A Bayesian approach to estimating the population prevalence of mood and anxiety disorders using multiple measures.

To compare trends in the estimated prevalence of mood and/or anxiety disorders identified from two data sources (self-report and administrative). Reviewing, synthesising and interpreting data from these two sources will help identify potential factors that underlie the observed estimates and inform public health action. We used self-reported, diagnosed mood and/or anxiety disorder cases from the Canadian Community Health Survey (CCHS) across a 5-year span (from 2003 to 2009) to estimate the prevalence among the Canadian population aged ≥15 years. We also estimated the prevalence of mood and/or anxiety disorders using the Canadian Chronic Disease Surveillance System (CCDSS), which identified cases using ICD-9/-10-CA codes from physician billing claims and hospital discharge records during the same time period. The prevalence rates for mood and/or anxiety disorders were compared across the CCHS and CCDSS by age and sex for all available years of data from 2003 to 2009. Summary rates were age-standardised to the Canadian population as of 1 October 1991. In 2009, the prevalence of mood and/or anxiety disorders was 9.4% using self-reported data v. 11.3% using administrative data. Prevalence rates obtained from administrative data were consistently higher than those from self-report for both men and women. However, due to an increase in the prevalence of self-reported cases, these differences decreased over time (rate ratios for both sexes: 1.6-1.2). Prevalence estimates were consistently higher among females compared with males irrespective of data source. While differences in the prevalence estimates between the two data sources were evident across all age groups, the reduction of these differences was greater among adolescent, young and middle-aged adults compared with those 70 years and older. The overall narrowing of differences over time reflects a convergence of information regarding the prevalence of mood and/or anxiety disorders trends between self-report and administrative data sources. While the administrative data-based prevalences remained relatively stable, the self-reported prevalences increased over time. These observations may reflect positive societal changes in the perceptions of mental health (declining stigma) and/or increasing mental health literacy. Additional research using non-ecological data is required to further our understanding of the observed findings and trends, including a data linkage exercise permitting a comparison of prevalence estimates and population characteristics from these two data sources both separately and merged.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

BackgroundThere is a significant body of evidence on the link between migration and mental health stressors. However, there has been very little research on the use of mental health services by immigrants in Canada. The prevalence of mental health professional consultations among immigrants, as well as its correlations, are not well understood and remain largely unknown.ObjectiveThis study aims to examine how specialist mental health visits (to a psychiatrist) differ from general mental health visits (to a family doctor or general practitioner) from immigrants, when compared to visits from those born in Canada, in a nationally representative sample of Canadian adults. This study also examines which group—immigrant or Canadian-born—suffers more from depression or anxiety, 2 of the more common mental health conditions.MethodsWe used data from the Canadian Community Health Survey (CCHS) between the years 2015 and 2016. The outcome variables included consultation with any mental health professional, consultation with a specialist (psychiatrist), and the prevalence of mood and anxiety disorders. The independent variable was immigrant status. Other variables of interest were adjusted for in the analyses. Multilevel regression models were developed, and all analyses were performed with Stata IC statistical software (version 13.0, StataCorp).ResultsThe prevalence of mood and anxiety disorders was significantly lower among immigrants compared with individuals born in Canada; the prevalence of mood disorders was 5.24% (389,164/7,422,773) for immigrants vs. 9.15% (2,001,829/21,885,625) for individuals born in Canada, and the prevalence of anxiety disorders was 4.47% (330,937/7,410,437) for immigrants vs. 9.51% (2,083,155/21,898,839) for individuals born in Canada. It is expected that individuals with a lower prevalence of mood or anxiety disorders would use mental health services less frequently. However, results show that immigrants, while less likely to consult with any mental health professional (OR=0.80, 95% CI 0.72-0.88, P<.001), were more likely to consult with a psychiatrist (OR=1.24, 95% CI 1.04-1.48, P=.02) for their mental health visits when compared to individuals born in Canada.ConclusionsThe results of this study reveal an unusual discord between the likelihood of mental health professional consultations with any mental health professional and mental health visits with psychiatrists among immigrants compared to nonimmigrants in Canada. Mental health initiatives need to be cognizant of the differences in the associated characteristics of consultations for immigrants to better tailor mental health services to be responsive to the unique needs of immigrant populations in Canada.

To assess whether estimates of survey structured interview diagnoses of mood and anxiety disorders were concordant with diagnoses of these disorders obtained from health administrative data. All Ontario respondents to the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) were linked to health administrative databases at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Survey structured interview diagnoses were compared with health administrative data diagnoses obtained using a standardized algorithm. We used modified Poisson regression analyses to assess whether socio-demographic factors were associated with concordance between the two measures. Of the 4157 Ontarians included in our sample, 20.4% had either a structured interview diagnosis (13.9%) or health administrative diagnosis (10.4%) of a mood or anxiety disorder. There was high discordance between measures, with only 19.4% agreement. Migrant status, age, employment, and income were associated with discordance between measures. Our findings indicate that previous estimates of the 12-month prevalence of mood and anxiety disorders in Ontario may be underestimating the true prevalence, and that population-based surveys and health administrative data may be capturing different groups of people. Understanding the limitations of data commonly used in epidemiologic studies is a key foundation for improving population-based estimates of mental disorders.

Novel Insights Into Pathological Anxiety and Anxiety-Related Disorders.

Employment Among Persons With Past and Current Mood and Anxiety Disorders in the Israel National Health Survey

DAVID J. A. DOZOIS and KEITH S. DOBSON (Eds.) The Prevention of Anxiety and Depression: Theory, Research and Practice Washington, DC: American Psychological Association, 2004, 344 pages (ISBN 1-59147-079-X, $49.95 Hardcover) Psychological and pharmacological treatments of anxiety and depression have evolved considerably in the past decade. The increase in the range of psychoactive medications on the market and the development of increasingly sophisticated psychological models of mood and anxiety disorders have led to considerable refinement of treatment protocols. Despite these advances, the overall prevalence rates of mood and anxiety disorders have not decreased, many sufferers are refractory to the most effective treatments on offer, and many people suffer recurrences of these disorders following successful treatment. Furthermore, there is considerable evidence that least some disorders have their origins in normal experiences reported by the majority of individuals (e.g., obsessions are highly similar in content and nature to intrusive thoughts experienced by most people). Finally, as the editors of this book note, empirical research on vulnerability factors in anxiety and mood disorders has evolved to the point that study of prevention is now viable. The study of the prevention of mood and anxiety disorders, then, is timely and important. Dozois and Dobson have compiled an impressive volume whose chapters identify and then address the highly complex issues relevant to prevention of anxiety and depression, ending with an excellent summary and synthesis of the body of work covered in the text. The book features contributions by leading researchers in the area, the level of scholarship is ccmsistently high, and the writing is clear and accessible. In the first chapter, Dozois and Dobson outline the theoretical complexities of studying prevention. What theoretical model of prevention to follow - the classic primary-secondary-tertiary intervention model, or more recent models that distinguish between prevention targeting the general public, those identified as potentially at risk, and those identified as actually exhibiting early signs and symptoms of the disorder? The strength of the former model is that it includes relapse prevention, which is essential when discussing anxiety and mood disorders that are recurrent. The strength of the latter models is in their distinction between prevention targeted those exhibiting risk factors and those who exhibit symptoms of the disorder itself. The editors adopt the classic model but encourage their contributors to distinguish between prevention models organized around risk factors from those based on early signs or symptoms of the disorder, where possible. Chapter 2 provides an excellent overview of the descriptive features of anxiety and mood disorders, their impact, and their prevalence and course. The authors then present a cogent analysis of these data, specifying their implications for prevention. The importance of prevention becomes startlingly clear when the authors note that a) most anxiety and mood disorders originate in childhood; b) childhood onset is associated with greater severity and functional impairment; c) disorders in children are undertreated; d) anxiety disorders appear to precede depression, but anxiety disorders are generally undertreated; and, e) subclinical symptomatology reliably predicts the development of clinically significant impairment but is grossly underdetected. The authors also identify important lapses in our understanding of the development of anxiety and mood disorders. For example, why is the prevalence of mood disorders so much higher in women? Why are anxiety and depression so highly related? This chapter serves to establish the critical role that prevention has to play in reducing the prevalence of anxiety and mood disorders; prevention is clearly the wave of the future. Chapters 3 and 4 review the challenges involved in studying prevention. …

Prevalence of Mood, Anxiety, and Substance-Abuse Disorders for Older Americans in the National Comorbidity Survey-Replication

Context: Mood and anxiety disorders appear to be overrepresented in adults with cardiovascular diseases (CVDs). These disorders have been associated with poorer biopsychosocial outcomes in this population. Mood and anxiety disorders often co-occur, but the prevalence of this comorbidity and their potential additive effects in patients with CVD remain understudied. Aims: This study aimed to estimate the prevalence and co-occurrence rates of mood and anxiety disorders in the general adult population living with CVD. Associations between mood and anxiety disorder status and sociodemographic characteristics, somatic comorbidities, perceived mental health, and health-care service use were also investigated. Methods: A total of 6,792 adults aged 25 years or older and living with CVD were selected from the 2015–2016 Canadian Community Health Survey. Mood and anxiety disorders were identified based on self-report diagnoses made by a qualified health professional. All other variables were assessed using questionnaires. Results: An estimated 17.7% of the studied population reported having been diagnosed with a mood or anxiety disorder. More precisely, 6.6% reported a mood disorder, 5.5% reported an anxiety disorder, and an additional 5.6% reported both. The presence of mood or anxiety disorders was associated with poorer perceived mental health and higher health-care service use, and these associations were stronger when mood and anxiety co-occurred. Conclusions: Approximately one in six adults with CVD reported suffering from mood or anxiety disorders, and a third of them presented both conditions. This study also suggests that co-occurring anxiety and mood disorders lead to greater vulnerability than either disorder in adults with CVD.

Prevalence and Predictors of Persistent Versus Remitting Mood, Anxiety, and Substance Disorders in a National Sample of Older Adults

Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE. Following prospective registration (PROSPERO; CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in samples of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted. The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q1 ] = 36.29, p < 0.0001); the prevalence of anxiety disorders based on unstructured clinician assessment was 8.1% (95% CI 5.7-11.4%), compared to a prevalence of 27.3% (95% CI 22.1-33.3%) based on a structured clinical interview. There were no significant moderators of depressive disorder diagnosis. Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.

To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder. Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities. The entire VA Health Care System. Population-based sample of veterans with obesity (N = 2,485,658). Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders. Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder. Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI.

The process of migration and resettlement has been associated with increased risk for psychiatric illness. Our study sought to examine the association between age at immigration and risk for mood, anxiety, and substance use disorders (SUDs) among adult immigrants in Canada. Data from the Canadian Community Health Survey: Mental Health and Well-Being, a cross-sectional study of psychiatric disorder conducted in 2002, was used to identify a representative sample of adult immigrants in Canada (n = 4946). Logistic regression was used to examine the association between age at immigration (0 to 5 years, 6 to 17 years, and 18 years and older) and 12-month prevalence of mood and anxiety disorders, and SUDs. Immigrants who arrived prior to age 6 years reported the highest risk for mood (OR 3.41; 95% CI 1.7 to 7.0) and anxiety disorders (OR 6.89; 95% CI 3.5 to 13.5), compared with those who immigrated at the age of 18 years or older, after adjusting for covariates, including duration of residence. Younger age at immigration was associated with increased risk of having a current mood disorder, anxiety disorder, or SUD. These findings speak to the importance of developing and evaluating targeted prevention programs for young immigrant children and adolescents.

ObjectiveTo estimate the prevalence of mood and anxiety disorders among adults seeking care in primary healthcare centers in Cordoba city, Argentina.MethodsCross-sectional analysis of a random sample of adults 18–69 years of age seeking care for general health problems in public (i.e., government-funded) primary healthcare centers in Cordoba city, Argentina in 2010–2011. Mood and anxiety disorders were assessed in the participants’ lifetime, and in the last 12 months and 30 days using the World Mental Health Composite International Diagnostic Interview 3.0, and defined following the International Classification of Diseases, tenth revision.ResultsOverall, 1,067 participants were included in the current analysis [mean age 35.6 (SD 13.2) years, 83.7% female]. The lifetime, 12-month and 30-day prevalence of any mood or anxiety disorder was 40.4% [95% confidence interval (95%CI) 37.4–43.4%], 20.1% (17.8–22.7%) and 7.8% (6.2–9.6%), respectively. The prevalence of anxiety disorders was higher compared to mood disorders when assessed in the participants’ lifetime [29.7% (95%CI 27.0–32.5%) versus 19.3% (17.0–21.8%)], and in the last 12 months [14.9% (12.8–17.2%) versus 8.7% (7.1–10.6%)] and 30 days [5.8% (4.5–7.4%) versus 2.3% (1.5–3.4%)]. Age and marital status-adjusted odds ratios for any mood or anxiety disorder in the participants’ lifetime and in the last 12 months and 30 days comparing women versus men were 1.19 (95%CI 0.85–1.67), 1.70 (1.07–2.69), and 2.26 (1.02–5.00), respectively.ConclusionThe prevalence of mood and anxiety disorders is high among adults seeking care in primary healthcare centers in Cordoba city, particularly among women. Integration of primary and mental health services is warranted.

ObjectivesWe aim to determine the prevalence and the course of anxiety and mood disorders in Dutch adolescents (12–18 years old) with type 1 diabetes, and to examine correlates of symptom severity, including parental emotional distress.MethodsParticipants were 171 adolescents and 149 parents. The Diagnostic Interview Schedule for Children‐IV was used to assess current, past year and lifetime anxiety and mood disorders in adolescents. Symptom severity and diabetes distress were measured with validated questionnaires. Correlates of these symptoms were examined using hierarchical regression analyses and included demographics (adolescent sex and age), clinical factors (diabetes duration, treatment modality, most recent glycated hemoglobin A1c; all extracted from medical charts), adolescent diabetes distress, and parent emotional distress.ResultsTwenty‐four (14%) adolescents met the criteria for ≥1 disorder(s) in the previous 12 months. Anxiety disorders were more prevalent than mood disorders (13% vs. 4%). Lifetime prevalence of anxiety and mood disorders was 29% (n = 49). The presence of any of these disorders earlier in life (from 5 years old up to 12 months prior to assessment) was associated with disorders in the past 12 months (OR = 4.88, p = 0.001). Higher adolescent diabetes distress was related to higher symptoms of anxiety (b = 0.07, p = 0.001) and depression (b = 0.13, p = 0.001), while demographics, clinical characteristics, and parental emotional distress were not related.ConclusionsAnxiety and mood disorders are common among adolescents and related to earlier disorders. Higher diabetes distress was related to higher symptom severity. Clinicians are advised to address past psychological problems and remain vigilant of these problems.