Selective attention to threat bias in delusion-prone individuals

The study examined the selective attention to threat bias in delusion-prone individuals recruited from New Religious Movements (NRMs). Twenty-seven delusion-prone NRM individuals were compared with 25 individuals with psychotic disorders and 63 non-delusion-prone individuals on a Stroop task, together with psychotic and delusion proneness measures. NRM individuals showed significantly lower levels of selective attention to threat bias compared with individuals with psychotic disorders but not with non-delusion-prone individuals. Selective attention to threat bias was also not correlated with distress associated with delusional ideation. These findings may be specific to delusion-prone NRM individuals. The absence of the selective attention to threat bias may be related to levels of safety and security among members of NRMs.     

Social inequalities in depression and suicidal ideation among older primary care patients

Purpose

Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.

Methods

Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.

Results

Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67–2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34–3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38–3.98).

Conclusions

There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.     

Asthma, life events and psychiatric disorders: a population-based study

Purpose

Although asthma and other chronic physical conditions have been shown to be associated with psychiatric symptoms, the relative contributions of negative life events to this association and impaired quality of life (QOL) are not clear.

Methods

This is a cross-sectional study of a nationally representative sample of Singaporean adults aged 20–59 (n = 2,847). Individuals were grouped by asthma, other chronic physical conditions, and no chronic physical conditions. Participants were assessed life events (list of threatening experiences questionnaire), psychiatric disorders [schedule for clinical assessment in neuropsychiatry diagnoses of psychiatric disorder including any psychiatric disorder, major depressive disorder (MDD) and generalized anxiety disorder (GAD)], and QOL (medical outcomes study 12-item short form).

Results

In multivariate analyses controlling for confounding variables, asthma and other chronic physical conditions, compared to no chronic physical conditions, both showed similarly (two- to four-fold) elevated odds ratio (OR) of association with MDD and GAD. However, the asthma group reported more life events as compared to other chronic physical conditions (OR = 4.33, 95 % CI: 2.09–8.95) or no chronic physical conditions (OR = 7.64, 95 % CI: 3.87–15.06). Life events accounted significantly for excess coexistence of psychiatric disorders with asthma over participants without chronic physical conditions. It also contributed significantly to relatively worse QOL observed among individuals with asthma.

Conclusions

In this cross-sectional study, life events among adults in Singapore appeared to mediate the co-occurrence of psychiatric disorders and functional impairment with asthma, more than with other chronic physical conditions. This should be further investigated in longitudinal studies.     

Psychotic disorders are more common in ethnic minority than in Dutch native defendants

Purpose

The prevalence of psychotic disorders among prisoners from racial or ethnic minority groups remains uncertain. We therefore compared the frequency of psychotic disorder in ethnic minority and Dutch native defendants using the nationwide database of elaborate pre-trial reports.

Methods

Analysis of a nationwide database of pre-trial reported defendants in the Netherlands between 2000 and 2006 (n = 12,752).

Results

A diagnosis of a psychotic disorder was more common in ethnic minority than in Dutch native defendants (21.1 vs. 10.2 %). The odds ratio of this diagnosis, adjusted for age, gender, IQ below 85 and abuse of cannabis or hard drugs, was 2.6 (95 % CI 2.2–3.0). This odds ratio was highest for African defendants (OR = 5.2; 95 % CI 3.7–7.4).

Conclusions

Psychotic disorders were more common among pre-trial reported defendants from ethnic minorities than among their Dutch native counterparts.     

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.     

Variations in incidence and age of onset of acute and transient psychotic disorders

Purpose

To determine incidence and age of onset of the ICD-10 category of ‘acute and transient psychotic disorders’ (ATPDs) characterised by subtypes with polymorphic, schizophrenic and predominantly delusional symptoms, pointing out differences from schizophrenia (SZ) and bipolar affective disorder (BD).

Methods

We identified all subjects aged 15–64 years who were listed for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs (n = 3,350), SZ (n = 4,576) and BD (n = 3,200) in 1995–2008. Incidence rates and rate ratios (IRR; 95 % confidence interval) by gender and age were calculated.

Results

The incidence of ATPDs was 6.7 per 100,000 person-years, similarly high for both genders (IRR 1.0; 0.9–1.1). Among the ATPD subtypes, polymorphic psychotic disorder was more common in females (IRR 1.4; 1.2–1.6) as opposed to those featuring schizophrenic symptoms, which tended to occur in younger males (IRR 1.4; 1.2–1.7). No significant gender difference was found for acute predominantly delusional disorder (IRR 1.0; 0.9–1.2), which had a later onset than any ATPD subtypes. SZ had an incidence twice as high in males (IRR 2.0; 1.9–2.2), and an earlier age of onset than ATPDs. A different pattern was observed for BD in terms of a slightly greater incidence in females (IRR 1.1; 1.0–1.1), and a later age of onset than both ATPDs and SZ.

Conclusion

These findings are likely to reflect the heterogeneity of the clinical features encompassed by ATPDs, and contribute to building a case for their revision in ICD-11.     

Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients

Objectives

This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China.

Method

A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected.

Results

The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0 %, and 21.1 %, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL).

Conclusion

Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.     

Psychotic experiences and social functioning: a longitudinal study

Purpose

Both adolescent psychotic experiences and poor social functioning precede psychotic disorder; however, whether poor social functioning is also a risk factor for rather than a consequence of adolescent psychotic experiences is not clear. We investigate this question as well as whether deterioration in social functioning confers the strongest risk of psychotic experiences and whether theory of mind ability mediates any association, in a large community sample.

Methods

Measures of social functioning (peer problems and prosocial behaviour) at ages 7 and 11 and theory of mind ability and psychotic experiences at age 12 were collected in a large community sample (n = 3,592). The association between social functioning and psychotic experiences was examined using logistic regression models at each age and any additional impact of deterioration in social functioning between ages 7 and 11. The potential role of theory of mind as a mediator was also investigated.

Results

Peer problems at both ages were independently associated with psychotic experiences at age 12 (7 years OR 1.11 95 % CI 1.03, 1.20), (11 years OR 1.13 95 % CI 1.05, 1.22). Theory of mind ability did not mediate this association. The association was not restricted to those with deteriorating social functioning (interaction term; p = 0.49).

Conclusions

Poor childhood social functioning precedes adolescent psychotic experiences. There was no evidence that those with deteriorating social functioning were at greatest risk.     

Prevalence and risk factors of psychotic symptoms: in the city of Izmir, Turkey

Background

Psychotic symptoms, psychotic-like experiences and schizotypal signs can emerge in different socio-cultural circumstances and cause clinical or non-clinical pictures. Transient or self-limiting psychotic-like experiences are more prevalent than clinical psychotic disorders. The aim of this study is to determine the prevalence and sociodemographic correlates of psychotic symptoms in an urban area.

Methods

A cross-sectional study was conducted among the residents of two districts in the urban area of Izmir, Turkey. Among the systematically selected 1,500 residents of 85,212-study population, a total of 1,268 individuals (response rate: 84.5%) were screened for any lifetime psychotic symptoms.

Results

Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms. CIDI (+) psychotic symptoms were found in 3.6% of the screened sample. Logistic regression analysis showed that being a female (OR = 2.4, 95% CI = 1.2–5.1), having a first degree family history of any mental disorders (OR = 13.9, 95% CI = 5.7–34.3), lack of social support (OR = 4.5, 95% CI = 2.3–8.6) and alcohol use (OR = 4.9, 95% CI = 2.3–10.6) were all related to psychotic symptoms.

Conclusion

Prevalence of any psychotic symptom is lower compared to European studies. Alcohol might be considered as a risk factor for developing psychotic symptoms in the Turkish cultural setting.     

Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia

Purpose

This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants’ level of need.

Methods

Participants (n = 497) were stratified by level of need (“high” or “moderate”) and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level.

Results

Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU.

Conclusions

Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.     

Impact of psychosis on Portuguese caregivers: a cross-cultural exploration of burden, distress, positive aspects and clinical-functional correlates

Purpose

Further cross-cultural comparisons are needed on caregiving consequences of chronic psychotic disorders. The EPSILON study (European Psychiatric Services: Inputs Linked to Outcome Domains and Needs) involved five European countries, but not Portugal. We aimed to analyse the impact of severe mental illness in a Portuguese sample and to provide support to comparisons with some of the EPSILON results, focusing on the north-European Dutch centre.

Methods

We studied 108 caregiver-patient dyads by a consecutive sampling of people with schizophrenia-spectrum disorders in psychiatric outpatient services. Relatives’ assessments included the Involvement Evaluation Questionnaire, European version (IEQ), the 12-item General Health Questionnaire (GHQ-12); the loss, stigma and positive aspects’ subscales of the Experience of Caregiving Inventory, and the Social Network and Family Coping Questionnaires. Patients were assessed regarding symptoms, disability and global functioning.

Results

Caregiving rewards and negative consequences co-existed. On the IEQ, 49.1 % reported negative consequences and rank order of domain scores was worrying > urging > tension > supervision. More than one-third of caregivers were psychologically distressed according to GHQ screenings. Involvement Evaluation Questionnaire scores were correlated with caregivers’ distress, stigma, loss, patient’s involvement and other ways of coping, and patients’ variables. Some of these failed to be included in a regression model.

Conclusions

Many of these Portuguese caregivers were at risk regarding burden and psychological distress. In comparison with other European samples, caregiving arrangements and assessments were typical of Mediterranean countries, as Italy or Spain. All IEQ scores were significantly higher than those in the Netherlands. On account of small numbers, caution is needed in the interpretation of associations.     

Risk factors for depressive disorders in very old age: a population-based cohort study with a 5-year follow-up

Purpose

Depressive disorders are common among the very old, but insufficiently studied. The present study aims to identify risk factors for depressive disorders in very old age.

Methods

The present study is based on the GERDA project, a population-based cohort study of people aged ≥85 years (n = 567), with 5 years between baseline and follow-up. Factors associated with the development of depressive disorders according to DSM-IV criteria at follow-up were analysed by means of a multivariate logistic regression.

Results

At baseline, depressive disorders were present in 32.3 % of the participants. At follow-up, 69 % of those with baseline depressive disorders had died. Of the 49 survivors, 38 still had depressive disorders. Of the participants without depressive disorders at baseline, 25.5 % had developed depressive disorders at follow-up. Baseline factors independently associated with new cases of depressive disorders after 5 years were hypertension, a history of stroke and 15-item Geriatric Depression Scale score at baseline.

Conclusions

The present study supports the earlier findings that depressive disorders among the very old are common, chronic and malignant. Mild depressive symptoms as indicated by GDS-15 score and history of stroke or hypertension seem to be important risk factors for incident depressive disorders in very old age.     

A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention

Purpose

Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility.

Methods

A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them.

Results

In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p < 0.001), getting along with others (p < 0.001), life activities (p < 0.001) and participation in the society (p < 0.001). The factors that were significantly associated with disability in the two groups (BAD and schizophrenia) were: unemployment status (p < 0.001) and remittance source of income (p < 0.001), while those that spent not more than ?2,000 (13 dollars) per month on treatment (p = 0.004) were observed to be less disabled.

Conclusions

Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated.     

Psychotic experiences in people who have been sexually assaulted

OBJECTIVE: In recent years, there has been a call for greater awareness of the relationship between trauma and psychosis, and several studies involving patients with psychotic disorders have found a link between traumatic life experience and the development of psychosis. However, little research has examined psychotic experiences in a traumatised population. METHOD: This study investigated psychotic experiences in a sample of 40 survivors of sexual assault (SA) compared to a control group without a history of sexual assault (measured using a self-report questionnaire) and examined the psychological factors that may contribute to the development of psychotic experiences in sexually traumatised individuals. In particular, the role of dissociation and cognitive factors such as post-traumatic cognitions were explored. RESULTS: Of the 26 sexually assaulted participants that were interviewed, 46% reported auditory hallucinations and 46% reported visual hallucinations. A significantly higher rate of psychotic phenomena (delusional ideation and predisposition to hallucinations) was found in the sexually assaulted group compared to the control group. Severity of SA trauma was significantly associated with severity of PTSD and psychotic symptomatology. Dissociation was strongly associated with all measures of psychotic phenomena and negative cognitions about the self and the world were associated with predisposition to hallucinations and delusional ideation. Regression analyses revealed that after controlling for the severity of SA trauma, dissociation and negative beliefs about the self significantly predicted delusional distress, and dissociation significantly predicted predisposition to visual hallucinations. CONCLUSIONS: These exploratory findings support the idea that psychotic phenomena may be caused by traumatic life experiences and highlight the need for further research. The implications of these results for research and clinical practice are discussed.     

Delusional ideation and self-esteem in individuals with psychotic disorders

The present study is an examination of the association of self-esteem with various themes of delusional thinking for individuals with psychotic disorders. Individuals with psychotic disorders (N = 30) completed a measure of delusional ideation and a measure of severity of delusions and also a measure of self-esteem. Results indicated individuals with higher levels of delusional thinking in the domains of persecution, thought disturbances, catastrophic ideation/thought broadcast, and negative self had lower self-esteem (p < 0.05). The 2 measures of delusional ideation or severity were not related to one another, yet they yielded similar relationships in terms of self-esteem, indicating both assessments may be useful and unique. Results are discussed in relation to previous research investigating self-esteem and delusions and delusional ideation.     

A controlled evaluation of a brief parenting psychoeducation intervention in Burundi

Purpose

Conduct problems and emotional distress have been identified as key problems among children and adolescents in post-war Burundi. This pilot study aims to evaluate the impact of a brief parenting psychoeducation intervention on children’s mental health.

Methods

This study employs a controlled pre and post evaluation design. The two-session psychoeducation intervention was offered to groups of parents of children (mean age 12.3 years, 60.8 % female) who had been screened for elevated psychosocial distress. Children in the intervention group (n = 58) were compared to a waitlist control group (n = 62). Outcome indicators included child-reported levels of aggression (using the Aggression Questionnaire), depression symptoms (using the Depression Self Rating Scale) and perceived family social support.

Results

The intervention had a beneficial effect on reducing conduct problems compared to the control condition (Cohen d = 0.60), especially among boys, while not showing impact on depression symptoms or family social support. Parents evaluated the intervention positively, with increased awareness of positive parenting strategies and appropriate disciplinary techniques reported as the most common learning points.

Conclusion

A brief parenting psychoeducation intervention conducted by lay community counselors is a promising public health strategy in dealing with widespread conduct problems in boys living in violence-affected settings and not so for social and emotional indicators and for girls. An efficacy study is warranted to confirm these preliminary findings.     

The effect of spirituality and religious attendance on the relationship between psychological distress and negative life events

Purpose

The aim of this study was to assess the effect of religious attendance and spirituality on the relationship between negative life events and psychological distress.

Methods

This was a cross-sectional study of 1,071 community dwelling adults from East Baltimore, Maryland who participated in the fourth (2004–2005) wave of the Baltimore Epidemiologic Catchment Area study. The 20-item General Health Questionnaire (GHQ-20) was used to measure psychological distress. Multiple regression models were used to assess the association between negative life events and distress as well as to measure the effect of religious attendance and spirituality on the association between psychological distress and negative events while adjusting for demographic variables, past distress and social support from friends and relatives.

Results

In pooled analysis, negative events were significant predictors of distress, b = 1.00, β = 0.072, p < 0.05. Religious attendance and spirituality did not affect or modify the association between negative events and distress. However, religious attendance was inversely associated with distress with higher frequency of attendance associated with lower distress after controlling for demographic and social support factors, b = ?2.10, β = ?.110, p < 0.01 for attending 1–3 times a month; b = ?2.39, β = ?0.156, p < 0.01 for attending weekly; and b = ?3.13, β = ?0.160, p < 0.001 for attending more than once per week. In stratified analysis, negative events were associated with distress for those who were low on spirituality, b = 1.23, β = 0.092, p < .05, but not for those who were high on spirituality; the association between religious attendance and decreased distress was true only for those scoring high in spirituality. Social support accounted for some of the inverse association between religious and distress.

Conclusion

Religious attendance and spirituality may play a role in how people experience and deal with difficult life situations.     

Moral objections to suicide and suicidal ideation among mood disordered Whites, Blacks, and Hispanics

Understanding the beliefs that protect individuals against suicide can help to enhance suicide prevention strategies. One measure of suicide non-acceptability is the moral objections to suicide (MOS) sub-scale of the reasons for living inventory (RFLI). This study examined the MOS and suicidal ideation of White, Black, and Hispanic individuals with mood disorders. We expected minority individuals to have stronger objections to suicide.

Method

Eight hundred and four, White (588), Black (122) and Hispanic (94) participants with DSM-IV diagnoses of MDD or bipolar disorder were administered the scale for suicide ideation, the reasons for living inventory and several measures of clinical distress.

Results

Higher suicidal ideation was modestly correlated with lower MOS scores overall (r = 0.15, p = 0.001). Among Blacks however the relationship was inverted: despite having higher suicidal ideation than Whites or Hispanics, Blacks reported the least accepting attitudes toward suicide.

Conclusion

These results suggest that attitudes regarding the acceptability of suicide may be independent of suicidal ideation.     

Treatment seeking and barriers to treatment for alcohol use in persons with alcohol use disorders and comorbid mood or anxiety disorders

Purpose

This study compared the prevalence and patterns of treatment seeking and barriers to alcohol treatment among individuals with alcohol use disorders (AUD) with and without comorbid mood or anxiety disorders.

Methods

We used data from the national epidemiologic survey on alcohol and related conditions to examine alcohol treatment seeking, treatment settings and providers, perceived unmet need for treatment and barriers to such treatment. Our sample consisted of 5,003 individuals with AUD with a comorbid mood or anxiety disorder and 6,734 individuals with AUD but without mood or anxiety disorder comorbidity.

Results

The group with mood or anxiety disorder comorbidity was more likely to seek alcohol treatment than the group without such comorbidity (18 vs. 12 %, p < 0.001). The comorbid group was also more likely to perceive an unmet need for such treatment (8 vs. 3 %, p < 0.001) and to report a larger number of barriers (2.81 vs. 2.20, p = 0.031). Individuals with AUD with comorbid mood or anxiety disorders were more likely than those without to report financial barriers to alcohol treatment (19 vs. 10 %, p = 0.032).

Conclusions

Individuals with AUD and comorbid mood or anxiety disorders would likely benefit from the expansion of financial access to alcohol treatments and integration of services envisioned under the Affordable Care Act.