Psychiatric Epidemiological Studies Research Articles

Epidemiology of DSM-5 psychiatric disorders in Kenyan youth with low and high psychosis risk

IntroductionThere are few psychiatric epidemiology studies among Kenyan youth and fewer among those at high psychosis risk (HR). MethodsThis study assessed the epidemiology of DSM-5 psychiatric disorders in HR and low-risk (LR) individuals to inform research and mental health services. 567 participants (aged 15–25) in HR (n = 246) and LR (n = 260) groups based on Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen scores. Diagnostic Interview Schedule, version 5 (DIS-5) assessed DSM-5 psychiatric disorder prevalence. Diagnostic comorbidity and demographic relationships were investigated. ResultsA higher prevalence was observed for all DSM-5 disorders in the HR group, significantly for gambling disorder (13% vs. 5.8%), major depressive disorder (9.8% vs. 3.8%), antisocial personality disorder (5.7% vs. 2.3%), general anxiety disorder (4.9% vs. 0.4%), oppositional defiant disorder (3.3% vs. 0.4%), panic disorder (2.8% vs. 0.8%), and anorexia nervosa (2.8% vs. 0%). Gambling disorder was the most prevalent and showed significant gender effects (males>females). DiscussionPsychiatric disorders occur at increased rates among HR compared to LR. Prevalence rates found are lower than in US studies, except for gambling disorder which was highly prevalent. Large-population-based epidemiology studies in Africa are needed to estimate rates, particularly of disorders such as schizophrenia, accurately.

Early developments of psychiatric epidemiology in Chile: a local history with global implications

Abstract This viewpoint discusses a conference paper titled: “Epidemiological research on mental morbidity in Chile”, which summarizes a handful of studies from 1950s in Chile covering conditions such as alcoholism, psychosis, epilepsy, and neurosis. These were the first psychiatric epidemiological population studies conducted in the Southern hemisphere, but they are largely unknown globally. We argue that the Chilean studies have important implications for modern psychiatric epidemiology, as well as for related fields such as global mental health and mental health services research. This piece starts by describing the general sociopolitical context and presenting the main methodological features of the studies. It focuses then on three specific implications for the field: 1) promoting decoloniality in psychiatric epidemiology; 2) ensuring methodological rigor and feasibility; and 3) informing the development of mental health policy and services.

Epidemiological analysis of mental health morbidity in Tamil Nadu.

Existing psychiatric epidemiological studies from Tamil Nadu with methodological limitations and variations had under-reported the prevalence of mental morbidity. Robust data from a representative population-based epidemiological study are not readily available to guide mental health programs in Tamil Nadu. This study aimed to estimate the prevalence, correlates, and treatment gap of mental morbidity in the state of Tamil Nadu using data from National Mental Health Survey (NMHS) of India, 2015-2016. NMHS in Tamil Nadu was conducted in 60 clusters of 4 districts (Trichy, Tirunelveli, Thoothukudi, and Namakkal) using a door-to-door survey and multistage sampling proportionate to rural, urban nonmetro, and urban metro population. Mini-International Neuropsychiatric Interview (M.I.N.I version 6) and Fagerstrom nicotine dependence scale were administered on a representative adult (aged ≥18 years) sample to assess the mental morbidity. Prevalence and 95% confidence intervals (CIs) were estimated after weighing the sample for survey design. A total of 3059 adults from 1069 households were interviewed. The overall weighted prevalence of lifetime and current mental morbidity was 19.3% (95% CI: 19.0%-19.6%) and 11.8% (95% CI: 11.6%-12.0%) respectively. Participants who were men (largely contributed by substance-use disorders), aged 40-49 years, from rural areas, and from lower income quintile had higher prevalence of mental morbidity. The treatment gap was 94.2% for any mental health problem. Common mental disorders (depression, anxiety, and substance-use) accounted for most of the morbidity. The burden and treatment gap for mental health morbidity is high in Tamil Nadu. The findings call for urgent policy level and systemic action to strengthen mental health program in Tamil Nadu.

Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore.

The main aims of the study were to: establish the average levels of psychological distress, suicidality and positive mental health (PMH); and examine their associated risk and protective factors in the population of Singapore during the early phase of the COVID-19 pandemic. Participants from a national psychiatric epidemiological study conducted in the general population of Singapore from 2016 to 2018, who had agreed to be re-contacted, were invited to participate in the study that was conducted from May 2020 to June 2021. Questionnaires assessing psychological distress, causes of stress, resilience and PMH were administered. A total of 1,129 respondents completed the study. The mean age was 47.7 (standard deviation = 16.5) years. The prevalence of stress, depression and anxiety was 7.1%, 8.0% and 8.4%, respectively. The final pathways model showed that high concerns related to possible COVID-19 infection of family members or friends were significantly associated with higher stress (β = 0.242, P<0.001), depression (β = 0.152, P=0.001) and anxiety (β = 0.280, P<0.001). High resilience was significantly associated with lower stress (β = -0.482, P<0.001), depression (β = -0.394, P<0.001) and anxiety (β = -0.516, P<0.001), and with high PMH (β = 0.498, P<0.001). The findings highlight the negative impact of fear of COVID-19 infection, social distancing and isolation on the mental health of the population. Resilience and PMH were associated with lower psychological stress, and interventions to improve these characteristics can enhance mental health and well-being.

Association between stroke and psychosis across four nationally representative psychiatric epidemiological studies

Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date, there are no general population studies on their joint prevalence and association. To estimate the joint prevalence of stroke and psychosis and their statistical association using nationally representative psychiatric epidemiology studies from two high-income countries (the UK and the USA) and two middle-income countries (Chile and Colombia) and, subsequently, in a combined-countries data-set. Prevalences were calculated with 95% confidence intervals. Statistical associations between stroke and psychosis and between stroke and psychotic symptoms were tested using regression models. Overall estimates were calculated using an individual participant level meta-analysis on the combined-countries data-set. The analysis is available online as a computational notebook. The overall prevalence of probable psychosis in stroke was 3.81% (95% CI 2.34-5.82) and that of stroke in probable psychosis was 3.15% (95% CI 1.94-4.83). The odds ratio of the adjusted association between stroke and probable psychosis was 3.32 (95% CI 2.05-5.38). On the individual symptom level, paranoia, hallucinated voices and thought passivity delusion were associated with stroke in the unadjusted and adjusted analyses. Rates of association between psychosis and stroke suggest there is likely to be a high clinical need group who are under-researched and may be poorly served by existing services.

Invited Commentary: Modern Epidemiology Confronts COVID-19-Reflections From Psychiatric Epidemiology.

Dimitris et al. (Am J Epidemiol. 2022;191(6):980-986) outline how the coronavirus disease 2019 (COVID-19) pandemic has, with mixed results, put epidemiology under the spotlight. While epidemiologic theory and methods have been critical in many successes, the ongoing global death toll from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the sometimes chaotic public messaging underscore that epidemiology as a field has room for improvement. Here, we use examples from psychiatric epidemiologic studies conducted during the COVID-19 era to reflect on errors driven by overlooking specific major methodological advances of modern epidemiology. We focus on: 1) use of nonrepresentative sampling in online surveys, which limits the potential knowledge to be gained from descriptive studies and amplifies collider stratification bias in causal studies; and 2) failure to acknowledge multiple versions of exposures (e.g., lockdown, school closure) and differences in prevalence of effect measure modifiers across contexts, which causes violations of the consistency assumption and lack of effect transportability. We finish by highlighting: 1) the heterogeneity of psychiatric epidemiologic results during the pandemic across place and sociodemographic groups and over time; 2) the importance of following the foundational advancements of modern epidemiology even in emergency settings; and 3) the need to limit the role of political agendas in cherry-picking and reporting epidemiologic evidence.

Design and field procedures for the clinical reappraisal of the Composite International Diagnostic Interview version 3.3 in Qatar's national mental health study.

The Composite International Diagnostic Interview (CIDI) has been clinically reappraised in several studies conducted mainly in the US and Europe. This report describes the methodology used to conduct one of the Middle East's largest clinical reappraisal studies. The study was carried out in conjunction with the World Mental Health Qatar-the first national psychiatric epidemiological study of common mental disorders in the country. This study aimed to evaluate the diagnostic consistency of core modules of the newly translated and adapted Arabic version of the CIDI 5.0 against the independent clinical diagnoses based on the Structured Clinical Interview for DSM-5 (SCID-5). Telephone follow-up interviews were administered by trained clinicians using the latest research edition of the SCID for DSM-5. Telephone administered interviews were key in the data collection, as the study took place during the COVID-19 pandemic. Overall, within 12months, 485 interviews were completed. The response rate was 52%. Quality control monitoring documented excellent adherence of clinical interviews to the rating protocol. The overall methods used in this study proved to be efficient and effective. For future research, instrument cultural adaptation within the cultural context is highly recommended.

The Hong Kong youth epidemiological study of mental health (HK-YES)-A population-based psychiatric epidemiology study of youth mental health in Hong Kong: A study protocol.

Young people in Hong Kong have been facing numerous population-level events over the past year, including social unrest and the COVID-19 pandemic. Representative data concerning the mental health of youths, however, is limited. The Hong Kong Youth Epidemiological Study of Mental Health (HK-YES) is commissioned to provide the first representative prevalence estimates and correlates of mental disorders among young people in Hong Kong. It will also examine the help-seeking behaviours, treatment rates, quality of life, and functional outcomes of the young people. More importantly, the direct and indirect economic costs of mental disorders in youths will be estimated. A total of 4500 community-dwelling participants aged 15-24 years from Hong Kong will be surveyed. Participants will be selected using a multistage stratified sampling design to provide representative estimates of the youth population in Hong Kong. All interviews will be conducted using computer-assisted personal interviewing methods for assessments covering areas of psychiatric diagnoses, symptomatology, functioning, quality of life, disability, service utilization, health economic costs of mental disorders, and sociodemographic and lifestyle characteristics. A population-weighted prevalence will be estimated using survey weights. Methods such as multivariate logistic and linear regression analyses will be used to calculate the risks and odds of factors that might be associated with different mental disorders. As the first population-based youth study in Hong Kong, HK-YES collects extensive and representative data on different mental conditions and their associated factors among young people. The information gathered will be important for future planning on youth mental health services in Hong Kong and will offer the opportunity for a more meaningful comparison of data with other youth populations.

Bayesian outcome selection modeling.

In psychiatric and social epidemiology studies, it is common to measure multiple different outcomes using a comprehensive battery of tests thought to be related to an underlying construct of interest. In the research that motivates our work, researchers wanted to assess the impact of in utero alcohol exposure on child cognition and neuropsychological development, which are evaluated using a range of different psychometric tests. Statistical analysis of the resulting multiple outcomes data can be challenging, because the outcomes measured on the same individual are not independent. Moreover, it is unclear, a priori, which outcomes are impacted by the exposure under study. While researchers will typically have some hypotheses about which outcomes are important, a framework is needed to help identify outcomes that are sensitive to the exposure and to quantify the associated treatment or exposure effects of interest. We propose such a framework using a modification of stochastic search variable selection, a popular Bayesian variable selection model and use it to quantify an overall effect of the exposure on the affected outcomes. The performance of the method is investigated empirically and an illustration is given through application using data from our motivating study.

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study.

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

The Netherlands Mental Health Survey and Incidence Study-3 (NEMESIS-3): Objectives, methods and baseline characteristics of the sample.

NEMESIS-3 (Netherlands Mental Health Survey and Incidence Study-3) is a psychiatric epidemiological cohort study of the Dutch general population that replicates and expands on two previous NEMESIS-studies conducted in 1996-1999 and 2007-2018 respectively. The main aims of NEMESIS-3 are to provide up-to-date information on the prevalence, incidence, course and consequences of mental disorders, their risk indicators, and to study the relevant time trends. This paper gives an overview of the objectives and methods of NEMESIS-3, especially of the recently completed first wave, and describes the sample characteristics. NEMESIS-3 is based on a multistage, stratified random sampling of individuals aged 18-75years. Face-to-face interviews were laptop computer-assisted and held at the respondent's home. A slightly modified Composite International Diagnostic Interview (CIDI) version 3.0 was used to assess both Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and DSM-5 mental disorders. Two follow-up waves are planned three and sixyears after baseline. In the first wave, performed from November 2019 to March 2022, 6194 individuals were interviewed: 1576 respondents before and 4618 respondents during the COVID-19 pandemic. The average interview duration was 91min and the response rate was 54.6%. The sample consisted of 50.4% women and had a mean age of 47.9years. The sample was reasonable nationally representative, although some sociodemographic groups were somewhat underrepresented. Despite the COVID-19 restrictions, we were able to build a large and comprehensive dataset of good quality, permitting us to investigate the latest trends in mental health status, various new topics related to mental health, and the extent to which the pandemic has had an effect on the population's mental health.

Beyond Shared Care in Child and Adolescent Psychiatry

Abstract Based in the multicultural context of Montreal, Quebec, Canada, this article reviews shared care and collaborative care models which privilege consultations between primary and specialty care in children's mental health. An overview of Canada's two largest child psychiatric epidemiological studies outlines the nonclinical community prevalence in Ontario (18.5%) and Quebec (15%) of children's mental health problems along with salient family and community risk factors. Given the high prevalence of children's mental health problems and the burden of care undertaken by primary care practitioners, the interface between the first line of care and mental health services is crucial yet often characterized by poor communication, a lack of mutual comprehension, and limited collaboration. Collaborative mental health care has been defined as “a family physician or other primary care provider working together with a psychiatrist or other mental health worker in a mutually supportive partnership.” This definition is extended to describe a spectrum of partnerships in child and adolescent psychiatry (CAP): shared care, collaborative care, and related collaborative community practices. The author's experience with these models is presented with an overview of a pilot study on CAP shared care in Montreal. Two other recent trends in Quebec are explored: an innovation called “Medical Specialists Responding in Child and Adolescent Psychiatry” for community mental health-care teams and the pair aidant or “peer helper” model reaching out to patients and families with a member who suffers from mental health problem to serve as a helper, a model, and part of the support network.

Symposium

West Bengal is a unique state that has a unique geography and extra-ordinary people. Despite that, the people from Bengal being held in very high esteem for their knowledge, love for their rich culture, leadership qualities; West Bengal has quite high rates of mental illness compared to the Indian average. Psychiatry as a subject developed in West Bengal much earlier and richer compared to the other parts of the country. One of the two pillars of the psychiatry that developed in West Bengal was the development of the mental asylums/hospitals that also gave way to the development of the General Hospital psychiatry under the pioneering leadership of Dr. Girindra Sekhar Bose and his setting up of a psychiatry OPD(first Psychiatry OPD in a GHPU in Asia) at the premises of R. G. Kar Medical College and Hospital in 1933. As time went by, and the institutes and the GHPUs evolved, Bengal saw the development of research, sphere-headed by extra-ordinary psychiatrists in the field of psychiatric epidemiology. Elanger et al (‘71) and Nandi et al (‘74-‘75) were the first groups to publish prevalence studies from West Bengal using questionnaire driven, house to house survey with good methodology. Special and high risk population psychiatric epidemiological studies outnumbered and contributed to the lion’s share of the data presented by the researchers from West Bengal totalling 7 out of the 8 studies published before 2001. Further Prof. D. N. Nandi is hailed to be the only one to be doing follow up prevalence study from India and also incidence studies in psychiatric epidemiology. If one goes into the history of the epidemiological studies from India, no account shall be complete without quoting the studies from West Bengal.

Epidemiology of Mental Disorders

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

Risk factors for severity of social withdrawal in adolescence: Understanding hikikomori as a spectrum

IntroductionSocial withdrawal, or hikikomori, is one of Japan’s most serious psychosocial issues. The concept gained international attention around 2010 and widespread psychiatric epidemiological studies have since been conducted.ObjectivesWith an understanding of the extensive range of hikikomori circumstances as a spectrum, we aimed to quantitatively measure the severity of hikikomori in adolescent subjects, an age group considered particularly susceptible to the condition, and to identify factors associated with its severity.MethodsWe selected population demographics, socioeconomic data, and psycho-behavioral characteristics as factors related to hikikomori and explored their associations with hikikomori severity using cross-sectional analysis. Subjects were a patient group of middle school students examined as outpatients at a psychiatric clinic during adolescence for a chief complaint of hikikomori and a control group of middle school students matched for sex and age. Subjects’ parents completed a questionnaire pertaining to their child’s hikikomori symptoms and living environment along with the Child Behavior Checklist (CBCL). The data collected was then statistically analyzed.ResultsT-test results demonstrated that scores for all CBCL syndrome scales were significantly higher in the patient group, but no scores fell within the clinical range. Multiple regression analysis revealed that being anxious/depressed, somatic complaints, lack of communication between parents, and overuse of the Internet were statistical predictors of hikikomori severity.ConclusionsIt may be possible to prevent hikikomori from becoming severe if the above predictors are used to identify high-risk individuals requiring active intervention while hikikomori is at an early stage.DisclosureNo significant relationships.

Chronic Pain and Mood Disorders in Asian Americans.

Purpose: Pain and mood disorder frequently coexist. Yet, for Asian Americans (AAs), scant information about pain and mood disorder is available. Our aims were to compare (1) the rates of pain and mood disorders and (2) the magnitude of associations between pain and mood disorders between AAs and European Americans (EAs), and across different Asian subgroups.Methods: An analytical data was constructed from the Collaborative Psychiatric Epidemiology Studies (CPES), a representative sample of community-residing U.S. adults (n = 9,871). Pain morbidity was assessed by self-report. Mood disorders, including major depression and anxiety disorders, were assessed using the diagnostic interview. Analysis included descriptive statistics and multivariate logistic regression modeling. All analyses were weighted to approximate the U.S. populations, and controlled for sociodemographic and immigration characteristics.Results: Greater proportion of EAs, compared to AAs, endorsed lifetime pain (56.8% vs. 35.8%). Having life pain disorders elevated the likelihood of lifetime mood disorder by more than 2-folds (weight adjusted odds ratio (WAOR): 2.12, 95% CI: 1.77, 2.55). Having pain disorders over the past 12 months elevated the likelihood of mood disorder in the same time period by more than 3-folds (WAOR: 3.29, 95% CI: 2.02, 5.37) among AAs. The magnitude of the association between pain and psychiatric morbidity were greater in Vietnamese Americans compared to other AAs and EAs.Discussion: The conventional belief that rates of pain and mood disorders are greater in AAs than EAs may need to be further examined. Vietnamese Americans may be particularly vulnerable for experience of comorbid pain and mood disorders.

Childhood trauma and bullying-victimization as an explanation for differences in mental disorders by sexual orientation

Sexual minority individuals are more likely to have mental disorders, including mood, anxiety, and substance use disorders, compared to heterosexual individuals. Whether experiencing trauma or bullying-victimization during childhood explains these differences is currently unclear. We used a psychiatric epidemiological general population-based study to assess whether childhood trauma severity and bullying-victimization before age 16 explains the difference by sexual attraction in mental disorders. Data from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; N = 6392) were used to examine (1) whether same/both-sex attraction and predominantly other-sex attraction is linked to self-reports of childhood trauma (types and severity) and bullying-victimization, and (2) whether these experiences explain differences between these groups in lifetime and 12-month prevalence of DSM-IV disorders assessed by the Composite International Diagnostic Interview 3.0. Same/both-sex attracted individuals reported a higher childhood trauma severity score compared to exclusively other-sex attracted individuals (B = 0.93, SE = 0.20, p < .001), and were more likely to report bullying-victimization (OR = 2.51 95%CI[1.68, 3.74]). DSM-IV disorders were more prevalent among same/both-sex attracted individuals than among exclusively other-sex attracted individuals (ORs ranged from 1.57 to 4.68). There were no differences in DSM-IV disorders for predominantly other-sex attracted individuals. Childhood trauma severity explained between 9.0% and 57.0% of significant indirect associations between same/both-sex attraction and DSM-IV disorders. Sexual minority individuals experience more types of, and more severe childhood trauma, and are more likely to experience bullying-victimization. These negative experiences partly explained disparities in mental disorders.

Duration of anxiety disorder and its associated risk indicators: Results of a longitudinal study of the general population.

Data on episode duration of anxiety disorders are required for informing patients and for disease management, but such data from population studies are lacking. Three-year longitudinal data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the general adult population (N = 6646). Respondents with a new (first or recurrent) anxiety disorder were selected (n = 158). DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview; the Life Chart Interview assessed episode duration and recovery rates. Among those with anxiety disorder, median episode duration was 7.5 months and mean duration was 15.2 months. 38.8% had not recovered at 12 months and 30.1% not at 36 months. Longer duration was associated with older age, not having a paid job, higher neuroticism, more physical disorders, and worse physical functioning. Also, in the general population, anxiety disorder has a rather chronic course. After 12 months the cumulative recovery rate flattened. To prevent and manage chronicity, timely treatment, and chronic disease management are required. The risk indicators found may help to identify individuals with an anxiety disorder at risk for chronicity.

Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study.

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.