Antecedents of the risk of recovery from DSM-III-R social phobia.

BACKGROUND: This study reports antecedents of recovery from DSM-III-R social phobia. METHODS: Retrospective data were obtained from 1116 individuals age 15 to 64 participating in a large population health survey in the province of Ontario, Canada RESULTS: Approximately 50% of the sample recovered from their illness. Survival analysis revealed a median length of illness of 25 years with peak periods of risk of recovery occurring between 30 and 45 years duration. Using discrete time multivariate hazard regression analysis, statistically significant predictors of recovery from social phobia included: childhood social contextual factors (one or no childhood siblings, a small town childhood place of residence), characteristics of the disorder (onset past the age of 7, less than three disorder symptoms), an absence of co-morbid health-related conditions and psychiatric disorders (chronic health problems and major depression), and the occurrence of co-morbid chronic health problems and major depression prior to the onset of the disorder. CONCLUSIONS: Our data indicate that social phobia in the general population is a chronic and unremittent disorder. Determinants of recovery are rooted in distal childhood circumstances, disorder attributes, and the physical and mental health status of individuals over the life course.     

Social phobia and potential childhood risk factors in a community sample

BACKGROUND: This study examined the relationship between potential childhood risk factors and social phobia in an epidemiological sample. Identifying risk factors such as childhood adversities can often uncover important clues as to the aetiology of a disorder. This information also enables health care providers to predict which individuals are most likely to develop the disorder. METHODS: Data came from the Mental Health Supplement to the Ontario Health Survey of a survey of 8116 Canadian respondents, aged 15-64. Social phobia was diagnosed using the Composite International Diagnostic Interview (CIDI). Childhood risk factors were assessed by a series of standardized questions. RESULTS: A positive relationship was observed between social phobia and lack of close relationship with an adult, not being first born (in males only), marital conflict in the family of origin, parental history of mental disorder, moving more than three times as a child, juvenile justice and child welfare involvement, running away from home, childhood physical and sexual abuse, failing a grade, requirement of special education before age 9 and dropping out of high school. Many of these variables remained significant after controlling for phobias, major depressive disorder and alcohol abuse. The data also suggest that some childhood risk factors may interact with gender to influence the development of social phobia. CONCLUSIONS: Although an association was detected between social phobia and childhood risk factors, naturalistic prospective studies are needed to clarify the aetiological importance of these and other potential risk factors for the disorder.     

Urban-rural mental health differences in great Britain: findings from the national morbidity survey

BACKGROUND: Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. METHODS: Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. RESULTS: Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress, factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in treatment. CONCLUSIONS: There are considerable British urban rural differences in mental health, which may largely be attributable to more adverse urban social environments.     

Psychiatric symptoms and disorders in phenylketonuria

Psychological and psychiatric problems are well documented across the lifespan of individuals with early-treated phenylketonuria (PKU). Early-treated children and adolescents tend to display attentional problems, school problems, lower achievement motivation, decreased social competence, decreased autonomy, and low-self-esteem. As they enter adulthood, early-treated individuals may carry forward low self-esteem and lack of autonomy but also tend to develop depressed mood, generalized anxiety, phobias, decreased positive emotions, social maturity deficits, and social isolation. The correlation between level of metabolic control and severity of symptoms suggests a biological basis of psychiatric dysfunction. Additionally, psychosocial factors such as the burden of living with a chronic illness may contribute to psychological and psychiatric outcomes in PKU. The lack of a PKU-specific psychiatric phenotype combined with the observation that not everyone with PKU is affected highlights the complexity of the problem. More research on psychiatric and psychological outcomes in PKU is required. Of particular importance is the routine monitoring of emotional, behavioral, and psychosocial symptoms in individuals with this metabolic disorder. Longitudinal studies are required to evaluate the impact of new and emerging therapies on psychiatric and psychosocial functioning in PKU. Unidentified or untreated emotional and behavioral symptoms may have a significant, lifelong impact on the quality of life and social status of patients.     

康复期精神分裂症患者生活质量及其影响因素分析

目的探讨康复期精神分裂症患者的生活质量及其影响因素。方法采用健康状况问卷(SF-36)、简明精神病评定量表(BPRS)、副反应量表(TESS)等对120例住院康复期精神分裂症患者进行评定,并与120例正常健康人群进行对照。结果住院康复期精神分裂症患者生活质量SF-36总评分、躯体功能(PF)、躯体健康所致的角色限制(RP)、社交功能(SF)和情感问题所致的角色限制(RE)显著低于健康对照组,差异均有显著统计学意义(t=4.99,4.41,5.92,7.79,4.04;P均<0.01);社会支持少、病程短、年龄轻、无业、独居的患者生活质量差(P<0.05);多因素逐步回归分析显示,影响患者生活质量的主要因素依次为BPRS、SSRS、工作、婚姻、TESS(P<0.01～0.05)。结论康复期精神分裂症患者的生活质量全面低下,影响因素是多方面的,在临床工作中应予以重视。     

Stigma and bipolar disorder: A review of the literature

Background

Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research.

Methods

PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD.

Results

Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD.

Limitations

Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization.

Conclusions

Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life.     

THE ASSOCIATION OF MULTIPLE NEIGHBORHOOD PERCEPTIONS WITH DEPRESSION AMONG A HIGHLY IMPOVERISHED URBAN SAMPLE

Studies show a link between neighborhoods and depression. Multiple social processes may contribute to this relationship. This study examines multiple neighborhood social factors simultaneously and how each may contribute to depression. 717 individuals were recruited from high‐drug‐use areas in Baltimore, Maryland to be interviewed. Participants reported perceptions of their neighborhood and depressive symptoms. The influence of four neighborhood factors (social disorder, institutional control, individual control, and future risk) on presence of depression was assessed using logistic regression. Higher levels of social disorder (OR:1.36) and perceived future risk of crime (OR:1.41) were associated with greater odds of depression. These relationships remained even when accounting for other neighborhood and individual factors. These results suggest perceived social disorder and future risk of being a victim of crime may be particularly salient in exacerbating depressive symptoms. This research may be beneficial for individual and community‐based interventions for prevention and treatment of depression.     

Social support, rheumatoid arthritis and quality of life: concepts, measurement and research

In recent years, medical technology has improved considerably and the possibilities to replace destructed parts of the body that have been affected by rheumatoid arthritis (RA), have grown also. However, the availability and application of advanced techniques does not automatically entail an improvement of quality of life of individuals. Although the physical (dis)ability of RA patients very often leads to certain restrictions, it is not the only element in the evaluation of life-as-a-whole. The way in which the RA patient copes with the uncertainty of tomorrow and the management of pain and fatigue is another important element in evaluating quality of life. Beside personality factors, social network and social support are regarded to play an important role in this respect and subsequently in the well-being of individuals in general, and especially where it concerns individuals suffering from a chronic disease. Today, a growing number of evidence of the beneficial impact of social support is available of which some of them are discussed.     

Health-related quality of life in narcolepsy

Narcolepsy is a chronic sleep disorder characterised by symptoms of excessive daytime sleepiness and cataplexy. The aim of this study was to describe the health-related quality of life of people with narcolepsy residing in the UK. The study comprised a postal survey of 500 members of the UK narcolepsy patient association, which included amongst other questions the UK Short Form 36 (SF-36), the Beck Depression Inventory (BDI), and the Ullanlinna Narcolepsy Scale (UNS). A total of 305 questionnaires were included in the final analysis. The results showed that the subjects had significantly lower median scores on all eight domains of the SF-36 than normative data, and scored particularly poorly for the domains of role physical, energy/vitality, and social functioning. The BDI indicated that 56.9% of subjects had some degree of depression. In addition, many individuals described limitations on their education, home, work and social life caused by their symptoms. There was little difference between the groups receiving different types of medication. This study is the largest of its type in the UK, although the limitations of using a sample from a patient association have been recognised. The results are consistent with studies of narcolepsy in other countries in demonstrating the extensive impact of this disorder on health-related quality of life.     

Does intra-uterine growth discordance predict differential risk for adult psychiatric disorder in a population-based sample of monozygotic twins?

The study of discordant monozygotic twins may identify important developmental risk factors for adult psychiatric disorder. Differential experience in utero is one candidate environmental risk factor that may distinguish monozygotic twins. In this report, we examine whether intra-pair differences in birth weight predicts discordance for adult psychiatric disorders in 527 female monozygotic twin pairs from a population-based twin registry. Twins were personally interviewed about their lifetime history of DSM-III-R alcoholism, anorexia nervosa, bulimia nervosa, generalized anxiety disorder, major depression, panic disorder, social phobia and simple phobia. Birth weight was estimated from birth certificates, or from retrospective maternal, paternal and self-reports. Conditional logistic regression is used to characterize the association between intra-pair differences in birth weight and discordance for psychiatric disorder in monozygotic twins. The twin with the heavier birth weight in discordant pairs is (insignificantly) more likely to have a history of alcoholism or bulimia. The twin with the lighter birth weight in discordant pairs is (insignificantly) more likely to have a history of major depression, simple phobia, panic disorder, anorexia nervosa, social phobia or generalized anxiety disorder. For all psychiatric disorders examined, the lighter (or heavier) co-twin at birth is not systematically the affected twin within discordant pairs.     

Chronic HIV infection and health related quality of life in resource poor settings-an assessment from South East Nigeria

BackgroundHealth-related quality of life reflects a patient''s general subjective perception of the effect of an illness or intervention on physical, psychological and social aspects of daily life. HIV infection is a major public health problem especially in developing countries where poor health infrastructure and poverty are prevalent. This paper addresses the quality of life in patients with chronic HIV infection in South East Nigeria and addresses issues that may help improve the current situation.MethodsA cross-sectional survey was carried out at the University of Nigeria Teaching Hospital, Enugu, to assess patients with HIV receiving antiretroviral therapy (ART) using a validated structured questionnaire (WHOQoL-BREF). Ethical clearance for the study was obtained. Study period was from October - December, 2017. Data obtained was analysed.ResultsA total of 389 HIV patients consented to the study. Over 70% were aged 18- 45 years and majority were females. Females had a higher quality of life score with respect to the domain of psychological health while males had a higher score with respect to the environmental domain. Older age and presence of co-morbidities were significantly associated with affectation of physical health while younger age was associated with affectation of psychological health domain.ConclusionHIV impairs the quality of life for affected individuals in South East Nigeria especially across the domains of physical and psychological health. No age group is spared. The presence of co-morbidities significantly reduces quality of life in these patients. Younger patients may require mental health services in the management of their disease.     

Psychosocial counseling to improve quality of life in HIV infection

Psychosocial interventions such as cognitive behavioral stress management (CBSM), may enhance coping and social support which contribute to an improvement of quality of life factors such as emotional functioning, social functioning, and sense of well-being, for HIV-infected men during several phases of HIV spectrum disease. These phases include the acutely stressful period immediately following notification of HIV+ status, the adjustment period following this news, and the process of dealing with chronic symptomatic HIV infection. Normalization of some aspects of immunological status were found to accompany some of these psychosocial changes in the short-run. Longer-term follow-up indicated relationships between psychosocial factors and improved immunological status and physical functioning up to 2 years later. Factors such as an increased use of active coping strategies, including relaxation exercises, use of more functional appraisals and elicitation of social support, and decreased use of denial/avoidance coping strategies, may be key predictors of longer-term emotional well-being, social functioning, and physical functioning in HIV-infected populations. Special issues need to be addressed in emerging models of quality of life assessment in HIV populations. For example, the way resurgence of stigmatization and self-doubt affects sense of identity and well-being need to be addressed in quality of life research as well as in psychosocial interventions. Loss of employment and its financial and existential consequences are also factors which impact sense of self and well-being, and need to be addressed both in research as well as in interventions. The effect of repeated HIV-related bereavements upon an individual's social network and the emotional, social, and physical sequelae of bereavement have implications for HIV quality of life research as well. Quality of survival time has become a paramount issue in the context of HIV spectrum disease. Examining the relationships among coping strategies, social support, emotional well-being, realistic appraisals of one's functioning in comparison to their aspirations, and the influence of psychosocial functioning on disease course are central missions of our research program.     

Effects of stress and social support on recurrence in bipolar disorder

BACKGROUND: Limited research has examined the impact of social support on the course of bipolar disorder, although results suggest a probable link. This study examines prospectively the effects of stressful events and social support on episode recurrence in bipolar I disorder. METHODS: Fifty-two outpatients with bipolar I disorder recruited from an urban community were followed every 3 months for up to 1 year. At the initial interview, individuals reported separately on perceived social support from a best friend, parent, and romantic partner, combined to form a total network support score. Ongoing prospective assessments of stressful life events, symptomatology, and medication compliance were completed over 1 year. Logistic regressions were utilized to predict episode recurrence. RESULTS: As predicted, both higher levels of stress and lower levels of social support from the total network independently predicted depressive recurrence over a 1-year follow-up, after controlling for clinical history and compliance. Social support did not moderate the impact of stress. LIMITATIONS: Only a 1-year follow-up was obtained, and sample sizes may have been insufficient to detect prediction of manic episodes. Direction of causality between support and recurrence is hypothesized but cannot be definitively determined. CONCLUSIONS: Higher levels of stress and perceptions of less available and poorer quality close relationships are associated with recurrence. Interventions that target these psychosocial vulnerabilities may help alter the course of bipolar I disorder. Research with larger samples should further examine the possible polarity-specific effects of social risk factors.     

Social and personal resources and the prevalence of phobic disorder in a community population

BACKGROUND: Phobic disorder is one of the most prevalent psychiatric disorders in community populations and much attention has focused on the association of sociodemographic factors and social resources with the disorder. There has been little investigation of the more personal resources such as self-confidence, religiosity, social support and self-perceived health that may increase vulnerability. METHODS: We used a sample of 2914 community residents aged 18 or older who participated in the Duke University Epidemiologic Catchment Area Study to explore the relationship between both social and personal resources and the prevalence of DIS/DSM-III phobic disorder. RESULTS: The 1-month prevalence of any phobic disorder was 7.6%. In bivariate analyses, we found both race/ethnicity and gender differences in prevalence, with a higher prevalence of phobic disorder in African-Americans and females. Lower socio-economic status, rural residence and unmarried status were also associated with current prevalence. No association was found for social network and social interaction. Impaired subjective social support, low self-confidence, perceived poorer physical health and co-morbid psychiatric disorder were significantly associated with current prevalence in uncontrolled analyses, while associations between lack of a confidant as well as religiosity and phobic disorder were not. Female gender (OR = 1.7), perceived low self-confidence (OR = 2.0), and two interaction terms, age x co-morbid psychiatric disorder and race/ethnicity x perceived physical health were associated with phobic disorder in controlled analyses using logistic regression. CONCLUSIONS: We conclude that both social and personal resources, particularly self-confidence, co-morbidity and perceived physical health are important correlates of phobic disorder.     

Social Cognitive Factors,Physical Activity,and Mobility Impairment in Adults with Multiple Sclerosis

Among those with multiple sclerosis (MS), mobility impairment is common and significantly affects independent functioning and quality of life. The purpose of the study was to examine the role of physical activity in mobility impairment in individuals with MS and explore the social cognitive factors of social support, outcome expectations, and self-efficacy that facilitate physical activity among those with the disease. A sample of 319 individuals with MS were assessed on the following: family and friend social support, self-efficacy, and physical and social outcome expectations. Self-reported physical activity, perceived ambulation disability, balance confidence, and fall history were also measured. The structural model fit the data (χ² (29) = 24.49, p = 0.70; Root Mean Square Error of Approximation < 0.01; Comparative Fit Index = 1.0; Normed Fit Index = 0.96; Goodness of Fit Index = 0.98; Standardized Root Mean Square Residual = 0.03). The primary findings of the study revealed that physical activity was strongly linked to mobility impairment (path coefficient, –0.43), such that increasing levels of physical activity were associated with less mobility impairment. The most important predictors of health-promoting levels of physical activity were self-efficacy (path coefficient, 0.48) and social support (path coefficient, 0.38), with support from friends being a stronger indicator of social support than support from family. It may be prudent to design interventions aimed at increasing physical activity, especially in regard to helping individuals become more efficacious and building larger social networks, as this may serve to forestall advancing mobility impairment in those with MS.     

Prevalence of dysthymic disorder in primary care.

BACKGROUND: Dysthymic disorder is characterised as a chronic state of depressed mood which is not otherwise attributable to physical, psychological or social events. While it can occur alone, there is increasing evidence that the majority of individuals who meet criteria for dysthymic disorder also experience more severe episodic mood disorders throughout their lifetime, and there is also an aggregation of mood disorders within their family members. Patients with dysthymic disorder are most often seen in primary care. Some researchers suggest that the majority of these individuals are never diagnosed or are not diagnosed until a more severe episodic mood disorder develops. The objective of this study was to determine the 12-month prevalence of Axis I psychiatric disorders, and in particular dysthymic disorder, in a primary care Health Service Organization in Ontario, Canada. METHODS: Eligible and consenting adults registered with a primary care Health Service Organization were screened using the modified form of the University of Michigan Composite International Diagnostic Interview. RESULTS: Of the 6280 eligible subjects, 4327 (69%) consented to screening. Two hundred and twenty-two (5.1%) subjects screened positive for dysthymic disorder. In addition, 90% of those who screened positive for dysthymic disorder also screened positive for other Axis I disorders including major depressive disorder, panic, simple phobia, and generalized anxiety disorder. CONCLUSIONS: There is much potential for the primary care physician to play a pivotal role in the recognition and treatment of dysthymic disorder and associated Axis I disorders. A focus on the family as a unit for care may be especially important given the reported aggregation of dysthymic disorder within families.     

Suicides and serious suicide attempts: two populations or one?

BACKGROUND: Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. METHODS: Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. RESULTS: Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. CONCLUSIONS: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.     

Can poverty get under your skin? basal cortisol levels and cognitive function in children from low and high socioeconomic status

It is well known that individuals from more advantaged social classes enjoy better mental and physical health than do individuals within lower classes. Various mechanisms have been evoked to explain the association between socioeconomic status (SES) and health. One mechanism that has received particular attention in recent years is stress. It has been shown that individuals lower in SES report greater exposure to stressful life events and a greater impact of these events on their life than individuals higher in SES. In order to measure whether the development of the relationship between SES and mental health is sustained by exposure to high levels of glucocorticoids, we measured morning salivary cortisol levels as well as cognitive function (memory, attention, and language) in 307 children (from 6 to 16 years of age) from low versus high SES in the Montreal area in Canada. The results revealed that low SES children from 6 to 10 years old present significantly higher salivary cortisol levels when compared to children from high SES. This difference disappears at the time of school transition, and no SES differences are observed in salivary cortisol levels during high school. However, children from low and high SES do not differ with regard to memory or to attentional and linguistic functions. Also, mothers of low SES children reported higher feelings of depression and more unhealthy behaviors, while mothers of high SES children reported higher stress related to work or family transitions. Altogether, these results show that low SES in young children is related to increased cortisol secretion, although the impact of SES on cortisol secretion is absent after transition to high school. These data are interpreted within the context of the equalization process of class patterning. Four social explanatory factors are suggested to explain the disappearance of SES differences in basal cortisol levels after school transition, taking into account the influence of family environment on the child's secretion of stress hormones.