Debate: Giving prevention a chance to prove its worth in lowering common mental disorder prevalence:how long will it take?

Large increases in treatment of Common Mental Disorders (CMD) have failed to reduce population prevalence and global burden. Preventive strategies are needed to lower CMD prevalence and burden. Giving prevention a real chance to prove its promise will require: (a) full embedment in social institutions; (b) long-term structural funding; (c) targeting major CMD determinants early in life combining population-level and individual-level strategies; and, (d) integrated evaluation of short-term and long-term effects to guide implementation. Targeting life skills and resilience of children and parenting skills of their parents has the potential for long-term benefits for multiple outcomes including well-being, social, economic, and financial domains as well as mental health outcomes. However, the large investments may not occur without compelling proof of effectiveness, but evaluation of effectiveness cannot occur without long-term, structural investments. Overcoming this impasse requires a paradigm shift. Randomized controlled trials of initial efficacy need to be supplemented by evaluation strategies for long-term surveillance of community-based programs that guide implementation while assessing long-term effectiveness

Unipolar Depression and the Progression of Coronary Artery Disease:Toward an Integrative Model

Background: Despite extensive research on the relationship between depression and coronary artery disease (CAD) after an acute coronary syndrome (ACS), causal interpretations are still difficult. This uncertainty has led to much confusion regarding screening and treatment for depression in CAD patients. Method: A critical and conceptual analysis of the pertinent literature, which elaborates the implications of the heterogeneity in symptom pattern, etiology, and course of depression in CAD patients. Results: We propose an integrative dynamic model of the depression-CAD relationship. The model rests on three core hypotheses: (1) Depression in CAD patients consists of mixtures of two types of depression, denoted as 'cognitive/affective' and 'somatic' depression, each having a somewhat characteristic symptom expression and etiology. (2) Effects of depression on CAD depend on the type and duration of depression. The dynamic aspect of the model indicates that post-ACS depression shifts, when it persists, from a marker of the severity (somatic type) and meaning (cognitive/affective type) of the ACS to a largely indirect causal factor in the progression of CAD. (3) The most plausible pathways mediating the effects of persistent/recurrent depression, irrespective of type, on cardiac prognosis are behavioral and act by making depressed CAD patients more susceptible to other CAD risks. The model offers testable predictions and explanations for a variety of apparently unrelated or inconsistent findings. Conclusion: The proposed model may have potential for integrating findings regarding the depression-CAD relationship, contributing to the clarification of discords on screening and treatment of depression, and guiding future research. Copyright (C) 2011 S. Karger AG, Base

A longitudinal perspective on childhood adversities and onset risk of various psychiatric disorders

It is well-known that childhood adversities can have long-term effects on mental health, but a lot remains to be learned about the risk they bring about for a first onset of various psychiatric disorders, and how this risk develops over time. In the present study, which was based on a Dutch longitudinal population survey of adolescents TRAILS (N = 1,584), we investigated whether and how childhood adversities, as assessed with three different measures, affected the risk of developing an incident depressive, anxiety, or disruptive behavior in childhood and adolescence. In addition, we tested gender differences in any of the effects under study. The results indicated that depressive, anxiety and disruptive behavior disorders each had their own, characteristic, pattern of associations with childhood adversities across childhood and adolescence, which was maintained after adjustment for comorbid disorders. For depressive disorders, the overall pattern suggested a high excess risk of incidence during childhood, which decreased during adolescence. Anxiety disorders were characterized by a moderately increased incident risk during childhood, which remained approximately stable over time. Disruptive behavior disorders took an intermediate position. Of the three childhood adversities tested, an overall rating of the stressfulness of the childhood appeared to predict onset of psychiatric disorders best. To conclude, the risk of developing a psychiatric disorder after exposure to adversities early in life depends on the nature of the adversities, the nature of the outcome, and the time that has passed since the adversities without disorder onset

Environmental influences on adult neuroticism:A systematic review

Behavioral-genetic studies show substantial non-genetic influences on variance of neuroticism within a population. Longitudinal studies show a small but steady drop in testretest correlations with increasing time intervals. This suggest environmental effects on neuroticism, but a systematic overview of which environmental determinants account for change in neuroticism is lacking. We review (specific or unique) environmental influences that modify the neuroticism setpoint in adulthood and therewith individual life trajectories. Results are interpreted in light of the so-called ‘mixed model’ in which within-person changes in neuroticism are subdivided over short term perturbations around the setpoint of neuroticism versus more persistent changes in the setpoint itself. To account for genetic confounding and shared environmental influences studies of monozygotic (MZ) twin pairs discordant for neuroticism and longitudinal studies that report on environmental factors that predict within-individual change in neuroticism are reviewed. Our results indicate that the neuroticism setpoint is consistently touched by experiences that affect central aspects of one’s identity and status, mainly role transitions as partner (marriage/divorce) and employee (job loss/promotion). Especially interpersonal stress, conflict, and major events that were unpredictable, uncontrollable, unexpected, undesirable, and ‘off time’ from a life history perspective were followed by changes in neuroticism that persisted more than six months, which suggest setpoint change. Most change after severe SLEs persisted over a decade. Long-term and detailed studies are required to elucidate the details of the ‘mixed model’ of change in neuroticism. An understanding of the specifics of the events that lead to persistent changes in neuroticism may enable us to craft prevention strategies to tackle the vulnerability for mental disorders inherent in high neuroticism, rather than to wait for their manifestation

Территориальные диспропорции демографических явлений, влияющих на формирование рабочей силы (на примере Севастопольского горсовета)

Рассмотрены основные диспропорции демографических явлений на микро-территориальном уровне, влияющие на формирование рабочей силы. Разработаны предло-жения методического характера по изучению геодемографических процессов крупного го-рода (на примере г.Севастополя).Розглянуто основні диспропорції демографічних явищ на мікро-територіальному рів-ні, що впливають на формування робочої сили. Розроблено пропозиції методичного характе-ру по вивченню геодемографічних процесів великого міста (на прикладі м. Севастополя).Territorial disproportions of the demographic phenomena at micro -territorial level which affecting to forming of labour power are considered. Suggestions of methodical character on the study of geodemographics processes of large city (on the example of Sevastopol) are developed

Bullying and Victimization in Elementary Schools: A Comparison of Bullies, Victims, Bully/Victims, and Uninvolved Preadolescents

Research on bullying and victimization largely rests on univariate analyses and on reports from a single informant. Researchers may thus know too little about the simultaneous effects of various independent and dependent variables, and their research may be biased by shared method variance. The database for this Dutch study was large (N = 1,065) and rich enough to allow multivariate analysis and multisource information. In addition, the effect of familial vulnerability for internalizing and externalizing disorders was studied. Gender, aggressiveness, isolation, and dislikability were most strongly related to bullying and victimization. Among the many findings that deviated from or enhanced the univariate knowledge base were that not only victims and bully/victims but bullies as well were disliked and that parenting was unrelated to bullying and victimization once other factors were controlled.

Life changes and depressive symptoms: the effects of valence and amount of change

Background Only few studies have focused on the effects of positive life changes on depression, and the ones that did demonstrated inconsistent findings. The aim of the present study was to obtain a better understanding of the influence of positive life changes on depressive symptoms by decomposing life changes into a valence and an amount of change component. Methods Using hierarchical multiple regression, we examined the unique effects of valence (pleasantness/unpleasantness) and amount of change on depressive symptoms in 2230 adolescents (M age: 16.28 years) from the TRAILS study. Results Adjusted for age, gender and pre-event depressive symptoms, the amount of life change was positively associated with depressive symptoms. A small excess of positive life changes predicted fewer symptoms, but experiencing a large excess of positive life changes did not have any additional beneficial effects, rather the opposite. Valence was more strongly associated with cognitive-affective than with neurovegetative-somatic symptoms. Conclusions More positive life changes relative to negative life changes can protect against depressive symptoms, yet only when the amount of change is limited. This study encourages examination of the effects of life changes on specific symptom clusters instead of total numbers of depressive symptoms, which is the current standard