Major Mental Disorders Research Articles

A Cross-Sectional Study on Cognitive Errors and Obsessive-Compulsive Disorders among Young People During the Outbreak of Coronavirus Disease 2019.

Given that the lockdown measures taken so as to diminish the dissemination of the COVID-19 pandemic are likely to create major mental disorders such as obsessive-compulsive disorder (OCD), the present study was conducted aiming to evaluate the prevalence of OCD and cognitive errors among young people during the outbreak of coronavirus disease 2019. The present study is a descriptive, cross-sectional study in which a total of 150 young people aged 13 to 19 were randomly included. Maudsley Obsessive-Compulsive Inventory Questionnaire (MOCI) and Cognitive Error Questionnaire (CEQ) were completed, and then their results were analyzed by SPSS 22 software. The results revealed that 67.3% of the subjects who were evaluated may have demonstrated OCD symptomatology. The prevalence of obsessive-compulsive disorder symptoms in women was slightly higher than in men (72.1 compared to 60.3%). Likewise, the test results indicated that there was a significant difference between obsessive-compulsive disorder symptom in men and women (p = .001). There was also a significant difference between the two groups with OCD symptoms and without OCD symptoms in all the components of cognitive errors (p = .001). To the authors’ best of knowledge, this is the first study that has evaluated OCD symptoms at the time of COVID-19 prevalence. The findings suggest the need to enhance the prevention of relapse during social restrictions as well as to develop other strategies including online consultation and digital psychiatric management.

Problems of psychopathologic systematics: alternative approaches and clinical practice requests

The reliability and validity of traditional classifications give rise to justifiable criticism because of the conventionality of the boundaries between norm and pathology, fuzzy delimitation of disorders and their frequent co-occurrence, heterogeneity and clinical instability of symptoms within the diagnostic categories. There is little evidence that the majority of mental disorders are discrete entities. Discontent with the expert consensus classifications have led to attempts at a new quantitative and empirical systematization of psychopathology. Two alternative projects have been proposed: Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP). The aim of the paper is to clarify the conceptual framework of RDoC and HiTOP, discuss their advantages and disadvantages in terms of the prospects for use in clinical practice.

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease

IntroductionDifferent studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL. Patients and methodsSubjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test. ResultsIn all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p=0.005), mood disorder (p=0.004), anxiety disorder (p=0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p=0.01). Major depressive disorder (p=0.004), social phobia (p=0.03), PTSD (p=0.02), and Generalized Anxiety Disorder (p<0.001), were found to be significantly associated with lower QoL. ConclusionsIBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.

Assessment of major mental disorders in a German peripartum cardiomyopathy cohort.

AimsPeripartum cardiomyopathy (PPCM) is a heart disease affecting women during the last month of pregnancy or in the first months after delivery. The impact of the disease on mental health is largely unknown.Methods and resultsMajor mental disorders were assessed by a structured clinical interview in 40 patients with a confirmed PPCM diagnosis, and the data were compared with published prevalence in postpartum women. Circulating biomarkers associated with mental health, such as kynurenine, serotonin, and microRNA (miR)‐30e, were evaluated in PPCM and compared with matched healthy pregnancy‐matched postpartum controls (PP‐Ctrl). Major mental disorders were diagnosed in 65% (26/40) of the PPCM cohort. The prevalence for major depressive disorders was 4‐fold, for post‐traumatic stress disorder 14‐fold, and for panic disorder 6‐fold higher in PPCM patients compared with postpartum women without a PPCM diagnosis. Compared with PP‐Ctrl, PPCM patients displayed elevated levels of serum kynurenine (P < 0.01), reduced levels of serum serotonin (P < 0.05), and elevated levels of plasma miR‐30e (P < 0.05).ConclusionsThe majority of PPCM patients in the present cohort displayed mental disorders with a higher prevalence of major depressive disorders, post‐traumatic stress disorder (PTBS), and panic disorder, compared with postpartum women without a PPCM diagnosis. This higher prevalence was associated with an impaired tryptophan metabolism and elevated levels of the depression‐associated miR‐30e, suggesting a potential predisposition for mental disorders at the time of PPCM diagnosis. Consequently, physicians should be aware of the increased risk for mental disorders in PPCM patients, and psychiatric assessment should be included in the diagnosis and management of PPCM patients.

Short communication: Self-reported sleep-wake disturbances preceding onset of full-threshold mood and/or psychotic syndromes in community residing adolescents and young adults

BackgroundInsomnia may predict onset of mental disorders in adults. However, it is unclear whether the same directional relationship exists during the peak age range for the onset of major mental disorders and/or whether other types of sleep-wake disturbance, such as hypersomnia, show similar associations. MethodsLongitudinal follow-up of >1800 community residing twins and non-twin siblings (mean age ~26; 57% female). Adjusted relative risk ratios and 95% confidence intervals (Adj RR and 95% CI) were estimated for onset of depression, hypomania and psychosis in individuals with prior self-reported exposure to Insomnia and/or Hypersomnia or proxies for insomnia disorder (Insomnia and Daytime Impairment) and atypical symptom profile (Hypersomnia and Anergia). ResultsRisk of onset differed somewhat according to type of syndrome and the nature of sleep-wake disturbance (e.g. Insomnia alone increased risk of first onset of psychosis). Overall, the risk for onset of any syndrome was best identified using composite measures (Adj RR were ~1.5–2.5) such as Insomnia and Hypersomnia, Insomnia and Daytime Impairment, or Hypersomnia and Anergia, rather than singular items describing night-time disruption only. ConclusionsThe magnitude of risk of onset of major mental health problems and the availability of effective, low-cost, individual and population-based interventions for sleep-wake disturbances, suggest that it is justifiable to introduce screening for and strategies to overcome sleep problems in youth.

An integrative gene network-based approach to uncover the cellular and molecular infrastructures of schizophrenia

AimsHigh phenotypic and endophenotypic heritability of schizophrenia indicates substantial involvement of genetic elements in the occurrence of this disorder. Multiplicity of hypotheses about the genetic basis of schizophrenia pathogenesis suggests that there is still no integrated image from cellular and molecular infrastructure of this disorder. Materials and methodsHere, we aimed to gain an integrated insight into the genetic basis of schizophrenia through gene set enrichment and network analysis to find the most important developmental stages/brain regions, chromosomal locations and metabolic pathways involved in the pathogenesis of schizophrenia. We investigated major mental disorders whose genetic bases are significantly overlapping with the schizophrenia gene set. Key findingsEnrichment analyses uncovered 60 developmental stages/brain regions, 21 chromosomal hotspots and 16 pathways which are significantly associated with the found gene set. Our results demonstrated early mid-fetal/cortex as the most prominent developmental stage/brain region, chr16q22 as the most significant cytoband and the neuroactive ligand-receptor interaction as the most central pathway associated with schizophrenia. Further analyses revealed that autistic disorder has the most shared genes with schizophrenia. Moreover, mitogen-activated protein kinase-3 (MAPK3), calcium voltage-gated channel subunit alpha1 C (CACNA1C), solute carrier family 6 member 4 (SLC6A4) and 5-hydroxytryptamine receptor 2A (HTR2A) genes are the most central genes in the pathogenesis of schizophrenia. SignificanceIn addition to summarizing what has been found on schizophrenia-associated genes in an integrative holistic framework, our results may help identify principle schizophrenia-associated cellular and molecular infrastructures, and provide support for further investigation on potential diagnostic and therapeutic biomarkers for schizophrenia.

Dental Medicine and Psychiatry: The Need for Collaboration and Bridging the Professional Gap.

Dental health and mental health are strongly associated. Neglecting either of them can negatively influence on the other and induce many health and communication problems. Association between oral/dental health, self-esteem, quality of life and holistic health has been recognized for a long time. There has been increasing interest in dental health among patients with major mental disorders as well as in mental states and problems among patients with orodental disorders. Despite of huge progress in the field of dentistry psychiatric patients have had poor oral/dental health. Patients with major mental disorders have quite number of the risk factors for oral disease and consequently poorer dental health, but oral/dental problems and diseases are commonly overlooked or neglected. Bad or inappropriate dental care is related to the patients' amotivation, ignorance, fears, low economic status, stigmas and negative attitudes by the medical professionals. It is important to stress that dental diseases in psychiatric patients deserve the same attention as other comorbid somatic diseases. In this review we accentuate the need for more collaboration in order to bridge the professional gap between dentistry and psychiatry.

Institutional adjustment of young adults undergoing forensic assessment

ABSTRACT Adolescence and emerging adulthood are considered distinct developmental periods and times of peak criminal offending and onset of many major mental disorders. Previous research suggests that adolescents and young adults in adult correctional institutions adjust more poorly than their older counterparts do, and psychosocial adjustment is associated with pre-existing vulnerability. Research with institutionalized young adults is sparse. We studied institutional and psychosocial adjustment of men admitted to a forensic psychiatric hospital. Overall, younger age on admission was associated with previous vulnerability (i.e. adverse childhood experiences) and institutional adjustment (e.g. assaults, management problems), but not psychosocial adjustment (i.e. mood problems, psychosis, social withdrawal). Age had small and inconsistent effects on adjustment measures in regression analyses controlling for length of stay. Comparing the 141 young adults aged 18–24 with 141 men aged 25–59 matched on pre-admission psychiatric and criminal history did not yield age-related group differences. The apparent poorer adjustment of young adults may be attributable to younger onset of psychiatric and criminal justice involvement, resulting in earlier admission to the institution.

A certificate in youth psychiatry: meeting the training needs of psychiatrists.

This paper provides the rationale for the development of sub-specialty training in youth psychiatry. Training needs for youth psychiatry are discussed and the opportunities provided by sub-specialisation in youth psychiatry are presented. The majority of mental disorders have their onset prior to 25 years. There has been substantial recent growth in services to meet the clinical needs of young people. The development of these services has exposed gaps in current training for psychiatrists, which varies considerably between child and adolescent, and adult psychiatry. Competencies acquired by psychiatrists in youth mental health are non-standardised, which may hinder optimal care. Sub-specialty training in youth psychiatry is needed to meet workforce demands. The development of a certificate in youth psychiatry, by the RANZCP Section for Youth Mental Health, is underway. This will complement existing training and provide trainees and psychiatrists the opportunity to develop specialist skills in the provision of mental health care for young people negotiating the transition between adolescence and adulthood.

Inflammation in Mental Disorders: Is the Microbiota the Missing Link?

Research suggests that inflammation is important in the pathophysiology of mental disorders. In addition, a growing body of evidence has led to the concept of the microbiota-gut-brain axis. To understand the potential interactions, we begin by exploring the liaison between the immune system and mental disorders, then we describe the evidence that the microbiota impact the immune response in the developing brain. Next, we review the literature that has documented microbiome alterations in major mental disorders. We end with a summary of therapeutic applications, ranging from psycho-biotics to immunomodulatory drugs that could affect the microbiota-gut-brain axis, and potential treatments to alleviate the adverse effects of antipsychotics. We conclude that there is promising evidence to support the position that the microbiota plays an important role in the immunological pathophysiology of mental disorders with an emphasis on psychotic disorders and mood disorders. However, more research is needed to elucidate the mechanisms.

A systematic review on the genotoxic effect of serotonin and norepinephrine reuptake inhibitors (SNRIs) antidepressants.

Depression is a major mental disorder affecting millions of people worldwide. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are one of the antidepressant drugs prescribed for depression treatment. There are many contradiction studies about the adverse effect and genotoxicity of SNRIs. So here, based on the guidelines proposed at the PRISMA statement, we performed a quantitative systematic review by searching international electronic databases (PubMed, Scopus, Embase, and Web of Science) for published documents on SSNRIs and their genotoxicity effects. The database searches retrieved 336 records, 18 of which met the inclusion criteria. Evaluation of the selected articles showed that a total of 9 articles were appropriate for final review. Most of these studies (78%) reported positive results for the genotoxicity of SNRIs CONCLUSION: Finally, we can conclude that these drugs have the potential to damage DNA.

Pourquoi les neurosciences ne tiennent pas leurs promesses pour la psychiatrie ?

Biological research has produced major advances in our understanding of our bodies and, where systems go wrong, is producing remedies to address these, but it has yet to do the same for the mind. This is because no causative biological evidence has been found for the major mental disorders in contrast to the wealth of psychosocial findings. This disparity in regard and resource needs to be addressed.

S162. MULTI-MODAL ANALYSIS OF THE EFFECTS OF URBAN UPBRINGING ON BRAIN STRUCTURE: THE FOR2107 COHORT

BackgroundUrbanicity has been identified as a major environmental risk factor for schizophrenia as well as other major mental disorders. While initial structural brain imaging studies have pointed to medial and lateral prefrontal cortices being associated with urbanicity during childhood and adolescence, most of these studies have been limited to smaller samples and single analysis methods. The present study used the large ongoing FOR2107 multi-centre study cohort (Kircher et al., 2018) to analyse associations of urban upbringing.MethodsWe analysed a data set of n=625 healthy subjects without a current or previous psychiatric disorder (ascertained through SCID-I interviews), who underwent 3 Tesla MRI scanning, obtaining a high-resolution T1-weighted MPRAGE and a DTI scan. We subsequently also analysed a pilot samples of 42 patients with DSM-IV schizophrenia. We obtained data on urban upbringing (Lederbogen score; Lederbogen et al., 2014) for the first 15 years of life, as well as number of moves. T1 data were pre-processed using CAT12 software, using surface-based morphometric analysis of cortical thickness (CT) with 15 mm smoothing. DTI data were analysed using the TBSS approach in FSL software. We used general linear models to calculate multiple regression analyses using both linear and quadratic (non-linear) associations with urbanicity scores, followed up by analyses of correlations with number of relocations (as unspecific stress factors). Analyses of CT and DTI were each corrected for multiple comparisons using FWE.ResultsIn the healthy subject cohort we identified a significant negative linear correlation (p=0.042 FWE cluster-level; p=0.014 peak-level) between urban upbringing scores and cortical thickness (CT) in a right precuneus / posterior cingulate cluster (x/y/z=35;-88;-15), while non-linear analysis identified an additional trend in the left occipital cortex (p=0.073 FWE cluster-level; -17;-100;15). We did not find significant effects for number of relocations/moves. DTI analysis of fractional anisotropy (FA) showed a significant association (all p<0.05 FWE-corrected) for the uncinate fasciculus and inferior fronto-occipital fasciculus. CT analysis in the schizophrenia pilot cohort showed similar effects, but in a more dorsal precuneus cluster (6;-56;45) only at uncorrected levels.DiscussionOur study identified structural variation in cortical thickness in the precuneus / posterior cingulate cortex of healthy subjects, regions linked to abnormal DMN activity and stress. While the trend-level finding in schizophrenia patients was located in an adjacent cluster, our findings can be interpreted as these medial parietal lobe structure mediating this particular risk factor. Our findings argue against a more wide-spread non-specific effect, as seen in some earlier smaller studies, but points to distinct neuronal network as mediators of this particular risk. The identified brain regions are linked to stress. Unlike previous prefrontal findings, they suggest a new link to the precuneus, a central hub of the default mode network. Given that these effects were observed in clinically healthy subjects, our findings also carry implications for a better understanding of the macro-environment in adolescence.

Gene-Environment Interactions in Major Mental Disorders in the Czech Republic.

BackgroundMental disorders affect about one-third of the human population, are typically chronic and significantly decrease the quality of life. Presently, the treatment of mental illnesses is far from adequate with a substantial proportion of the patients being pharmacoresistant and suffering from relapses. One of the reasons for this complicated situation is that we do not precisely know about the causes of mental disorders, so their treatment cannot be causal. The etiology of a mental disorder is typically based on a combination of molecular (genetic) and environmental factors.AimThe aim of the project is to discover the gene–environment interactions (GxE) in a wide spectrum of mental disorders.MethodsThe design of our study is innovative in the sense that we intend to study large groups of associated mental disorders as a whole instead of in isolation. This would enable us to map out the possible environmental causal factors in detail in relation to their character, magnitude and timing. The project also allows a study of genetics (including epigenetics and microbiomes) as well as the environment simultaneously. We plan on involving three study groups: the first group are patients suffering from schizophrenia or a mood disorder such as major depression, recurrent depressive disorder and bipolar affective disorder; the second group of patients have anxiety disorders; and the third group are healthy volunteers from the general population who are genetically unrelated. All of the study subjects will undergo the following assessments: a psychiatric examination, the identification of stressful life events with the aid of a questionnaire, the examination of their reaction to stress, genetic and epigenetic (microRNA) assessments and the analysis of oral and gut microbiome.ConclusionWe expect that some of the genetic as well as environmental factors in the studied mental disorders are shared, while some others are specific. We also expect that the GxE (gene–environment interaction) in schizophrenic and affective disorders will be different from the GxE in anxiety disorders and that the GxE in the studied mental disorders will differ generally from the GxE in healthy volunteers. Our results can help in the prevention and individualized treatment of a range of mental disorders.

Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study.

Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries. To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course. Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder. Cluster analysis of neurocognitive test scores derived three subgroups described as 'normal range' (n = 243, 38.6%), 'intermediate impairment' (n = 252, 40.1%), and 'global impairment' (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI -0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI -0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time. Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.

Bipolar disorder among married women in Bangladesh: Survey in Rajshahi city.

Bipolar disorder (BPD) is a major mental disorder which not only affects the personal and social functioning of an individual, but also inflicts a huge economic burden on the family. Yet, the study of BPD in Bangladesh is rare and poorly documented. Responding to the dire need, we conducted a new study to determine the prevalence of, and detect the associated factors of, BPD among married women in Rajshahi City, Bangladesh. We conducted a cross-sectional study, selecting households in Rajshahi City using a multi-stage random sampling design. The data consisted of 279 married women, who were screened for BPD using the bipolar spectrum diagnostic scale (BSDS). Frequency distribution, chi-square test and binary logistic regression model were used respectively to determine the prevalence, identify the associated factors and quantify their effects on BPD. The prevalence of BPD among married women in Rajshahi City was 2.5%, with an additional 7.2% classified as probable BPD. A binary logistic regression analysis established the following six main factors of BPD: (1) comorbid mental disorder [AOR = 8.232, 95% CI = (1.397, 50.000), p<0.05]; (2) poor relationship with husband [AOR = 11.775, 95% CI = (2.070, 66.667), p<0.01]; (3) poverty [AOR = 1.600, 95% CI = (2.086, 122.709), p<0.01]; (4) high educational level [AOR = 0.177, 95% CI = (0.037, 0.843), p<0.05]; (5) lack of immediate treatment if sick [AOR = 2.941, 95% CI = (1.259, 6.871), p<0.05]; and (6) death of beloved one/s [AOR = 2.768, 95% CI = (1.130, 6.777), p<0.05]. Our survey involved self-reporting, which is typically affected by differing levels of understanding and bias. Also, a cross-sectional, observational study cannot establish an actual cause-and-effect relationship. Some other potentially important factors such as environment, lifestyle, familial customs, effects of drugs, treatment options and outcomes, etc. were not studied. Also, save mental disorder, all other comorbidities remained undocumented. This study laid down the foundation for conducting further research on identifying different factors affecting BPD, and for studying other issues related to BPD among married women in Bangladesh. Among such factors are familial environment and culture, comorbidities, treatment options, treatment outcomes, biochemical feature, environmental factors, etc. This study also recommends that, while treating BPD patients, health professionals should focus on comorbidities and family matters.

Why hasn't neuroscience delivered for psychiatry?

Biological research has produced major advances in our understanding of our bodies and, where systems go wrong, is producing remedies to address these, but it has yet to do the same for the mind. This is because no causative biological evidence has been found for the major mental disorders in contrast to the wealth of psychosocial findings. This disparity in regard and resource needs to be addressed.

Prevalence of self-reported subthreshold phenotypes of major mental disorders and their association with functional impairment, treatment and full-threshold syndromes in a community-residing cohort of young adults.

Subthreshold syndromes (STS) frequently precede the onset of full-threshold syndromes (FTS) of the corresponding mental disorder (homotypic continuity). This study examines whether subthreshold conditions are comorbid and whether there is heterotypic continuity also between STS and FTS. Data were extracted from the Brisbane "19Up" cohort study of twins and siblings (N = 1838; 56% female) on individuals who (i) completed self-report ratings of depression-like (DLE), hypomanic-like (HMLE) and psychotic-like experiences (PLE) and (ii) were assessed for mood and psychotic FTS using the Composite International Diagnostic Interview (CIDI). Associations between STS and FTS were estimated using adjusted prevalence ratios (APR) and 95% confidence intervals (CI). STS are prevalent, with 22% reporting DLE, 14% HMLE and 5% PLE; 7% reported >1 STS, with PLE most likely to demonstrate comorbidity. Individuals with DLE were likely to meet CIDI criteria for depression (APR: 3.71, 95% CI: 2.83, 4.89), hypo/mania (APR: 3.62, 95% CI: 2.21, 5.94) and psychotic disorders (APR: 1.74, 95% CI 1.08, 2.83). Individuals with HMLE were likely to meet CIDI criteria for depression (APR: 2.29, 95% CI: 1.58, 3.31) and hypo/mania (APR: 2.51, 95% CI: 1.29, 4.91); those with PLE were likely to meet criteria for hypo/mania (APR: 5.8, 95% CI: 1.90, 17.70) and psychotic disorders (APR: 17.27, 95% CI: 7.54, 39.65). The findings suggest that STS are common among young adults and show heterotypic as well as homotypic continuity with FTS and support the need for more trans-diagnostic research on the evolution of major mental disorders.

Prévalence des troubles mentaux dans une communauté rurale à Parakou au nord Bénin

BackgroundThe burden of mental disorders is high in sub-Saharan Africa but the reliable epidemiological data for its prevalence are too scarce in this setting. We aimed to determine the prevalence of major mental disorder in a rural community in northern Benin. MethodsIt was a cross-sectional study with a door-to-door survey and included all people aged more than 18 years in the Tourou rural community in northern Benin. The face-to-face interview were done with respect the confidentiality. The French version of Composite International Diagnostic Interview (CIDI) was used for the screening of mental disorders. The data were analyzed by using EPI-INFO 7.1 software. The prevalence of each disorders were determined and their 95% confidence interval. ResultsA total of 603 subjects were included, including 62.23% of men and 18 to 77 years old with an average of 27.29 years±9.24 years. Among them, 327 subjects had at least one mental disorder with an overall prevalence of 54.22% [95% CI: 41.56–69.14]. The prevalences of the major mental disorders were for the current major depressive episode (MDE) 32.34% [28.65–36.26%]; past MDE 11.61% [9.22–14.50%]; current social phobia 14.26% [11.62–17.37%]; Current Obsessive Compulsive Disorders 20.73% [17.61–24.23%]; generalized anxiety 9.62% [7.44–12.33%]; psychotic syndrome whole life 30.18% [26.57–34.05%]; antisocial personality disorders 5.47% [7.44–12.33%]; alcohol dependence 3.98% and drug dependence 1.33%. ConclusionThese findings suggest an increased incidence of mental illness in rural community in northern Benin and calls for urgent prevention and community care.

Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

BackgroundThere has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers’ knowledge, confidence, attitudes and detection rate of major mental disorders in Mulanje, Malawi.MethodThe study used a quasi-experimental method (single cohort pre- and post-measures) with an interrupted time-series design. A 2 day mhGAP training was delivered to 43 primary healthcare workers (PHWs) working in 18 primary care clinics serving the entire population of Mulanje, Malawi (population 684,107). Modules covered were psychosis, moderate-severe depression, and alcohol & substance use disorders. The PHWs completed pre and post-tests to assess knowledge, confidence and attitudes. Number of diagnosed cases was obtained from clinic registers for 5 months prior to and 7 months following training. Data was analyzed using mean scores, t-test, one-way analysis of variance and linear regression.ResultsThe mean knowledge score increased significantly from 11.8 (SD: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t (42) = 7.79, p < 0.01. Similarly, mean knowledge score was significantly higher 6 months post training at 13.9 (SD: 2.52) compared to before; t (42) = 4.57, p < 0.01. The mean confidence score also increased significantly from 39.9 (SD: 7.68) before training to 49.6 (SD: 06.14) immediately after training; t (84) = 8.43, p < 0.01. It was also significantly higher 6 months post training 46.8, (SD: 6.03) compared to before; t (84) = 6.60, p < 0.01. One-way analysis of variance showed no significant difference in mean scores on all four components of the scale used to measure attitudes. A significant positive change in the trend in mental health service utilization after the intervention was demonstrated using a segmented linear regression (β = 2.43 (95% CI 1.02; 3.83) as compared to before (β = − 0.22 (95% CI − 2.67; 2.23) and immediately after (β = 1.63 (95% CI − 7.31; 10.57).ConclusionThe findings of this study add to the growing evidence for policy makers of the effectiveness of mhGAP training and supervision in a resource-constrained country.