The distribution of the common mental disorders: social inequalities in Europe

Background: The social class distribution of the common mental disorders (mostly anxiety and/or depression) has been in doubt until recently. This paper reviews the evidence of associations between the prevalence of the common mental disorders in adults of working age and markers of socio-economic disadvantage. Methods: Work is reviewed which brings together major population surveys from the last 25 years, together with work trawling for all European population studies. Data from more recent studies is examined, analysed and discussed. Because of differences in methods, instruments and analyses, little can be compared precsiely, but internal associations can be examined. Findings: People of lower socio-economic status, however measured, are disadvantaged, and this includes higher frequencies of the conditions now called the 'common mental disorders' (mostly non-psychotic depression and anxiety, either separately or together). In European and similar developed populations, relatively high frequencies are associated with poor education, material disadvantage and unemployment. Conclusion: The large contribution of the common mental disorders to morbidity and disability, and the social consequences in working age adults would justify substantial priority being given to addressing mental health inequalities, and deprivation in general, within national and European social and economic policy

Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population

Objectives: Autism is difficult to identify in adults due to lack of validated self-report questionnaires. We compared the effectiveness of the autism-spectrum quotient (AQ) and the Ritvo autism–Asperger's diagnostic scale-revised (RAADS-R) questionnaires in adult mental health services in two English counties. Methods: A subsample of adults who completed the AQ and RAADS-R were invited to take part in an autism diagnostic observation schedule (ADOS Module 4) assessment with probability of selection weighted by scores on the questionnaires. Results: There were 364 men and 374 women who consented to take part. Recorded diagnoses were most commonly mood disorders (44%) and mental and behavioural disorders due to alcohol/substance misuse (19%), and 4.8% (95% CI [2.9, 7.5]) were identified with autism (ADOS Module 4 10+). One had a pre-existing diagnosis of autism; five (26%) had borderline personality disorders (all female) and three (17%) had mood disorders. The AQ and RAADS-R had fair test accuracy (area under receiver operating characteristic [ROC] curve 0.77 and 0.79, respectively). AQ sensitivity was 0.79 (95% CI [0.54, 0.94]) and specificity was 0.77 (95% CI [0.65, 0.86]); RAADS-R sensitivity was 0.75 (95% CI [0.48, 0.93]) and specificity was 0.71 (95% CI [0.60, 0.81]). Conclusions: The AQ and RAADS-R can guide decisions to refer adults in mental health services to autism diagnostic services

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence ofpsychopathy, and the distribution and correlates of psychopathic traits in a representative national sample ofprisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage,cross-sectional survey of prisoners in England and Wales in 1997 (n=496). Poisson regression analysis wascarried out to examine independent associations between correlates and PCL-R total and factor scores. Theprevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlatedwith younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial,narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disordersor schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among maleprisoners in England and Wales but lower than in most previous studies using selected samples. However,most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme ofa spectrum of social and behavioral problems among prisoners.</p

Violence and psychiatric morbidity in a national household population--a report from the British Household Survey

This study measured the prevalence of self-reported violence and associations with psychiatric morbidity ina national household population, based on a cross-sectional survey in 2000 of 8,397 respondents in Great Britain.Diagnoses were derived from computer-assisted interviews, with self-reported violent behavior over the previous5 years. The 5-year prevalence of nonlethal violence in Britain was 12% (95% confidence interval: 11, 13). The riskof violence was substantially increased by alcohol dependence (odds ratio ¼ 2.72, 95% confidence interval: 1.85,3.98), drug dependence (odds ratio ¼ 2.63, 95% confidence interval: 1.45, 4.74), and antisocial personality disorder(odds ratio ¼ 6.12, 95%confidence interval: 3.87, 9.66). Low prevalences of these conditions (7%, 4%, and 4%,respectively) contrasted with their relatively high proportions of attributed risk of violence (23%, 15%, and 15%).Hazardous drinking was associated with 56% of all reported violent incidents. Screening positive for psychosisdid not independently increase risk (odds ratio ¼ 3.20, 95% confidence interval: 0.35, 29.6). The study concludedthat psychiatric morbidity makes a significant public health impact on violence exerted primarily by persons withany personality disorder, substance dependence, and hazardous drinking. Population interventions for violentbehavior are appropriate for hazardous drinking as are targeted interventions for substance dependence andantisocial personality disorder. Despite public concern, the risks of violence from persons with severe mentalillness were very low.</p

Violence and psychiatric morbidity in a national household population--a report from the British Household Survey

This study measured the prevalence of self-reported violence and associations with psychiatric morbidity ina national household population, based on a cross-sectional survey in 2000 of 8,397 respondents in Great Britain.Diagnoses were derived from computer-assisted interviews, with self-reported violent behavior over the previous5 years. The 5-year prevalence of nonlethal violence in Britain was 12% (95% confidence interval: 11, 13). The riskof violence was substantially increased by alcohol dependence (odds ratio ¼ 2.72, 95% confidence interval: 1.85,3.98), drug dependence (odds ratio ¼ 2.63, 95% confidence interval: 1.45, 4.74), and antisocial personality disorder(odds ratio ¼ 6.12, 95%confidence interval: 3.87, 9.66). Low prevalences of these conditions (7%, 4%, and 4%,respectively) contrasted with their relatively high proportions of attributed risk of violence (23%, 15%, and 15%).Hazardous drinking was associated with 56% of all reported violent incidents. Screening positive for psychosisdid not independently increase risk (odds ratio ¼ 3.20, 95% confidence interval: 0.35, 29.6). The study concludedthat psychiatric morbidity makes a significant public health impact on violence exerted primarily by persons withany personality disorder, substance dependence, and hazardous drinking. Population interventions for violentbehavior are appropriate for hazardous drinking as are targeted interventions for substance dependence andantisocial personality disorder. Despite public concern, the risks of violence from persons with severe mentalillness were very low.</p

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence ofpsychopathy, and the distribution and correlates of psychopathic traits in a representative national sample ofprisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage,cross-sectional survey of prisoners in England and Wales in 1997 (n=496). Poisson regression analysis wascarried out to examine independent associations between correlates and PCL-R total and factor scores. Theprevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlatedwith younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial,narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disordersor schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among maleprisoners in England and Wales but lower than in most previous studies using selected samples. However,most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme ofa spectrum of social and behavioral problems among prisoners.</p

Comparisons of weighted prevalence estimates of Revised Clinical Interview Schedule symptom scores (≥2).

<p>Comparisons of weighted prevalence estimates of Revised Clinical Interview Schedule symptom scores (≥2).</p

Socio-demographic characteristics of the South East London Community Health (SELCoH) and Adult Psychiatric Morbidity Study (APMS) 2007 England samples.

<p>Values are numbers (percentages) of respondents; weighted percentages to account for survey design; frequencies are unweighted and may not add up due to missing values.</p>a<p>Social class is based on occupation and participants without a current occupation were excluded in both samples.</p

Comparisons of adjusted odds ratios for common mental disorder, hazardous alcohol use and illicit drug use by socio-demographic and socio-economic indicators in combined data from both studies.

<p>NS = non-significant.</p><p>Weighted percentages to account for survey design.</p>a<p>. Fully adjusted model with combined comparable data from both studies; age entered as a continuous variable in fully adjusted model.</p

Comparisons of prevalence estimates of common mental conditions and psychiatric diagnoses by gender.

<p>Weighted percentages to account for survey design.</p