WHO Composite International Diagnostic Interview Research Articles

Internet-based cognitive–behavioural therapy for prevention of depression during pregnancy and in the post partum (iPDP): a protocol for a large-scale randomised controlled trial

IntroductionThe objective of this randomised controlled trial (RCT) is to examine the effects of smartphone-based cognitive–behavioural therapy (CBT) in preventing the onset of major depressive episodes (MDE) among pregnant women.Methods...

Is Recovery from Cannabis Dependence Possible? Factors that Help or Hinder Recovery in a National Sample of Canadians with a History of Cannabis Dependence.

Objectives To identify among Canadian adults who have ever been dependent upon cannabis, the prevalence of risk and protective factors associated with (1) cannabis remission, (2) the absence of psychiatric disorders or addictions in the past year (APD), and (3) positive mental health (PMH). Method Data from Statistics Canada's nationally representative 2012 Canadian Community Health Survey-Mental Health (n = 20, 777, of whom 336 have a history of cannabis dependence) was used. Chi-square tests and logistic regression analyses were conducted. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) measures were used to determine lifetime cannabis dependence, past-year remission from cannabis depression, and the absence of psychiatric disorders in the past year (APD) (i.e., no suicidal ideation, depressive episodes, anxiety disorders, bipolar disorders, or any substance dependence). PMH is comprised of three factors: APD, happiness or life satisfaction and social and psychological well-being. Results Among those with a history of cannabis dependence, 72% were in remission from cannabis dependence. Although 53% were free of major psychiatric disorders and any substance dependence and 43% of respondents were in PMH, these percentages were dramatically lower than those without a history of cannabis dependence (92% and 74%, respectively). Positive outcomes were more common among women, older respondents, those with higher levels of social support, and those who had never had major depressive disorder or generalized anxiety disorder. Conclusion Although many Canadians with a history of cannabis dependence achieve remission and a large minority are truly resilient and achieve PMH, many are failing to thrive. Targeted outreach is warranted for the most vulnerable individuals with a history of cannabis dependence (e.g., men, younger respondents, those with low social support and a history of mental illness).

Co-Morbidity between Major Depression and Schizophrenia: Prevalence and Clinical Characteristics.

The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.

Psychological distress with and without a history of depression: Results from the World Mental Health Japan 2nd Survey (WMHJ2)

BackgroundPsychological distress is prevalent and heterogenous. Checking a history of depression may contribute to identifying those who need intensive preventive support, but few studies have examined how different the dysfunction of people with and without a history of depression among those with psychological distress are. The study aimed to compare the two groups in physical health problems, level of social and familial support. MethodsThe World Mental Health Japan 2nd Survey (WMHJ2), a cross-sectional, nationally representative face-to-face survey of residents aged 20–75 years old, was conducted from 2013 to 2015. We defined psychological distress as a K6 score of 5 or more. A history of major depressive disorder (MDD) was assessed by the WHO Composite International Diagnostic Interview version 3.0. Multinomial logistic regression analysis was used to examine the associations of sociodemographic characteristics, physical health problems, social support and mental health service use among those with no psychological distress, with psychological distress having no history of MDD, and with psychological distress having a history of MDD, adjusted for sociodemographic characteristics. ResultsUnemployment, physical health problems, and lack of social support were much more common among those with psychological distress without a history of MDD than those with no psychological distress, and were largely comparable with those with psychological distress having a history of MDD. LimitationsThe relatively low response rate might limit generalizability. ConclusionsThe dysfunction in psychological distress without a history of MDD was largely equivalent to that seen in distress with a history of MDD.

180 Is Mental Health Treatment Associated With Decreased Emergency Department Utilization?

Mental illness is known to be associated with increased emergency department utilization and tailored interventions have been created to reduce overuse. Little research, however, has examined the effect of standard care mental health treatment delivered in the community on ED utilization. This study aimed to determine the association of community mental health treatment with emergency department utilization among individuals with depression (MDD), generalized anxiety disorder (GAD), or panic disorder. Those with mental health diagnoses who reported receiving outpatient mental health treatment in the past year were hypothesized to be less likely to endorse utilizing the emergency department as one of their main providers of care. These data come from the MIDUS Refresher study, a publicly accessible data set of 2588 individuals from across the US. Participants were asked “where do you usually go if you are sick or need advice about your health?” and given the option of endorsing yes or no to “hospital emergency room” in addition to other primary care settings. MDD, GAD, and panic disorder were assessed using the WHO Composite International Diagnostic Interview. Number of chronic conditions was measured through participant report. Mental health treatment was measured through participant report of seeing a psychiatrist, general doctor, counselor, or religious leader for their mental health in the past 12 months, or of taking prescription medication for anxiety or depression over the past 30 days. 3.8% (N=135) of the sample qualified for GAD, 7.4% (N=263) qualified for panic disorder, and 13.3% (N=476) qualified for MDD. 11% (N=399) of the sample reported they would “usually go” to the ED, but only 1.3% (N=48) ranked the ED as health care setting they visited most often. Diagnosis of GAD, MDD, panic disorder, or a combination of the three was significantly associated with more chronic conditions (M=4.35, SD 3.66) than no diagnosis (M=2.69, SD=2.49), (t(-9.023), p<.001).As a whole, participants with at least one mood/anxiety diagnosis were more likely to report using the ED than those without, adjusting for race/ethnicity, education, age, sex and number of chronic symptoms (n=2518, AOR 1.584, 95% CI 1.204-2.084, p=.001). After propensity score matching by nearest neighbor, among participants with at least one mood/anxiety diagnosis, there was not a significant difference between those who did and did not receive mental health treatment in report of ED utilization when adjusting for race/ethnicity, education, age, sex and number of chronic symptoms (n=206, AOR .939, 95% CI .427-2.065, p=.876). This study found no association between mental health treatment and decreased ED utilization among individuals with mood/anxiety disorder. However, those with a mental health diagnosis had a significantly higher rate of chronic physical symptoms. As a result, future interventions that seek to decrease ED utilization among individuals with mood and anxiety disorders should target chronic physical conditions as well as mental health symptoms.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Prevalence of intimate partner violence victimization and its association with mental disorders in the Korean general population.

This study assessed the association between experiencing physical or sexual intimate partner violence (IPV) and mental health among women in the general Korean population. A total of 3160 South Korean women aged 18 to 74 responded to the Korean version of the WHO-Composite International Diagnostic Interview (K-CIDI), version 2.1., and questions about IPV. Multiple logistic regression was used to examine the odds of developing mental disorders associated with each type of IPV. Victimization by any type of IPV was associated with significantly increased odds of experiencing any mental disorders in the lifetime (OR 4.4, 95% CI 2.4-8.0). Participants who experienced sexual IPV had the highest odds of having mental disorders (OR 14.3, 95% CI 4.1-54.8). Sexual IPV experience among participants was associated with higher odds of major depressive disorder, anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, specific phobias, agoraphobia, and nicotine dependence. Alcohol use disorder was highly associated with experiencing physical IPV (OR 3.8, 95% CI 1.7-8.0). Among women who experienced IPV, the youngest age group, from 18 to 35years old (2.6%, 95% CI 1.4-3.8), and the never married group (2.7%, 95% CI 1.2-4.2) experienced the highest proportion of any form of IPV. Mental disorders throughout the lifetime are highly associated with the experience of IPV among women and are most prevalent among those who experienced sexual IPV. Thus, to prevent mental disorders among female IPV victims, treatment specific to each type of IPV should be provided early.

Post-traumatic Stress Disorder and Functional Disability among Internally Displaced Persons in North-East Nigeria

The prolonged Boko Haram crises in North-East Nigeria caused serious displacement and left the survivors with multiple psychological consequences such as Posttraumatic stress disorder (PTSD). A high prevalence rate of PTSD among Internally Displaced Persons (IDPs) has been reported across literatures. This study aimed to determine the factors that are associated with PTSD and its relationship with functional disability among IDPs in Yobe State, Nigeria. This was a cross sectional study of 450 respondents, recruited using a systematic sampling method. We used Harvard Trauma Questionnaire to screen for symptoms of PTSD and definite diagnosis made with WHO Composite International Diagnostic Interview (CIDI), PTSD Module. Hopkins Symptom Checklist was used for symptoms of depression and definite diagnosis made with CIDI Depression Module. The WHO Disability Assessment Schedule 2.0 was used to measure functional disability. There were 192 (45.5%) males and 230(54.5%) female respondents. The mean age of respondents was 39.4±18.50 years with range of 18-80 years. Significant PTSD symptoms were found among 159(37.7%) of the IDPs while Clinical interview gave a definite prevalence of 18.5%. Two hundred and forty-four (57.8%) of the respondents had disability scores in the mild range, 17.5% in the moderate range while 20.7% were in the severe range. Majority of those with disability scores in the severe range had PTSD. Factors significantly associated with PTSD were age, marital status, duration of displacement, type of abode, general living condition, self-reported general health, and disability score. A High prevalence rate of PTSD was found among IDPs and the severity of disability correlated well with having diagnosis of PTSD in the study.

Prevalence and correlates of generalized anxiety disorder in Singapore: Results from the second Singapore Mental Health Study

The aim of this paper is to report findings on the epidemiology of generalized anxiety disorder (GAD) using data from the Singapore Mental Health Study (SMHS) 2016, and draw comparisons with results from the first SMHS in 2010. Singapore residents aged 18 years and above participated in the household survey where the WHO Composite International Diagnostic Interview 3.0 was administered to assess the prevalence of GAD and other mental health conditions. The findings revealed that the lifetime prevalence of GAD was 1.6% among the Singapore general population in 2016, an increase from the 0.9% in 2010. More lifetime GAD cases were reported across several sociodemographic groups including age and employment status. Lifetime GAD was significantly associated with higher odds of several comorbid psychiatric conditions (OR = 3.8–9.3, p < 0.05). Treatment seeking behavior did not differ significantly when compared to SMHS 2010 and there was still a considerable treatment gap among individuals with GAD. Future intervention programs to reduce anxiety and encourage help-seeking behavior could be implemented at institutes of higher learning and workplace settings to reach the targeted audience.

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

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

Time trends in depression prevalence and health-related correlates: results from population-based surveys in Germany 1997\u20131999 vs. 2009\u20132012

BackgroundAlthough an “epidemic” of depression is frequently claimed, empirical evidence is inconsistent, depending on country, study design and depression assessment. Little is known about changes in depression over time in Germany, although health insurance companies report frequency increases. Here we examined time trends in depression prevalence, severity and health-related correlates in the general population.MethodsData were obtained from the mental health module of the “German Health Interview and Examination Survey for Adults” (2009–2012, n = 3265) and the mental health supplement of the “German National Health Interview and Examination Survey 1998” (1997–1999, n = 4176), excluding respondents older than 65. 12-month major depressive disorder (MDD), severity and symptoms were assessed based on the WHO Composite International Diagnostic Interview. Health-related quality of life (SF-36), self-reported sick days or days with limitations in normal daily life activities were examined, too. Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes.ResultsOverall, MDD 12-month prevalence remained stable at 7.4%. Women showed a shifted age distribution with increased prevalence at younger ages, and increasing MDD severity. Time trends in health-related correlates occurred both in participants with and without MDD. Mental health disability increased over time, particularly among men with MDD, reflected by the mental component score of the SF-36 and days with activity limitation due to mental health problems. Demographic changes had a marginal impact on the time trends.ConclusionsIn contrast to the ongoing international debate regarding increased depression rates in western countries, we found no increase in overall MDD prevalence in Germany over a long period. In conclusion, increased depression frequencies in national health insurance data and growing health care costs associated with depression are not attributable to overall prevalence changes at a population level. However, shifted age distribution and increased severity among women may reflect a rising depression risk within this specific subgroup, and changes in health-related correlates indicate a growing mental health care need for depression, particularly among men.

Sex Differences in Alcohol-Related Problems Among a Sample of HIV-Positive Nigerians

Although alcohol use is common among persons living with HIV/AIDS (PLWHA), and heavy drinking is more common worldwide in males than females, studies of sex differences in risk for development of symptoms of alcohol dependence have yielded mixed results. In Nigeria, there is a paucity of data on sex differences in alcohol-related problems among PLWHA. This has hindered our ability to tailor treatment to best meet the needs of PLWHA. To address this gap, the present study examined alcohol use patterns and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)-related symptoms in a sample of 331 HIV and AIDS patients (64.4% female; Mage = 38.1 years, SD = 9.1 years) recruited from Lagos State University Teaching Hospital Ikeja. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI), Version 7.0, was administered to assess alcohol use and DSM-IV-related symptoms. Based on responses to the interview, patients were classified as having or not having complication(s) or symptom(s). Logistic regressions adjusting for age and marital status revealed that women were at lower risk than men for alcohol-related problems. Symptoms of craving and tolerance did not differ across sex. Study findings support the need for policy to be geared toward sex-specific prevention and harm-reduction approaches among HIV-positive individuals.

Schizophrenia and co-morbid obsessive - compulsive disorder: Clinical characteristics

Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging co-morbid condition. Also, the relationship between SZ and OCD remains unclear. The aim of this study was to describe the co-morbidity of obsessive-compulsive disorder (OCD) among schizophrenia (SZ) patients and compare clinical characteristics of schizophrenia patients with versus without comorbid OCD. A cohort-study was carried out on 396 patients enrolled between November 2011 to June 2014 at the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without comorbid OCD (SZ-OCD vs SZ). 396 subjects were interviewed. Age of SZ-OCD patients was 42.69 ± 14.33 (years old) whereas SZ patients without OCD ranged 41.59 ± 13.59 years old. There were statistically significant differences in clinical characteristics between SZ with and without OCD : age (p = 0.010), BMI (body mass index; p = 0.011), education (p = 0.033), employment (p = 0.019), cigarette smoking (p = 0.039), sheesha smoking (p = 0.008), and prevalence of consanguinity (p = 0.043). In particular, the rate of consanguinity in the current generation was 31.8% [95% CI = 29.1-34.7]. Also, there were statistically significant differences at Hamilton Depression score, General Health Score, Clinical Global Impression- Score, duration of illnesses, and Global Assessment of Functioning (p < 0.001). The results show that anxious, mood and psychotic dimensions rated higher among SZ - OCD ones than SZ only patients. This study confirms that SZ-OCD is a common co-morbidity and prevalence of SZ OCD is higher among patients reporting a degree of consanguinity. Even if this condition is under-recognized in clinical practice, it may significantly change SZ presentation and outcome since psychopathological dimensions report higher scores in the co-morbidity sample.

An Epidemiological Study of Substance Use Disorders Among Emerging and Young Adults

We investigated the prevalence of substance use disorders (SUDs) among emerging adults and quantified the extent to which emerging adults, compared with young adults, have increased odds for SUDs. Data were from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Respondents were 15 to 39 y of age ( n = 9228) and were categorized as: early emerging adults (15 to 22 y); late emerging adults (23 to 29 y); and, young adults (30 to 39 y). SUDs [alcohol or drug abuse/dependence (AAD or DAD)] were measured using the WHO Composite International Diagnostic Interview 3.0. The prevalence of SUDs was compared across age groups, and odds ratios (OR) and 95% confidence intervals (CI) were computed from logistic regression models adjusting for sociodemographic and health covariates. Analyses were weighted to maintain representativeness to the Canadian population. The prevalence of AAD was 8.0%, 6.6%, and 2.7% for early emerging adults, late emerging adults, and young adults, respectively. For DAD, the prevalence was 6.4%, 3.6%, and 1.3%. After covariate adjustment, early and late emerging adults had greater odds of reporting AAD (OR = 3.2, 95% CI = 2.2 to 4.9 and OR = 2.4, 95% CI = 1.6 to 3.4, respectively) or DAD (OR = 4.2, 95% CI = 2.5 to 7.0 and OR = 2.5, 95% CI = 1.6 to 4.1, respectively) compared with young adults. Differences between early and late emerging adults were not significant. Emerging adults are at increased odds for SUDs. Lack of differences between early and late emerging adults provide evidence of the extension of emerging adulthood into the late 20s. Findings have implications for the provision of screening and treatment of SUDs during this developmental period.

Association of Urbanicity With Psychosis in Low- and Middle-Income Countries

Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). This international population-based study used cross-sectional survey data collected as part of the World Health Organization (WHO) World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (≥18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. Urban vs nonurban residence, determined by the WHO based on national data. Psychotic experiences, assessed using the WHO Composite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. Among the 215 682 participants (50.8% women and 49.2% men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95% CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95% CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95% CI, 0.87-1.07), OR for low-income countries of 0.98 (95% CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95% CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95% CI, 0.73-1.16), OR for low-income countries of 0.92 (95% CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95% CI, 0.67-1.27) for psychotic disorder. Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This finding may provide better understanding of the mechanisms by which urban living may contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparities may vary between developing and developed nations.

The epidemiology of personality disorders in the Sao Paulo Megacity general population.

IntroductionMost studies on the epidemiology of personality disorders (PDs) have been conducted in high-income countries and may not represent what happens in most part of the world. In the last decades, population growth has been concentrated in low- and middle-income countries, with rapid urbanization, increasing inequalities and escalation of violence. Our aim is to estimate the prevalence of PDs in the Sao Paulo Metropolitan Area, one of the largest megacities of the world. We examined sociodemographic correlates, the influence of urban stressors, the comorbidity with other mental disorders, functional impairment and treatment.MethodsA representative household sample of 2,942 adults was interviewed using the WHO-Composite International Diagnostic Interview and the International Personality Disorder Examination-Screening Questionnaire. Diagnoses were multiply imputed, and analyses used multivariable regression.Results and discussionPrevalence estimates were 4.3% (Cluster A), 2.7% (Cluster B), 4.6% (Cluster C) and 6.8% (any PD). Cumulative exposure to violence was associated with all PDs except Cluster A, although urbanicity, migration and neighborhood social deprivation were not significant predictors. Comorbidity was the rule, and all clusters were associated with other mental disorders. Lack of treatment is a reality in Greater Sao Paulo, and this is especially true for PDs. With the exception of Cluster C, non-comorbid PDs remained largely untreated in spite of functional impairment independent of other mental disorders.ConclusionPersonality disorders are prevalent, clinically significant and undertreated, and public health strategies must address the unmet needs of these subjects. Our results may reflect what happens in other developing world megacities, and future studies are expected in other low- and middle-income countries.

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Of 51,547 respondents (response=71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

Comparison of Psychiatric Comorbidity and Quality of Life (QOL) in Persons with Tuberculosis and People Living with HIV in South-South Nigeria

BACKGROUND: Tuberculosis and HIV are two chronic infective medical diseases commonly associated with psychiatric co-morbidity, which further affect the quality of life of the sufferers. AIM: The study was to determine and compare the relationship between psychiatric co-morbidity and quality of life in persons with tuberculosis and PLWHIV. METHODOLOGY: Two hundred and thirty subjects living with HIV and 140 subjects with tuberculosis were recruited. Those with clinically chronic conditions, or comorbid medical condition and treatment Resistant tuberculosis were excluded. Subjects were further administered with the study’s instruments including the socio-demographic questionnaire, GHQ-12, the brief version of the WHO Quality of Life instrument (WHOQOL-Bref) and WHO Composite International Diagnostic Interview (WHO CIDI). Results were presented via descriptive and analytical methods. RESULTS: The study found a prevalence of psychiatric co-morbidity of 19.8% among PLWHIV and 28.4% among subjects with tuberculosis (p = 0.004). For the PLWHIV, domain scores for quality of life were as follows; 60.71±15.57, 62.34±26.32, 61.57±25.04, 55.15±14.00 and 65.81±21.84 while tuberculosis was 50.97±13.87, 57.22±46.36, 54.51±45.04, 50.01±15.10 and 49.34±21.84 (p = 0.001) for physical, psychological, social relationship, environment domains and general health facet respectively. Furthermore, presence of psychiatric comorbidity significantly inversely correlated with quality of life among persons with both medical diseases. CONCLUSION: The study found a statistically significant higher prevalence of psychiatric co-morbidity and lower quality of life among the subjects with tuberculosis compared with PLWHIV. Findings suggest strongly that in managing patients with these conditions, attention should be paid to their mental health and subjective quality of life.

Population attributable fractions of psychopathology and suicidal behaviour associated with childhood adversities in Northern Ireland

Childhood adversities are strong predictors of psychopathology and suicidality. However, specific adversities are associated with different outcomes, with cross-national variations reported. The current study examined rates of adversities reported in Northern Ireland (NI), and associations between adverse childhood experiences and psychopathology and suicidal behaviour were explored. Data was obtained from the Northern Ireland Study of Health and Stress (NISHS), conducted as part of the World Mental Health (WMH) survey initiative (2004–2008); response rate 68.4% (n = 1,986). The on-line survey used, the WHO Composite International Diagnostic Interview (CIDI) to examine psychopathology and associated risk factors in the NI population. Prevalence rates of retrospectively reported childhood adversities were calculated, with gender and age variations explored. Females were more likely to experience sexual abuse. Individuals who grew up during the worst years of the civil conflict in NI experienced elevated levels of childhood adversities. Participants who endured childhood adversities were more likely to have mental health problems but variations in risk factors were found for different disorders. Parental mental illness was associated with all disorders however, with ORs ranging from 2.20 for mood disorders to 4.07 for anxiety disorders. Population attributable fractions (PAF) estimated the reduction in psychopathology and suicidal behaviour in the population if exposure to adverse childhood events had not occurred. The highest PAF values were revealed for parental mental illness and sexual abuse. The findings indicate that a substantial proportion of psychopathology and suicide risk in NI are attributable to childhood adversities, providing support for early intervention and prevention initiatives.

Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys.

The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.