General Psychiatric Morbidity Research Articles

Psychological impact of the earthquake 2023 in Turkey

BackgroundThe Turkish and Syrian earthquake on February 6th 2023, was one of the deadliest earthquakes in the last decade. It affected approximately 26 million people and left at least 50.000 dead. In this paper, we analyzed the psychological impact and the relationship between mental health factors, earthquake-related experiences and stressors, and resources related to the earthquake, 4 months after the event.MethodsWe conducted an analytical cross-sectional study, applying a survey to 320 adults (18–93 years old) in Adiyaman, Turkey. Post-traumatic stress disorder (PTSD) symptoms were assessed using the PC-PTSD, general psychiatric morbidity using the GHQ-12, together with questions focusing on suicidality, drug abuse, as well as experiences, related stressors and received support related to the earthquake.ResultsWe found a high prevalence of general mental health symptoms, and of PTSD. Fear of aftershocks and the loss of close family members were found to be risk factors for such symptoms. We didn’t find significant differences in the GHQ or the PC-PTSD scores when considering ethnicity, religion or financial income.ConclusionsHigh levels of general mental health symptoms and PTSD symptoms were found 4 months after the earthquake and need to be addressed in all groups, independently from potential religious, social or ethnic backgrounds. The results indicate a large psychiatric and material burden on the entire sample and some priority needs.

Costing the mental health harms of sexual and physical violence in adulthood: a prevalence-based analysis

Abstract Background When economists estimate how much violence ‘costs’, they rarely address the longer-term mental health harms resulting from sexual violence or the combined impact of sexual and physical violence, nor have most gender-disaggregated costs. Methods We applied prevalence-based modelling techniques to estimate the annual cost of experience of violence in adulthood, in terms of reduced quality of life and health service costs. Data were drawn from multiple sources, including the general population probability sample Adult Psychiatric Morbidity Survey. Prevalence and duration estimates used weighted data. Adjusted marginal effects for limiting mental health conditions and substance dependence were estimated for experience of sexual violence, physical violence, and sexual and physical violence combined. Disability weights were applied to estimate associated reduced quality of life and relative risks applied to health service delivery costs. Findings The estimated cost in 2019 of long-term reduced quality of life adults in England experienced because of violence during their adult years was £3,767 mil (€4,290 mil), with associated healthcare costs of £4,130 mil (€4703 mil). Both the costs of long-term lost quality of life and healthcare were higher in women than men. The costs associated with combined sexual and physical violence were particularly high, with an estimated 96% of these costs resulting from experiences of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim. Conclusions Sexual and physical violence both have substantial and independent associations with long-term mental distress, substance dependence and treatment and service use. Violence reduction interventions have the potential to reduce health service costs and increase population level quality of life. Future costings of sexual violence should fully incorporate the long-term impacts on mental health and gender-disaggregate estimate.

Development and validation of the Soweto Stress Scale: Mixed-methods, population-based study of adults living in Soweto, South Africa

This article moves from ethnography to epidemiology to generate a locally specific assessment of stress and evaluates it correlates with general psychiatric morbidity. We conducted two related ethnographic studies of stress and distress in Soweto, South Africa (N=107). We then used these studies to develop the Soweto Stress Scale, piloted the scale, and then evaluated its use in an epidemiological surveillance study of stress and health (N=933). We used factor analyses to evaluate factor structure and maximum likelihood estimates to evaluate comparative fit indices. The Keiser-Meyer-Olkin test identified sufficient sample variation, and the scale was suitable for factor analysis. The confirmatory factor analysis supported a single-factor model with a χ2(df) (104) = 475.88; p < 0.001. Even though the comparative fit index/Tucker-Lewis index were poor and could not be improved, the Cronbach's alpha (0.81) was excellent, suggesting that the model was a reasonable representation of the data. The final model indicated that there was covariance between items and consistency with our theoretical concept of stress. The Soweto Stress Scale shows strong internal consistency and reflects a very localized view of social stressors and may serve to identify those with higher psychological morbidity. Given the racial, ethnic, and linguistic diversity within South Africa, our emic stress scale was tested in a community sample but may be useful for screening individuals with higher levels of stress or psychological distress within clinical settings.

Prolonged grief disorder in Chinese Shidu parents who have lost their only child

ABSTRACT Background: China has the largest population of ‘“loss-of-only-child’ parents, that are also known as Shidu parents in Chinese society; however, little is known about their unresolved grief. Objective: This is the first study to examine the grief symptoms, prevalence, comorbidity and potential predictors of prolonged grief disorder (PGD) in such parents, taking into consideration that the new PGD diagnostic criteria ICD-11 will soon be implemented in China. Methods: 149 Shidu parents completed assessments of PGD (PG-13), PTSD (PCL-C), depression (CES-D) and general psychiatric morbidity (GHQ-12) via in-person interviews. Results: Of the 149 Shidu parents, 22.2% met the PGD criteria, with a mean of 7.59 years post-loss, and 62.4% experienced daily longing or yearning. Regression analysis indicated that fewer years since loss, subjective perception of poor economic situation, female gender and more hospital visits were prominent risk factors for the development of PGD. Older age of the parents at the time of child loss was also associated with PGD. Parents with PGD had higher comorbidity of PTSD or depression compared with those without PGD. Conclusions: There is a high prevalence of PGD and a high rate of comorbidity between PGD and PTSD or depression in Shidu parents in China, which highlights the need of timely developing effective assessments and interventions to prevent PGD in this population, particularly in female, recently bereaved, low-income and aged parents who lost their only child.

Prevalence and Socio-Demographic Correlates of Mental Health Problems Among Iranian Health Sciences Students.

The primary objective of the present study was to compare the mental health status of Iranian medical vs other health sciences students and to examine how demographic factors relate to their mental health problems. A total of 560 medical and other health sciences students (250 (44.6%) males and 310 (55.4%) females) were recruited from Iran University of Medical Sciences. Data were obtained by self-administered questionnaire, including questions on socio-demographic characteristics. The Beck Depression Inventory, Beck Anxiety Inventory, General Health Questionnaire, and WHO well-being index were used to assess mental health status of students. Ten percent of students had BDI scores consistent with clinically significant depression (6.6% mild, 1.8% moderate, 1.6% severe), and 28.7% had BAI scores consistent with clinically significant anxiety (20.7% mild, 7.1% moderate, 0.9% severe). Kurdish students had an odds ratio (OR) of 2.71 (95% CL, 1.22-6.02) for mild to severe depression symptoms when compared to Persian students. The prevalence of distressed health sciences students and poor psychological well-being was 13.4% and 14.1%, respectively. Maternal education gave an OR of 0.57 (0.35-0.93) for anxiety symptoms, after adjustment for all other factors. The possibility of general psychiatric morbidity was significantly lower in students who studied medicine (OR, 0.40 (0.21-0.71)). Being born in the capital city was associated with better psychological well-being (OR, 0.48 (0.26-0.86)). Ethnicity, birthplace, discipline, and maternal educational level were major determinants of mental health status among health sciences students. Further research should be undertaken to determine the prevalence of psychological disorders using more reliable diagnostic interview.

Prevalence, comorbidity, quality of life and use of services of obsessive-compulsive disorder and subthreshold obsessive-compulsive symptoms in the general adult population of Greece

Objective: We aimed to describe the epidemiology of obsessive-compulsive disorder (OCD) and related subthreshold symptoms in the general population of Greece and to assess the comorbidity, use of health services and impact on quality of life of these syndromes in the general population.Methods: This was a secondary analysis of the 2009–2010 general population Greek psychiatric morbidity survey (4902 participants living in private households, response rate 54%). Psychiatric disorders were assessed with the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D.Results: 1.69% of the participants (95% confidence interval [CI]: 1.33%–2.05%) met criteria for current OCD while 2.79% met criteria for subthreshold obsessive-compulsive symptoms (95%CI: 2.33%–3.26%). In the adjusted analysis few sociodemographic associations remained statistically significant. Although the full-blown syndrome was more severe in terms of comorbidity and quality of life our results showed that even subthreshold obsessive-compulsive symptoms were associated with significant comorbidity and reductions in quality of life. Use of mental health services was small.Conclusions: OCD is an under-treated public health problem that needs more attention in Greece and elsewhere. Provision of specialised mental health services should be a priority for publicly funded national health systems.KeypointsOCD is common in the general population of Greece with few sociodemographic associations apart from subjective financial difficulties.The comorbidity pattern of the full-blown syndrome versus the subthreshold obsessive-compulsive symptoms is similar and differs in magnitude in the expected way.Quality of life in OCD is greatly reduced especially when there is chronicity and/or comorbidity with depression.Use of services is limited but comorbidity with depression may increase the chances of consultation with a mental health professional.

Status of mental-health services for adolescents with psychiatric morbidity in youth correctional institutions in Lagos

Background: High prevalence rates of psychiatric morbidity have been documented among adolescents within youth correctional institutions in Nigeria. However, there has not been prior investigation to determine the capacity for and nature of mental health services being provided in these institutions. Objectives: To assess psychiatric morbidity among adolescents within youth correctional institutions in Lagos, while simultaneously examining the capacity for and the scope of mental health services. Methods: Psychiatric morbidity and alcohol/substance use disorder were assessed among 165 respondents using the Strengths and Difficulties Questionnaire, and the CRAFFT screening tool for adolescent substance use disorder. Availability of mental-health services in the institutions was examined using an ‘audit protocol’.Results: We found prevalence rates of 18.2% and 15.8% of general psychiatric morbidity and alcohol/ substance use disorder, respectively, among the adolescents. Only about a third (34.3%; n = 20) of the operational staff at the institutions had educational backgrounds relevant to psycho-social services for children/adolescents, while less than a quarter (22.4%, n = 13) has ever received any training in child mental health services. There was no evidence of mental health screening and intervention in the service framework within the institutions.Conclusions: We concluded that there was evidence for significant mental health service gaps within the youth correctional services in Lagos.

Factors Affecting Emergency Department Use by a Chronically Homeless Population.

Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals. A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified by using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics. In a three-month period, 30% of participants visited the ED one or two times (moderate ED use) and 12% visited three or more times (high-ED use). ED use was most strongly associated with poor health and utilization of other non-ED services and to a lesser extent with housing status. Increased ED utilization was associated with both general medical and psychiatric morbidity and greater use of non-ED services. Thus ED use was related to high need and acuity and was not ameliorated by use of other services. Housing instability and homelessness contributed less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.

Body image perception and mental health of in-school adolescents in Benin City, Nigeria.

Perception of one's physical appearance is important in the development of the concept of body image. Desire to achieve the unrealistic image of 'physical perfection' often make adolescents feel discontented; thus leading to mental health problems. To assess body image perception (BIP) and its relationship with mental health of secondary school adolescents in Benin City, Nigeria. The study was cross-sectional and descriptive, conducted in senior secondary schools in Benin City. Six hundred randomly selected subjects completed the 28-item General Health Questionnaire, the appearance evaluation (AE) and body areas satisfaction (BAS) subscales of the Multidimensional Body-Self Relations Questionnaire (MBSRQ), and a sociodemographic data collection sheet. Cross tabulation of categorical variables and correlation analysis was performed by means of SPSS version 19.0, with level of significance set atP= 0.05. Two hundred and twenty three (36.7%) and 46.2% of the respondents were dissatisfied with their appearance and discrete aspects of their bodies, respectively. The prevalence of probable psychiatric morbidity was 35.4%. AE and BAS subscales of the MBSRQ had significant but weak negative correlation with psychiatric morbidity (r = -0.195,P= 0.000; r = -0.097,P= 0.018, respectively). BIP was significantly associated with psychiatric morbidity. Subjects who were less satisfied with their general appearance and discrete aspects of their body screened positive for general psychiatric morbidity.

A Cross-sectional Study on Posttraumatic Stress Disorder and General Psychiatric Morbidity Among Adult Survivors 3 Years After the Wenchuan Earthquake, China.

After the Wenchuan earthquake, a large number of studies have focused on postearthquake psychological disorders among survivors; however, most of these studies were conducted within a relatively short period. This study was conducted to examine the symptoms of posttraumatic stress disorder (PTSD) and general psychiatric morbidity among adult survivors 3 years after the Wenchuan earthquake, China. Through a multistage systematic sampling approach, a cross-sectional survey of 360 participants, 18 years or older, was conducted. The prevalence of PTSD and general psychiatric morbidity was 10.3% and 20.6%, respectively. Multivariate analysis revealed significant predictors for PTSD, including female gender and having felt guilt concerning someone's death or injury. Significant predictors for general psychiatric morbidity included unmarried status and having been in serious danger. These results suggest that mental health services should be continuously available to earthquake survivors.

Prevalence and correlates of depression and anxiety disorder in a sample of inmates in a Nigerian prison.

Prisoners tend to be marginalized and deprived of the rights and privileges that other citizens in the community enjoy. Their separation from families, adverse effects on health of prison environment, and the uncertainty about the future place a great psychological burden on them which can lead to the development of mental illness. The aim of this study was to determine the prevalence of psychiatric morbidity (depression and anxiety) and the associated factors among a sample of the prison inmates. The study was descriptive and cross-sectional in design; it was conducted in a medium security prison in Benin City, Nigeria. Participants were interviewed with the Self-Reporting Questionnaire-20, the Hospital Anxiety and Depression Scale, and a socio-demographic questionnaire. Two hundred and fifty-two prisoners who were selected by systematic sampling techniques participated in the study and the data were analyzed using the 16th version of the SPSS with the statistical level of significance set at p < 0.05. Data were presented in tables; frequencies and percentages were calculated. Chi-square and logistic regression statistical tests were performed to determine variables that have relationship with psychiatric morbidity. The mean age of the respondents was 33.6 years (SD ± 9.29), and the majority of the respondents (43.7%) were in the age range 21-30 years. The prevalence of general psychiatric morbidity (SRQ-20 caseness) was 80.6%, while 72.6% and 77.8% were found to be positive for depression and anxiety symptoms respectively on the HADS. Overall, 84.5% of the respondents had at least one type of psychiatric morbidity. Age, marital status, self-reported physical and mental health, previous mental illness, imprisonment status, prison accommodation, prison meal, and health care services were found to be significantly associated with depression, anxiety or general psychiatric morbidity. Self-reported poor current mental health was the only variable that predicted all the three types of psychiatric morbidity. Prisoners in this study, and as in previous reports, had high prevalence rates of psychiatric morbidity. Thus, prisoners have a need for regular psychiatric screening and treatment. The consequences of untreated psychiatric morbidity and the need for improved health care services and infrastructure in the prison were discussed.

Prevalence and Risk Factors for Anxiety and Depression among Commercial Bank Workers in Abeokuta, southwestern Nigeria

Objective : There is a dearth of studies on anxiety and depression among well defined occupational groups. Current evidence suggests that both conditions may be found among workers exposed to stressful work conditions and they impact negatively on productivity. The aim of this study was to determine the prevalence of Generalised Anxiety Disorder (GAD) and Major Depression (MD) and their associated socio-demographic and work-related factors among commercial bank workers in Abeokuta. Method: Using a cluster sampling method, two hundred and eighty six (286) bank workers in 14 randomly selected banks were assessed in a two-stage survey procedure. The first stage involved the administration of a socio-demographic questionnaire and the 20-item Self Reporting Questionnaire (SRQ-20) to all consenting bank workers to screen for general psychiatric morbidity, while the second stage involved interview of SRQ cases and a proportion of non cases with the Structured Clinical Interview for DSM IV axis I Diagnosis (SCID) for the diagnosis of GAD and MD. Results: The prevalence of GAD and MD were 5.6% and 1.7% respectively. Identified risk factors for GAD included female gender (OR 5.1, 95% CI 1.6-16.1), age less than 30 years (OR 17.1, 95% CI 2.2-131.6), single marital status (OR 4.2 95% CI 1.5-11.7), and middle occupational post (=7.16, df=2, p=0.02). Major Depression (MD) was associated with longer average daily working hours (t=-2.2, p=0.026), complaints of health problems in the previous month (= 8.8, p=0.012), as well as use of sedative medication (OR=17.2, 2.3-125). Conclusion: GAD and MD occur among bank workers and they are related to socio-demographic, health and occupational correlates. These findings suggest the need to adopt a holistic approach in developing effective prevention strategies, which may include the promotion of occupational mental health and stress management programmes among vulnerable occupational groups for enhancement of health and productivity.

Experienced Carers Helping Others (ECHO): Protocol for a Pilot Randomised Controlled Trial to Examine a Psycho‐educational Intervention for Adolescents with Anorexia Nervosa and Their Carers

Experienced Carers Helping Others (ECHO) is an intervention for carers of people with eating disorders. This paper describes the theoretical background and protocol of a pilot multicentre randomised controlled trial that will explore the use of two variants of ECHO for improving outcomes for adolescents with anorexia nervosa (AN) referred for outpatient care. Adolescent patients and their carers (typically parents and close others in a supportive role) will be recruited from 38 eating disorder outpatient services across the UK. Carers will be randomly allocated to receive 'ECHOc' guided self-help (in addition to treatment as usual), 'ECHO' self-help only (in addition to treatment as usual) or treatment as usual only. Primary outcomes are a summary measure of the Short Evaluation of Eating Disorders at 6- and 12-month follow-ups. Secondary outcomes are general psychiatric morbidity of AN patients and carer, carers' coping and behaviour, and change in healthcare use and costs at 6- and 12-month follow-ups. Therapist effects will be examined, and process evaluation of ECHOc will be completed. The findings from this pilot trial will be used in preparation for executing a definitive trial to determine the impact of the preferred variant of ECHO to improve treatment outcomes for AN.

Trial of CBT for impulse control behaviors affecting Parkinson patients and their caregivers

To test the effects of a novel cognitive-behavioral therapy (CBT)-based intervention delivered by a nurse therapist to patients with Parkinson disease (PD) with clinically significant impulse control behaviors (ICB). This was a randomized controlled trial comparing up to 12 sessions of a CBT-based intervention compared to a waiting list control condition with standard medical care (SMC). A total of 27 patients were randomized to the intervention and 17 to the waiting list. Patients with a Mini-Mental State Examination score of <24 were excluded. The coprimary outcomes were overall symptom severity and neuropsychiatric disturbances in the patients and carer burden and distress after 6 months. Secondary outcome measures included depression and anxiety, marital satisfaction, and work and social adjustment in patients plus general psychiatric morbidity and marital satisfaction in carers. There was a significant improvement in global symptom severity in the CBT intervention group vs controls, from a mean score consistent with moderate to one of mild illness-related symptoms (χ(2) = 16.46, p < 0.001). Neuropsychiatric disturbances also improved significantly (p = 0.03), as did levels of anxiety and depression and adjustment. Measures of carer burden and distress showed changes in the desired direction in the intervention group but did not change significantly. General psychiatric morbidity did improve significantly in the carers of patients given CBT. This CBT-based intervention is the first to show efficacy in ICB related to PD in terms of patient outcomes. The hoped-for alleviation of carer burden was not observed. The study demonstrates the feasibility and potential benefit of a psychosocial treatment approach for these disturbances at least in the short term, and encourages further larger-scale clinical trials. The study provides Class IV evidence that CBT plus SMC is more effective than SMC alone in reducing the severity of ICB in PD, based upon Clinical Global Impression assessment (χ(2) = 16.46, p < 0.001): baseline to 6-month follow-up, reduction in symptom severity CBT group, 4.0-2.5; SMC alone group, 3.7-3.5.

Childhood cognitive function and adult psychopathology: associations with psychotic and non-psychotic symptoms in the general population

BackgroundLower cognitive ability in childhood is associated with increased risk of future schizophrenia, but its relationship with adult psychotic-like experiences and other psychopathology is less understood.AimsTo investigate whether this childhood risk factor is shared with adult subclinical psychiatric phenotypes including psychotic-like experiences and general psychiatric morbidity.MethodA population-based sample of participants born in Great Britain during 1 week in March 1946 was contacted up to 20 times between ages 6 weeks and 53 years. Cognition was assessed at ages 8, 11 and 15 years using a composite of age-appropriate verbal and non-verbal cognitive tests. At age 53 years, psychotic-like experiences were self-reported by 2918 participants using four items from the Psychosis Screening Questionnaire and general psychiatric morbidity was assessed using the scaled version of the General Health Questionnaire (GHQ-28).ResultsPsychotic-like experiences were reported by 22% of participants, and were highly comorbid with other psychopathology. Their presence in adults was significantly associated with poorer childhood cognitive test scores at ages 8 and 15 years, and marginally so at age 11 years. In contrast, high GHQ scores were not associated with poorer childhood cognition after adjustment for the presence of psychotic-like experiences.ConclusionsPsychotic and non-psychotic psychopathologic symptoms are highly comorbid in the general population. Lower childhood cognitive ability is a risk factor for psychotic-like experiences in mid-life; these phenomena may be one end of a continuum of phenotypic expression driven by variation in early neurodevelopment.

Identification of clinically significant psychological distress and psychiatric morbidity by examining quality of life in subjects with occupational asthma

BackgroundThe Juniper Asthma Specific Quality of Life Questionnaire (AQLQ(S)) is a questionnaire that allows measurement of disease specific quality of life. We wanted to examine correlations between the (AQLQ(S)) general and different subscale scores and both psychiatric morbidity and levels of psychological distress in individuals with occupational asthma (OA) and to determine if results in the emotional function subscale allow identification of individuals with clinically significant psychological distress or current psychiatric disorders.MethodsThis was a cross-sectional study of individuals with OA who were assessed during a re-evaluation for permanent disability, after they were no longer exposed to the sensitizing agent. Patients underwent a general sociodemographic and medical history evaluation, a brief psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD) and completed a battery of questionnaires including the AQLQ(S), the St-Georges Respiratory Questionnaire (SGRQ), and the Psychiatric Symptom Index (PSI).ResultsThere was good internal consistency (Cronbach alpha = 0.936 for the AQLQ(S) total score) and construct validity for the AQLQ(S) (Spearman rho = -0.693 for the SGRQ symptom score and rho = -0.650 for the asthma severity score). There were medium to large correlations between the total score of the AQLQ(S) and the SGRQ symptom score (r = -.693), and PSI total (r = -.619) and subscale scores (including depression, r = -.419; anxiety, r = -.664; anger, r = -.367; cognitive disturbances, r = -.419). A cut-off of 5.1 on the AQLQ(S) emotional function subscale (where 0 = high impairment and 7 = no impairment) had the best discriminative value to distinguish individuals with or without clinically significant psychiatric distress according to the PSI, and a cut-off of 4.7 best distinguished individuals with or without a current psychiatric disorder according to the PRIME-MD.ConclusionsImpaired quality of life is associated with psychological distress and psychiatric disorders in individuals with OA. Findings suggest that the AQLQ(S) questionnaire may be used to identify patients with potentially clinically significant levels of psychological distress.

Coping With the Impact of Working in a Conflict Zone

Diplomats as a result of their work in conflict zones are "at risk" of exposure to intense psychological stressors. This study investigated the mental and physical health of diplomats working in a war zone. The study used a comparative retrospective cohort design. Mental and physical health outcomes were compared for two groups of United Kingdom diplomats: those who had completed postings in Iraq and/or Afghanistan, and those deployed overseas to nonhardship posts. Diplomats posted to Iraq and Afghanistan and individuals who experienced trauma had significantly more symptoms of posttraumatic stress disorder. There were no significant differences between the groups in levels of general psychiatric morbidity, fatigue, and alcohol misuse. Although personnel who went to war zones or suffered trauma were more psychologically symptomatic, the increased burden of symptoms was not associated with frank illness.

The missing p in psychiatric training: why it is important to teach pain to psychiatrists.

Pain problems are exceedingly prevalent among psychiatric patients. Moreover, clinical impressions and neurobiological research suggest that physical and psychological aspects of pain are closely related entities. Nonetheless, remarkably few pain-related themes are currently included in psychiatric residency training. To provide clinical and scientific rationale for psychiatric-training enrichment with basic tenets of pain medicine and to raise the awareness and sensitivity of physicians, scientists, and educators to this important yet unmet clinical and public health need. We present 3 lines of translational research evidence, extracted from a comprehensive literature review, in support of our objectives. First, the neuroanatomical and functional overlap between pain and emotion/reward/motivation brain circuitry suggests integration and mutual modulation of these systems. Second, psychiatric disorders are commonly associated with alterations in pain processing, whereas chronic pain may impair emotional and neurocognitive functioning. Third, given its stressful nature, pain may serve as a functional probe for unraveling pathophysiological mechanisms inherent in psychiatric morbidity. Pain training in psychiatry will contribute to deeper and more sophisticated insight into both pain syndromes and general psychiatric morbidity regardless of patients' pain status. Furthermore, it will ease the artificial boundaries separating psychiatric and medical formulations of brain disorders, thus fostering cross-fertilizing interactions among specialists in various disciplines entrusted with the care of patients experiencing pain.

Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan

BackgroundOn average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. In earthquakes developing countries are prone to large-scale destruction because of poor structural quality of buildings, and preparedness for earthquakes. On 8th October 2005, a major earthquake hit the remote and mountainous region of northern Pakistan and Kashmir. We wanted to find out the rate of PTSD in a randomly selected sample of participants living in earthquake area and the correlates of the PTSD. MethodThe study was conducted 18months after the earthquake. We selected a sample of men and women living in the houses and tents for interviews. Using well established instruments for PTSD and general psychiatric morbidity we gathered information from over 1200 people in face to face interviews. We gathered information about trauma exposure and loss as well. Results55.2% women and 33.4% men suffered from PTSD. Living in a joint family was protective against the symptoms of PTSD. Dose of exposure to trauma was associated with the symptoms of PTSD. Living in a tent was associated with general psychiatric morbidity but not with PTSD. LimitationsWe used questionnaire instead of interviews to detect the symptoms of psychiatric disorders. ConclusionsThe symptoms of PTSD are common 18months after the earthquake and they are specifically associated with the dose of trauma exposure. This may have implications for rehabilitation of this population.

Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake

BackgroundThe association between ages and psychological impact of natural disasters has not been well characterized. A population-based study was conducted 15 months after the 2008 Sichuan earthquake to assess whether elderly survivors were more likely to develop posttraumatic stress disorder (PTSD) and general psychiatric morbidity.MethodsA population-based survey of 327 survivors (152 elders, 175 younger adults) was conducted in severely affected areas by the earthquake, using a multi-stage systematic sampling design.ResultsCompared with the younger adult survivors, the elderly were more likely to have symptoms of PTSD (22.5% vs. 8.0%, p = 0.001) and general psychiatric morbidity (42.0% vs. 25.4%, p = 0.003). Risk factors, such as being elderly, having been in serious danger, having lost family members, and having felt guilt concerning one's death or injury were significantly associated with developing PTSD; being elderly, having family members or friends seriously injured, and having felt guilt concerning one's death or injury were significantly associated with developing general psychiatric morbidity. Utilization of mental health services is strongly associated with the decreased risk for developing both of the symptoms.ConclusionCompared with the younger adults, the elderly survivors were more likely to develop PTSD and general psychiatric morbidity. More mental health services should be distributed to the elderly and groups at particular risk, to ensure their smooth mental health reconstruction after the earthquake.