Mental Health Survey Initiative Version Research Articles

Prevalence of suicidal ideation and associated factors among pregnant women attending ANC follow-up clinic in Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022

Suicide is a worldwide concern and ranks as the third leading cause of death among individuals of reproductive age. According to many findings, Ethiopia remains to suffer with a considerable number of suicide deaths and attempts, so more research on the prevalence of suicidal ideation is necessary. Since there is limited research available about suicide ideation/attempts specifically from the study area, evidence-based and solution-oriented research is necessary. This study sought to determine the prevalence of suicidal ideation and its contributing factors among pregnant women visited ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital. Institutional based cross-sectional study was conducted among 174 pregnant women who visit ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital, from June 01 to August 30, 2022. Participants were selected by using a systematic random sampling method. The World Mental Health (WMH) survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to measure suicidal ideation and attempt. The data was entered into SPSS version 25 for analysis, and descriptive and inferential statistics were done. Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with suicidal ideation and attempt among pregnant women. Variables with a P value less than 0.05 were considered statistically significant with 95% CI. In the current study 174 pregnant women were screened, and 168 volunteered to participate with a response rate of 96.5%. The finding showed that the prevalence of suicidal ideation and a suicidal attempt was 5.4% (95% CI: 1.8–8.9) and 4.8% (95% CI: 1.8–8.9) respectively. Unplanned pregnancy [AOR: 1.9(1.22–0.88)], history of abortion [AOR: 2.5(1.5–12.6)], history of stillbirth [AOR: 2.32(1.7–13.2)], HIV status of seropositive [AOR: 1.5(01.2–16.0)] and history of lifetime substance use [AOR: 1.6(1.3–12.0)] were significant positive predictors of prevalence of suicidal ideation. The study finding shows that the prevalence of suicidal ideation and attempt among pregnant women was low. Unplanned pregnancy, history of abortion, history of stillbirth, HIV status of seropositive, and history of lifetime substance use were variables significantly associated with suicidal ideation among pregnant women.

Psychological Distress Associated With Suicidal Ideation Among Glaucoma Patients Attending at Tertiary Eye Care Clinic, Gondar, Ethiopia.

Suicide is defined as the deliberate taking of one's own life with either implicit or explicit proof; however, it can also refer to the contemplation or actualization of suicide. Suicide is a mental illness with several contributing factors. It is frequently linked to sex, age, health problems, substance misuse, and traumatic life experiences. The purpose of this study was to evaluate the prevalence of suicide thought and attempts among glaucoma patients and its contributing factors in Gondar, Ethiopia, 2022. An observational cross-sectional study was conducted on 422 glaucoma patients at the Tertiary Eye Care Clinic, University of Gondar Comprehensive and Specialized Hospital. Suicidal ideation and attempts were assessed using the suicidality module of the World Mental Health Survey Initiative version of the World Health Organization's Composite International Diagnostic Interview. Bivariate and multivariate logistic regressions were conducted to identify factors associated with suicidal ideation and attempts. The variables with a p-value less than 0.05 and a 95% CI were considered statistically significant. The overall prevalence of suicidal ideation and attempt was 6.4% with a 95% CI of 4.3-9.2% and 2.4% with a 95% CI of 1.1-4.3%, respectively. In multivariate analysis, severe psychological distress, moderate psychological distress, mild psychological distress, and current substance use were identified as risk factors for suicidal ideation, whereas living alone, co-morbid chronic medical disease, and ever-present substance use were identified as risk factors for suicidal attempts. Based on this study finding, the prevalence of suicidal ideation and attempts was high among glaucoma patients. This study may provide further information to pay much attention to the physical health care of patients with glaucoma. More representative samples, or rather, a cross-sectional study design, should be used in future studies aiming for more precise data.

Suicidal behavior and associated factors among prisoners in Dilla town, Dilla, Ethiopia 2020: An institutional based cross-sectional study.

BackgroundSuicide is a serious cause of mortality worldwide and is a psychiatric emergency. Among prisoners, it is the leading cause of death compared to the general population. However, suicide in prison is a neglected public health issue especially in middle- and low-income countries including Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of suicidal behavior among prisoners in Dilla Town Correctional Center, South Ethiopia.MethodsAn institution-based cross- sectional study was conducted from May13- June 13, 2020 in the Dilla Town Correctional Center. The simple random sampling technique was used to select 650 prisoners. Data were collected by face-to—to-face interview. Suicidal ideation and attempts were assessed by using the suicidality module of World Mental Health survey initiative version of the World Health Organization composite International diagnostic interview. Data were coded, entered with EP-data version 3.1, and analyzed by using Statistical Package for Social Science version 24. Multivariate binary logistic regression analysis was used to determine the significant association between explanatory variables and outcome variables at 95% CI.The resultsThe prevalence of suicidal ideation and attempt among prisoners were 21.9% (95%CI, 18.4–25.2) and 13.1% (95%CI, 10.6–15.8), respectively. Female sex [(AOR) = 2.6, 95%CI, (1.39, 8.2)], divorced/widowed [AOR = 3.67, 95%CI, (2.05, 6.58)], family history of mental illness [AOR = 2.49, 95%CI, (1.41, 4.38)], common mental disorder [AOR = 1.98, 95%CI, (1.25, 3.16)] and poor social support [AOR = 2.68, 95%CI, (1.42, 5.06)] were statistically associated with suicidal ideation. Whereas, female sex [AOR = 3.24, 95%CI, (1.89, 9.4)], previous incarceration [AOR = 2.38, 95%CI, (1.2, 5.16)], and family history of mental illness [AOR = 2.08, 95%CI, (1.11, 3.9)] were associated with suicide attempt.ConclusionThe prevalence of suicidal ideation and attempts among prisoners were high. The special attention in early screening and treatment of suicide among prisoners and collaborating with health institutions is important for better management and prevention.

Prevalence and Factors Associated With Suicidal Ideation Among Adult Eritrean Refugees in Northern Ethiopia

BackgroundThe present study assessed the prevalence of and factor associated with suicidal ideations among adult Eritrean refugees in Tigray, Ethiopia.MethodsA community-based cross-sectional study was carried out among 400 adult refugees living in the Mai-Aini refugee camp in Tigray, Northern Ethiopia from September 2019 to May 2020. The response variable was suicidal ideation and was measured using World Mental Health (WMH) Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview. We applied bivariate and multivariate logistic regression to determine predictors for suicide ideations. Odds ratios and p-values were determined to check the associations between variables, and a p-value <0.05 was considered as a cut-off for statistical significance.ResultsThe prevalence of suicidal ideations was 20.5% (95% CI: 16.4%, 24.5%). Having previous history of trauma [AOR = 2.3, 95% CI: 1.4, 4.5], a history of chronic illness [AOR = 2.9, 95% CI: 1.3, 6.5], a family history of mental disorder [AOR = 3.08, 95% CI: 1.3, 7.06], and history of post-traumatic stress disorder [AOR = 5.7, 95% CI: 2.8, 11.5] were significantly associated with suicidal ideations.ConclusionsThis study showed that during the stay in the refugee camp, there was a high prevalence of suicide ideations compared to the prevalence of suicide ideations among the general populations of Ethiopia, Europe, and China, and the lifetime pooled prevalence across 17 countries. Having previous history of trauma, a history of chronic illness, a family history of mental disorder, and history of post-traumatic stress disorder were the factors statistically associated with the suicidal ideation.

Suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma medical center, Ethiopia.

Suicidal ideation (SI) among pregnant women is a major public health concern worldwide and is associated with a higher risk of completed suicide. However, there are limited studies that determined the prevalence and the potential determinants of suicidal ideation in Sub-Saharan Africa, including Ethiopia. Therefore, this study aimed to explore the prevalence of suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma, Ethiopia. An institutional-based cross-sectional study was conducted among 423 pregnant women attending Jimma medical center in Southwest, Ethiopia. A systematic random sampling technique was used to select the study participants. Suicidal ideation assessed using the Suicidality Module of the World Mental Health survey initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI). Other tools used are EPDS, Abuse Assessment Scale (AAS), DASS -21, PSS, Maternity Social Support Scale (MSSS), and Pittsburgh Sleep Quality Index (PSQI). A multivariable logistic regression analysis was used to explore the potential determinants of suicidal ideation among the participants. The prevalence of SI among women who are on antenatal care was found to be 13.3% (95% CI (10.1,16.4). In multivariable analysis, marital status with lack of cohabiting partners (AOR = 2.80,95%CI:1.23,6.37), history of abortion (AOR = 2.45,95% CI:1.03,5.93), having depression (AOR = 4.28,95% CI:1.75,10.44),anxiety(AOR = 2.99,95% CI:1.24,7.20), poor sleep quality (AOR = 2.85,95% CI:1.19,6.79), stress (AOR = 2.50, 95% CI:1.01,5.67), and intimate partner violence (AOR = 2.43, 95% CI:1.07,5.47) were found to be significant predictors of suicidal ideation. The prevalence of SI among pregnant women was found to be huge. Lack of cohabiting partners, previous history of abortion, depression, anxiety, intimate partner violence, poor sleep quality, and stress were variables that are independent predictors of suicidal ideation. Screening and interventions of antenatal SI are needed.

Prevalence and Associated Factors of Suicidal Ideation and Attempt among Prisoners in Ethiopia: A cross-sectional study.

Suicide is a serious cause of mortality worldwide and the single most common cause of death in the prison population. Studies on suicidal ideation and attempt among prison people in Ethiopia are limited. Therefore, the objective of this study was to assess the prevalence and associated factors of suicidal ideation and attempt among prisoners in Debre Markos Correctional Center, northwest, Ethiopia, 2019. An institution-based cross-sectional study was conducted using the simple random sampling technique; a total of 640 participants was recruited. Suicidal ideation and attempts were assessed using the suicidality module of the World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). The prevalence of suicidal ideation and attempt were 21.9% and 13.1% with 95% CI (18.40, 25.20) and (10.60, 15.80) respectively. The study revealed that female sex (AOR=2.60, 95%CI: 1.39, 8.20) and family history of mental illness (AOR=2.08, 95%CI: 1.11, 3.90) were significantly associated with both suicidal ideation and attempt. Whereas divorced/widowed (AOR=3.67, 95%CI: 2.05, 6.58), common mental disorder (AOR=1.98, 95%CI: 1.25, 3.16) and poor social support (AOR=2.68, 95%CI: 1.42, 5.06) were statistically associated with suicidal ideation, and previous incarceration (AOR=2.38, 95%CI: 1.20, 5.16) was significantly associated with a suicide attempt. The result shows that the prevalence of suicidal ideation and attempt were serious problems among prisoners. As a result, inmate people need greater attention and interventions for suicidal behaviors.

Magnitude and associated factors of suicidal ideation and attempt among people with epilepsy attending outpatient treatment at primary public hospitals in northwest Ethiopia: a multicentre cross-sectional study

ObjectiveThis study aimed to assess magnitude and associated factors of suicidal ideation and attempt among people with epilepsy attending outpatient treatment at primary public hospitals, northwest Ethiopia using suicide module...

Is the Black-White mental health paradox consistent across age, gender, and psychiatric disorders?

Objectives The Black-White mental health epidemiological paradox (i.e. Black Americans’ lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders. Method We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001–2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder. Results The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45–64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups. Conclusion Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study.

Suicide is a disastrous act which has a significant effect on the global burden of disease, contributing yearly to 1.4% of the total burden with the foremost role played by a people aged between 15 and 35 years. Medical students are one of the high-risk groups for suicide. This increased risk may begin during medical school and leads to premature death. But, there is a paucity of epidemiologically reliable data on the issue. Therefore, the current study was aimed to assess the prevalence and associated factors of suicidal ideations and attempt among undergraduate medical students of Haramaya University. An institutional based cross-sectional study was conducted from May 13 to June 12, 2019 at College of Health and Medical Science, Haramaya University. Stratified sampling technique was used and a total of 757 participants were selected by using simple random sampling technique. Data were collected using a self-administered questionnaire. Suicidal ideation and attempt were assessed by using suicidal module of world mental health survey initiative version of the World Health Organization, composite international diagnostic interview. Data were analyzed using Statistical Package for Social Science Version 20. Descriptive results were presented by tables and graphs. Bivariate and multivariate logistic regression analyses were done to identify factors associated with suicidal ideation and attempt. P-values less than 0.05 were considered statistically significant and the strength of association was presented by an adjusted odds ratio with 95% confidence interval. The study showed that the prevalence of suicidal ideation and attempt were 23.7% (95%CI, 20.5-26.8) and 3.9% (95%CI, 2.6-5.5), respectively. Cumulative grade point average (AOR = 0.30, 95% CI: 0.18-0.49), current alcohol use (AOR = 2.26, 95%CI: 1.45-3.55), depression (AOR = 3.58, 95%CI: 2.23-5.76), anxiety (AOR = 3, 95%CI: 1.88-4.77), and poor social support (AOR = 2.57, 95%CI: 1.41-4.68) were the factors statistically associated with the suicidal ideation. Depression (AOR = 5.4, 95%CI: 1.45-20.14) and anxiety (AOR = 3.19, 95%CI: 1.01-10.18) were associated with the suicidal attempts. This study showed that the high prevalence of suicidal ideation and attempt as compared to the prevalence of suicidal behavior among other university students who were studying in other fields. Cumulative Grade Point Average, current alcohol use, depression, anxiety and poor social support were the factors statistically associated with the suicidal ideation. Depression and anxiety were the ones associated with the suicidal attempt. Early screening, detection and management of suicidal behavior and associated mental health problems were recommended for undergraduate medical students.

Factors Associated with Suicidal Ideation, and Attempt Among Cancer Patients in Ayder Comprehensive Specialized Hospital: Cross-Sectional, Mekelle, Ethiopia

Background: Cancer patients are at high risk for suicide, particularly, when they are informed about the cancer diagnosis. However, there is a limited study in Ethiopia therefore, assessing suicidal ideation, attempt, and its associated factors are needed for intervention. Methods: An institutional-based cross-sectional study was conducted from March to June 2019 at Ayder comprehensive specialized hospital with a total of 297 participants. Suicide module of the World Mental Health (WMH) survey initiative version adopted from the World Health Organization (WHO) and used to assess suicidal ideation and attempt. Binary logistic regression analysis employed to identify factors associated with suicidal ideation and attempt. Odds ratio with 95% CI and P-value &lt;0.05 was applied to identify significantly associated factors. Results: The lifetime prevalence of suicidal ideation and the attempt was found to be 27.9% [95%CI (22.3, 31.6)] and 8.4% [95%CI (5.2, 10.3)] respectively. Being female [AOR= 2.23, 95%CI (1.27, 3.92)], stage IV cancer [AOR=2.08, 95%CI(1.47, 3.81)], having depression and anxiety [AOR=2.31, 95%CI(1.24,4.32)], poor social support [AOR=3.70, 95%CI(2.01,6.78)], and level 4 performance status [AOR=3.73, 95%CI(1.71, 8.13)] were the factors associated with lifetime suicidal ideation. While being in level 4, performance status was also significantly associated with suicidal attempt. Conclusion: Both suicidal ideation and attempt among cancer patients are high. The suicidal ideation had a statistical association with sex, stage of cancer, having depression and anxiety, social support, and level of performance. Therefore, health education for early screening and treatment for depression and anxiety, and giving social support are crucial for the reduction of suicide.

Association between insomnia and cognitive performance, gray matter volume, and white matter microstructure in cognitively unimpaired adults

BackgroundMounting evidence links poor sleep quality with a higher risk of late-life dementia. However, the structural and cognitive correlates of insomnia are still not well understood. The study aims were to characterize the cognitive performance and brain structural pattern of cognitively unimpaired adults at increased risk for Alzheimer’s disease (AD) with insomnia.MethodsThis cross-sectional study included 1683 cognitively unimpaired middle/late-middle-aged adults from the ALFA (ALzheimer and FAmilies) study who underwent neuropsychological assessment, T1-weighted structural imaging (n = 366), and diffusion-weighted imaging (n = 334). The World Health Organization’s World Mental Health Survey Initiative version of the Composite International Diagnostic Interview was used to define the presence or absence of insomnia. Multivariable regression models were used to evaluate differences in cognitive performance between individuals with and without insomnia, as well as potential interactions between insomnia and the APOE genotype. Voxel-based morphometry and tract-based spatial statistics were used to assess between-group differences and potential interactions between insomnia and the APOE genotype in gray matter volume and white matter diffusion metrics.ResultsInsomnia was reported by 615 out of 1683 participants (36.5%), including 137 out of 366 (37.4%) with T1-weighted structural imaging available and 119 out of 334 (35.6%) with diffusion-weighted imaging. Individuals with insomnia (n = 615) performed worse in executive function tests than non-insomniacs and displayed lower gray matter volume in left orbitofrontal and right middle temporal cortex, bilateral precuneus, posterior cingulate cortex and thalamus, higher gray matter volume in the left caudate nucleus, and widespread reduction of mean and axial diffusivity in right hemisphere white matter tracts. Insomnia interacted with the APOE genotype, with APOE-ε4 carriers displaying lower gray matter volumes when insomnia was present, but higher volumes when insomnia was not present, in several gray matter regions, including the left angular gyrus, the bilateral superior frontal gyri, the thalami, and the right hippocampus.ConclusionsInsomnia in cognitively unimpaired adults at increased risk for AD is associated to poorer performance in some executive functions and volume changes in cortical and subcortical gray matter, including key areas involved in Alzheimer’s disease, as well as decreased white matter diffusivity.

Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey.

Hazardous alcohol consumption presents a serious threat to the health and wellbeing of all people and is linked to chronic and acute health problems. To: (i) estimate the prevalence of alcohol use disorders and remission from alcohol abuse and dependence in the South African (SA) population; and (ii) determine whether age of onset, education, sex and level of cohort alcohol use are associated with commencement of use, regularity of use, and transitions to and remission from more harmful levels of use. The study was a nationally representative sample of 4 315 individuals aged ≥18 years. In a multistage, area probability sample of adults, data were collected from 4 311 alcohol users using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview version 3.0. All analyses were carried out using SAS version 9.4. Of the respondents, 40.6% indicated lifetime use of alcohol, 35.3% reported regular use, and 8.8% met diagnostic criteria for alcohol abuse and 2.7% for alcohol dependence. The prevalence of remission from lifetime abuse without dependence was 55.9%. The median age of onset of alcohol use was 20 years, with transition from use to regular use occurring within ~1 - 3 years. The results suggest that males, students (compared with those who had completed a high level of education) and greater alcohol use in the respondent's birth cohort were all associated with increased odds of commencing alcohol use. For transitions from use to regular use, increased odds were associated with males, greater birth cohort alcohol use, low education and later (&gt;21 years) onset of first alcohol use. Our findings suggest that cohort alcohol use is associated with transition to commencement of use and from use to regular use in the general SA population. The study further highlighted the need for interventions among males and university students, given that hazardous alcohol consumption seems to be the most prevalent public health issue encountered by university students and males.

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Cross-sectional household surveys. Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ≥0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.

Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil.

Important transformations in psychiatric healthcare (HC) delivery have been implemented in Latin America during the beginning of 21st century. However, information on current service uses patterns is scant, obstructing the estimates and proper planning of service needs for general population. The current investigation aims to describe patterns and estimates predictors of 12-month HC use by individuals with mental disorders in São Paulo metropolitan area, Brazil. Data are from São Paulo Mental Health Survey, a cross-sectional multistage representative study. Participants were face-to-face interviewed in their household, using a structured diagnostic interview, the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. A total of 5037 respondents, non-institutionalised, aged 18 years and older were interviewed. The response rate was 81.3%. We determined the percentages of individuals with 12-month DSM-IV anxiety, mood and substance disorders that received treatment in the 12 months prior to assessment in main service sectors (specialty mental health, general medicine, human services (HS), and complementary and alternative medicine). The number of visits and percentage of individuals who received treatment at minimally adequacy also was estimated. Multilevel regression controlled contextual variables that influenced the use of service and treatment adequacy. Only 10.1% of respondents used some HC service in the 12 months prior to assessment for their psychiatric problems, including 3.9% of them being treated either by a psychiatrist, 3.5% by a non-psychiatrist mental health specialist, 3.3% by a general medical (GM) provider, 1.5% by a HS provider and 1.4% by a complementary and alternative medical provider. In general, those participants who received service in the mental health specialty sector reported more visits than those in the GM sector (median 3.9 v. 1.5 visits). The cases seen in specialty sector outnumber those visiting GM treatment in terms of minimally adequate treatment (54.6 v. 23.2%). The likelihood of receiving treatment was significantly greater among individuals diagnosed with any anxiety and mood disorder, presenting more severe disorders, and with possession of HC insurance. The great majority of individuals with an active mental disorder in São Paulo were either untreated or insufficiently treated. Awareness and training programmes to GM professionals are advocated to improve recognition, care take and referral to specialty care when needed. Proper integration among HC sectors is recommended.

TRAUMA EXPOSURE AND RISK OF SUICIDAL IDEATION AMONG ETHNICALLY DIVERSE ADULTS.

Little is known about the association between trauma exposure and suicidal ideation across racial/ethnic groups. Our study aim was to determine the association between trauma exposure and suicidal ideation in a nationally representative ethnically diverse sample of adults. This study included 14,866 White, Hispanic, Black, and Asian participants 18 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003), comprised of three nationally representative studies (NCS-R, NSAL, and NLAAS). Lifetime history of suicidal ideation as assessed in the World Health Organization's World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI). Of the 81% respondents who reported being exposed to trauma as assessed in the WMH-CIDI, 12.1% endorsed lifetime suicidal ideation. Additionally, of the 19% who did not report trauma, 1.1% endorsed lifetime suicidal ideation. Fully adjusted, multivariable logistic regression models revealed two traumas consistently associated with significantly higher odds for suicidal ideation across all four racial groups examined: Assaultive/interpersonal violence and child maltreatment. Asians, in particular, had the highest likelihood for suicidal ideation in both trauma categories, with a near threefold increased odds for assaultive/interpersonal violence exposure (OR: 2.56; 95% CI: 1.71-3.83) and nearly ninefold increased odds for child maltreatment exposure (OR: 8.43; 95% CI: 4.91-14.49). Suicidal ideation in racially/ethnically diverse American adults is strongly associated with assaultive/interpersonal violence and child maltreatment, independent of PTSD, MDD, and substance use. These findings highlight the need for monitoring of suicidal behavior following assaultive/interpersonal trauma and child maltreatment, regardless of the presence of a psychiatric disorder.

CBT for Child Anxiety May Confer Long-Term Protection From Suicidality

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessCBT for Child Anxiety May Confer Long-Term Protection From SuicidalityMark MoranMark MoranSearch for more papers by this authorPublished Online:6 Feb 2015https://doi.org/10.1176/appi.pn.2015.1b9AbstractTreatment response significantly predicted lifetime suicidal ideation. Those who were nonresponders were significantly more likely to report experiencing suicidal ideation in the past 12 months and past two weeks.Successful cognitive-behavioral therapy (CBT) for childhood anxiety disorder may confer long-term benefits for suicide prevention, according to a report published online in the Journal of the Academy of Child and Adolescent Psychiatry on December 17, 2014.Evidence for an independent relationship between anxiety and suicidality has been mixed, but a study, “Cognitive-Behavioral Therapy for Child Anxiety Confers Long-Term Protection From Suicidality,” appears to show a correlation between anxiety and later suicidality and between treatment response and suicidality. “The [study] is the first to demonstrate the protective function of successful evidence-based treatment for childhood anxiety disorders on suicidal ideation in late adolescence and young adulthood,” said Courtney Benjamin Wolk, Ph.D., and colleagues at the Center for Mental Health Policy and Services Research at the University of Pennsylvania Perelman School of Medicine.They analyzed follow-up data on a sample of children drawn from two separate randomized, controlled trials evaluating CBT for child anxiety reported in the Journal of Consulting and Clinical Psychology in 1997 and 2008. A total of 155 young people were eligible to participate, of whom 66 were located and participated in follow-up.At posttreatment evaluation, 40 (60.6 percent) subjects were classified as treatment responders (defined as the principal anxiety disorder at pretreatment no longer present at posttreatment), and 26 (39.4 percent) were treatment nonresponders. At 7- to 19-year follow-up, treatment responders had significantly lower rates of panic disorder, alcohol dependence, and drug abuse in adulthood when compared with treatment nonresponders.Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory.At 7- to 19-year follow-up, 18 (27.3 percent) participants reported experiencing suicidal ideation in their lifetime, nine (13.6 percent) endorsed having made one or more suicide plans, and six (9.1 percent) described one or more suicide attempts in their lifetime on the CIDI. A retrospective report indicated that suicidal ideation had a mean age of onset of 15.83 and had occurred most often at a mean age of 19.61.Statistical analysis demonstrated that treatment response significantly predicted lifetime suicidal ideation endorsement on the CIDI, such that those who were treatment nonresponders were more likely to report having experienced suicidal ideation at 7- to 19-year follow-up. This remained significant when controlling for additional pretreatment variables hypothesized to predict increased risk for suicidality, including primary diagnosis and presence/absence of a childhood depressive disorder.Moreover, those who were treatment nonresponders were significantly more likely than responders to report having experienced suicidal ideation in the past 12 months and past two weeks at 7- to 19-year follow-up.The researchers acknowledged that there was no control group, so it is not appropriate to infer causation from the study results. Moreover, suicide plans and attempts were infrequently endorsed in the sample, which may have limited the ability to detect differences between treatment responders and nonresponders.Nonetheless, the researchers said the results are important. “It was particularly noteworthy that no participants who were CBT treatment responders endorsed experiencing suicidal ideation in the past month or past two weeks at 7- to 19-year follow-up,” they stated. “Conversely, treatment nonresponders were more likely to endorse lifetime and recent suicidal ideation, suggesting more chronic and enduring patterns of suicidal ideation, which potentially confers risk for suicidal plans, attempts, and completion. This pattern was observed for both self-report and interview report of suicidal ideation, strengthening confidence in the robustness of this finding. The findings add to a growing literature suggesting that successful CBT for a childhood anxiety disorder confers protection from later sequelae.”They added that timing emerged as an important pattern in suicidality. “In those individuals who experienced suicidality, suicidal ideation reportedly manifested in midadolescence and, importantly, did so several years prior to suicidal plans and/or attempts,” they stated. “Cross-sectional studies have previously indicated that the conversion from suicidal ideation to attempts typically occurs within one year of ideation onset, suggesting a potentially longer conversion window among youth with anxiety disorders with respect to suicidal ideation. This window may be a critical time for suicidality prevention and intervention occurring in mid- to late adolescence.”The study was supported by the National Institute of Mental Health. ■“Cognitive Behavioral Therapy for Child Anxiety Confers Long-Term Protection From Suicidality” can be accessed here. ISSUES NewArchived

Cognitive-Behavioral Therapy for Child Anxiety Confers Long-Term Protection From Suicidality

Evidence for an independent relationship between anxiety and suicidality has been mixed. Few studies have examined this relationship in youth seeking treatment for anxiety. The present study examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts at a follow-up interval of 7 to 19 years. We hypothesized that successful treatment for an anxiety disorder in childhood would be protective against later suicidality. The present study was a 7- to 19-year (mean= 16.24 years; SD= 3.56 years) follow-up study. Adults (N= 66) completed cognitive-behavioral treatment (CBT) for anxiety as children. Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory-II (BDI-II). Results indicate that participants who responded favorably to CBT during childhood were less likely to endorse lifetime, past-month, and past-2-week suicidal ideation than treatment nonresponders. This was consistent across self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, although the infrequent occurrence of both limited the ability to detect findings. Results suggest more chronic and enduring patterns of suicidal ideation among individuals with anxiety in childhood that is not successfully treated. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits and underscores the importance of the identification and evidence-based treatment of youth anxiety.

Epidemiology of Anxiety Disorders in the Australian General Population: Findings of the 2007 Australian National Survey of Mental Health and Wellbeing

The aims of this study were to report 12-month and lifetime prevalence for anxiety disorders in the Australian general population, identify sociodemographic and clinical correlates of anxiety disorders, and report the rates of comorbidity among anxiety, affective, and substance use disorders across the lifespan. The 2007 National Survey of Mental Health and Wellbeing was a nationally representative, face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years. Diagnoses for anxiety, affective and substance use disorders were made according to the DSM-IV using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. 12-month and lifetime prevalence of anxiety disorders were 11.8% and 20.0%, respectively. Anxiety disorders had a similar median age of onset (19 years) compared to substance use disorders (20 years), but earlier than affective disorders (34 years). Social phobia was the earliest onset anxiety disorder (median 13 years), with generalized anxiety disorder the latest (median 33 years). Significant correlates of the presence of anxiety disorders included being female, single, not in the labour force, in the middle age groups, not having post-graduate qualifications, having a comorbid physical condition, and having a family history of mental disorders. Being in the oldest age ranges and being born in another non-English speaking country were associated with lower odds of having an anxiety disorder. Body mass index was not associated with the presence of an anxiety disorder. Anxiety disorders were highly comorbid, particularly with major depression, dysthymia, and alcohol dependence. Comorbidity with substance use disorders reduced with age. Comorbidity with affective disorders was high across the lifespan. Anxiety disorders are common, can have an early onset, and are highly comorbid. Prevention, early detection, and treatment of anxiety disorders should be a priority.

Affective disorders and anxiety disorders predict the risk of drug harmful use and dependence

To investigate whether affective disorders, anxiety disorders and alcohol use disorders may increase the risk of subsequently developing drug (non-alcohol-related) dependence and/or drug (non-alcohol-related) harmful use. A retrospective cohort study based on nationally representative household survey data collected from the 2007 National Survey of Mental Health and Wellbeing (MHW). The MHW survey applied the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) to collect information on ICD-10 mental disorder diagnoses. Ages at first onset for mental disorders and harmful drug use were used to reconstruct the cohort according to definition of exposure, time at risk and outcome. A total of 8841 Australian adults aged 18-85 years who were included in the 2007 MHW survey. Participants with affective disorders and anxiety disorders were at higher risk of drug harmful use and drug dependence, and the effects did not vary by the length of time respondents had been exposed to mental disorders. It is uncertain whether experience of affective disorders and anxiety disorders, possibly prior to the disorder being identified by the individual or a health worker, may lead to self-medication with psychoactive substances or whether common genetic factors linking mental disorder and drug use disorders are the underlying cause. Symptoms of mental health disorders should alert health-care providers to the possibility of drug use disorder comorbidity and the need for early intervention, especially among young males.

Epidemiological aspects of intermittent explosive disorder in Japan; prevalence and psychosocial comorbidity: Findings from the World Mental Health Japan Survey 2002-2006

The purpose of the present study is to evaluate the prevalence of intermittent explosive disorder (IED) as well as its comorbidity with other mental disorders in a Japanese community sample. Subjects were 4,134 residents in selected sites in Japan. Diagnoses of mental disorders are based on the World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview. Lifetime and 12-month prevalence of IED were 2.1% and 0.7%, respectively, whereas those of narrow IED were 1.2% and 0.6%, respectively. Male gender and young age were positively associated with an increased prevalence of IED. Mood and anxiety disorders as well as suicidal ideation were shown to be associated with IED in both genders. The overall association between anxiety disorders and IED was stronger in women than in men. Positive association of substance use problems with IED was also observed. Similar findings were observed between those psychosocial factors and narrow IED. These results suggest that people having those mixed complications might have a high suicidal risk. Further research using psychological measures for anger suppression will lead to more thorough understanding of the effects of IED on psychosocial comorbidity and suicidal risk.