Biogenetic explanations and public acceptance of people with eating disorders

Purpose

It has been assumed that biogenetic causal models may improve public attitudes toward people with mental illnesses. The present study examines whether biogenetic attributions are positively associated with acceptance of people suffering from these disorders.

Methods

Population surveys were conducted in two large German cities. Respondents were presented with a vignette depicting a young female suffering from either anorexia nervosa (N = 680) or bulimia nervosa (N = 667), followed by a fully structured interview including questions on causal attributions, emotional reactions and desire for social distance.

Results

Attribution to hereditary factors showed hardly any relationship with attitudes toward people with symptoms of eating disorders. Respondents who endorsed brain disease as a cause tended more to hold those afflicted responsible for their condition, they also expressed more negative emotions and a stronger preference for social distance.

Conclusions

Our results do not support the notion that promulgating biogenetic causal models of eating disorders helps decrease the stigma surrounding these illnesses; it may even entail the risk of increasing it.     

Non-fatal burden of disease due to mental disorders in the Netherlands

Purpose

To estimate the disease burden due to 15 mental disorders at both individual and population level.

Methods

Using a population-based survey (Nemesis, N = 7,056) the number of years lived with disability per one million population were assessed. This was done with and without adjustment for comorbidity.

Results

At individual level, major depression, dysthymia, bipolar disorder, panic disorder, social phobia, eating disorder and schizophrenia are the disorders most markedly associated with health-related quality of life decrement. However, at population level, the number of affected people and the amount of time spent in an adverse health state become strong drivers of population ill-health. Simple phobia, social phobia, depression, dysthymia and alcohol dependence emerged as public health priorities.

Conclusions

From a clinical perspective, we tend to give priority to the disorders that exact a heavy toll on individuals. This puts the spotlight on disorders such as bipolar disorder and schizophrenia. However, from a public health perspective, disorders such as simple phobia, social phobia and dysthymia—which are highly prevalent and tend to run a chronic course—are identified as leading causes of population ill-health, and thus, emerge as public health priorities.     

Profiling disordered eating patterns and body mass index (BMI) in the English general population

Purpose

Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007.

Method

Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities.

Results

The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent’s life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders (‘marginal anorexia’ relating to anorexia nervosa and ‘binge eaters’ relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as ‘normal eaters’, with a low probability of eating problems and a normal BMI.

Conclusions

Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.     

Risk factors for mental disorder among university students in Australia: findings from a web-based cross-sectional survey

Purpose

To identify variables associated with common mental disorders in an Australian university population.

Methods

We invited all Australia-based students from a large public university (N = 24,209) to participate in a web-based student mental health survey. Outcome measures included the patient health questionnaire depression, anxiety, and eating disorders modules, and the alcohol use disorders identification test. Explanatory variables of interest included gender, age, year of study, degree type, financial means, parental education, domestic/international status, and sexual orientation. Multiple logistic regression analysis was used to estimate independent associations with the four outcomes.

Results

Complete responses were received from 6,044 students (25 %). Proportions reporting depression, anxiety, eating disorders, and harmful drinking were 8, 13, 14, and 8 %, respectively, while 30 % had at least one of these disorders. The groups with the highest rates of disorder were women, 25–34-year-olds, students on low income, and homosexual or bisexual students. Parental education was not associated with disorder, nor was international/domestic status.

Conclusion

This is the first study examining mental disorders in a population-based sample of university students in Australia. Given increasing student numbers and participation of students from lower socio-economic backgrounds, policy is urgently needed to promote better mental health in this population, to routinely identify vulnerable students, and to intervene early. Groups in particular need are women, students on low incomes, and homosexual or bisexual students.     

Socioeconomic status and children’s mental health: results from the Bergen Child Study

Purpose

It is generally accepted that mental health problems are unequally distributed across population strata defined by socioeconomic status (SES), with more problems for those with lower SES. However, studies of this association in children and adolescents are often restricted by the use of global measures of mental health problems and aggregation of SES-indicators. We aim to further elucidate the relationship between childhood mental health problems and SES by including more detailed information about mental health and individual SES-indicators.

Methods

The participants (N?=?5,781, age 11–13) were part of the Bergen Child Study (BCS). Mental health was assessed using the teacher, parent and self-report versions of the Strengths and Difficulties Questionnaire (SDQ), including an impact section, used to measure symptom dimensions and probability of psychiatric disorders. Parent reports of family economy and parental education were used as SES measures.

Results

For each SES indicator we confirmed an inverse relationship across all the symptom dimensions. Poor family economy consistently predicted mental health problems, while parental education level predicted externalizing disorders stronger than internalizing disorders.

Conclusion

In this Norwegian sample of children, family economy was a significant predictor of mental health problems as measured across a wide range of symptom dimensions and poor economy predicted a high probability of a psychiatric disorder. Longitudinal studies of the impact of low family income as well as other SES factors on externalizing and internalizing symptom dimensions and disorders are called for.     

Socioeconomic status and the risk of depression among UK higher education students

Background

Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable.

Methods

The study was a cross-sectional online survey of 923 undergraduate students attending 6 UK Universities in the academic year 2009–2010 who completed a modified version of the Zagazig Depression Scale (ZDS).

Results

Overall, 58.1 % of female and 59.9 % of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control.

Conclusion

Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one’s life may be protective.

Application

Since depression has strong impact on students’ learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.     

Estimated rates of mental disorders in, and situational characteristics of, incidents of nonfatal use of force by police

Purpose

To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia.

Methods

A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties.

Results

More than a third of people on whom the police resorted to using force (n = 1,621, 38 %) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5 %, OR = 9.03, 95 % CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1 %, OR = 9.73, 95 % CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95 % CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95 % CI (1.11, 1.78), p = 0.005].

Conclusions

Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.     

Prevalence of mental health disorders among low-income African American adolescents

Purpose

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population.

Methods

Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city.

Results

Based on the C-DISC, 3.8, 5.1 and 7.7 % of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders.

Conclusions

Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.     

Mental health first aid responses of the public: results from an Australian national survey

Background

Surveys of the public in a range of Western countries have shown a predominant belief in social stressors as causes of mental disorders. However, there has been little direct cross-cultural comparison. Here we report a comparison of public beliefs about the causes of mental disorders in Japan and Australia.

Methods

Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs about causes and risk factors in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over.

Results

In both countries, both social and personal vulnerability causes were commonly endorsed across all vignettes. The major differences in causal beliefs were that Australians were more likely to believe in infection, allergy and genetics, while Japanese were more likely to endorse "nervous person" and "weakness of character". For risk factors, Australians tended to believe that women, the young and the poor were more at risk of depression, but these were not seen as higher risk groups by Japanese.

Conclusion

In both Japan and Australia, the public has a predominant belief in social causes and risk factors, with personal vulnerability factors also seen as important. However, there are also some major differences between the countries. The belief in weakness of character as a cause, which was stronger in Japan, is of particular concern because it may reduce the likelihood of seeking professional help and support from others.     

Association between annual earnings and mental disorders in Spain: individual and societal-level estimates

Purpose

Indirect costs of mental disorders are considerable and include loss of work productivity. We aimed to study the association between personal annual earnings and common mental disorders in Spain.

Methods

A cross-sectional population study of a representative sample of noninstitutionalized adults from Spain was performed (ESEMeD-Spain). CIDI 3.0 was administered to assess DSM IV mental disorders, and the Sheehan Disability Scales were used for severity appraisal. Four categories of mental disorders were defined: 12-month serious, 12-month moderate, 12-month mild, and lifetime. Personal annual earnings were assessed. Three models were fitted to estimate differences in annual earnings associated with mental disorders, controlling for sociodemographic variables.

Results

Prevalence rates of 12-month mental disorders were: mild 4.6%, moderate 3.8%, and serious 1.6%. Respondents with 12-month serious mental disorder (SMD) were less likely to report any earnings compared to those with no mental disorders (OR?=?0.16; 95% CI?=?0.07–0.34, p?Conclusion This is the first study in Spain that describes the earnings gap between individuals with and without mental disorders. Despite the low prevalence of SMD, they represent considerable societal-level productivity loss. Prevention and treatment of SMD should improve work productivity.     

Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities

Purpose

This study investigated differences in mental health knowledge and beliefs between participants from the Iraqi and Sudanese refugee communities, and Australian-born individuals, in Sydney, Australia.

Methods

Ninety-seven participants were given vignettes of characters describing symptoms of major depressive disorder and posttraumatic stress. They were required to identify psychological symptoms as disorders, rate beliefs about the causes of and helpful treatments for these disorders, and rate attitude statements regarding the two characters.

Results

Australian participants recognized the presented symptoms as specific mental disorders significantly more than Iraqi and Sudanese participants did, and reported causal and treatment beliefs which were more congruent with expert beliefs as per the western medical model of mental disorder. The Sudanese group endorsed supernatural and religious causal beliefs regarding depression and posttraumatic stress symptoms most often; but both Sudanese and Iraqi participants strongly supported options from the supernatural and religious treatment items. However, evidence for pluralistic belief systems was also found.

Conclusions

Although sampling was non-random, suggesting caution in the interpretation of results, it appears that the mental health literacy of lay Australians may be more aligned with the western medical model of mental disorder than that of Iraqi and Sudanese refugee communities. Mental health literacy support needs of Iraqi and Sudanese refugee communities resettled in western countries such as Australia might include education about specific symptoms and causes of mental disorder and the effectiveness of psychiatric treatments. These findings provide useful directions for the promotion of optimal service utilization among such communities.     

Multidimensional health locus of control and depressive symptoms in the multi-ethnic population of the Netherlands

Purpose

Ethnic inequalities in health in Western societies are well-documented but poorly understood. We examined associations between health locus of control (HLC) and depressive symptoms among native and non-native Dutch people in the Netherlands.

Methods

We used hierarchical multiple linear regression analyses on a representative sample of the multi-ethnic population of Amsterdam and The Hague (n = 10,302). HLC was measured with the multidimensional health locus of control scale. Depressive symptoms were measured with the Kessler Psychological Distress scale.

Results

Multivariate analyses showed that HLC contributes to ethnic differences in the prevalence of depressive symptoms. Respondents who scored high on external locus of control (PHLC) were more likely to have depressive symptoms than those with a low score on PHLC (β = 0.133, p < 0.001). Conversely, respondents scoring high on internal locus of control (IHLC) were less likely to have depressive symptoms compared to those scoring low on IHLC (β = ?0.134, p < 0.001). The associations were most pronounced among Turkish-Dutch and Moroccan-Dutch respondents.

Conclusion

Our findings suggest that HLC contributes to ethnic inequalities in depressive symptoms, especially among Turkish and Moroccan ethnic groups. Professionals (e.g. clinicians and policy makers) need to take HLC into account when assessing and treating depression among ethnic minority groups, particularly in Turkish and Moroccan populations. Future research should look further into the associations within these groups.     

Adoption, family relations and psychotic symptoms among Palauan adolescents who are genetically at risk for developing schizophrenia

Purpose

This paper focuses on the role of adoption and family relations as moderators of genetic risk for psychotic disorders.

Methods

Participants included 184 adolescents in the Republic of Palau identified to be at genetic risk for schizophrenia and other psychotic disorders. Palau is an island nation in Micronesia with a lifetime prevalence of 1.99% for schizophrenia and 2.67% for psychotic disorders more broadly defined [24]. In Palauan culture, kinship adoption is a common cultural practice; 47 of the 184 participants had been adopted at an early age. The current study was designed to test the hypothesis that adoption would function as a protective factor among Palauan youth at genetic risk for the development of psychotic symptoms. Participants were evaluated for psychotic and other psychiatric symptoms using KSADS-PL [16]. Concurrently, the Youth Self Report [1] was used to assess the perceived quality of family relationships.

Results

Results indicated that adopted adolescents were more likely to develop psychotic symptoms than non-adopted adolescents. However, perceived family relations moderated the association between adoption status and psychotic symptoms, such that adopted adolescents with poorer family relations reported disproportionately higher rates of psychotic symptoms. Family relations also moderated the association between level of genetic risk and psychotic symptoms, independently of adoption status.

Conclusion

Consistent with previous research, adolescents at high genetic risk who reported more positive family relations also reported fewer psychotic symptoms [4, 29].     

Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

Background

Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.

Methods

The entire school population of 16–17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991–1993 (n?=?2300). Adolescents with positive screenings (n?=?307) and matched non-depressed controls (n?=?302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17–19 years after the baseline study (n?=?375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants’ ages of 18 and 35 years.

Results

Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose–response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR?=?1.63, CI 0.55–4.85; 2–4 symptoms: OR?=?2.77, 95% CI 1.04–7.39;?≥?5 symptoms: OR?=?5.75, 95% CI 1.98–16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p?<?0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose–response relationship (p?<?0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p?<?0.05).

Conclusions

Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

     

Prevalence and correlates of disordered eating in a general population sample: the South East London Community Health (SELCoH) study

Purpose

Disordered eating has been shown to be more prevalent than full eating disorders diagnoses. However, research on its prevalence, socio-demographic, psychological correlates, and patterns of service use in multi-ethnic samples is still limited. This paper explores these associations in a South London-based (UK) sample.

Methods

The South East London Community Health (SELCoH) study is a general population survey (N = 1,698) of individuals aged 16+. Disordered eating was defined as ≥2 positive answers at the SCOFF questionnaire. Crude and adjusted logistic and multinomial logistic regression models were fit to investigate associations between socio-demographic characteristics, disordered eating, psychiatric comorbidity, and service use.

Results

A total of 164 (10 %) participants reported disordered eating and the majority were from ethnic minorities. In adjusted models, Asian ethnicity was associated with purging, loss of control eating and preoccupation with food. Individuals with disordered eating had higher odds of screening positive for post-traumatic stress disorder and personality disorders and of having anxiety/mood disorders, suicidal ideation/attempts, hazardous levels of drinking, and used drugs in the previous year. Only 36 % of individuals with disordered eating had sought professional help in the previous 12 months mostly through their general practitioner (27.4 %), followed by psychotherapists (12.8 %) and mental health specialists (5.5 %).

Conclusion

This study found a high prevalence of disordered eating, especially amongst ethnic minorities, and associations with a number of psychiatric conditions. Overall few participants accessed specialist services. These findings suggest that both disordered eating manifestations amongst ethnic minorities and access to care need better investigation.     

Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia

Purpose

Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors.

Methods

One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale.

Results

There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains.

Conclusion

Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.     

The relationship between cognitive ability and depression: a longitudinal data analysis

Purpose

There is literature indicating cognitive ability and depression are related, but few studies have examined the direction of the relationship. This study examined the relationship between depression levels and cognitive abilities from adolescence to early adulthood.

Methods

Using the National Longitudinal Study of Adolescent Health (n = 14,322), this study used path modeling to investigate the relationship between depression and cognitive ability at baseline and again 8 years later.

Results

After controlling for initial levels of depression, cognitive ability, and other covariates, depressive symptoms in adolescence are related to cognitive ability in early adulthood, but adolescent cognitive ability is not related to adult depression levels. Moreover, after controlling for adolescent levels of depression and cognitive ability, the cognitive ability–depression relationship disappears in adulthood.

Conclusions

The cognitive ability–depression relationship appears early in life, and it is likely that the presence of depressive symptoms leads to lower cognitive ability. Thus, intervening at early signs of depression not only can help alleviate depression, but will likely have an effect of cognitive ability as well.