Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders

To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems. Data were derived from the European Study of Epidemiology of Mental Disorders, a survey representative of the adult population of six countries: Belgium, France, Germany, Italy, the Netherlands and Spain (n = 8,796). The World Mental Health Composite International Diagnostic Interview was used to assess attitudes and DSM-IV diagnoses. The attitudes referred to beliefs that the respondents would seek professional help when faced with a serious emotional problem, would feel comfortable talking about personal problems with a professional, would not be embarrassed if friends knew about the professional help, and respondents' perceived effectiveness of mental health care. Almost a third of the respondents held the view that professional care was worse than or equal to no help when faced with serious emotional problems. Female gender, being younger than 65 years of age, high income, living in Spain or Italy, presence of mood disorder and previous service use were associated with at least two of the four assessed attitudes towards mental health help-seeking. All four attitudes were significantly associated with mental health care use, also after adjustment for previous service use. The low perceived effectiveness of professional care calls for serious action aiming to improve the visibility and credibility of the mental health care sector

Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression

Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders

Mediators of the association between depression and role functioning

Mediators of the association between depression and role functioning.Objective: While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear. Method: Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning. Results: The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant). Conclusions: Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning

Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders

This study assessed the factor structure, internal consistency, and discriminatory validity of the World Health Organization Disability Assessment Schedule (WHODAS) version used in the European Study of the Epidemiology of Mental Disorders (ESEMeD). In total 8796 adults were assessed using the ESEMeD WHODAS (22 severity and 8 frequency items). An Exploratory Factor Analysis (EFA) with promax rotation was done with a random 50%. The other half was used for confirmatory factor analysis (CFA) comparing models (a) suggested by EFA; (b) hypothesized a priori; and (c) reduced with four items. A CFA model with covariates was conducted in the whole sample to assess invariance across Mediterranean (Spain, France and Italy) and non-Mediterranean (Belgium, Germany and the Netherlands) countries. Cronbach's alphas and discriminatory validity were also examined. EFA identified seven factors (explained variance: 80%). The reduced model (six factors, four frequency items excluded) presented the best fit [Confirmatory Fit Index (CFI) = 0.992, Tucker-Lewis Index (TLI) = 0.996, Root Mean Square Error of Approximation (RMSEA) = 0.024]. The second-order factor structure also fitted well (CFI = 0.987, TLI = 0.991, RMSEA = 0.036). Measurement non-invariance was found for Embarrassment. Cronbach's alphas ranged from 0.84 for Participation to 0.93 for Mobility. Preliminary data suggest acceptable discriminatory validity. Thus, the ESEMeD WHODAS may well be a valuable shortened version of the WHODAS-II, but future users should reconsider the filter questions. Copyright (c) 2008 John Wiley & Sons, Ltd

High prevalence of mental disorders and comorbidity in the Geneva Gay Men's Health Study

BACKGROUND: Several large surveys have suggested high prevalence of psychiatric disorders among gay men and other men who have sex with men. METHODS: In 2002, a comprehensive health survey was conducted among 571 gay men in Geneva, Switzerland, using probability-based time-space sampling. The Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess 12-month prevalence of major depression, specific phobia, social phobia, alcohol dependence, and drug dependence. RESULTS: Nearly half (43.7%, 95% CI=39.0-48.4) of the sample fulfilled the criteria for at least one of the five DSM-IV disorders: 19.2% had major depression, 21.9% had specific and/or social phobia, and 16.7% had an alcohol and/or drug dependence disorder in the past 12 months. Over one quarter of the cases were comorbid with another kind of disorder, and 35.7% of cases consulted a health care professional in the past 12 months for mental health. Like cases, screen-positives for mood and/or anxiety disorders (24.7%) also reported significantly greater disability and lower quality of life. CONCLUSIONS: Nearly two-thirds of this community sample of gay men was affected by psychiatric morbidity with new evidence for comorbidity, subthreshold disorders, and low levels of awareness of psychiatric disorders and their treatment. This population needs to be a priority in psychiatric epidemiology and mental public health

Mediators of the association between depression and role functioning

OBJECTIVE: While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear. METHOD: Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning. RESULTS: The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant). CONCLUSIONS: Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning.These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481). The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spai