Multiple informants: mortality associated with psychiatric disorders in the Stirling County Study

This paper applies new statistical procedures for analyzing multiple-source information about the relation of psychiatric diagnoses to mortality. The data come from the Stirling County Study, a longitudinal community investigation of adults, that collected multiple-source reports (self-report and physician-report) about psychiatric disorders. These reports are used as predictors of mortality risk over a 16-year follow-up period (1952-1968). Despite extensive efforts, one or both of these reports were sometimes missing. Missingness of self-report was related to demographic characteristics as well as to physician-reports of psychiatric diagnosis. The statistical procedures used here draw together into a single frame of reference both informant reports for the initial Stirling survey and relate these to mortality risk using weighted generalized estimating equation regression models for time to event data. This unified method has two advantages over traditional approaches: 1) the relative predictiveness of each informant can be assessed and 2) all subjects contribute to the analysis. The methods are applicable to other areas of epidemiology where multiple informant reports are used. The results for self-reports and physician-reports of disorders were comparable: Psychiatric diagnosis was associated with higher mortality, particularly among younger subjects.     

Detection of psychiatric disorders among Asian patients presenting with somatic symptoms.

Patients from India and Pakistan frequently communicate their emotional distress in terms of somatic sensations and somatic metaphors. Language and cultural difficulties may prevent recognition of psychiatric disorders. A new questionnaire is described, to assist identification of psychiatric disorders among Asian patients who present with somatic symptoms.     

脑外伤致精神障碍相关因素分析

目的 探讨脑外伤相关因素与精神障碍发生的关联性.方法 随机选择纳入某院2010年1月～2011年6月因意外事故或其他原因导致的脑外伤患者80例,40例患者为脑外伤后导致了早期的精神障碍患者(精神障碍组),40例患者为脑外伤后未出现精神障碍的患者(对照组),采用格拉斯哥昏迷评分(GCS)、SF-36量表和艾森克人格问卷(EPQ)对80例患者进行问卷调查,并比较两组患者以上调查内容的差异.结果 是否有经济赔偿、两组患者入院时意识得分(CGS)、两组患者生命质量的躯体健康(PCS)和精神健康得分(MCS)、和EPQ评分在精神障碍组与对照组差异有统计学意义(P＜0.05).非条件Logistic回归分析发现,患者GCS评分高于8分和EPQ评分小于25分显著性的能降低患者患精神障碍的可能性(P＜ 0.001).PCS和MCS评分越低,患者患精神障碍可能性越高,差异具有统计学意义(P＜0.001).结论 脑外伤所致精神障碍与损伤后昏迷程度有一定关联,同时与患者的人格特征密切联系.今后在对脑外伤患者治疗的过程中,不但要针对脑外伤本身进行有效的治疗,更应该从人格特征和认知的角度出发,开展相应的心理学干预.     

Relationship between spiritual well-being and minor psychiatric disorders: a cross-sectional study

OBJECTIVE: To assess the influence of spiritual well-being in mental health of college students. METHODS: It was interviewed 464 medical and law students of Pelotas, Brazil. Data collection was carried out in groups in the school classroom, 43 absent students were not interviewed and represented a loss of 9.3% of the sample. It was used a self-reported questionnaire with three instruments: 1) Spiritual Well-Being Scale (SWBS), 2) SRQ-20, and 3) a precoded questionnaire with questions on sociodemographic data, religious/spiritual practices, and stressful life events. Statistical analysis was performed using Chi-square test and logistic regression. RESULTS: Most of the students (80%) declared that they had a spiritual belief and/or religious denomination. The mean score of spiritual well-being was 90.4 with scores 45.6 and 45.1 in the existential and religious subscales, respectively. SWBS showed an association with religious practices, but it was not influenced by sociodemographic and cultural variables. Subjects presenting low and moderate spiritual well-being showed a doubled risk of presenting minor psychiatric disorders (MPD) (OR=0.42; 95%CI: 0.22-0.85). Subjects presenting low or moderate existential well-being showed almost five times more MPD (OR=0.19; 95%CI: 0.08-0.45). CONCLUSIONS: The study reveals spiritual well-being as a protection factor for minor psychiatric disorders, and that the results were mostly due to the Existential Well-Being subscale.     

社会经济地位与心理障碍相关性的多水平模型分析

目的 探讨社会经济地位(SES)与社医人群心理障碍的相关性.方法 利用浙江省15岁以上人群精神病流行病学调查数据(n=14 632),采用多水平logistic回归模型拟合个体SES维度(教育、收入、职业)和地理SES维度(居住地区)与心理障碍的相关性.心理障碍评定采用GHQ-12(分界值为3/4).结果 浙江省社区人群心理障碍的患病率为18.5%(95%CI:17.9%～19.1%),略高于河北省的16.7%(u=4.39,P＜0.001).年家庭人均收入、职业等SES指标与心理障碍相关性较大;低收入组(相对于高收入组)OR=3.45,95%CI:1.72～6.67;无业/失业组(相对于非农业劳动者)OR=2.03,95%CI:1.73～2.40;心理障碍在县(市)水平具有集聚性,但作用较小;教育程度对心理障碍无影响.结论 社区人群心理障碍与SES呈逆向梯度变化趋势,且主要与个体SES维度有关,地理SES维度(居住地区)有影响,但作用很小.     

Regression analysis of multiple-source longitudinal outcomes: a "Stirling County" depression study.

Epidemiologic studies of psychiatric disorders have increasingly relied on multiple sources of information to improve the validity of diagnoses and repeated assessments over time to provide a longitudinal perspective. In this paper, the authors present a general multivariate logistic regression method for the simultaneous analysis of discrete outcomes that exhibit such features. This approach permits risk factor and agreement analyses within a unified framework and appropriately uses data from subjects who may be missing some outcomes. The authors use this approach to analyze data from a "Stirling County" study of depression. During a 3- to 4-year period in the early 1990s, 631 subjects were assessed in two separate interviews, on each occasion with two diagnostic schedules (the DePression and AnXiety schedule (DPAX) and the Diagnostic Interview Schedule (DIS)). The female:male ratio of depression was found to be different for the DPAX and the DIS (0.8 and 1.6, respectively). Education was inversely associated with depression, while the effects of time, the subject's age, and the interviewer's sex were essentially null. With respect to the outcomes' association, agreement between the DPAX and the DIS was low. In addition, stability of the DPAX over time was significantly higher than that of the DIS. No covariates were found to affect significantly the association between outcomes.     

Managing psychiatric disorders in primary care: 2. Anxiety

Most anxious patients are first seen and treated by primary care physicians. Treatment is generally long-term, and often the results are not what either patient or physician would regard as optimal. Nevertheless, timely and appropriate intervention can markedly improve function--it may make the difference between a generally satisfying life and one lived in fear and isolation.     

毛细支气管炎发展为哮喘的危险因素研究

目的 探讨毛细支气管炎与哮喘相关关系.方法 对269例毛细支气管炎患儿的患病情况、个人史、既往史、家族史、生活环境及毛细支气管炎后的治疗等相关因素进行问卷调查,统计哮喘的发生率,并进行回顾性分析.结果 毛细支气管炎发展为哮喘的发生率为57.60%.父母亲哮喘史、湿疹、过敏性鼻炎等是毛细支气管炎发展为哮喘的高危因素;母乳喂养>4个月、喘息缓解期吸入激素是保护因素.结论 毛细支气管炎合并危险因素易发展为哮喘,尽量控制和预防危险因素并早期防治可能是减少哮喘发生的有效手段.     

Homosexuality and psychiatric disorders: correlation not shown

A secondary analysis of part of the data collected for the Netherlands mental-health survey and incidence study, revealed that homosexual men and women have a higher chance of psychiatric disorders than heterosexuals. However, there are some serious doubts about the reliability and validity of these results. These concern the validity of the measuring instrument used for homosexual populations (the Composite International Diagnostic Interview), the representativeness of the sample of homosexuals participating in the study, and the statistical analysis of the raw data. In discussing their analysis, the authors pay too little attention to methodological flaws, which might explain their findings. In general, they seem to underestimate the methodological and ethical complications associated with this type of comparative research. Therefore, the study offers no hard scientific evidence to support the contention that homosexuals show a much higher rate of psychiatric disorders in comparison to heterosexuals.     

DSM-III-R: the conflict over new psychiatric diagnoses

The inclusion of three new diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) has generated much controversy. Many women's groups and mental health organizations objected to paraphilac rapism, premenstrual dysphoric disorder, and masochistic personality disorder. Findings from a national survey of social workers' attitudes about DSM indicated that the majority of respondents did not support adoption of the proposed diagnoses, although many were undecided. The conflict has reopened the debate about the manual among mental health professionals. The opinions of social work practitioners potentially can influence whether these and other controversial diagnoses are included in the upcoming DSM-IV.     

Affective disorders: analysis of their comorbidity in the more frequent psychiatric disorders

Comorbidity is defined as the presence of two or more independent diseases in the same subject. This paper reviews the comorbidity of affective disorders with other mental disorders. We focus on the disorders of anxiety, schizophrenia, dependence on psychoactive substances, eating disorders, personality disorders and obsessive-compulsive disorder. To this end, we have carried out an extensive review that has taken account of numerous studies, as well as of different diagnostic orientations (categorical or dimensional). In general the presence of affective symptoms and/or disorders in the context of other mental pathologies is high. Moreover, comorbidity has a high transcendence with respect to clinical prognosis (worse response to treatments, greater symptomatic persistence, greater tendency to chronicity and greater risk of mortality) and the social consequences (decline in work performance and greater use of resources). Nonetheless, we must bear in mind that the analysis of the comorbidity of affective disorders in other mental disorders is complex and controversial, not only because of its high frequency, but also because of the existence of symptomatic overlap, scarcity of signs and pathognomonic symptoms, variability of diagnostic criteria, applied methodological differences, as well as a scarcity of longitudinal and prospective studies.     

Epidemiological survey of psychiatric disorders in Japanese school children. Part III: Prevalence of psychiatric disorders in junior high school children

In order to determine the prevalence of psychiatric disorders in junior high school children, an epidemiological survey of Japanese regular public junior high school children was conducted using Rutter's questionnaire method for screening and a diagnostic interview by pediatricians for the final diagnosis. Both teacher's and parent's questionnaires by Rutter were utilized. Two pediatricians carried out semi-structured interviews of 10-12 minutes for every child and diagnosed their mental state. In part 1 (previously reported), the Japanese version of Rutter's questionnaires was found to be satisfactory for screening, and the diagnostic interview used in this survey was shown to be a reliable tool for the diagnosis of psychiatric disorders of the adolescent. In part 2, the prevalence of psychiatric disorders was studied in the 592 school children who were the subject of the preliminary survey. In the present study, a total of 1,992 children from 5 junior high schools in Gunma prefecture were surveyed cross-sectionally of whom 1,672 (84.3%) screened negative, and 312 (15.7%) positive. The positives and a part of the negatives were randomly selected for interviews, and were diagnosed as to whether they have psychiatric disorders or not by the criteria of Rutter. The overall prevalence rate of diagnosed psychiatric disorders in these school children was 14.8%, (20.1% for males and 8.3% for females). The prevalence rate is significantly higher in males than in females. Disorders diagnosed were classified into emotional, conduct, and mixed disorder, based on Rutter's classification. No cases of schizophrenia and anorexia nervosa were found here as well as in the preliminary survey. The ratio of emotional to conduct disorders was 1.9. Prevalence of conduct disorder in females was one seventh that in males. This study also revealed that the questionnaire method is effective for screening for psychiatric disorders in children, but is not sufficient for differentiating types of disorders. Therefore the diagnostic interview was shown to be useful not only for epidemiological surveys but also for mental health services.     

The relationship between perinatal psychiatric disorders and contraception use among postpartum women

Background

The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established.

Study Design

This was a prospective cohort study with 831 pregnant women recruited from 10 primary care clinics of the public sector in São Paulo followed up to 18 months after delivery.

Results

Among 701 postpartum women, 644 women (91.8%) had resumed sexual activity. Two hundred fifty-three women (39.2%) were classified as using a less effective contraception method (LECM). The presence of perinatal psychiatric disorder (in pregnancy and/or postpartum) was not associated with LECM. Resumption of sexual life 3 months or beyond after delivery was associated with LECM (odds ratio=1.28, 95% confidence interval: 1.02–1.56).

Discussion

Although the use of an LECM after delivery is common, contraception choice is not associated with perinatal depressive/anxiety symptoms. However, women who delay the resumption of sexual activity after delivery should be counseled on the use of available contraceptive methods.     

Doors and thresholds: Jeddi's approach to psychiatric disorders

Professor Essedik Jeddi and his team have introduced a most significant institutional and therapeutic innovation at the Ibn Rochd and Pinel section of the Razi university long-term mental hospital in Tunis (Tunisia). The innovation focuses upon the ambiguity of doors and boundaries in the mental asylum. Doors and walls influence the rhythm of activity and the nature of contact between patients, therapists and the wider society and culture. If they are very rigid, they may disjoin the patient from him- or herself, from his/her body, social network and culture. On the other hand, if such boundaries are completely neglected they may merge these related dimensions as undifferentiated entities. Jeddi's innovation is primarily concerned with placing the spatio-temporal experience of the body and the intimate interpersonal interaction at the centre of treatment. It aims at establishing creative modes of expression, interaction and exchange such as tea-sessions, dancing, singing, verbal communication, clay-modelling, figurative or plastic expression, agricultural works. These relationships mediate and differentiate at the same time between the patient, his/her body-self, and his/her social and cultural world, thus avoiding both the disjunction and the merging. It would seem that the activities concerned with the distinction between ‘inside’ and ‘outside’, peasant and urban, self and other (e.g. dancing and singing) are of paramount importance in bringing about such mediating and differentiating relationships. In the present study we limit ourselves to one particularly revealing therapeutic activity, namely dancing to live music. Jeddi's innovation is a unique blend of current developments in psychiatry and psychotherapy with Arabo-Islamic science and philosophy.