Mood and anxiety disorders across the adult lifespan: a European perspective

BACKGROUND: The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries. METHOD: Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries. RESULTS: No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ≥ 80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age. CONCLUSIONS: Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously

Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys

BACKGROUND: Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors. METHODS: Data come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria. RESULTS: Prevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 % overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 % of all PTSD occurring among the 5 % of respondents classified by the model as having highest PTSD risk. CONCLUSION: Although PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs

Proportion of patients without mental disorders being treated in mental health services worldwide

Publisher Copyright: © 2015, Royal College of Psychiatrists. All rights reserved.Background: Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather 'the worried well'. Aims: To examine the association of past-year mental health treatment with DSM-IV disorders. Method: The World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs. Results: Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment. Conclusions: The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.publishersversionpublishe

Drop out from out-patient mental healthcare in the World Health Organization's World Mental Health Survey initiative

Funding information: ... The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health...Background: Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada. Aims: To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys. Method: Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted. Results: Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower-middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit. Conclusions: Drop out needs to be reduced to ensure effective treatment.publishersversionpublishe

Proportion of patients without mental disorders being treated in mental health services worldwide

Background Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather 'the worried well'. Aims To examine the association of past-year mental health treatment with DSM-IV disorders. Method The World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs. Results Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment. Conclusions The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.status: publishe

Parent psychopathology and offspring mental disorders: results from the WHO World Mental Health Surveys

Background Associations between specific parent and offspring mental disorders are likely to have been overestimated in studies that have failed to control for parent comorbidity. Aims To examine the associations of parent with respondent disorders. Method Data come from the World Health Organization (WHO) World Mental Health Surveys (n = 51 507). Respondent disorders were assessed with the Composite International Diagnostic Interview and parent disorders with informant-based Family History Research Diagnostic Criteria interviews. Results Although virtually all parent disorders examined (major depressive, generalised anxiety, panic, substance and antisocial behaviour disorders and suicidality) were significantly associated with offspring disorders in multivariate analyses, little specificity was found. Comorbid parent disorders had significant sub-additive associations with offspring disorders. Population-attributable risk proportions for parent disorders were 12.4% across all offspring disorders, generally higher in high- and upper-middle-than low-/lower-middle-income countries, and consistently higher for behaviour (11.0-19.9%) than other (7.1-14.0%) disorders. Conclusions Parent psychopathology is a robust non-specific predictor associated with a substantial proportion of offspring disorders.Analysis GroupAnalysis GroupBristolMyers SquibbBristol-Myers SquibbEli Lilly CompanyEli Lilly CompanyEPIQEPI-QGlaxoSmithKlineGlaxoSmithKlineJohnson & Johnson PharmaceuticalsJohnson & Johnson PharmaceuticalsOrtho-McNeil Janssen Scientific AffairsOrthoMcNeil Janssen Scientific AffairsPfizerPfizerSanofiAventis GroupeSanofi-Aventis GroupeShire USShire USUnited States National Institute of Mental Health [R01MH070884, R01MH093612]United States National Institute of Mental HealthNIMHNIMH [HHSN271200700030C]John D. and Catherine T. MacArthur FoundationJohn D. and Catherine T. MacArthur FoundationPfizer FoundationPfizer FoundationUS Public Health ServiceUS Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]Fogarty International Center [FIRCA R03-TW006481]Fogarty International CenterPan American Health Organization (PAHO)Pan American Health Organization (PAHO)Eli Lilly & Company FoundationEli Lilly & Company FoundationOrthoMcNeil PharmaceuticalOrtho-McNeil PharmaceuticalShireShireState of Sao Paulo Research Foundation (FAPESP)State of Sao Paulo Research Foundation (FAPESP) [03/00204-3]Ministry of HealthMinistry of HealthNational Center for Public Health ProtectionNational Center for Public Health ProtectionShenzhen Bureau of HealthShenzhen Bureau of HealthShenzhen Bureau of Science, Technology, and InformationShenzhen Bureau of Science, Technology, and InformationMinistry of Social ProtectionMinistry of Social ProtectionEuropean CommissionEuropean Commission [QLG5-1999-01042, SANCO 20041231]Piedmont Region (Italy)Piedmont Region (Italy)Fondo de Investigacion Sanitaria, Institut de Salud Carlos III, Spain [FIS 00/0028]Fondo de Investigacion Sanitaria, Institut de Salud Carlos III, SpainMinisterio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]Ministerio de Ciencia y Tecnologia, SpainDepartament de Salut, Generalitat de Catalunya, Spain, Institut de Salud Carlos IIIDepartament de Salut, Generalitat de Catalunya, Spain, Institut de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]Government of IndiaGovernment of IndiaWHOWHOUnited Nations Development Group (UNDG)United Nations Development Group (UNDG)Japan Ministry of Health, Labour and WelfareJapan Ministry of Health, Labour and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]Lebanese Ministry of Public HealthLebanese Ministry of Public HealthWHO (Lebanon)WHO (Lebanon)National Institute of Health/Fogarty International CenterNational Institute of Health/Fogarty International Center [R03 TW006481-01]Janssen CilagJanssen CilagEli LillyEli LillyAstraZenecaAstraZenecaHikma PharmHikma PharmNovartisNovartisNational Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]National Institute of Psychiatry Ramon de la FuenteNational Council on Science and TechnologyNational Council on Science and Technology [CONACyT-G30544-H]WHO (Geneva)WHO (Geneva)WHO (Nigeria)WHO (Nigeria)Federal Ministry of Health, Abuja, NigeriaFederal Ministry of Health, Abuja, NigeriaHealth & Social Care Research & Development Division of the Public Health AgencyHealth & Social Care Research & Development Division of the Public Health AgencyChampalimaud FoundationChampalimaud FoundationGulbenkian FoundationGulbenkian FoundationFoundation for Science and Technology (FCT)Foundation for Science and Technology (FCT)US National Institute of Mental Health [R01-MH059575, RO1-MH61905]US National Institute of Mental HealthNational Institute of Drug AbuseNational Institute of Drug AbuseSouth African Department of HealthSouth African Department of HealthUniversity of Michiganuniversity of MichiganNational Institute of Mental Health [U01-MH60220]National Institute of Mental HealthRobert Wood Johnson FoundationRobert Wood Johnson Foundation [044708

Drop out from out-patient mental healthcare in the World Health Organization's World Mental Health Survey initiative.

BACKGROUND: Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada. AIMS: To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys. METHOD: Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted. RESULTS: Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/lower-middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit. CONCLUSIONS: Drop out needs to be reduced to ensure effective treatment

The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas

Abstract Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas