Comorbidity of Common Mental Disorders with Cancer and Their Treatment Gap: Findings from the World Mental Health Surveys

Objective This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. Methods Data were derived from the World Mental Health Surveys (N = 66,387; n = 357 active cancer, n = 1373 cancer survivors, n = 64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12 months. Cancer status was ascertained by self-report of physician\u27s diagnosis. Results Twelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE = 2.1) than cancer-free respondents (13.3%, SE = 0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR) = 1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE = 0.9) compared with cancer-free respondents did not differ significantly (AOR = 0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12 months, 59% sought services for mental health problems (SE = 5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE = 6.0; 41.2%, SE = 3.0; 35.6%, SE = 0.6) and low-middle-income countries (46.4%, SE = 11.0; 22.5%, SE = 9.1; 17.4%, SE = 0.7). Conclusions Community respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors

The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys

We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures

Street Working Children in the Kurdistan Region of Iraq followed over 16 years : Mental Health and Traumatization

The overall aims of the research this thesis is based upon were to assess mental disorders and trauma experiences of street working boys in Duhok (in the Kurdistan region of Iraq), compare them with schoolboys of the same community, follow the street working boys into adulthood, and examine the continuity of mental disorders, as well as their adult perspectives on their previous street work. A group of 100 street working boys was examined in 2004–2005, and 40 of the same group (as adults) in 2021. Psychiatric diagnoses were obtained through structured diagnostic interviews, using the Mini-International Neuropsychiatric Interview for Children and Adolescence (MINI KID) and Mini-International Neuropsychiatric Interview (MINI) instruments at baseline and follow-up, respectively. Behavioural problems and competencies were assessed at baseline by the Child Behaviour Checklist, and experienced traumas were assessed at baseline by the Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C). At follow-up all participants were interviewed about their perspectives and experiences, then their responses in the interviews were subjected to thematic analysis. Schoolboys of the same age from the same city were recruited in 2011, assessed in the same way and compared with the street working boys. The research was presented in four appended papers, designated Papers I-IV. As described in Paper I, 98% of the 100 street children worked to meet economic needs of their families, and there were very high rates of parental illiteracy: 90% of their fathers and 95% of their mothers were illiterate. Mental disorders were common: 61% had at least one mental disorder, most frequently one or more anxiety disorders (57%). In Paper II, types and frequencies of experienced traumas were compared between street working boys and schoolboys. A significantly higher proportion of street working boys had experienced at least one traumatic event than the schoolboys (96% versus 64%, p < 0.001), although both groups lived in a region burdened by conflicts and war. The largest effect size was found for torture, with an odds ratio of (28.4). In the study reported in Paper III, street work was found to have had both positive and negative consequences for the children. The positive consequences included development of work and social skills, being responsible and able to support their families. Negative consequences included impaired adult mental and physical health. In addition, an important identified resilience factor was social support from families, other adults and/or peers. The study reported in Paper IV found that 28 (70%) of the participants met criteria for at least one mental disorder at follow-up. The proportion with any depressive disorder increased from 7.5% at baseline to 40% at follow-up (p=0.002), but proportions with any anxiety disorder or externalizing disorder did not significantly change. Of those with an anxiety disorder in childhood, 42.5% continued to have it in adulthood

Street Working Children in the Kurdistan Region of Iraq followed over 16 years : Mental Health and Traumatization

The overall aims of the research this thesis is based upon were to assess mental disorders and trauma experiences of street working boys in Duhok (in the Kurdistan region of Iraq), compare them with schoolboys of the same community, follow the street working boys into adulthood, and examine the continuity of mental disorders, as well as their adult perspectives on their previous street work. A group of 100 street working boys was examined in 2004–2005, and 40 of the same group (as adults) in 2021. Psychiatric diagnoses were obtained through structured diagnostic interviews, using the Mini-International Neuropsychiatric Interview for Children and Adolescence (MINI KID) and Mini-International Neuropsychiatric Interview (MINI) instruments at baseline and follow-up, respectively. Behavioural problems and competencies were assessed at baseline by the Child Behaviour Checklist, and experienced traumas were assessed at baseline by the Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C). At follow-up all participants were interviewed about their perspectives and experiences, then their responses in the interviews were subjected to thematic analysis. Schoolboys of the same age from the same city were recruited in 2011, assessed in the same way and compared with the street working boys. The research was presented in four appended papers, designated Papers I-IV. As described in Paper I, 98% of the 100 street children worked to meet economic needs of their families, and there were very high rates of parental illiteracy: 90% of their fathers and 95% of their mothers were illiterate. Mental disorders were common: 61% had at least one mental disorder, most frequently one or more anxiety disorders (57%). In Paper II, types and frequencies of experienced traumas were compared between street working boys and schoolboys. A significantly higher proportion of street working boys had experienced at least one traumatic event than the schoolboys (96% versus 64%, p < 0.001), although both groups lived in a region burdened by conflicts and war. The largest effect size was found for torture, with an odds ratio of (28.4). In the study reported in Paper III, street work was found to have had both positive and negative consequences for the children. The positive consequences included development of work and social skills, being responsible and able to support their families. Negative consequences included impaired adult mental and physical health. In addition, an important identified resilience factor was social support from families, other adults and/or peers. The study reported in Paper IV found that 28 (70%) of the participants met criteria for at least one mental disorder at follow-up. The proportion with any depressive disorder increased from 7.5% at baseline to 40% at follow-up (p=0.002), but proportions with any anxiety disorder or externalizing disorder did not significantly change. Of those with an anxiety disorder in childhood, 42.5% continued to have it in adulthood

Adaptation, Validity, and Reliability of the Patient Health Questionnaire (PHQ-9) in the Kurdistan Region of Iraq

Aim: The Patient Health Questionnaire (PHQ-9) is widely used for detecting and screening depression in Iraq. However, no psychometric assessment has been performed on any Iraqi version. This study aims at studying the reliability and validity of the Iraqi Kurdish version of the PHQ-9 as tool for identifying depression. Methods: A cross-sectional study design was used; data were collected from 872 participants (49.3% female and 51.7% male) at Primary Health Care Centers (PHCCs) in the host community as well as from Internal Displaced Persons (IDPs) and refugee camps. Sociodemographic information was obtained; PHQ-9 for the diagnosis and screening of depression and Self Reporting Questionnaire 20 items (SRQ-20) for the screening of common mental illnesses were administered. Validity and reliability analyses were performed. Results: In total, 19% of the participants had a PHQ-9 total score equal to or higher than the clinical cut-off of 10 for diagnosing depressive disorder. The internal consistency of the PHQ-9 was good (Cronbach’s alpha coefficient was 0.89). Good concurrent validity for PHQ-9 compared with SRQ-20 (71%, p < 0.001) was found. Conclusions: The PHQ-9 demonstrates good psychometric properties and proves to be a good tool for detecting and screening depression

Motor Development of Children in the Kurdistan Region of Iraq: Parent Survey

The actual literature highlights the importance of the socio-cultural context in the development of children. However, there is a lack of specific evidence about the middle East, especially regarding the development of Kurdish children who are living in a post-war scenario, in a country which is experiencing continuous instability due to the different crises. The main aim of this study is to identify the features of the motor development of Kurdish children according to parents’ opinion. A comparison with Italian children is provided as a Western example, which reflects data from the literature. In the study, 331 parents of Kurdish and Italian children aged between 3 and 7 years were involved. Parents filled the questionnaire at kindergartens, after providing consent. The questionnaire was conceptualized, designed, tested and provided ad hoc for this study; it focused on the timing of development, concerning major milestones like head control, sitting and standing-up. The questionnaire consists of 15 questions and has not been standardized yet. A logistic regression showed several differences between Kurdish and Italian children, like head control (p = 0.007) or the manipulation of big objects (p < 0.0001). These results identify the effect of the socio-cultural context and the impact of the growing environment of the child. Moreover, the results of this survey show the need for introducing different adapted, translated and validated assessment tools for motor development, considering differences related to the socio-cultural context

Effects (direct and indirect via WHODAS dimension scores) of conditions on perceived health VAS, overall sample.

<p>WMH surveys.</p><p>p-value<0.05.</p>1<p>Only dimensions with statistically significant effect are included. Getting along and Discrimination not statistically significant.</p

Relative WHODAS dimension contributions to the indirect effect of disability on perceived health VAS for each condition, overall sample.

<p>WMH Surveys (Alcohol Abuse and Drug Abuse are not represented because their respective overall indirect effect is not significant).</p