Risk Factor For Psychiatric Disorders Research Articles

Psychiatric disorders in hypertrophic cardiomyopathy

Objective Depression is undertreated in cardiac disease. Our aim was to evaluate frequency and risk factors of psychiatric disorders in hypertrophic cardiomyopathy. Methods This was a two-phase epidemiological approach, using screening questionnaire then gold standard structured clinical interview. A cohort of 148 patients aged ≥18 (78% response rate) attending a dedicated hypertrophic cardiomyopathy clinic (1996–1998) were screened for psychiatric morbidity using Hospital Anxiety and Depression Scale and Social Adjustment Scale. Likely cases and noncases were evaluated by Structured Clinical Interview for DSM-III-R. The main outcome measure was prevalence of psychiatric diagnoses, with descriptive comparison against population statistics. Results Thirty-seven percent of cardiomyopathy patients fulfilled criteria for anxiety disorder and 21% for mood disorder. Presence of mood disorder was associated with chest pain [relative risk (RR) 4.5, 95% CI 2.8–17.5], older age (2.8, 1.4–5.6), higher perceived risk of death (5.4, 2.3–13.0), poorer social adjustment (2.1, 1.1–4.2) and problems with sexual relations (1.5, 1.2–3.6). Presence of anxiety disorders was associated with chest pain (RR 3.5, 95% CI 2.1–26.0), higher perceived risk of death (2.0, 1.2–3.4), perception of physical symptoms as ‘severe’ (2.2, 1.2–4.2) and more recent diagnosis (1.7, 1.0–2.7). Conclusions Patients with cardiomyopathy have an elevated risk of mood disorders and anxiety disorders. Several demographic and clinical factors were found to be associated with these psychiatric conditions. Proper treatment intervention is likely to improve quality of life.

Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents

Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. The majority of putative risk factors were specific to one disorder or one disorder domain. A unique or 'signature set' of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. Our findings support the need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex.

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care

Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care. Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25-75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two "other mental health disorders" (somatization and disordered eating) and five sub-threshold conditions. The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had 'other mental disorders' and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45-64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population. This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study

Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms. A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years. Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME. This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

Understanding differences in past year psychiatric disorders for Latinos living in the US

This study seeks to identify risk factors for psychiatric disorders that may explain differences in nativity effects among adult Latinos in the USA. We evaluate whether factors related to the processes of acculturation and enculturation, immigration factors, family stressors and supports, contextual factors, and social status in the US account for differences in 12-month prevalence of psychiatric disorders for eight subgroups of Latinos. We report results that differentiate Latino respondents by country of origin and age at immigration (whether they were US-born or arrived before age 6: In-US-as-Child [IUSC]; or whether they arrived after age 6: later-arrival immigrants [LAI]). After age and gender adjustments, LAI Mexicans and IUSC Cubans reported a significantly lower prevalence of depressive disorders than IUSC Mexicans. Once we adjust for differences in family stressors, contextual factors and social status factors, these differences are no longer significant. The risk for anxiety disorders appears no different for LAI compared to IUSC Latinos, after age and gender adjustments. For substance use disorders, family factors do not offset the elevated risk of early exposure to neighborhood disadvantage, but coming to the US after age 25 does offset it. Family conflict and burden were consistently related to the risk of mood disorders. Our findings suggest that successful adaptation into the US is a multidimensional process that includes maintenance of family harmony, integration in advantageous US neighborhoods, and positive perceptions of social standing. Our results uncover that nativity may be a less important independent risk factor for current psychiatric morbidity than originally thought.

Prevalence and risk factors of psychiatric disorders in an industrial population in India.

Background:Recent information on psychiatric morbidity in industrial employees is not available in India. Such information may help in building mental health care for this population.Aim:The aim was to study the prevalence of psychiatric morbidity and the risk factors associated with it in an industrial population.Materials and Methods:Two hundred thirty-eight individuals were selected by a stratified randomisation technique and screened using the General Health Questionnaire-12 (GHQ-12), Johns Hopkins University Hospital Test for alcoholism and a semistructured questionnaire for other substance use, sleep problems and past psychiatric history. Following a detailed clinical interview, diagnoses were based on International Classification of Diseases (ICD)–10, Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR).Results:The prevalence rate for psychiatric disorder of one month's duration in the study population was 51.7%. Substance use, depression, anxiety and sleep disorders were common. Comorbidities were found in 65% of the subjects. Both univariate analysis and stepwise multiple regression revealed that educational level, perceived stress, job satisfaction and stressful life events were the independent determinants of psychiatric morbidity.Conclusion:A significant proportion of industrial employees had psychiatric morbidity and many psychosocial factors were associated with caseness.

Association of 677C>T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene with bipolar disorder and schizophrenia

Methylenetetrahydrofolate reductase (MTHFR) gene polymorphism 677C>T has been shown to be a risk factor for psychiatric disorders. We investigated the genotype and allelic frequencies of MTHFR 677C>T polymorphism in the group of patients with bipolar disorder type I (BDI) ( n = 200) and schizophrenia ( n = 200), and in the control group ( n = 300). Odds ratio (OR) for patients with BD and schizophrenia with 677T allele was 1.988 ((95% CI = 1.370–2.883); P = 0.0003 ( P = 0.0006 after Bonferroni correction)) and 1.796 ((95% CI = 1.237–2.609); P = 0.0020 ( P = 0.0040 after Bonferroni correction)), respectively. The stratification of patients based on gender revealed significant association of 677T allele with male patients with BDI and schizophrenia (OR = 2.393; 95% CI = 1.429–4.006; P = 0.0008 and OR = 2.036; 95% CI = 1.207–3.433; P = 0.0073, respectively). This finding indicates possible association of BD and schizophrenia with the 1p36.3 MTHFR locus.

Stem cell transplantation: Risk factors for psychiatric morbidity

The aim of this study was to determine the risk factors for psychiatric disorder in haematological cancer patients during hospitalization for stem cell transplantation. In this 3-year prospective study, 220 patients received stem cell transplantation at a single institution. Structured psychiatric interviews applying standardized diagnostic criteria were performed at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 interviews. Psychiatric disorder (any depressive, anxiety, or adjustment disorder) prevalence at the time of hospital admission was 21% and psychiatric disorder incidence during post-admission follow-up was 22%. After adjusting for multiple confounders in multivariate logistic regression analyses, we found that younger age, women, a past psychiatric history, lower functional status, pain, smoking cessation, and higher regimen-related toxicity were significantly associated with psychiatric disorder risk. Our study findings may help to improve identification of the patients most at risk for psychiatric disturbances during hospitalization for stem cell transplantation.

Depression and Quality of Life in Patients Living 10 to 18 Years Beyond Heart Transplantation

The purpose of this study was to advance current understanding of factors that influence long-term quality-of-life (QoL) outcomes after heart transplantation, by addressing the influence of depression on perceived health status. Data were collected from all recipients (n = 137) still alive at >10 years after transplantation. They completed the Short Form Health Survey (SF-36) inventory and the Beck Depression Inventory (BDI) questionnaire, while objective measures of health status were retrieved from medical records. All instruments used had acceptable reliability and validity. Data were analyzed using descriptive statistics, general linear regression models and survival analysis. We assessed 137 patients who received transplants between November 1985 and June 1994 in Pavia and have survived 10 to 18 years after transplantation (mean 13.64 years, SD 2.25). They rated their health as good and only the physical QoL (PCS) was impaired when compared with the general population. Thirty-two percent of patients experienced mood depressive symptoms in the long term after transplantation, indicating a low perceived QoL. Higher educational qualification (p = 0.049), being unemployed and receiving a disability pension (p = 0.001), high triglycerides levels (p = 0.020) and lack of physical activity (p < 0.001) were predictors of high BDI scores. Assessment of depression levels and better understanding of risk factors for psychiatric disorders in the long term after transplantation could be of benefit in predicting negative outcomes and allowing future developments in patient management.

Maternal separation stress drastically decreases expression of transthyretin in the brains of adult rat offspring

Adversity in early life has been recognized as a risk factor for psychiatric disorders. In experimental animals, maternal separation (MS) during the neonatal period has been shown to be critical for susceptibility to stress in adult offspring. In this study, we used DNA microarray analysis of rat hippocampal samples to investigate differential gene expression caused by 8-hour MS (MS-8h) every other day during the neonatal period. We found 15 up-regulated and 9 down-regulated genes. We added samples from a daily 15-minute MS (MS-15m) group and performed quantitative real-time PCR to validate the results. Expression of transthyretin (TTR), which is specifically expressed in the choroid plexus (CP), was drastically reduced in the MS-8h group. Two other CP-enriched genes, angiotensin I converting enzyme I and insulin-like growth factor II (IGF-II), were also significantly down-regulated in the MS-8h rats, while significant reduction of IGF-II expression was also found in the MS-15m group. These MS-induced differential gene expressions could be involved in the molecular mechanisms of stress susceptibility. Our findings indicate that the CP, in addition to the neuronal and glial system, might play an important role in determining stress susceptibility.

Temperament and Its Implications for Neuroimaging of Anxiety Disorders

We review the attributes of inhibited and uninhibited infant temperaments, and their developmental trajectories into early adulthood. Inborn individual differences in infants' propensity to respond to novel people and objects are associated with persistent differences in the responsivity of the amygdala to novelty, as measured with functional magnetic resonance imaging, after more than 20 years of development. Because an inhibited temperament is a risk factor for developing later psychiatric disorders, particularly generalized social anxiety disorder, temperamental differences are confounds in neuroimaging and genetic studies. Longitudinal studies are a unique tool for understanding the developmental and temperamental risk factors for psychiatric disorder.

Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables

Objectives:There are few studies on epilepsy and psychopathology in people with intellectual disability (mental retardation) despite epilepsy prevalence rates that are thirty times higher than in the general population. The...

Association between organizational inequity and incidence of psychiatric disorders in female employees.

Prior research on work-related factors in the aetiology of psychiatric disorders has been concentrated on job control, job demands and social support. To broaden the view to managerial procedures, we examined whether the extent to which employees are treated with equity in the workplace predicts their mental health. Organizational equity refers to decision-making procedures, which are consistently applied, open, correctable and include input from affected parties (procedural justice). It also refers to respectful and considerate treatment of individuals by supervisors (relational justice). A cohort of 1786 female hospital employees with no psychiatric disorder at baseline responded to a questionnaire on organizational equity. From the responses, both an individual score and a work unit mean score were assigned to each participant. The outcome was new reports of doctor-diagnosed psychiatric disorders during the 2-year follow-up. Odds ratios and 95% confidence intervals were corrected for clustering of the data. After adjustment for age and salary, odds ratio of new psychiatric disorders for self-reported low procedural justice was 1.9 (95% CI 1.1 to 3.2). Corresponding odds ratio for low procedural justice, as assessed with work unit mean scores, was 1.7 (95% CI 1.5 to 2.0). These associations remained statistically significant after additional adjustment for mental distress at baseline and job control, job demands and social support. Relational justice did not predict psychiatric disorders. Research on organizational equity provides new information about potential work-related determinants of mental health. Low procedural justice seems to be an independent risk factor for psychiatric disorders in female employees.

A multicenter study on the prevalence of psychiatric disorders among new referrals for epilepsy in Japan.

To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD-10 criteria for psychiatric disorders. From April 2000 to March 2001, 398 patients with epilepsy, who were referred to nine neuropsychiatric outpatient clinics specialized for epilepsy in the Tokyo metropolitan area, were evaluated by using a newly developed five-axis classification scheme. Forty-two percent of the subjects showed a psychiatric disorder. Twenty-four percent of the total showed psychiatric disorders, including neurotic disorders in 8%, psychotic disorders in 7%, and affective disorders in 1%. In addition, 23% of the total showed mental retardation, and 18% showed personality disorders. A logistic regression analysis revealed that the three risk factors for a psychiatric disorder were mental retardation, temporal lobe epilepsy (as opposed to other subtypes), and a high seizure frequency. The presence of mental retardation was the primary risk factor for developing a psychiatric disorder, especially a schizophrenia-spectrum disorder. The type of epilepsy alone is not a strong predictor of psychiatric illness, and intractable temporal lobe epilepsy with a high seizure frequency is accountable for the link between the epilepsy and the psychiatric illness.

Adolescents' self-reported problems as predictors of psychopathology in adulthood: 10-year follow-up study.

Knowledge of the course of psychopathology from adolescence into adulthood is needed to answer questions concerning origins and prognosis of psychopathology across a wide age range. To investigate the 10-year course and predictive value of self-reported problems in adolescence in relation to psychopathology in adulthood. Subjects from the general population, aged 11-19 years, were assessed with the Youth Self-Report (YSR) at initial assessment, and with the Young Adult Self-Report (YASR), the Composite International Diagnostic Interview (CIDI) and three sections of the Diagnostic Interview Schedule (DIS) 10 years later. Of the subjects with deviant YSR total problem scores, 23% (males) and 22% (females) had deviant YASR total problem scores at follow-up. Subjects with initial deviant YSR total problem, internalising and externalising scores had higher prevalences of DSM-IV diagnoses at follow-up. Adolescent problems tended to persist into adulthood to a moderate degree. High rates of problems during adolescence are risk factors for psychiatric disorders in adulthood.

Prevalence and Risk of Depression and Anxiety-Related Disorders During the First Three Years After Heart Transplantation

Although poor psychological adjustment to organ transplantation appears to be a major contributor to reduced quality of life and increased physical morbidity, the prevalence and risk factors for psychiatric disorder have not been considered beyond the first 12-18 months after transplantation. The authors enrolled a representative sample of 191 heart transplant recipients in a prospective examination of the prevalence, clinical characteristics, and risk factors for DSM-III-R major depressive disorder (MDD), generalized anxiety disorder (GAD), associated adjustment disorders, and posttraumatic stress disorder related to transplant (PTSD-T) during the 3 years postsurgery. Survival analysis indicates that cumulative risks for disorder onset were MDD, 25.5%; adjustment disorders, 20.8% (17.7% with anxious mood); PTSD-T, 17.0%; and any assessed disorder, 38.3%. There was only one case of GAD. PTSD-T onset was limited almost exclusively to the first year posttransplant. Episodes of MDD (but not anxiety disorders) that occurred later posttransplant (8 to 36 months postsurgery) were more likely than early posttransplant episodes to be treated with psychotropic medications. For both MDD and anxiety disorders, later episodes were less likely to be precipitated by transplant-related stressors than other life stressors. Factors increasing cumulative risk for psychiatric disorder posttransplant included pretransplant psychiatric history, female gender, longer hospitalization, more impaired physical functional status, and lower social supports from caregiver and family in the perioperative period. Risk factors' effects were additive; the presence of an increasing number of risk factors bore a dose-response relationship to cumulative risk of disorder.

A pessimistic attitude towards the future and low psychosocial functioning predict psychiatric diagnosis among treatment-seeking adolescents.

The objective was to study factors associated with psychiatric diagnosis among adolescents (n = 164) seeking psychiatric care for mental symptoms. Psychiatric diagnosis was confirmed by a structured diagnostic interview. Psychosocial functioning was assessed with the Global Assessment of Functioning Scale, and the Beck Depression Inventory and Offer Self-Image Questionnaire were also used. Background data were gathered. A majority (76%) of the adolescents met DSM-III-R criteria for psychiatric diagnosis. The self-image was more negative and the Beck score was higher among these adolescents than the others. All who had attempted suicide had a psychiatric disorder. Those diagnosed as having a psychiatric disorder consumed alcohol in order to get drunk more often than others. Continual conflicts with parents and smoking were not associated with the existence of a psychiatric disorder. In logistic regression analysis, low psychosocial functioning (OR = 3.9) and an uncertain or pessimistic attitude towards the future (OR = 9.1) proved to be independent risk factors for psychiatric disorders. Health service staff should be aware of factors associated with psychiatric disorders in adolescents so that they can identify those at high risk.

Dopamine receptor D2 Ser/Cys 311 variant is associated with delusion and disorganization symptomatology in major psychoses.

The D2 receptor (DRD2) is a binding site of many psychoactive drugs and it has been proposed as a genetic risk factor for psychiatric disorders. The aim of this investigation was to study the DRD2 S311C variant in major psychoses. We studied 1182 inpatients with diagnoses of bipolar disorder (n = 480), major depressive disorder (n = 269), schizophrenia (n = 366), delusional disorder (n = 44), psychotic disorder not otherwise specified (n = 23) and 267 healthy controls. Eight hundred and eighty-seven subjects were also scored for their lifetime symptomatology using the the Operational Criteria checklist for psychotic illness (OPCRIT). DRD2 variants were not associated with affected subjects even when possible confounders like gender and onset were considered. When we considered the 887 subjects with the symptomatologic analysis, we observed a significant association of the DRD2 S311C variant with both delusion and disorganization features. The association was present independently from diagnoses. Our results do not show that coding variants of the DRD2 S311C play a major role in conferring susceptibility to major psychoses, but they may be connected with disorganized and delusional symptomatology independently from diagnoses.

Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farmworkers in California

In this study, the prevalence of and risk factors for 12 psychiatric disorders were examined by sex and ethnicity (Indian vs non-Indian) among Mexican migrant farm-workers working in Fresno County, California. Subjects aged 18 through 59 years were selected under a cluster sampling design (n = 1001). A modified version of the Composite International Diagnostic Interview was used for case ascertainment. The effects of sociodemographic and acculturation factors on lifetime psychiatric disorders were tested. Lifetime rates of any psychiatric disorder were as follows: men, 26.7% (SE = 1.9); women, 16.8% (SE = 1.7); Indians, 26.0% (SE = 4.5); non-Indians, 20.1% (SE = 1.3). Total lifetime rates were as follows: affective disorders, 5.7%; anxiety disorders, 12.5%; any substance abuse or dependence, 8.7%; antisocial personality, 0.2%. Lifetime prevalence of any psychiatric disorder was lower for migrants than for Mexican Americans and for the US population as a whole. High acculturation and primary US residence increased the likelihood of lifetime psychiatric disorders. The results underscore the risk posed by cultural adjustment problems, the potential for progressive deterioration of this population's mental health, and the need for culturally appropriate mental health services.

Sexual and physical abuse during early childhood or adolescence and later drug addiction

Sexual or physical abuse of children are discussed as possible causes or risk-factors for psychiatric disorders like posttraumatic stress disorder, alcohol and drug addiction. The aim of this study was to identify possible differences between sexually or physically abused and non-abused patients with polytoxic drug abuse. 100 patients with polytoxic drug abuse were interviewed during their therapy about a history of sexual abuse prior to the age of sixteen. Using different questionnaires we tried to find possible differences between drug users being sexually abused or not and risk factors for later drug addiction. 70% of the female and 56% of the male drug users had been sexually abused as children, 40% of the male and 50% of the female participants had a history of severe sexual abuse with sexual intercourse. In over 50% friends or relatives were the perpetrators committed the crime, in no case the parents had. More than 40% showed also a history of physical abuse. Significantly more drug users than alcohol abusers had a sexual trauma. Especially severe sexual abuse was associated with abuse of hard illegal drugs. Furthermore, we could find significantly more symptoms such as autoaggressive and suicidal behaviour, social isolation, reduced emotional binding to others, tendency to be persistently victimized, prostitution and violence against others in the group of sexually abused. Many of these symptoms are not only characteristic of addiction, but can be found also in other psychiatric diseases such as borderline and eating disorder. In conclusion, we could not find a significant correlation between sexual abuse and later drug addiction. 80% of the drug users themselves did not relate the fact of being sexually abused as child to later drug abuse. However, there seems to be a positive correlation between sexual abuse and a more severe addiction to illegal drugs as well as higher rates of symptoms with a negative course of the disease. For this group of patients with an unfavourable prognosis special therapeutic concepts are needed.