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

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

Distribution of the WHODAS dimension scores by income level. The WMH Surveys.

<p>Distribution of the WHODAS dimension scores by income level. The WMH Surveys.</p

General mediation model used in analyses.

<p>The figure displays the general mediation model that has been used to estimate effects according to path-diagrammatic conventions. Squares represent variables. <i>D_i</i> is one of the <i>p = 19</i> disorders under consideration, <i>M_j</i> is one of the <i>k = 8</i> mediating variables (disability dimensions), and VAS is the final outcome. Arrows represent regression slope parameters from independent variables to outcomes. The <i>δ</i> parameters stand for the direct effect regression from disorders to the final outcome. The <i>ι</i> parameters indicate the two regression components of the disorder indirect effects as mediated by <i>M</i>: a) <i>p</i> x <i>k</i> regression parameters from <i>D</i> to <i>M</i> (<i>ι_Dij</i>) and b) k regression parameters from <i>M</i> to VAS (<i>ι_M</i>_j). For each disorder the model can be decomposed in two paths: 1) VAS regressed on disorders, and 2) a causal mediation chain of VAS regressed on mediators which in turn are regressed on disorders. The partial indirect effect of a certain disorder <i>D_i</i> through a mediator <i>M_j</i> is <i>ι_Dij</i> x <i>ι_Mj</i>, whereas its total indirect effect is the sum of the <i>k</i> products across mediators (). Total effects for a disorder are the sum of direct and total indirect effect (<i>δ_i</i>+<i>Ι_i</i>). Directionality cannot be assumed as a causal association in our study due to its cross-sectional, observational nature. Also notice that in the general model, the effect of each disorder on each mediator is adjusted by the direct effect of the remaining disorders (thus controlling for comorbidity), while the impact of a disorder on VAS is controlled by the total effects of the other disorders. Disability is thus fully taken into account, even though it is decomposed in subscales. The effects on VAS are also controlled for age, gender, employment status and country.</p

Direct and indirect effects (via WHODAS dimensions) of common chronic conditions on perceived health VAS, overall sample.

<p>WMH Surveys.</p