World Mental Health Survey Version Research Articles

Associations between water, sanitation, and depression among older people in Ghana: empirical evidence from WHO-SAGE Wave 2 survey

Background While depression is the most frequent psychiatric disorder among the older adults, the use of water and sanitation has been associated with both physical and psychological adverse outcomes. We investigated the associations of water and sanitation with depressive symptoms among older adults in Ghana. Methods The study used data from 4,735 participants in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 2 of adults aged ≥50 years. Major depressive episode (MDE) was assessed using the World Mental Health Survey version of the Composite International Diagnostic Interview and we classified water and sanitation sources based on the Joint Monitoring Program. Multivariate logistic regressions evaluated the associations. Results Approximately 7.3% of respondents reported a MDE, 90% and 78% used improved water sources and sanitation facilities respectively, and 77% shared sanitation facilities. Individuals who used unimproved water sources and unimproved sanitation were 1.6 and 1.3 times more likely to report MDE respectively. Also, sex-based analysis showed that the effect of the use of unimproved water and sanitation on depression was much appreciable and more substantial among women compared to men. Conclusions The findings suggest the importance of water and sanitation to the well-being of older people, particularly among women. Policies targeted at improving the mental health in old age should include water and sanitation.

Association between food insecurity and depression among older adults from low- and middle-income countries.

To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression. In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

Cross‐cultural comparison of symptom networks in late‐life major depressive disorder: Yoruba Africans and the Spanish Population

The concept of European psychologisation of depression versus somatisation in non-European populations has been the basis of several studies of cultural psychopathology in the general population. Little is currently known about cross-cultural differences and similarities in late-life depression symptom reporting. We cross-culturally compared symptom reporting in the context of Major Depressive Disorder (MDD) among community-dwelling older adults from Spain and Nigeria. We relied on data from two household multistage probability samples comprising 3,715 persons aged 65 years or older in the Spanish and Nigerian populations. All participants underwent assessments for MDD using the World Mental Health Survey version of the Composite International Diagnostic Interview. Cross-cultural comparison of broad somatic and psychological categories as well as relationship and influence of individual symptoms were analysed using the Symptom Network Analysis approach. Current MDD was diagnosed in 232 and 195 older persons from Spain and Nigeria, respectively. The symptom network of the two samples were invariant in terms of global strength, S(GSPAIN , GNIGERIA ) = 7.56, P = .06, with psychological and somatic symptoms demonstrating centrality in both countries. However, country-specific relationships and influence of individual symptoms were found in the network structure of both samples, M(GSPAIN , GNIGERIA ) = 2.95, P < .01. Broad somatic and psychological symptoms categories contributed to the structural network of older Africans and their peers from the Spanish population. Variations in the relationship and influence of individual symptoms suggests that the functional and "communicative" role of individual symptoms may be differentiated by context specific imperatives. J Am Geriatr Soc 68:-, 2020.

Injury and depression among 212 039 individuals in 40 low- and middle-income countries.

Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey. Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations. The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46). Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.

Physical injury and depression in six low- and middle-income countries: A nationally representative study

BackgroundStudies on the association between physical injury and depression in low- and middle-income countries (LMICs) are scarce. Therefore, our goal was to analyze the association between physical injury and depression using nationally representative data from six LMICs. MethodsCross-sectional data from the Study on Global Ageing and Adult Health (SAGE) survey (2007–2010) were analyzed (N = 42,489). Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Any injury in our analysis referred to having experienced traffic injury or other injury in the past 12 months. Multivariable logistic regression analysis and meta-analyses were used to assess associations. ResultsOverall, the prevalence of depression was higher among those who had any injury compared to those without injuries (9.0% vs. 3.7%). Compared to having no injury, any injury without disability was associated with a 1.72 (95%CI=1.18–2.50) times higher odds for depression, while the odds for injury with disability was much higher (OR =3.81; 95%CI=2.16–6.73). The pooled estimate (OR) for the association between any injury and depression based on a meta-analysis using country-wise estimates was 3.28 (95%CI = 1.71–6.31) and a moderate level of between-country heterogeneity was observed (I2 = 63.1%). LimitationsCausality or temporal associations cannot be established due to the cross-sectional nature of the study. ConclusionsPersonalized mental health care to victims of physical injury may reduce risk for depression. Treating disability as the result of injuries may also be effective in the prevention of depressive disorders.

Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries

BackgroundDepression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries.MethodsCross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.ResultsThe prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P < 0.001). Tuberculosis was associated with a 1.98 (95% CI 1.47–2.67), 1.75 (95% CI 1.26–2.42), and 3.68 (95% CI 3.01–4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains.ConclusionsDepression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.

Child death and maternal psychosis-like experiences in 44 low- and middle-income countries: The role of depression

BackgroundStudies on the effect of child death on the mental wellbeing of women in low- and middle-income countries (LMICs) are scarce despite the high child mortality rates. Thus, the aim of the current study was to assess the association between child death and psychosis-like experiences (PLEs), as well as the role of depression in this association. MethodsData from 44 LMICs which participated in the World Health Survey (WHS) were analyzed. A total of 59,444 women who ever gave birth, aged 18–49years, without a self-reported lifetime psychosis diagnosis, were included in the analysis. The World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI) was used to establish the diagnosis of past 12-month DSM-IV depression, and assess four positive psychotic symptoms. Depression was defined as self-reported lifetime depression diagnosis and/or past 12-month depression. Multivariable logistic regression analyses were performed. ResultsAfter adjustment for potential confounders, women who experienced child death had higher odds for all types of PLEs (when unadjusted for depression) (OR 1.20–1.71; p<0.05) and depression (OR=1.64; 95%CI=1.39–1.93). When adjusted for depression, only delusion of control was strongly associated with child death (OR=1.54; 95%CI=1.20–1.97). ConclusionsChild death may be an important determinant of mental wellbeing among women in LMICs. Given the known adverse health outcomes associated with PLEs and depression, as well as the co-occurrence of these symptoms, mental health care may be particularly important for mothers who have experienced child loss in LMICs.

Risk and functional significance of psychotic experiences among individuals with depression in 44 low- and middle-income countries.

Studies on whether the co-occurrence of psychotic experiences (PEs) and depression confers a more pronounced decrement in health status and function compared with depression alone are scarce in the general adult population. Data on 195 479 adults aged ⩾18 years from the World Health Survey were analysed. Using the World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI), depression in the past 12 months was categorized into four groups: depressive episode, brief depressive episode, subsyndromal depression, and no depression. Past 12-month psychotic symptoms were assessed using four questions on positive symptoms from the CIDI. Health status across seven domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort, vision) and interviewer-rated presence of a mental health problem were assessed. Multivariable logistic and linear regression analyses were performed to assess the associations. When compared with those with no depression, individuals with depression had higher odds of reporting at least one PE, and this was seen across all levels of depression severity: subsyndromal depression [odds ratio (OR) 2.38, 95% confidence interval (CI) 2.02-2.81], brief depressive episode (OR 3.84, 95% CI 3.31-4.46) and depressive episode (OR 3.75, 95% CI 3.24-4.33). Having coexisting PEs and depression was associated with a higher risk for observable illness behavior and a significant decline in health status in the cognition, interpersonal activities and sleep/energy domains, compared with those with depression alone. This coexistence of depression and PEs is associated with more severe social, cognitive and sleep disturbances, and more outwardly apparent illness behavior. Detecting this co-occurrence may be important for treatment planning.

Lifetime Prevalence, Age and Gender Distribution and Age-of-Onset of Psychiatric Disorders in the São Paulo Metropolitan Area, Brazil: Results from the São Paulo Megacity Mental Health Survey

To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the São Paulo Metropolitan Area (SPMA). The São Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%. Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders. Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.

High Occurrence of Mood and Anxiety Disorders Among Older Adults

Little is known about prevalence rates of DSM-IV disorders across age strata of older adults, including common conditions such as individual and coexisting mood and anxiety disorders. To determine nationally representative estimates of 12-month prevalence rates of mood, anxiety, and comorbid mood-anxiety disorders across young-old, mid-old, old-old, and oldest-old community-dwelling adults. The National Comorbidity Survey Replication (NCS-R) is a population-based probability sample of 9282 participants 18 years and older, conducted between February 2001 and April 2003. The NCS-R survey used the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Continental United States. We studied the 2575 participants 55 years and older who were part of NCS-R (43%, 55-64 years; 32%, 65-74 years; 20%, 75-84 years; 5%, >or=85 years). This included only noninstitutionalized adults, as all NCS-R participants resided in households within the community. Twelve-month prevalence of mood disorders (major depressive disorder, dysthymia, bipolar disorder), anxiety disorders (panic disorder, agoraphobia, specific phobia, social phobia, generalized anxiety disorder, posttraumatic stress disorder), and coexisting mood-anxiety disorder were assessed using DSM-IV criteria. Prevalence rates were weighted to adjust for the complex design to infer generalizability to the US population. The likelihood of having a mood, anxiety, or combined mood-anxiety disorder generally showed a pattern of decline with age (P < .05). Twelve-month disorders showed higher rates in women compared with men, a statistically significant trend with age. In addition, anxiety disorders were as high if not higher than mood disorders across age groups (overall 12-month rates: mood, 5% and anxiety, 12%). No differences were found between race/ethnicity groups. Prevalence rates of DSM-IV mood and anxiety disorders in late life tend to decline with age, but remain very common, especially in women. These results highlight the need for intervention and prevention strategies.

São Paulo Megacity Mental Health Survey - a population-based epidemiological study of psychiatric morbidity in the São Paulo metropolitan area: aims, design and field implementation

The São Paulo Megacity Mental Health Survey is a population-based cross-sectional survey of psychiatric morbidity, assessing a probabilistic sample of household residents in the São Paulo Metropolitan Area, aged 18 years and over. Respondents were selected from a stratified multistage clustered area probability sample of households, covering all 39 municipalities, without replacement. Respondents were assessed using the World Mental Health Survey version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), which was translated and adapted into the Brazilian-Portuguese language. Data was collected between May 2005 and April 2007 by trained lay interviewers. The World Mental Health Survey version of the Composite International Diagnostic Interview comprises clinical and non-clinical sections, arranged as Part I and Part II, producing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Classification of Diseases - 10th Revision. Mood, anxiety, impulse-control and substance use disorders, and suicide-related behavior, considered core disorders, as well as socio-demographic information, were assessed in all respondents. Non-clinical modules and non-core clinical sections (obsessive-compulsive disorder, post-traumatic stress disorder, gambling, eating disorders, neurasthenia, pre-menstrual disorders, psychotic symptoms and personality traits) were assessed in a sub-sample (2,942 respondents), composed by all respondents with at least one core disorder and a 25% random sample of those who were non-cases. A total of 5,037 individuals were interviewed, with a global response rate of 81.3%. Saliva samples were collected from 1,801 respondents, with DNA extracted stored pending further investigations.

Psychiatric disorders in Mexico: Lifetime prevalence in a nationally representative sample

No national data on lifetime prevalence and risk factors for DSM-IV psychiatric disorders are available in Mexico. To present data on lifetime prevalence and projected lifetime risk, age at onset and demographic correlates of DSM-IV psychiatric disorders assessed in the Mexican National Comorbidity Survey. The survey was based on a multistage area probability sample of non-institutionalised people aged 18-65 years in urban Mexico. The World Mental Health Survey version of the Composite International Diagnostic Interview was administered by lay interviewers. Of those surveyed, 26.1% had experienced at least one psychiatric disorder in their life and 36.4% of Mexicans will eventually experience one of these disorders. Half of the population who present with a psychiatric disorder do so by the age of 21 and younger cohorts are at greater risk for most disorders. Our results suggest an urgent need to re-evaluate the resources allocated for the detection and treatment of psychiatric illnesses in Mexico.

Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey

This paper describes the 12-month prevalence, severity and demographic correlates of 16 DSM-IV psychiatric disorders and service utilization in the Mexican urban population aged 18-65 years of age. This is representative of 75% of the national adult population. The sample design was a strict probability selection scheme. The response rate was 76.6%. The World Mental Health Survey version of the Composite International Diagnostic Interview was installed on laptops and administered by lay interviewers. An international WHO task force carried out its translation into Spanish. The 12-month prevalence of any disorder was 12.1%. The most common disorders were specific phobia (4.0%), major depressive disorder (3.7%) and alcohol abuse or dependence (2.2%). The 12-month prevalence of very severe disorders was 3.7% of which only 24% used any services. Age was the only variable associated with any 12-month disorder, with the younger more likely to report any disorder. Income was associated with severity, with low and low-average incomes more likely to report a 12-month disorder. Females were more likely to report a mood and anxiety disorder, but less likely to report a substance disorder. The group of separated/widowed/divorced was more likely to report a mood and an impulse-control disorder. The results show that while psychiatric disorders are common in the Mexican population, very severe mental disorders are less common and there is extreme under-utilization of mental health services.

Mental Illness Treatment Still Elusive for Many

Mental Illness Treatment Still Elusive for Many

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.