Pregnant women with psychiatric illness are able to stop smoking

Smoking during pregnancy is associated with neonatal complications and health problems later in life. However, about 10% of the pregnant women in the Netherlands smoke and those with a psychiatric illness smoke even more frequently. Although giving up smoking may be more difficult for these women, it does not lead to an increase of psychiatric symptoms. We present two patients who smoked during pregnancy. A 28-year-old female started smoking again during her first pregnancy when her depression relapsed. We advised a higher dose of medication and with her midwife's support she gave up smoking. A 35-year-old female, suffering from posttraumatic stress disorder, had an increase of symptoms during her second pregnancy. She resumed smoking to feel more relaxed. Treatment with bupropion and an online support program helped her to give up smoking. We advise that every smoking pregnant woman with psychiatric problems be treated concurrently for the psychiatric illness and for smoking.     

Effects of Psychiatric Disorders on Labor Market Outcomes: A Latent Variable Approach Using Multiple Clinical Indicators

In this paper, we estimate the effect of psychiatric disorders on labor market outcomes using a structural equation model with a latent index for mental illness, an approach that acknowledges the continuous nature of psychiatric disability. We also address the potential endogeneity of mental illness using an approach proposed by Lewbel (2012) that relies on heteroscedastic covariance restrictions rather than questionable exclusion restrictions for identification. Data come from the US National Comorbidity Survey – Replication and the National Latino and Asian American Study. We find that mental illness adversely affects employment and labor force participation and also reduces the number of weeks worked and increases work absenteeism. To assist in the interpretation of findings, we simulate the labor market outcomes of individuals meeting diagnostic criteria for mental disorder if they had the same mental health symptom profile as individuals not meeting diagnostic criteria. We estimate potential gains in employment for 3.5 million individuals, and reduction in workplace costs of absenteeism of $21.6 billion due to the resultant improvement in mental health. Copyright © 2015 John Wiley & Sons, Ltd.     

Humoral concepts of mental illness in India

Based on interviews with patients at three allopathic psychiatric clinics in Bombay, Bangalore and Varanasi, employing a preliminary version of the Explanatory Model Interview for Classification (EMIC) to elicit indigenous explanations of illness and patterns of prior help seeking, we discuss popular humoral theories of mental disorder. Even though most laypersons are unfamiliar with the content of the classical treatises of Ayurveda, the humoral traditions which they represent influence current perceptions. Case vignettes clarify the nature of the relationship between cultural, familial and personal factors that influence the experience of illness.     

Health behaviours and health: evidence that the relationship is not conditional on income adequacy

This study used Canadian data to examine whether the relationships between two health behaviours (physical activity and smoking) and two measures of health (self-perceived health status and number of chronic health conditions) are conditional on income adequacy. Studies that have investigated the manner in which socioeconomic circumstances, such as income adequacy, and health behaviours interact to influence health are few in number and characterized by inconsistent findings. In addition, there is a complete absence of published Canadian research that has explored these relationships. I investigated the relationship between health behaviours and health by income adequacy with a secondary analysis of data from the first cycle of the National Population Health Survey (NPHS), conducted by Statistics Canada in 1994-95. The sample consisted of 11.941 NPHS respondents 20-64 years of age who did not have an illness or disability that prevented them from being employed. As a whole, findings from a series of hierarchical multiple regression analyses did not provide adequate evidence to conclude that the effects of physical activity and smoking on self-perceived health status and chronic health conditions are conditional on income adequacy. Instead, findings showed that the health behaviours each had a similar degree of influence on the self-perceived health status and number of chronic health conditions of respondents at all income adequacy levels. Moreover, the magnitude of the relationships between the health behaviours and health measures was very small. By enhancing knowledge about both the nature and magnitude of the relationships among Canadians' income adequacy, health behaviours, and health, this study makes a significant contribution to the small body of research that has explored the possibility that the relationship between health behaviours and health varies by socioeconomic circumstances. I conclude the paper with a discussion of the implications that the findings have for public health policies and programs.     

The association of illness perceptions with depressive symptoms and general psychological distress in parents of an offspring with autism spectrum disorder

BackgroundRaising a child with an autism spectrum disorder (ASD) is a severe stressor and parents often present high levels of depression. Depression is associated with illness perceptions but this association has not been studied in parents of ASD offspring.ObjectiveWe aimed to assess the prevalence of psychological distress symptoms and their associations with illness perceptions in parents with an ASD offspring.MethodsIn 111 parents of ASD offspring we assessed depressive symptoms (PHQ-9), illness perceptions (B-IPQ) and general psychological distress (GHQ-28). Multiple linear and logistic regressions were used to assess their independent associations.ResultsThe prevalence of parental clinically significant depressive symptoms was 34.2%, while 55% presented clinically significant levels of general psychological distress. Younger parents and those with lower financial resources had greater psychological distress and more severe depressive symptoms. Parents felt that the condition impacted their lives and believed it would be chronic. Their beliefs about the consequences and the chronicity of the disorder were significant independent correlates of their psychological distress and depressive symptoms severity.ConclusionsThese findings indicate that a remarkable proportion of parents with an ASD offspring present clinically significant depressive symptoms, which were associated with illness perceptions relevant to the consequences and the chronicity of the disorder. Our data encourage psychotherapeutic interventions aiming to support parents to deal with the consequences and chronicity of their offspring's disorder, in order to reduce parental psychological distress.     

The illness perceptions of women following acute myocardial infarction: implications for behaviour change and attendance at cardiac rehabilitation

Coronary heart disease (CHD) has been socially constructed as a gender-specific disease, with women seen not to be at risk (Lockyer, 2002). This is despite CHD being the leading cause of mortality in both men and women in the Western world (DH, 2004). The aim of this research was to explore the illness perceptions of a sample of women following acute myocardial infarction (MI). Relationships between illness perceptions and adoption of health-promoting behaviours, and attendance at a programme of cardiac rehabilitation were explored. The influence of age was also considered. Leventhal and Nerenz' Self- Regulatory Model of Illness Behaviour (1985) was used as the theoretical framework. This model consists of three stages: interpretation of symptoms, coping and appraisal. A qualitative research design was used. A purposeful sample of 10 women was selected on the basis of age and decision to attend cardiac rehabilitation. Data were collected by semi-structured interview, 3 months following the acute infarct, and analysed thematically. Stress was considered to be the cause of the MI, and although lifestyle factors were recognized, their significance was uncertain; perhaps as a result, lifestyle changes were limited. Overall, women had a perceived lack of control over the illness. The decision to attend a cardiac rehabilitation programme was influenced by beliefs relating to the identification of a known cause and level of perceived control of the illness. A belief that the illness was inevitable seemed to be more prevalent in older aged women. These findings have implications for health service providers in that they suggest that illness perceptions need to be explored and addressed before the decision to attend a programme of cardiac rehabilitation is made and health-promoting behaviours adopted.     

The effects of psychiatric disorders and symptoms on quality of life in patients with Type I and Type II diabetes mellitus

The purpose of this study was to evaluate the influence of psychiatric symptoms and illness status on the health-related quality of life (HRQOL) of outpatients with Type I and Type II diabetes mellitus. Using a two-stage design, all patients were assessed by two measures of quality of life (Diabetes Quality of Life Measure; Medical Outcome Study Health Survey) and a psychiatric symptoms checklist (SCL-90-R). Patients scoring 63 or greater on the global severity index of the SCL-90-R and 30% below this cutoff were then evaluated using the Structured Clinical Interview for the DSM-III-R (SCID). Quality of life in both Type I and Type II diabetes was influenced by the level of current psychiatric symptoms and presence of co-morbid psychiatric disorder, after controlling for number of diabetic complications (e.g. effect of lifetime psychiatric illness on diabetes-related HRQOL; F=46.8; df=3, 135; p < 0.005). These effects were found consistently across specific domains. Both recent and past psychiatric disorders influenced HRQOL. Separate analyses comparing patients with and without depression showed similar effects. No interaction effects between diabetes type, number of complications, and psychiatric status were found in analyses. Finally, increased severity of psychiatric symptoms was correlated with decreased HRQOL in patients without current, recent, or past psychiatric diagnosis. This study shows the consistent, independent contribution of psychiatric symptoms and illness to the HRQOL of patients with a co-existing medical illness. Thus, psychiatric interventions addressing common conditions, such as depression, could improve the HRQOL of patients without changing medical status.     

The relationship between body weight perceptions,weight control behaviours and smoking status among adolescents

OBJECTIVES: This paper examines the relation between body weight perceptions, weight control behaviours and smoking status among a representative sample of Ontario students. METHODS: Bivariate and multivariate logistic regression analysis was used to evaluate the association between smoking status and perception of being overweight, and between smoking status and specific weight control behaviours. RESULTS: Among females, the odds of being a smoker were significantly higher among those who perceived themselves to be overweight and who had employed weight control behaviours in the last 12 months. Among males, the adjusted odds of being a smoker was higher only among those who skipped meals in the past 12 months. CONCLUSIONS: Body weight perceptions and the use of weight control behaviours were significantly associated with predictors of smoking among adolescent females. This suggests a need to incorporate discussion on body weight perception and body image in smoking prevention and cessation programs targeted toward adolescent females.     

Reevaluation of secular trends in depression rates.

Results of numerous community surveys of psychiatric illness suggest a striking change in the occurrence of depression, with younger generations experiencing higher lifetime risk and earlier age of onset. Data from the National Institute of Mental Health Epidemiologic Catchment Area Survey (a cross-sectional survey of psychiatric morbidity in five US communities conducted between 1980 and 1984) were reexamined for evidence of methods effects which might contribute to these unexpected findings. A pattern of higher lifetime risk and earlier age of onset among recent birth cohorts was observed for every psychiatric disorder examined, with schizophrenia, major depression, and panic disorder showing equally strong trends. For respondents of all ages, reported first onset of major depression clustered in the 10-year period prior to the study interview, in contrast to the expectation that older respondents would report onset in early adulthood. Examination of individual psychiatric symptoms revealed a nearly universal pattern of decreasing lifetime prevalence among older respondents, a reversal of the expected accumulation of lifetime symptoms with age. These findings suggest that effects of study methods may contribute to the apparent temporal trends in prevalence of depression and that cross-sectional surveys may underestimate lifetime psychiatric morbidity among older respondents. Generational changes in the lifetime risk of depression or other psychiatric disorders may not be reliably assessed by cross-sectional survey data.     

Doing things with illness. The micro politics of the CFS clinic

This paper focuses on lay and professional ideas about the nature of chronic fatigue syndrome (CFS), and in particular, the ways in which understandings of the disorder are developed in a clinical setting. Our data are drawn from observations of consultations between sufferers and physicians in a UK medical out-patients clinic. We treat the clinic as a political field. That is to say, as an arena in which 'problems' (about the management of illness) are constituted, and alternative approaches and solutions to such problems are pressed. We note that in the realms of symptoms, aetiology and treatment evaluation, lay people in the CFS clinic have quite distinct ideas about what their problems are and how they might be analysed and managed--ideas that are often in conflict with those of medical professionals. Thus, lay sufferers, for example, operate within a different conceptual terrain from that of many professional experts. They are more likely to refer to a disease (myalgic encephalomyelitis or ME), rather than a syndrome. They call upon different kinds of hypotheses to explain their symptoms. They hold to conflicting ideas about the order of causal sequences, and they give emphasis to different kinds of phenomena in their accounts of illness. As a consequence, clinical consultations can often take on the form of a political contest between physician and patient to define the true and real nature of the patient's disorder--a micro political struggle in which neurological symptoms can be re-framed as psychiatric symptoms, and psychiatric symptoms as neurological. In short, a contest in which the demarcation lines between mind and body are continually assessed and re-defined, and the tenets of 'biomedicine' are constantly challenged.     

A group intervention to reduce smoking in individuals with psychiatric disorder: brief report of a pilot study

OBJECTIVES: To evaluate a group intervention to help individuals with psychiatric disorder stop smoking. METHOD: A waitlist-treatment crossover design. Outcome measures included smoking cessation, motivation to stop, the Fagerstrom Test for Nicotine Dependence (FTND), urinary cotinine and psychiatric symptoms on the General Health Questionnaire. RESULTS: 38 subjects participated, of whom 19 completed the waitlist and intervention phases. There were no significant differences between subjects and dropouts. During the waitlist period there were no significant changes in tobacco use. At the end of the intervention, almost a quarter had stopped smoking, (z = -2.24, p = 0.02). Subjects also showed significant improvements on state of change, FTND score and urinary cotinine levels. These improvements were maintained at three-month follow-up (n = 10). Psychiatric morbidity showed no change. CONCLUSIONS: It is possible to reduce smoking in individuals with psychiatric disorder. IMPLICATIONS: Larger randomised controlled trials are indicated to determine the relative contributions of nicotine replacement, bupropion and group interventions to smoking cessation in this population.     

A group intervention to reduce smoking in individuals with psychiatric disorder: brief report of a pilot study

Objectives: To evaluate a group intervention to help individuals with psychiatric disorder stop smoking.
Method: A waitlist-treatment crossover design. Outcome measures included smoking cessation, motivation to stop, the Fagerstrom Test for Nicotine Dependence (FTND), urinary cotinine and psychiatric symptoms on the General Health Questionnaire.
Results: 38 subjects participated, of whom 19 completed the waitlist and intervention phases. There were no significant differences between subjects and dropouts. During the waitlist period there were no significant changes in tobacco use. At the end of the intervention, almost a quarter had stopped smoking, ( z = -2.24, p =0.02). Subjects also showed significant improvements on state of change, FTND score and urinary cotinine levels. These improvements were maintained at three-month follow-up (n=10). Psychiatric morbidity showed no change.
Conclusions: It is possible to reduce smoking in individuals with psychiatric disorder.
Implications: Larger randomised controlled trials are indicated to determine the relative contributions of nicotine replacement, bupropion and group interventions to smoking cessation in this population.     

The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: A comparison of eating disordered and psychiatric inpatients

The authors compared rates of physical and sexual abuse in women with eating disorders (N = 102) and general psychiatric disorders (N = 49). Relationships between sexual abuse and severity of eating disordered and psychiatric symptoms were also examined. While high rates of sexual abuse were found in the eating disordered sample, these rates were not significantly higher than those found in the general psychiatric population. No relationship between a history of sexual abuse and severity of eating disordered symptoms was found. However, within the eating disordered group, sexually abuse subjects reported more severe psychiatric disturbances of an obsessive and phobic nature than nonabused subjects. These findings suggest that while sexually abusive experiences may be related to increased psychological distress, they do not serve to increase eating disordered symptomatology. © 1993 by lohn Wiley & Sons, Inc.     

Morbidity and Irish Catholic descent in Britain: relating health disadvantage to behaviour

Objectives. This paper critically evaluates the evidence for two health-related stereotypes of the Irish, namely that behaviours such as smoking and heavy drinking explain their excess morbidity in Britain, and secondly that, in illness, this ethnic group behaves more stoically. Design. Data are reported on over 850 respondents from each of three cohorts (aged 18, 39 and 58 in 1990/91) of the West of Scotland 20-07 Study, in which a small but pervasive excess of morbidity has been observed in those of Catholic background (in this area associated with Irish descent). Logistic regression was used to investigate any differences in drinking, smoking and participation in sport between those of Catholic and non-Catholic heritage, whilst controlling for sex and social class. Where a difference was observed, we looked for an association between health-related behaviour and the Catholic morbidity excess for six measures of physical and mental health. Finally, illness behaviour at age 39 and 58 was investigated for those experiencing one of a number of common symptoms in the month prior to interview, by noting whether a general medical practitioner (GP) was consulted. Results. The only difference in health-related behaviour was in the eldest cohort, where an excess of smoking was observed for the Catholics. However, except for lung power, smoking was not able to explain very much, if any, of the Catholic morbidity disadvantage. For most of the symptoms studied, GP consultation rates were similar, although there was a tendency towards Catholic over-consulting. Conclusion. This paper finds minimal evidence in favour of either stereotype: behaviours such as smoking and excess drinking were not strongly associated with the poor morbidity status of the Irish in the population we have studied; neither have the Irish been found to be more stoic in illness. Therefore the stereotypes are not an adequate explanation, nor a necessary correlate, of the frequent finding of raised morbidity in communities of Irish Catholic origin.     

Characteristics of monozygotic twins discordant for bulimia nervosa

OBJECTIVE: We studied monozygotic (MZ) twins who were discordant for bulimia nervosa in order to identify environmental factors that could have contributed to the expression of bulimia nervosa in only one member of these genetically identical twin pairs. METHOD: Female twin pairs from the Virginia Twin Registry were identified. One twin met DSM-III-R criteria for bulimia nervosa (excluding the frequency and duration criterion) and the co-twin either reported some symptoms of bulimia nervosa but never met full diagnostic criteria (n = 20 pairs) or reported no symptoms of bulimia nervosa (n = 10). We compared the twins on demographic, developmental, personality, and psychiatric dimensions using self- and maternal report. RESULTS: Affected twins were more likely to report lifetime generalized anxiety disorder and were described by their mothers as more anxious and fearful as children. They also had significantly lower mastery, optimism, and self-esteem, and significantly greater obsessive and compulsive symptoms than their unaffected co-twins. Affected twins recalled greater discord in their families but viewed their parents as more warm toward them than toward their unaffected co-twin. DISCUSSION: Given that MZ twins are genetically identical and share a common family background, differences between them must be attributable to unique environmental factors. Although it is difficult to disentangle predisposing risk factors from sequelae of psychiatric illness in a retrospective co-twin control design, the affected twins were perceived to have been more anxious as children by their mothers-possibly reflecting a predisposing trait. More extensive interviews are required to determine the nature of environmental events that contribute to the expression of the observed personality, behavioral, anxious, and eating-related traits in the affected twins.     

Patterns of unhealthy eating behaviours in a middle aged Scottish population.

This paper examines unhealthy eating in a middle aged Scottish population. Data from a 1989 survey of 500 Scottish men and women aged 45 to 59 years are used to explore inter-relations among five items of unhealthy eating, smoking and alcohol consumption. The results show that unhealthy eating behaviours are highly correlated, indicating strong links among certain nutrition habits. The findings also reveal that such patterns of unhealthy eating vary considerably between males and females. Finally, unhealthy eating behaviours were also found to be significantly associated with smoking and alcohol consumption. Implications of these findings for future research in epidemiology and health promotion are considered.     

Somatic symptoms and depression

Patients with psychiatric illness frequently visit their medical physicians with somatic complaints or amplification of complaints about chronic medical illness, yet few of these patients meet Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) criteria for a somatoform disorder. In a sample of 197 medical patients interviewed with the Diagnostic Interview Schedule, only 7.1% met DSM-III criteria for somatization disorder, but nearly one third of these patients met criteria for an abridged notion of somatization. Patients with current and lifetime major depression had significantly higher mean totals of positive somatic symptoms compared with controls who had no psychiatric disorder. Nearly one half of these patients with one or more depressive episodes in the course of their lifetime met the abridged criteria for somatization. This association of major depression with somatization is quite similar to findings from the Epidemiologic Catchment Area study suggesting that major depression, not the somatoform disorders, may be associated with most of the somatization seen in medical clinics.     

The determinants of four cancer-related risk behaviours

This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self-efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed.     

Class, perceptions of 'disordered' behaviour, and suggestions for therapy: a tri-cultural comparison

This paper presents findings from a tri-cultural study in which we argue that class differences pertain not only to rates of mental illness but also to recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting 'disordered behaviour'. It is hypothesized that regardless of respondent's cultural background, the extent to which a deviant behaviour will be defined as a mental health problem, and professional therapy will be suggested as a source of help for that problem, will be positively related to class. Findings from a sample selected from two small West Texas communities, and samples selected from Durango, Mexico, and Juiz de Fora, Brazil, indicate strong support for the first prediction only among the West Texas sample, whereas the second hypothesis concerning therapy suggestions is strongly supported among respondents in all three cultural settings. We conclude that these class differences in perceptions and suggestions concerning five examples of 'disordered' behaviours read to respondents relate to conditions of lower-class life in general. Particularly, structural support found for our hypothesis leads us to suggest a need for informal, nonbureaucratic mental health care systems created to serve lower-class populations residing in class-oriented societies, regardless of cultural differences which may exist among these societies.