Prior Mental Disorders Research Articles

The association between economic inactivity and mental health among young people: a longitudinal study of young adults who are not in employment, education or training.

Increasing rates of young people not in education, employment or training (NEETs) are a cause of concern both in Ireland and internationally, but little longitudinal research has examined the link between psychiatric disorder in young people and NEET status. The Challenging Times (CT) Study is a longitudinal, population-based study of psychopathology among 212 young Irish people. Clinical interviews were performed at two time points: 12-15 years and 19-24 years. NEET status in young adulthood was associated with a sevenfold increased risk of current suicidal ideation. This result was independent of prior adolescent mental disorder. NEET young people had a fourfold increased odds of being diagnosed with a mental disorder in childhood or early adolescence compared with their economically active peers. NEET young people were at an almost threefold increased risk of any mental health disorder a twofold increased risk of anxiety disorder and threefold increased odds of suicide attempts over their lifetime compared with economically active peers. NEET young people are at increased risk for mental disorder and suicidal ideation. The association is bidirectional, as prior mental disorder in adolescence appeared to account for much of the association between NEET status and current mental health problems. However, economic inactivity conveys an increased risk for suicidal ideation over and above that due to prior disorder. Our findings provide a compelling economic and societal argument for early intervention and treatment of mental disorder and the importance of vocational interventions for reducing suicide risk in young adults.

Mental Disorders, Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N=38,507). Most new soldiers with a pre-enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs=2.6-8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre-enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.

Onset of common mental disorders and suicidal behavior following women's first exposure to gender based violence: a retrospective, population-based study.

BackgroundWomen exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour (“mental disturbance”). Little is known however about the timing of onset of mental disturbance following first exposure to GBV amongst women with no prior mental disorder.MethodsThe analysis was undertaken on the Australian National Mental Health and Wellbeing Survey dataset (N = 8841). We assessed lifetime prevalence and first onset of common mental disorder and suicidal behaviour (mental disturbance) and exposure to GBV and its first occurrence based on the Composite International Diagnostic Interview Version 3 (WMH-CIDI 3.0). We used the Kaplan-Meier method to derive cumulative incident curves for first onset mental disturbance. The two derived subgroups were women who experienced GBV without prior mental disturbance; and women never exposed to GBV stratified to match the former group on age and socio-economic status.ResultsFor women with no prior mental disorder, the cumulative incidence curves showed a high incidence of all mental disturbances following first GBV, compared to women without exposure to GBV (all log rank tests <0.0001). Nearly two fifths (37%) of any lifetime mental disturbance had onset in the year following first GBV in women exposed to abuse. For these women, over half (57%) of cases of lifetime PTSD had onset in the same time interval. For GBV exposed women, half of all cases of mental disturbance (54%) and two thirds of cases of PTSD (66.9%) had onset in the five years following first abuse. In contrast, there was a low prevalence of onset of mental disturbance in the comparable imputed time to event period for women never exposed to GBV (for any mental disturbance, 1% in the first year, 12% in five years; for PTSD 3% in the first year, 7% in five years).ConclusionsAmongst women without prior mental disturbance, common mental disorders and suicidal behaviour have a high rate of onset in the one and five year intervals following exposure to GBV. There is a particularly high incidence of PTSD in the first year following GBV.

Association between mental disorders and subsequent adult onset asthma

Background and objectivesAssociations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. MethodsDuring face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. Results1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3–2.5), panic (OR = 1.4; 95%CI 1.0–2.0), generalized anxiety (OR = 1.3; 95%CI 1.1–1.7), specific phobia (OR = 1.3; 95%CI 1.1–1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1–1.9); binge eating (OR = 1.8; 95%CI 1.2–2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1–2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). ConclusionsA wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Importance/Objective: Although the suicide rate in the U.S. Army has traditionally been below age-gender matched civilian rates, it has climbed steadily since the beginning of the Iraq and Afghanistan conflicts and since 2008 has exceeded the demographically matched civilian rate. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent epidemiological and neurobiological study designed to generate actionable evidence-based recommendations to reduce Army suicides and increase knowledge about risk and resilience factors for suicidality and its psychopathological correlates. This paper presents an overview of the Army STARRS component study designs and of recent findings.Design/Setting/Participants/Intervention: Army STARRS includes six main component studies: (1) the Historical Administrative Data Study (HADS) of Army and Department of Defense (DoD) administrative data systems (including records of suicidal behaviors) for all soldiers on active duty 2004—2009 aimed at finding administrative record predictors of suicides; (2) retrospective case-control studies of fatal and nonfatal suicidal behaviors (each planned to have n = 150 cases and n = 300 controls); (3) a study of new soldiers (n = 50,765 completed surveys) assessed just before beginning basic combat training (BCT) with self-administered questionnaires (SAQ), neurocognitive tests, and blood samples; (4) a cross-sectional study of approximately 35,000 (completed SAQs) soldiers representative of all other (i.e., exclusive of BCT) active duty soldiers; (5) a pre-post deployment study (with blood samples) of soldiers in brigade combat teams about to deploy to Afghanistan (n = 9,421 completed baseline surveys), with sub-samples assessed again one, three, and nine months after returning from deployment; and (6) a pilot study to follow-up SAQ respondents transitioning to civilian life. Army/DoD administrative data are being linked prospectively to the large-scale survey samples to examine predictors of subsequent suicidality and related mental health outcomes.Main outcome measures: Measures (self-report and administratively recorded) of suicidal behaviors and their psychopathological correlates.Results: Component study cooperation rates are comparatively high. Sample biases are relatively small. Inefficiencies introduced into parameter estimates by using nonresponse adjustment weights and time-space clustering are small. Initial findings show that the suicide death rate, which rose over 2004—2009, increased for those deployed, those never deployed, and those previously deployed. Analyses of administrative records show that those deployed or previously deployed were at greater suicide risk. Receiving a waiver to enter the Army was not associated with increased risk. However, being demoted in the past two years was associated with increased risk. Time in current deployment, length of time since return from most recent deployment, total number of deployments, and time interval between most recent deployments (known as dwell time) were not associated with suicide risk. Initial analyses of survey data show that 13.9% of currently active non-deployed regular Army soldiers considered suicide at some point in their lifetime, while 5.3% had made a suicide plan, and 2.4% had attempted suicide. Importantly, 47—60% of these outcomes first occurred prior to enlistment. Prior mental disorders, in particular major depression and intermittent explosive disorder, were the strongest predictors of these self-reported suicidal behaviors. Most onsets of plans-attempts among ideators (58.3—63.3%) occurred within the year of onset of ideation. About 25.1% of non-deployed U.S. Army personnel met 30-day criteria for a DSM-IV anxiety, mood, disruptive behavior, or substance disorder (15.0% an internalizing disorder; 18.4% an externalizing disorder) and 11.1% for multiple disorders. Importantly, three-fourths of these disorders had pre-enlistment onsets.Conclusions: Integration across component studies creates strengths going well beyond those in conventional applications of the same individual study designs. These design features create a strong methodological foundation from which Army STARRS can pursue its substantive research goals. The early findings reported here illustrate the importance of the study and its approach as a model of studying rare events particularly of national security concern. Continuing analyses of the data will inform suicide prevention for the U.S. Army.

Do prior histories of violence and mental disorders impact on violent behaviour during encounters with police?

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services.

Abortion and Mental Health

To examine whether a first abortion increases risk of mental health disorders compared with a first childbirth with and without considering prepregnancy mental health and adverse exposures, childhood economic status, miscarriage history, age at first abortion or childbirth, and race or ethnicity. A cohort study compared rates of mental disorders (anxiety, mood, impulse-control, substance use, eating disorders, and suicidal ideation) among 259 women postabortion and 677 women postchildbirth aged 18-42 years at the time of interview from The National Comorbidity Survey-Replication. The percentage of women with no, one, two, and three or more mental health disorders before their first abortion was 37.8%, 19.7%, 15.2%, and 27.3% and before their first childbirth was 57.9%, 19.6%, 9.2%, and 13.3%, respectively, indicating that women in the abortion group had more prior mental health disorders than women in the childbirth group (P<.001). Although in unadjusted Cox proportional hazard models, abortion compared with childbirth was associated with statistically significant higher hazards of postpregnancy mental health disorders, associations were reduced and became nonstatistically significant for five disorders after adjusting for the aforementioned factors. Hazard ratios and associated 95% confidence intervals dropped from 1.52 (1.08-2.15) to 1.12 (0.87-1.46) for anxiety disorders; from 1.56 (1.23-1.98) to 1.18 (0.88-1.56) for mood disorders; from 1.62 (1.02-2.57) to 1.10 (0.75-1.62) for impulse-control disorders; from 2.53 (1.09-5.86) to 1.82 (0.63-5.25) for eating disorders; and from 1.62 (1.09-2.40) to 1.25 (0.88-1.78) for suicidal ideation. Only the relationship between abortion and substance use disorders remained statistically significant, although the hazard ratio dropped from 3.05 (1.94-4.79) to 2.30 (1.35-3.92). After accounting for confounding factors, abortion was not a statistically significant predictor of subsequent anxiety, mood, impulse-control, and eating disorders or suicidal ideation. LEVEL OF EVEDIENCE: II.

Onset of common mental disorders and suicidal behavior following women¿s first exposure to gender based violence: a retrospective, population-based study

Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour ("mental disturbance"). Little is known however about the timing of onset of mental disturbance following first exposure to GBV amongst women with no prior mental disorder. The analysis was undertaken on the Australian National Mental Health and Wellbeing Survey dataset (N = 8841). We assessed lifetime prevalence and first onset of common mental disorder and suicidal behaviour (mental disturbance) and exposure to GBV and its first occurrence based on the Composite International Diagnostic Interview Version 3 (WMH-CIDI 3.0). We used the Kaplan-Meier method to derive cumulative incident curves for first onset mental disturbance. The two derived subgroups were women who experienced GBV without prior mental disturbance; and women never exposed to GBV stratified to match the former group on age and socio-economic status. For women with no prior mental disorder, the cumulative incidence curves showed a high incidence of all mental disturbances following first GBV, compared to women without exposure to GBV (all log rank tests <0.0001). Nearly two fifths (37%) of any lifetime mental disturbance had onset in the year following first GBV in women exposed to abuse. For these women, over half (57%) of cases of lifetime PTSD had onset in the same time interval. For GBV exposed women, half of all cases of mental disturbance (54%) and two thirds of cases of PTSD (66.9%) had onset in the five years following first abuse. In contrast, there was a low prevalence of onset of mental disturbance in the comparable imputed time to event period for women never exposed to GBV (for any mental disturbance, 1% in the first year, 12% in five years; for PTSD 3% in the first year, 7% in five years). Amongst women without prior mental disturbance, common mental disorders and suicidal behaviour have a high rate of onset in the one and five year intervals following exposure to GBV. There is a particularly high incidence of PTSD in the first year following GBV.

Receiving Workplace Mental Health Accommodations and the Outcome of Mental Disorders in Employees With a Depressive and/or Anxiety Disorder

To investigate the association between receiving workplace accommodations and the 1-year risk of mood/anxiety disorders. A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria. In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Logistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65). Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders.

Associations between DSM-IV mental disorders and onset of self-reported peptic ulcer in the World Mental Health Surveys

ObjectiveRecent research demonstrating concurrent associations between mental disorders and peptic ulcers has renewed interest in links between psychological factors and ulcers. However, little is known about associations between temporally prior mental disorders and subsequent ulcer onset. Nor has the potentially confounding role of childhood adversities been explored. The objective of this study was to examine associations between a wide range of temporally prior DSM-IV mental disorders and subsequent onset of ulcer, without and with adjustment for mental disorder comorbidity and childhood adversities. MethodsFace-to-face household surveys conducted in 19 countries (n=52,095; person years=2,096,486). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Peptic ulcer onset was assessed in the same interview by self-report of physician's diagnosis and year of diagnosis. Survival analyses estimated associations between first onset of mental disorders and subsequent ulcer onset. ResultsAfter comorbidity and sociodemographic adjustment, depression, social phobia, specific phobia, post-traumatic stress disorder, intermittent explosive disorder, alcohol and drug abuse disorders were significantly associated with ulcer onset (ORs 1.3–1.6). Increasing number of lifetime mental disorders was associated with ulcer onset in a dose–response fashion. These associations were only slightly attenuated by adjustment for childhood adversities. ConclusionsA wide range of mental disorders were linked with the self-report of subsequent peptic ulcer onset. These associations require confirmation in prospective designs, but are suggestive of a role for mental disorders in contributing to ulcer vulnerability, possibly through abnormalities in the physiological stress response associated with mental disorders.

Trends in pre‐existing mental health disorders among parents of infants born in Western Australia from 1990 to 2005

To determine the prevalence of prior and current mental health disorders in parents, including trends over time. retrospective population cohort study using de-identified linked health data. Population of Western Australia. All parents of infants born in WA between 1990 and 2005. Prevalence of prior mental health disorders in parents by birth 2013 and by parent and child characteristics, including Aboriginality, maternal age, socioeconomic status and diagnostic groups. From 1990 to 2005, there was an increase in prevalence of prior mental health disorders in mothers, from 76 per 1000 births in 1990 to 131 per 1000 births in 2005 (3.7% increase per 2013 in the odds of children being born to mothers with a prior mental health disorder). There was also a 4.7% increase in odds per 2013 in the prevalence of mental health contacts that had taken place in the 12 months before the birth 2013 in mothers. In addition, there was an increase in prevalence of prior mental health disorders in fathers, from 56 per 1000 births in 1990 to 88 per 1000 births in 2005 (3.1% increase in odds per 2013). The diagnostic group with the highest prevalence in both mothers and fathers was substance-related disorders. From 1990 to 2005, there was an increase in prevalence of parents with a prior history of mental health disorders in WA. General practitioners and mental health workers can play an important role in identifying mental illness and in working with families to offer early intervention, referral and support.

Psychological Well-Being, Job Strain and Education Among Young Finnish Precarious Employees

This study examined the effect of precarious work (temporary and part-time present employment and unstable work history) on psychological well-being among young employees at age 31, controlling for prior mental disorders, education and job strain. The data of 1,070 women and 1,030 men was derived from the prospective unselected population-based Northern Finland 1966 Birth Cohort study. Results of univariate logistic regression models showed that among men, precarious work associated with all psychological well-being outcomes. Among women, only depressive symptoms at 31 years associated with precarious work. Among both genders, the association between precarious work and well-being outcomes diminished to a statistically non-significant level in multivariate analyses including prior mental diagnosis, education level and job strain. In the final multivariate logistic regression models, job strain and education level were the strongest factors associating with the well-being outcomes. The association between depression symptoms and precarious work was strongest in the highest educational class among men. These results emphasize the role of education and job strain in the enhancement of psychological well-being among young employees doing precarious work. The role of education seems to differ among genders, so that for women education acts as a resource also in precarious work while among highly educated men, not having a stable employment history increases the risk for depressive symptoms.

Rates of Mental Disorders Among German Soldiers Deployed to Afghanistan: Increased Risk of PTSD or of Mental Disorders In General?

Background: Controversy exists regarding the prevalence of military mission-related PTSD and other mental disorders among deployed soldiers. Methods: Based on a random stratified sample of n=1599 German soldiers (response rate (RR) 93%, n=1483), we assessed subjects 12 months after deployment to Afghanistan and compared findings to controls of n=932 never deployed soldiers (RR: 95%, n=889). Interviews were conducted by trained non-military clinical interviewers using the DSM-IV-TR-Composite International Diagnostic Interview (CIDI-military). Outcome measures were 12-month prevalence and incidence of PTSD, anxiety, depressive, substance use disorders and other DSM-IV-TR mental disorders. Results: Deployed soldiers reported high rates of combat-related and other traumatic events. Compared to controls they had a higher 12-month incidence (OR: 4.3) and prevalence (OR: 2.4) of PTSD, anxiety (OR: 3.6, 1.4), and alcohol use disorders (OR: 3.5, 1.9). They also had higher rates of multiple diagnoses (MR: 1.72) and higher anxiety distress scores. Incidence of PTSD and other mental disorders were best predicted by prior lifetime mental disorders. Conclusions: German soldiers deployed to Afghanistan are at increased risk of traumatic events and of mental disorders including PTSD as compared to never-deployed soldiers. The risk for other mental disorders subsequent to traumatic events such as anxiety, somatoform, and alcohol use disorders was substantially larger than the risk for PTSD. Prior mental disorders were found to be the strongest predictor of 12-month mental disorders and suggest that pre-mission psychopathological screening might be crucial to reduce mission-related mental health risks.

Delirious Mania

Delirious mania is a severe but under-recognized neuropsychiatric syndrome characterized by the rapid onset of delirium, mania, and psychosis, not associated with a prior toxicity, physical illness, or mental disorder. Catatonia is often a prominent feature of the syndrome. While initially believed to be rare, recent reports suggest that delirious mania may constitute up to 15% of all acute mania cases. When delirious mania is unrecognized or improperly treated, it can progress rapidly in severity and can become life-threatening. This article reviews the pathophysiology, diagnosis, and treatment of delirious mania and includes a detailed case report. Delirious mania is robustly responsive to high-dose lorazepam or electroconvulsive therapy (ECT); thus, early recognition and definitive treatment can be life-saving.

Prevalence and risk factors for first onset of suicidal behaviors in the Netherlands Mental Health Survey and Incidence Study-2

BackgroundTo report lifetime prevalences of suicidal ideation, plans and attempts, as well as risk factors for first onset suicidal behaviours and for the transition from ideation to first onset plan or attempt. MethodsData were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative survey among the general population aged 18–64 years (N=6646; response rate=65.1%). Face-to-face interviews were administered between November 2007 and July 2009. Suicidal behaviours and DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview 3.0. ResultsThe lifetime prevalence of suicidal ideation, plan and attempt was 8.3%, 3.0% and 2.2%, respectively. Among ideators, the probability of ever making an attempt was 26.8%. 76.5% of transitions from ideation to attempt occurred within the first year after ideation onset. Risk factors for suicidal behaviours included being female, younger, less educated, having had childhood trauma and a prior mental disorder. The strongest risk factors for the transition from ideation to first onset attempt were characteristics of prior suicidal behaviours, such as an early age of ideation onset and prior plans. LimitationsData were based on retrospective self-reports of mental disorders and suicidal behaviours. ConclusionsIt is important that health professionals verify suicide plans of their patients with suicidal ideas. They should also discuss the way their patients deal with problems and the kind of help they need, because a substantial proportion of (first) attempts was not intended to kill oneself. Preventive measures are best offered within the first year after ideation onset.

Malatya İl Merkezindeki Lise Son Sınıf Öğrencilerinin Ruhsal Durumlarının GSA-12 ile Değerlendirilmesi

Objective: The aim of this study, to determine the mental status of last-grade high school students and to inguire the relationship between their situation and some socio demographical variables. Methods: This cross-sectional study enrolled 9042 last phase-high-school students having education in the 2005-2006 educational years in the centre of Malatya. 1225 last-grade students attending general, science and vocational high schools were included using stratified cluster sampling method. A 12-item General Health Questionnaire (GHQ-12) and other data were collected using a questionnaire inguiring some socio demographic charestirstics were applied in the classes under supervision. The recommended cut off probable psychiatric morbidity between 1 and 2 of GHQ-12 was accepted. In the statistical evaluation of data was applied chi-square test and logistic regression method. Results: 80.3% of the students participating in the study has been training in general state and science high-school and 19.7% in vocational schools. 69.4% of the students got 2 and over point from GHQ-12. This remark showed as “bad” of general mental health status, when compared to male students (64.5%), disorderly status were significantly high in female (75.2%) students (OR:1.66; CI=1.29-2.14). There was no relationship between disorder symptoms of mental status and parents' educational status, family structure and having social security. On the other hand, according to the self statements of the students, the unsuccessful ones in school education had disorder status of general mental health by 3.78 fold (CI=2.35-6.07) higher than very successful students and by 1.59 fold (CI=1.19-2.11) higher than moderately successful students. The students with prior mental disorders had 5.32 fold (CI=2.55-11.09) higher disorderly status of mental health than the students without previous mental disorders. Conclusion: The disorderly status of mental health in the students were detected fairly high. The students should be informed about the serious psychological changes and efficient guidance services should be provided. Key words: GHQ-12; Adolescent; High School Student.

A history of mental health problems may predict maternal distress in women postpartum

Aimto elucidate the effects of prior mental disorders on newly delivered women's mental health and to compare the outcome of different instruments to screen for maternal distress and depression after childbirth. The sample of 232 Stockholm women responded to a questionnaire on background data and three questionnaires, Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Depression Symptoms Rating Scale (PPDS) at 4–6 weeks and 10–12 weeks after childbirth. Resultsshow that maternal distress was experienced by 20% of the women as assessed by the BDI and the EPDS at 4–6 weeks postpartum, and by 13–16% of the women at 10–12 weeks after childbirth. A regression analysis showed that a history of mental health problems influenced maternal self-assessment at both points-in-time. The following background data showed a small but significant impact on maternal self-assessment; younger age, lower educational level, and a short-term partner relationship. The most important emotional responses were sadness, guilt and self-blame across all three instruments at both points in time. Loss of pleasure, self-accusations, irritability, anger, worry and somatic symptoms such as muscular tension, headaches and stomach cramps also occurred. Conclusionwomen with prior mental health problems are more vulnerable for maternal distress and midwives at the antenatal health clinics should encourage pregnant women to express emotional issues during their transition to motherhood in order to offer appropriate professional support and care.

The role of mental disorders in the risk and speed of transition to alcohol use disorders among community youth

Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. A total of 3021 community subjects (97.7% lifetime AU) aged 14-24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication

Mental disorders are among the strongest predictors of suicide attempts. However, little is known about which disorders are uniquely associated with suicidal behavior due to high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans, and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9,282 US adults. Results revealed that approximately 80% of suicide attempters in the US have a temporally prior mental disorder. Anxiety, mood, impulse-control, and substance disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (odds ratios=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (e.g., PTSD) and poor impulse-control (e.g., conduct disorder, substance disorders) predict which suicide ideators go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.

Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits

Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders. Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios. Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders). Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.