADHD cases was 11.5%, distrib uted as follows: combined type, 6.4%; inattentive, 4.8%; and hyperactive-impulsive, 0.3%. Distribution by sex was as follows: males, 14.8%; and females, 7.7%; with an odds ratio of 2.1 (95% CI: 1 - 4.5, &#104 2 = 4.0, p <. 05). Clean prevalence of ADHD adjusted by equal sex distribution was 11.3%. Prevalence of BIF was 5.8%, DCD 3.0%, and mild mental retardation 3.9%. Prevalence of ADHD did not show differences by socioeconomic status (SES), in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES.     

Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples

An abridged somatization construct (the Somatic Symptom Index) derived from the Diagnostic Interview Schedule's somatization disorder items was tested on community epidemiological samples to examine its prevalence, risk factors, and predictive value. The construct had a high prevalence (range, 4.4% to 20% compared with .03% to 0.7% for the full DSM-III somatization disorder diagnosis), was related to low socioeconomic status, female gender, older chronological age, and Hispanic ethnic background. The presence of this construct determined preferential use of medical services and predicted high indices of disability. The Somatic Symptom Index may have practical utility for clinical and community studies of somatoform phenomena.     

Responding to the threat of HIV among persons with mental illness and substance abuse

PURPOSE OF REVIEW: This article discusses current knowledge regarding the threat of HIV among persons with mental illness and substance abuse, and strategies for reducing this threat. It contains a review of the prevalence and consequences of dual/triple diagnosis, HIV risk behaviour and current HIV risk-reduction interventions among persons with dual diagnosis and interventions for triply diagnosed individuals. RECENT FINDINGS: Many persons with dual diagnosis remain undetected and there is a high prevalence of sexual risk behaviours among persons with dual diagnosis. Case management and supportive housing programmes are feasible options for the delivery of HIV risk-reduction interventions among such patients, and the adaptation of integrated behavioural treatment interventions can improve behavioural and healthcare utilization outcomes. SUMMARY: The developing world continues to see an escalation in HIV incidence. A more complete understanding of mental health, substance use and HIV serostatus interactions is needed to serve vulnerable populations. Mental health status not only mediates HIV risk behaviours, but positive serostatus has various effects on mental health. Co-morbid substance abuse is common among HIV-positive individuals with mental illness, resulting in serious adverse effects. Separate services for individuals with co-occurring substance abuse are less effective than integrated treatment programmes.     

The Association between Economic Status and Depressive Symptoms: An Individual and Community Level Approach

Objective

The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level.

Methods

A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region.

Results

The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions.

Conclusion

The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.     

Race and restless legs syndrome symptoms in an adult community sample in east Baltimore

BACKGROUND & PURPOSE: Due to the relative absence of African-Americans seeking treatment for restless legs syndrome (RLS) in specialty clinics, a lower prevalence of RLS among African-Americans than Caucasians has been suggested. We compared the prevalence of RLS in African-Americans and Caucasians in a biracial community sample as part of Wave IV of the Baltimore Health and Mental Health Study. METHODS: Subjects included 1071 adults [358 African-Americans (35.0%), and 633 Caucasians (61.8%), and 33 others]. Diagnosis of RLS was based on endorsement of RLS symptoms on a seven-item RLS questionnaire during a household interview. Adjusted odds and 95% confidence intervals were calculated based on logistic regression models with diagnosis of RLS as the main outcome variables and African-American race as the main predictor while adjusting for other relevant sociodemographic and/or health-related variables. RESULTS: The prevalence of RLS in this population was 4.1%. The rates were similar for African-Americans (4.7%) and Caucasians (3.8%). After adjustment for age, gender, medical comorbidities, and socioeconomic status, no difference in the prevalence of RLS was found between African-Americans and Caucasians. CONCLUSION: RLS is comparably prevalent among African-American and Caucasian adults in the general population. Barriers affecting access to care settings for African-American RLS patients should be investigated in the future.     

Prevalence of smoking in psychiatric patients

Compelling evidence that tobacco-smoking is a form of drug addiction exists. The aim of this study is to determine the following: (1) prevalence of tobacco-smoking and of nicotine dependence in French psychiatric patients; (2) rates and patterns of tobacco smoking and of nicotine dependence according to diagnosis; (3) relationship between current smoking status and antipsychotic medications; and (4) relationship between cigarette smoking and neurological side effects induced by neuroleptics. A population of 711 psychiatric in- and outpatients was assessed using: (1) a detailed smoking self-questionnaire for smoking history and nicotine dependence; and (2) a questionnaire for staff covering treatments and DSMIII-R diagnoses. Data were analyzed using chi2 analysis of variance (ANOVA) tests (one factor) for quantitative comparisons between groups of patients, and analysis of covariance (ANCOVA) test with age covariate was performed for age-dependent variables. Prevalence of smoking in the population of psychiatric patients was significantly higher than in the French general population. Diagnoses among current smokers were mainly substance-related disorder and schizophrenia. The authors established correlations between prevalence of smoking and age, sex, marital and socioeconomic status, alcohol use, coffee consumption and other psychoactive substance use or abuse. The authors did not find relationship between smoking prevalence and institutionalization. Neuroleptic neurological side effects were significantly fewer among smokers compared to nonsmokers. However, the rate of smokers was significantly higher in psychiatric patients receiving neuroleptic drugs. Nicotine abuse in psychiatric patients, and especially in schizophrenic patients, could support the hypothesis that smoking is consistent with self-medication.     

Prevalence of smoking among psychiatric outpatients

The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented.     

Depression and anxiety in relation to social status. A prospective epidemiologic study

Longitudinal research in Stirling County, Atlantic Canada, indicated that during the 1950s and 1960s the prevalence of depression was significantly and persistently higher in the "low" socioeconomic status population than at other socioeconomic status levels. Anxiety was found to show a less clear picture. Incidence of depression after the study started was also higher among those who were initially in the low socioeconomic status group, supporting the view that the stress of poverty may be causally related to depression. There was also a trend for prior depression to be associated with subsequent downward social mobility, supporting the view that the concentration of depressed people at the lower end of the social hierarchy may result from handicapping aspects of the illness. Neither of these trends was statistically significant. More striking was evidence that, irrespective of socioeconomic status, depression carried a substantial risk for poor clinical course and outcome. Both depression and poverty tended to be chronic, and, accordingly, their association at the end of the study was influenced by their association at its beginning. The stability of the relationship between poverty and depression warrants the attention of caregivers and policymakers and raises new questions about strategies for the study of causal sequences.     

Socioeconomic status and stroke

This paper reviews the current evidence for the association between socioeconomic status and stroke incidence, survival, mortality, and other outcomes. The evidence is strongest for mortality and incidence of stroke, with high rates of stroke in low socioeconomic groups being a consistent finding. Low socioeconomic groups also have lower survival and greater stroke severity than high socioeconomic groups, although there is less evidence for this association. The mechanisms through which socioeconomic status affects stroke risk and outcomes are unclear but some studies report that differences in risk-factor prevalence could account for some of the variation. We discuss the implications of these findings and make recommendations for future research. Studies using prospective population-based methods with improved control for confounding factors are needed to confirm or refute these associations. Understanding the causal associations between socioeconomic status and stroke will allow interventions to be appropriately targeted and assessed.     

Prevalence of restless legs syndrome in Trabzon in the northeast Black Sea Region of Turkey: co-morbidities,socioeconomic factors and biochemical parameters

Abstract

Objectives:

Factors including heritability, climate features, co-morbid diseases and methodological differences between studies may underlie variation in the prevalence of restless legs syndrome (RLS). The purpose of this study was to assess the prevalence of RLS in Trabzon and to evaluate associated factors by including biochemical investigations.

Methods:

This community-based study was conducted among a random sample of 3789 adults. The criteria suggested by the International RLS Study Group were used in the assessment of RLS. Individuals responding affirmatively to at least one question were interviewed and examined by neurologists for definitive diagnosis of RLS. Age- and gender-matched RLS-negative individuals were enrolled in the control group. Blood samples from RLS patients and control subjects were collected after 12-hour fasting to evaluate fasting blood glucose, ferritin, vitamin B12, folic acid and creatinine.

Results:

The prevalence of RLS was 4.5%. Age, female gender and educational level were identified as independent risk factors for RLS. Peak prevalence rates were observed in the fourth decade in women and in the sixth decade in man. A familial history of RLS, low ferritin and vitamin B12 levels and multiparity were more common in women with RLS. Fasting blood glucose, folic acid and creatinine levels were not significantly different between the patients and controls.

Discussion:

The prevalence of RLS is relatively consistent in different regions of Turkey. Women with RLS may have different risk factors from men with RLS that may lead to increased prevalence at earlier ages. Low socioeconomic status may also affect the prevalence of RLS.     

A multicenter study of major depressive disorder among emergency department patients in Latin-American countries

This multicenter study estimated the prevalence of major depressive disorder (MDD) among emergency department patients in Latin America. To identify patients with MDD, we used a combination of DSM IV- criteria interview and a questionnaire screen including the center for Epidemiological Studies Depression Scale. We analyzed data from consecutive adult patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico and described the demographic and health status differences between MDD and non-MDD patients. Prevalence of MDD ranges from 23.0 to 35.0%. The estimates are based on a total of 1,835 patients aged 18 years and over, with response rates of 83.0%. Compared to non-MDD patients, MDD patients were more likely to be middle-aged, female, smokers, of lower socioeconomic status, and to report a diagnosis of asthma or arthritis/rheumatism. Multivariate analysis identified a lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems to be independently associated with MDD. Our data suggest that the prevalence of MDD is elevated among emergency department patients in Latin American countries. The integration of depression screening into routine emergency care merits serious consideration, especially if such screening can be linked to psychiatric treatment.     

The relationship between risk of hospitalization for schizophrenia, SES, and cognitive functioning

Although most studies find low socioeconomic status (SES) to be associated with prevalence of schizophrenia, incidence studies do not generally support this, and some even report an inverse association. The objective of the current historical prospective study was to examine the relationship between SES, cognitive functioning, and risk of hospitalization for schizophrenia in a population-based sample of Israeli adolescents. Subjects were 811 487 adolescents, assessed by the Israeli military draft board for socio-demographic factors and cognitive functioning. Data on later hospitalization for schizophrenia were obtained from a population-based hospitalization registry. Findings indicated that when simply examining SES and schizophrenia, lower SES was associated with greater risk of hospitalization for schizophrenia (Hazard Ratio [HR] = 1.193, 95% CI = 1.091-1.303). When dividing the cohort into low, average, and high cognitive functioning, SES did not influence the risk for schizophrenia among individuals with high and average cognitive functioning, whereas among individuals with low cognitive functioning, high SES was found to slightly increase the risk for schizophrenia (HR = 1.21, 95% CI = 1.03-1.42). One possible explanation for this finding might be that among individuals from low socioeconomic backgrounds, low IQ may reflect decreased opportunities related to SES, whereas among individuals from high SES backgrounds, low IQ might reflect risk for later psychopathology.     

One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study

The associations between the one-month prevalence rates of mental disorders and sociodemographic characteristics were investigated for 18571 people interviewed in the first-wave community samples of all 5 sites in the US National Institute of Mental Health (NIMH) Epidemiologic Catchment Area program. Men were found to have a significantly higher rate of cognitive impairment than women after controlling for the effects of age, race or ethnicity, marital status and socioeconomic status. Marital status was one of the most powerful correlates of mental disorder risk: the odds of separated or divorced people having any NIMH Diagnostic Interview Schedule disorder were twice that of married people after controlling for age, gender, race or ethnicity and socioeconomic status. The odds of those in the lowest socioeconomic status group having any Diagnostic Interview Schedule disorder was about 2.5 times that of those in the highest socioeconomic status group, controlling for age, gender, race or ethnicity and marital status. For all disorders except cognitive impairment, race or ethnicity did not remain statistically significant after controlling for age, gender, marital status and socioeconomic status.