Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

OBJECTIVE: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). METHODS: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. RESULTS: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. CONCLUSIONS: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.Fil: Cia, Alfredo H.. Centro de Investigaciones Médicas En Ansiedad; ArgentinaFil: Stagnaro, Juan C.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Aguilar Gaxiola, Sergio. University of California; Estados UnidosFil: Sustas, Sebastián Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Serfaty, Edith. Centro de Estudios Epidemiológicos; ArgentinaFil: Nemirovsky, Martin. Proyecto SUMA; ArgentinaFil: Kessler, Ronald C.. Harvard Medical School; Estados UnidosFil: Benjet, Corina. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz; Méxic

Efectos de intervenciones psicológicas en sobrevivientes de cáncer: una revisión..

Introduction: During the past decades early detection and effective cancer treatments have produced an increase in the number of cancer survivors. This represents a large group of patients susceptible to psychological, physical and social impairments after cancer treatment.Objective: To review the literature on the effects of psychological therapies in the management of psychological and / or somatic symptoms of cancer survivors. Method: A review of the literature reported in MEDLINE, PsycINFO, CINAHL, and MedicLatina Psychology and Behavioral Sciences Collection in the period January 2009 to December 2013 was conducted. Results: 24 articles were identified. Only 22 met the selection criteria; in 2 cases no access to the full articles was obtained, so only 19 were included. Statistically significant effects were identified in sleep difficulties, emotional symptoms, fatigue, quality of life, and post menopausal symptoms. Effect sizes were mostly small to moderate ranging from 0.00 - 1.40.Conclusions: The effects of most psychological interventions were positive whether independent or in combination with other treatment modalities. Interventions via telephone and online therapeutic modalities also showed positive results.Introducción: Durante las últimas décadas la detección temprana y tratamientos eficaces contra el cáncer han producido un aumento en el número de supervivientes de cáncer. Lo que representa un amplio grupo de pacientes susceptibles de presentar afectaciones psicológicas, físicas y sociales posteriores al tratamiento oncológico.Objetivo: Hacer una revisión de la literatura sobre los efectos de las terapias psicológicas en el manejo de aspectos psicológicos y/o síntomas de los supervivientes de cáncer. Método: Se realizó una revisión de la literatura reportada en MEDLINE, PsycINFO, CINAHL, MedicLatina y Psychology and Behavioral Sciences Collection en el periodo de Enero de 2009 a Diciembre de 2013.Resultados: Se identificaron 24 artículos. Solo 22 cumplieron con los criterios de selección, en 2 casos no se tuvo acceso a los artículos completos, por lo que solo se incluyeron 19. Se identificaron efectos estadísticamente significativos en afectaciones del sueño, bienestar emocional, fatiga, calidad de vida, y síntomas post menopáusicos; y tamaños del efecto entre 0,00 -1,40.Conclusiones: Los efectos de la mayoría de las intervenciones psicológicas fueron positivos tanto en modalidad única como en combinación con otras modalidades de tratamiento así como las intervenciones telefónicas y modalidades terapéuticas en línea

Effects of psychological interventions in cancer survivors: A review

Introduction: During the past decades early detection and effective cancer treatments have produced an increase in the number of cancer survivors. This represents a large group of patients susceptible to psychological, physical and social impairments after cancer treatment.Objective: To review the literature on the effects of psychological therapies in the management of psychological and / or somatic symptoms of cancer survivors. Method: A review of the literature reported in MEDLINE, PsycINFO, CINAHL, and MedicLatina Psychology and Behavioral Sciences Collection in the period January 2009 to December 2013 was conducted. Results: 24 articles were identified. Only 22 met the selection criteria; in 2 cases no access to the full articles was obtained, so only 19 were included. Statistically significant effects were identified in sleep difficulties, emotional symptoms, fatigue, quality of life, and post menopausal symptoms. Effect sizes were mostly small to moderate ranging from 0.00 - 1.40.Conclusions: The effects of most psychological interventions were positive whether independent or in combination with other treatment modalities. Interventions via telephone and online therapeutic modalities also showed positive results.</p

Service use among Mexico City adolescents with suicidality

Background We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts). Methods A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Discrete time survival analyses were used to assess the relationships between SROs and receiving treatment for emotional, alcohol, or drug problems. Results The prevalence of lifetime service use among respondents with SROs was 35% for those with ideation only, 44% for those with ideation and plan, 49% for those with gesture and 50% for those with attempt; the prevalence of 12-month service use was 10%, 24%, 6% and 21%, respectively. Timing between onset of SRO and receiving treatment for emotional, alcohol, or drug problems showed that about 50% of adolescents will have contact with a service provider before developing any SRO. Healthcare professionals were the most likely to be consulted, followed by school-based programs. Limitations This survey was limited to adolescents living in one of the largest metropolitan areas in the world and the analyses used data on retrospectively reported ages of onset that are subject to recall errors. Conclusions Most suicidal adolescents do not receive treatment, and many adolescents develop their suicidality in spite of prior contacts with service providers. Interventions to increase treatment, prevention, and monitoring are sorely needed for this vulnerable population.Psycholog

Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions

Context: The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences, but whether this is the case remains unclear because much prior research has involved unrepresentative samples and a selective focus on particular adversities or physical outcomes. The association between early-onset mental disorders and subsequent poor physical health in adulthood has not been investigated. Objective: To investigate whether childhood adversities and early-onset mental disorders are independently associated with increased risk of a range of adult-onset chronic physical conditions in culturally diverse samples spanning the full adult age range. Design: Cross-sectional community surveys of adults in 10 countries. Setting: General population. Participants: Adults (ie, aged >= 18 years; N=18 303), with diagnostic assessment and determination of age at onset of DSM-IV mental disorders, assessment of childhood familial adversities, and age of diagnosis or onset of chronic physical conditions. Main Outcome Measures: Risk (ie, hazard ratios) of adult-onset (ie, at age > 20 years) heart disease, asthma, diabetes mellitus, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early-onset (ie, at age <21 years) DSM-IV depressive and anxiety disorders, with mutual adjustment. Results: A history of 3 or more childhood adversities was independently associated with onset of all 6 physical conditions (hazard ratios, 1.44 to 2.19). Controlling for current mental disorder made little difference to these associations. Early-onset mental disorders were independently associated with onset of 5 physical conditions (hazard ratios, 1.43 to 1.66). Conclusions: These results are consistent with the hypothesis that childhood adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life. They require confirmation in a prospectively designed study. The long course of these associations has theoretical and research implications

The importance of physical and mental health in explaining health-related academic role impairment among college students

Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment

Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions

CONTEXT: The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences, but whether this is the case remains unclear because much prior research has involved unrepresentative samples and a selective focus on particular adversities or physical outcomes. The association between early-onset mental disorders and subsequent poor physical health in adulthood has not been investigated. OBJECTIVE: To investigate whether childhood adversities and early-onset mental disorders are independently associated with increased risk of a range of adult-onset chronic physical conditions in culturally diverse samples spanning the full adult age range. DESIGN: Cross-sectional community surveys of adults in 10 countries. SETTING: General population. PARTICIPANTS: Adults (ie, aged ≥18 years; N = 18 303), with diagnostic assessment and determination of age at onset of DSM-IV mental disorders, assessment of childhood familial adversities, and age of diagnosis or onset of chronic physical conditions. MAIN OUTCOME MEASURES: Risk (ie, hazard ratios) of adult-onset (ie, at age >20 years) heart disease, asthma, diabetes mellitus, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early-onset (ie, at age <21 years) DSM-IV depressive and anxiety disorders, with mutual adjustment. RESULTS: A history of 3 or more childhood adversities was independently associated with onset of all 6 physical conditions (hazard ratios, 1.44 to 2.19). Controlling for current mental disorder made little difference to these associations. Early-onset mental disorders were independently associated with onset of 5 physical conditions (hazard ratios, 1.43 to 1.66). CONCLUSIONS: These results are consistent with the hypothesis that childhood adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life. They require confirmation in a prospectively designed study. The long course of these associations has theoretical and research implications

The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium

Background: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. Method: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. Results: Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. Conclusions: Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization