Epidemiologic Catchment Area Research Articles

From the Midtown Manhattan Study to the Epidemiologic Catchment Area Study: the advent of mechanical objectivity in psychiatry.

In this paper I compare the methodology of two of the most famous epidemiological studies: The Midtown Manhattan Study (1952-60) and the Epidemiologic Catchment Area Study (1980-5). At first sight, there are few features that distinguish them; both were studies of large samples of the general population; they both used highly sophisticated methods of data analysis and standardized instruments; and they involved interviewers who were not professional clinicians. However, if we carefully compare the protocols that define how 'clinical' information is collected, we realize that some important changes in methodology were not only due to practical necessities, but also involved an important transformation in the role of the interviewer and the skills traditionally associated with the clinician.

COMMON INFECTIONS IN RELATION TO SLEEP DISTURBANCES BY RACE IN A POPULATION-BASED COHORT OF ADULTS

Abstract Common infections (e.g., human herpesviruses and Toxoplasma gondii (TOX)), are associated with poor health outcomes, but less is known about associations between these infections and sleep. Due to, for instance, structural racism leading to policies and practices resulting in relative economic disadvantage and subsequently poorer living condition, sleep disturbances and common infections are more prevalent in minoritized populations. We investigated the cross-sectional associations of common infections (i.e., herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and TOX with sleep disturbances, and determined whether these associations differed by race in 602 adults enrolled in the Baltimore Epidemiologic Catchment Area Study (mean age=59.0±12.8 years, 36.9% male, 35.6% minoritized). Participants donated a blood sample and were asked whether they had the insomnia symptoms “trouble falling asleep, staying asleep, or waking up too early” and reported on their habitual sleep duration. We measured immunoglobin G (IgG) antibodies to HSV-1, CMV, EBV, VZV, and TOX. After adjusting for sociodemographics, body mass index, comorbidities, household income, and household size, there were no associations between common infections and any sleep outcomes ; however, we observed interactions with race. Among White participants only, CMV seropositivity was associated with a lower odds of insomnia symptoms (OR = 0.26, 95% CI 0.10, 0.69) and TOX seropositivity was associated with shorter sleep duration (OR = 0.65, 95% CI 0.09, 1.21). Further research is needed to investigate mechanisms that may account for associations of CMV and TOX with sleep among White but not minoritized participants.

Validation of the Patient Health Questionnaire-9 and Patient Health Questionnaire-2 in the General Korean Population.

The Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 have not been validated in the general Korean population. This study aimed to validate and identify the optimal cutoff scores of the PHQ-9 and PHQ-2 in screening for major depression in the general Korean population. We used data from 6,022 participants of the Korean Epidemiological Catchment Area Study for Psychiatric Disorders in 2011. Major depression was diagnosed according to the Korean Composite International Diagnostic Interview. Validity, reliability, and receiver operating characteristic curve analyses were performed using the results of the PHQ-9 and Euro Quality of life-5 dimension (EQ-5d). Of the 6,022 participants, 150 were diagnosed with major depression (2.5%). Both PHQ-9 and PHQ-2 demonstrated relatively high reliability and their scores were highly correlated with the "anxiety/depression" score of the EQ-5d. The optimal cutoff score of the PHQ-9 was 5, with a sensitivity of 89.9%, specificity of 84.1%, positive predictive value (PPV) of 12.6%, negative predictive value (NPV) of 99.7%, positive likelihood ratio (LR+) of 5.6, and negative likelihood ratio (LR-) of 0.12. The optimal cutoff score of the PHQ-2 was 2, with a sensitivity of 85.3%, specificity of 83.2%, PPV of 11.6%, NPV of 99.5%, LR+ of 5.1, and LR- of 0.18. The PHQ-9 and PHQ-2 are valid tools for screening major depression in the general Korean population, with suggested cutoff values of 5 and 2 points, respectively.

Association of common infections with cognitive performance in the Baltimore Epidemiologic Catchment Area study follow-up.

Growing evidence suggests that some common infections are causally associated with cognitive impairment; however, less is known about the burden of multiple infections. We investigated the cross-sectional association of positive antibody tests for herpes simplex virus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), and Toxoplasma gondii (TOX) with Mini-Mental State Examination (MMSE) and delayed verbal recall performance in 575 adults aged 41-97 from the Baltimore Epidemiologic Catchment Area Study. In multivariable-adjusted zero-inflated Poisson (ZIP) regression models, positive antibody tests for CMV (p=.011) and herpes simplex virus (p=.018) were individually associated with poorer MMSE performance (p=.011). A greater number of positive antibody tests among the five tested was associated with worse MMSE performance (p=.001). CMV, herpes simplex virus, and the global burden of multiple common infections were independently associated with poorer cognitive performance. Additional research that investigates whether the global burden of infection predicts cognitive decline and Alzheimer's disease biomarker changes is needed to confirm these findings.

Deconstructing childhood conduct and adult antisocial criteria for the diagnosis of antisocial personality disorder

Antisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups defined by these aspects of the criteria have not been fully explored. Data for ASPD were analyzed for 3,498 individuals in the St Louis, Missouri, site of the Epidemiologic Catchment Area study of general population psychiatric disorders collected in the early 1980s using structured diagnostic interviews for DSM-III criteria. Effects of the criteria on population subgroups defined by various combinations of the criteria were examined. Earlier-onset conduct disorder was more severe than later-onset childhood conduct disorder, with more total childhood and adult symptoms and negative psychosocial adult outcomes (substance use disorders, criminality, and homelessness). Three subgroups with adult antisocial behaviors (differentiated by no conduct disorder, later-onset conduct disorder, and earlier-onset conduct disorder meeting ASPD criteria) were similar in numbers of adult antisocial symptoms, but the ASPD subgroup had more negative psychosocial adult outcomes. These findings provide evidence for and against reconsideration of the 15-year age-of-onset requirement for conduct symptoms in ASPD criteria.

Bullying, Psychological, and Physical Trauma During Early Life Increase Risk of Major Depressive Disorder in Adulthood: A Nationwide Community Sample of Korean Adults.

BackgroundThere is an association between early life traumas and the development of depression in adults. Few studies have used nationwide population-based samples to investigate whether the type of early life trauma differentially influences the risk of developing depression.MethodsMajor depressive disorder and early life trauma were assessed using the Korean version of the Composite International Diagnostic Interview (K-CIDI) for DSM-IV psychiatric disorder and a questionnaire for early life trauma in the Korean Epidemiological Catchment Area Study in 2016. A total of 4,652 participants were included in the final analysis. This study evaluated the effect of the type and frequency of reported early life trauma on the risk of developing MDD and the association between reported early life trauma and differential symptoms of MDD.ResultsIndividuals with reported early life trauma had a 3.7-fold increased risk of MDD. The risk of MDD was associated with bullying trauma (odds ratio (OR) = 1.847, p = 0.005) after adjusting for age, gender, marriage, job, and education years. The risk of MDD was increased as the types of reported early life traumas increased.ConclusionBullying trauma during early life represents a risk factor for MDD, especially in individuals exposed to multiple traumas in early life.

The association between traumatic life events and insomnia symptoms among men and women: Results from the Baltimore Epidemiologic Catchment Area follow-up study

Study objectivesTrauma exposure likely contributes to poor sleep, but relatively few studies have empirically tested this, instead focusing on posttraumatic stress disorder. Moreover, little is known about sex differences in sleep after trauma. The current study used a cross-sectional and retrospective design to test hypotheses that trauma exposure would be associated with subsequent insomnia symptoms, particularly among women, even after accounting for important covariates. MethodData from Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area Study (N = 1920) were used to examine associations between remote (prior to past year) and recent (past year) trauma and current sleep disturbance (insomnia, hypersomnia symptoms) in the total sample (Mage= 55, 63.2% women, 57.7% white), and separately in men and women. Sensitivity analyses were conducted among individuals with no pretrauma sleep disturbance to examine incident sleep disturbance. ResultsAmong all participants, both remote (odds ratio [OR] = 1.95, 95% confidence interval [CI] [1.34, 2.85]) and recent (OR = 1.94, 95% CI [1.31, 2.87]) trauma exposure were associated with increased odds of insomnia (OR = 2.41, 95% CI [1.54, 3.76]) but not hypersomnia. Associations between trauma and insomnia were particularly strong among women, but null among men. The relationship between trauma exposure and insomnia symptoms persisted among individuals with no pretrauma history of insomnia. ConclusionResults suggest women may be vulnerable to insomnia symptoms as sequelae of trauma. Future research should examine prospective associations between trauma and sleep in larger samples and how assessment and treatment of insomnia among women trauma survivors reduces the public health impact of trauma and poor sleep.

Epidemiology of Mental Disorders

This review describes the contribution of psychiatric epidemiology to our understanding of the distribution and determinants of psychiatric disorders. First, it describes basic concepts within epidemiology, such as prevalence, incidence, case definition, bias, and confounding, and their specific meaning within psychiatric research. The two basic study designs in epidemiology, cohort and case-control, are then reviewed. This discussion includes a tutorial on how to calculate key measures of association: risk ratio and odds ratio. Major community-based studies in psychiatric epidemiology are then reviewed, focusing on the Epidemiologic Catchment Area Study, the National Comorbidity Study and the National Comorbidity Study Replication, the National Survey of American Life, the National Latino and Asian American Study of Mental Health, and the National Epidemiologic Survey on Alcohol and Related Conditions. The review concludes with a discussion of pharmacoepidemiology and how it is critical to our understanding of the full impact of psychiatric medications postmarketing. In the future, epidemiology will be revolutionized with “big data” collection in both institutional and community settings. Nonetheless, the basic concepts presented in this review will continue to be relevant and critical to drawing sound, evidence-based conclusions about the true nature, correlates, and causes of psychiatric disorders. This review contains 6 tables, and 63 references. Key words: case-control study, cohort study, community-based studies, measures of association, pharmacoepidemiology, psychiatric epidemiology

Psychiatric comorbidity in the Baltimore ECA follow-up study: the matrix approach.

Psychiatric comorbidity is defined as the joint occurrence of two or more mental or substance use disorders. Widespread psychiatric comorbidity has been reported in treatment and population-based studies. The aim of this study was to measure the extent and impact of psychiatric comorbidity in a cohort of the Baltimore Epidemiologic Catchment Area study. We examined the comorbidity burden of 16 mental disorders in a cohort of 847 participants using both established and novel analytical approaches The Comorbidity to Diagnosis Inflation Ratio (CDIR), is a statistical instrument that quantifies impact of pairwise comorbid associations, both on the whole sample, as well as on each specific disorder. Most anxiety disorders had substantial co-occurrence with each other, as well as with Major Depressive Disorder (MDD). In addition, mood disorders had a high degree of comorbidity with Alcohol Dependence (AD). The CDIR for the whole sample was 1.32, indicating a ratio of 132 comorbidities per 100 diagnoses. The conditions with high sample prevalence were relatively less comorbid than the low prevalence conditions. Obsessive Compulsive Disorder had a comorbidity burden that was 89% greater than the overall sample. Anxiety disorders are highly interrelated, as well as highly comorbid with depression. The comorbidity phenomenon is linked to the differential prevalence of the analyzed conditions. Comorbidity frequency (most prevalent comorbid condition) appears mutually exclusive to comorbidity burden (most widely interrelated condition). While AD and MDD were the most frequently diagnosed disorders; low prevalence conditions as OCD and GAD were the most widely interrelated.

Trends in the Prevalence of Major Depressive Disorder by Sociodemographic Factors in Korea: Results from Nationwide General Population Surveys in 2001, 2006, and 2011.

BackgroundThis study investigated trends in the prevalence of major depressive disorder (MDD) by sociodemographic factors in South Korea.MethodsNational samples of the general population aged 18 years or older collected from the nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001 (n = 6,206), 2006 (n = 6,466), and 2011 (n = 5,986) were used. For MDD diagnosis, we conducted face-to-face interviews using the Korean version of the Composite International Diagnostic Interview. We performed logistic regression analyses stratified by gender, after adjusting for other sociodemographic variables, to calculate the 2006-to-2001 odds ratio (OR) and 2011-to-2001 OR by subgroups of sociodemographic factors to explore the association of MDD prevalence with sociodemographic factors over time.ResultsThe prevalence of MDD in the general population of South Korea increased steadily from 2001, to 2006, and to 2011 (1.6%, 2.5%, and 3.1%, respectively). Among the men, the prevalence of MDD continued to increase significantly in 18–29 years of age group (2006: adjusted OR [AOR], 3.32; 2011: AOR, 7.42), at-risk drinking group (2006: AOR, 3.56; 2011: AOR, 4.77), and not living with a partner group (2006: AOR, 3.24; 2011: AOR, 3.25). Meanwhile, among the women, the prevalence of MDD continued to significantly increase in the below-average household income group (2006: AOR, 2.58; 2011: AOR, 2.59), at-risk drinking group (2006: AOR, 2.02; 2011: AOR, 2.47), and unemployed group (2006: AOR, 1.48; 2011: AOR, 2.04).ConclusionThis study may provide significant information for public policymakers to allocate sufficient health resources on MDD to vulnerable groups, particularly, men aged 18–29 years and women living in households with below-average income, and for clinicians to develop appropriate screening and treatment modalities for MDD.

Gender-based examination of the association between individual symptoms of alcohol use disorder, major depressive disorder, and suicidal behaviors: a network analysis of data from the Korean Epidemiologic Catchment Area Study

BackgroundWe aimed to investigate the gender differences in the associations between the individual symptoms of AUD and MDD and SB using a network analysis. MethodsData from the 2011 and 2016 Korean Epidemiologic Catchment Area Study were analyzed. Variables were assessed using the Korean version of Composite International Diagnostic Interview. Of 11,124 total participants, 907 endorsing screening questions for AUD and MDD were included. The undirected and directed network structures of AUD, MDD, and SB were estimated and centrality and bridge centrality indices were examined. ResultsThe overall undirected network structure and global strength did not differ between genders. While three AUD symptoms had high strength indices in network structure for both genders, depressed mood for men and worthlessness/guilt for women were the bridge symptoms linking other MDD symptoms and AUD symptoms to SB and had the strongest influence on SB. Directed network indicated that for men, AUD symptoms were related to SB via MDD symptoms with tolerance being a dominant item. For women, none of the AUD symptoms were related to MDD symptoms and SB, and insomnia/hypersomnia was a dominant item. Worthlessness/guilt was the directly linked to SB in the directed network analysis for both genders. LimitationsCross-sectional design and the use of combined dataset with different time points. ConclusionsSome differential associations at the level of individual symptoms of AUD and MDD with SB were observed between men and women. Targeting to the central and bridging symptoms may improve the outcomes of SB interventions implemented among patients with AUD or MDD.

Transitional Employment and Psychological Distress: a Longitudinal Study.

Although it has been established that employed status is generally associated with better mental health than unemployed status, the psychological mechanisms that underlie the longitudinal association between employment status and psychological distress remain to be understood. Initial mental health, lower coping skills and social support, and more stressful events could potentially preselect certain vulnerable individuals to be at higher risk for unemployment or employment instability. The aim of this study was to examine the longitudinal association between employment status (including transitional employment status) and psychological distress, controlling for the effect of initial psychological distress, coping skills, social support, and stressful events. In 2009, residents from the epidemiological catchment area of south-west Montréal responded to a randomized household survey for adults. Follow-up surveys were conducted in 2011 and 2013 (n = 1168). Psychological distress was measured using the K-10 scale. Employment status was not significantly associated with psychological distress over time, however there were significant differences between the groups with the continually employed reporting the lowest average levels of psychological distress over time. Controlling for coping skills, social support, stressful events and initial psychological distress changed the strengths of the association between transitional employment status and psychological distress at follow-up. A significant longitudinal association between continual unemployment and psychological distress was observed. Initial psychological distress was significantly associated with becoming unemployed. Results suggest initial psychological distress as a risk factor for becoming unemployed and that the negative psychological implications of employment transitions can be significantly reduced when conditions for coping are optimized.

Age-related differences in the associations among at-risk drinking, alcohol use disorder, and psychological distress across the adult lifespan: a nationwide representative study in South Korea.

To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults. We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54years), near-old (55-64years), early-old (65-74years), and late-old (≥ 75years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups. Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023). These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD.

Predictors of Number of Healthcare Professionals Consulted by Individuals with Mental Disorders or High Psychological Distress.

This study assesses the contribution of predisposing, enabling, and needs factors and related variables that predicted the number of healthcare professionals consulted for mental health reasons among 746 individuals with mental disorders and high psychological distress. The data were drawn from the third (T3) and fourth data collection periods (T4) of a longitudinal study conducted in a Quebec/Canada epidemiological catchment area. Hierarchical linear regression was performed on the number of types of healthcare professionals consulted in the 12 months prior to T4. Predictors were identified at T3, classified as predisposing, enabling, and needs factors (i.e., clinical and related variables) according to the Andersen Behavioral Model. Three needs factors were associated with the number of types of healthcare professionals consulted: Post-traumatic stress disorder, stressful events, and marginally suicide ideation. Three enabling factors: Having a family physician, previous use of mental health services, and employment status were also related to the dependent variable. Poor self-perception of mental health status was the only predisposing factor retained. While needs factors were the main predictors of the number of types of healthcare professionals consulted, enabling factors may reduce the influence of needs factors, by the deployment of various strategies that facilitate continuous and appropriate care.

Beyond Depression: Estimating 12-Months Prevalence of Passive Suicidal Ideation in Mid- and Late-Life in the Health and Retirement Study

To provide valid estimates of the 12-month prevalence of passive suicidal ideation among older adults, without conditioning on depression status, using the Health and Retirement Study (HRS). Data come from the 2012 HRS (n = 17,434) and 2004/5 Baltimore Epidemiologic Catchment Area (ECA) Study (n = 755). In the HRS, passive suicidal ideation (i.e., thought a lot about death-your own, someone else's, or death in general) is only assessed on respondents who reported dysphoria/anhedonia; in the ECA, ideation is assessed on all respondents, regardless of depression. We compare two approaches to estimating the 12-month prevalence of passive suicidal ideation in the HRS without conditioning on depression symptoms: 1) a probit selection model within the HRS, and 2) a prediction model developed using appended ECA data applied to the HRS. Using observed data alone on those who screened positive for depression, 6% of older adults reported passive suicidal ideation in the past year. Depending on the approach used, between 5.4% and 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation had they been assessed. Correcting for this selection bias, between 10.9% and 13.4% of U.S. adults over age 50 experienced passive suicidal ideation in 2012. Population surveillance of suicidal ideation among older adults is biased by survey approaches that only assess ideation in the context of depression.

Stressful life events and cognitive decline: Sex differences in the Baltimore Epidemiologic Catchment Area Follow-Up Study.

The reasons why women are at higher risk than men for developing dementia are unclear. Although studies implicate sex differences in the effect of stress on cognitive functioning, whether stressful life events are associated with subsequent cognitive decline has received scant research attention. In Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area study, 337 men and 572 women (mean age=47years) reported recent (within the last year) and remote (from 1981 until 1year ago) traumatic events (eg, combat) and stressful life events (eg, divorce/separation). At Waves 3 and 4 (2004-2005), they completed the Mini Mental State Examination (MMSE) and a word-list memory test. Multivariable models were used to examine the association between traumatic and stressful life events at Wave 3 and cognitive change by Wave 4. A greater number of recent stressful life events at Wave 3, but not of more remote stressful events, was associated with greater verbal memory decline by Wave 4 in women but not in men. Stressful events were not associated with change in MMSE, and there were no associations between traumatic events occurring at any time and subsequent memory or MMSE decline in either sex. Unlike men, middle-aged women with a greater number of recent stressful life events demonstrate memory decline over a decade later. Sex differences in cognitive vulnerability to stressful life events may underlie women's increased risk of memory impairment in late life, suggesting that stress reduction interventions may help prevent cognitive decline in women.

Towards an integrated understanding of aggression in the general population: Findings from an epidemiological catchment area study

The goal of this study is to identify patterns of various forms of aggression in the general population and their psychosocial and environmental correlates. Data from the Montreal Epidemiological Catchment Area study (N = 1855) were analyzed using latent class analysis and multinomial logistic regression. Four classes were identified: a ‘Low Aggression’ profile (91.4%) – individuals were older, more likely to be women, and had greater quality of life – and three profiles with individuals displaying aggression. The ‘Acting out’ profile (4.3%) reported property and mild verbal aggression, and profile membership was associated with impulsivity. The ‘Violent’ profile (2.0%) reported severe verbal aggression and physical aggression, and membership was associated with posttraumatic stress disorder and substance use disorders. Finally, the ‘Self-injuring’ profile (2.2%) reported self-harming behaviors along with mild verbal aggression and property destruction and were psychologically distressed. Findings are consistent with the risk factors in violence risk assessment instruments. They also shed light on how different types of aggression are interrelated and may help in the development of a psychological formulation of individuals for whom different types of aggression co-occur so that integrated prevention strategies may be put in place.

Sociodemographic Determinants of Personality Disorder In Patients of Obsessive-compulsive Disorder

Background & objective: Obsessive Compulsive Disorder (OCD) is the 4th most prevalent psychiatric disorder in Epidemiological Catchment Area (ECA) Survey and most individuals with OCD have co-morbid personality disorders (PD). The present study was undertaken to find the prevalence of PD among patients with OCD and the sociodemographic determinants that influence the development PD in patients with OCD.
 Methods:The cross-sectional analytical study was conducted in OCD clinic of Bangabandhu Sheikh Mujib Medical University from January 2015 to September 2016. Respondents were recruited from the OCD patients diagnosed on the basis of DSM-IV criteria and face to face interview was conducted with the help of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II questionnaire). The main outcome variable was PD in patients of OCD and the exposure variables (determinants) were selected sociodemographic characteristics.
 Result: The mean age of the OCD patients was (28 ± 8.7) years. Almost half (49%) of OCD patients belonged to the age group 20-30 years. Female respondents were 53.6%. Among the respondents, 62% had co-morbid PD. The mean age of the OCD patients with PD was observed to be significantly higher (29.1 ± 9.1 years) than those without PD (26.2 ± 7.8 years) (p = 0.047). Male OCD patients were 2.4 (95% CI of OR: 1.2 – 4.7) times more likely to have PD than their female counterparts (p = 0.012). Ethnic groups other than Muslims tend to be associated with PD more often and carry more than 8-fold (95% CI of OR: 8.4 – 37.2) higher risk of having the condition (p = 0.001). Likewise, other occupants were nearly 2(95% CI of OR: 0.98 – 3.74) times more prone to have PD than the students (p = 0.056).
 Conclusion: Personality Disorders are highly prevalent among people with OCD which remains underdiagnosed & under-addressed. Male OCD patients, non-Muslims and occupants other than students are more prone to have PD. Persons with Personality Disorders are far more likely to refuse psychiatric help and deny their problems.
 Ibrahim Card Med J 2017; 7 (1&2): 44-50

Enduring mental health in the Baltimore epidemiologic catchment area follow-up study.

To estimate the prevalence of enduring mental health (EMH) and examine important correlates of EMH 23years later in the Baltimore Epidemiologic Catchment Area Follow-Up study. We estimated the prevalence of EMH among 964 adults with diagnostic data at all four study waves (1981-2004). Those with EMH were compared to those with any mental or behavioral disorder by demographic, psychosocial, and health characteristics. We used forward selection models to identify the most important predictors of EMH. Twenty-six percent of participants met criteria for enduring mental health across the four waves. Neuroticism, GHQ-20 score, childhood conduct problems, female sex, maternal depression, and poor self-rated health were negatively associated with EMH. We identified several malleable factors associated with a decreased likelihood of enduring mental health. Interventions that target high neuroticism, childhood conduct problems, or maternal depression may increase the likelihood that children achieve EMH later in life. Identifying and treating other factors such as poor self-reported health and greater psychological distress may also keep sub-clinical symptoms from developing into a full mental or behavioral disorder.

Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27years of follow-up.

Little is known about the effect of antisocial personality disorder (ASPD) on the risks of cause-specific mortality in the community. This study aimed to close this gap by evaluating if ASPD increases risks of cause-specific mortality in population-based residential and institutionalized samples with 27years of follow-up. Data were collected in four metropolitan sites as part of the Epidemiologic Catchment Area (ECA) study during 1979-1983. Records were linked to the National Death Index through the end of 2007. Cox proportional hazards models adjusted for propensity weights and sample weights were fitted to estimate the effect of ASPD on the hazard of dying. 420 respondents with ASPD (median survival age 71.0years) and 15,367 without ASPD (median survival age 84.6years) were included in this study. Those with ASPD were more likely to die from all causes (HR = 4.46; 95% CI = 2.44-8.16), suicide (HR = 2.81; 95% CI = 1.03-7.65), malignant neoplasms (HR = 4.09; 95% CI = 2.66-6.28), chronic lower respiratory disease (HR = 5.67; 95% CI = 2.92-11.0), and human immunodeficiency virus infection (HR = 8.07; 95% CI = 2.03-32.1), but not from accidents (HR = 0.58; 95% CI = 0.17-1.93) or heart disease (HR = 1.09; 95% CI = 0.43-2.76). Our findings demonstrate that antisocial personality disorder is a strong predictor of all-cause mortality, and cause-specific mortality. Early identification, treatment, and prevention of ASPD are important public mental health initiatives that could reduce premature mortality among this vulnerable population.