Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment

Background: Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive-compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited. Purpose: To estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive-compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample. Methods: Data from the German National Health Interview and Examination Survey-Mental Health Supplement (N=4181, age 18-65years), based on the standardized diagnostic Munich Composite International Diagnostic Interview. Results: The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs]≥3.3), compared to those without OCS. The OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs≥4.1) and bipolar disorders (ORs≥4.7). Participants in all three groups showed higher impairment (ORs≥3.1) and health-care utilization (ORs≥2.4), compared to those without OCS, even after controlling for covariates. Conclusions: Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization. This should be taken into account in future conceptualization and classification of OCD and clinical car

The use of weights to account for non-response and drop-out

Background: Empirical studies in psychiatric research and other fields often show substantially high refusal and drop-out rates. Non-participation and drop-out may introduce a bias whose magnitude depends on how strongly its determinants are related to the respective parameter of interest. Methods: When most information is missing, the standard approach is to estimate each respondent’s probability of participating and assign each respondent a weight that is inversely proportional to this probability. This paper contains a review of the major ideas and principles regarding the computation of statistical weights and the analysis of weighted data. Results: A short software review for weighted data is provided and the use of statistical weights is illustrated through data from the EDSP (Early Developmental Stages of Psychopathology) Study. The results show that disregarding different sampling and response probabilities can have a major impact on estimated odds ratios. Conclusions: The benefit of using statistical weights in reducing sampling bias should be balanced against increased variances in the weighted parameter estimates

The appropriateness of using a counter app in experimental studies assessing unwanted intrusive thoughts

The reliable and valid assessment of unwanted intrusive thoughts (UITs) is crucial. The main aim of the current research was to investigate if individuals who used a counter app (a program on a mobile device that is used to count the frequency of an event by pressing the volume-up button) to assess UITs retrospectively overreported the number of UITs. The secondary aim was to establish preliminary psychometric qualities of the counter app method. A UIT was activated in N = 87 students. They were randomly allocated to one of three experimental conditions: counter app, thought monitoring, or free thinking. Retrospective descriptors of the UIT, including its frequency, were taken. The second study (N = 118) mainly aimed to replicate the results of the first study. In both studies, the retrospective frequency ratings of the UITs were 2–3 times higher in individuals who had used the counter app compared to those in the control conditions. Preliminary indicators of convergent validity and test–retest reliability were good; criterion, discriminant, and predictive validity were unsatisfactory. To conclude, using event marking such as a counter app can result in an overestimation of UITs. Alternative methods of assessment of UITs are discussed

Psychological Flexibility as a Malleable Public Health Target: Evidence from a Representative Sample

Background: Identifying salient and widespread health-promoting targets is a prerequisite for efficient public health initiatives. We tested the moderating influence of psychological flexibility — a fundamental, trainable set of intrapersonal and interpersonal processes that help people manage stressors and strengthen alternative adaptive behaviors — on the relationship between known risk factors and physical health, mental health, and well-being. Method: A representative sample of 1035 participants in Switzerland aged 18 – 74 years answered questions about their physical health, health care utilization, mental health, well-being, and three risk factors: stressful life events, daily stress, and low social support. Statistical models tested whether psychological flexibility moderated the relationship between risk factors and outcomes. Results: Psychological flexibility consistently moderated the relationship between stress and all tested outcomes, following a dose response: Higher levels were more protective. Conclusions: Targeting psychological flexibility — a salient and widespread set of trainable skills — could promote various health outcomes

Parental alcohol use disorders and alcohol use and disorders in offspring: a community study

Background. We examined the association between parental alcohol use disorders and patterns of alcohol consumption and DSM-IV alcohol use disorders in their offspring in a community-based sample of young adults. Methods. Data are based on baseline and 4-year follow-up data of 2427 respondents aged 14–24 at baseline. Alcohol use and disorders in respondents were assessed using the Munich-Composite-International-Diagnostic-Interview with DSM-IV algorithms. Diagnostic information about parents was collected by family history information from the respondents, and by direct interview with one parent (cohort aged 14 to 17 years only). Results. Although the association between maternal and paternal alcohol use disorders and non-problematical drinking in offspring was minimal, there was a strong effect for the transition to hazardous use and for alcohol abuse and dependence; the effect of parental concordance for transition into hazardous use was particularly striking. Maternal history was associated with a higher probability of progression from occasional to regular use, whereas paternal history was associated with progression from regular to hazardous use. Parental alcoholism increased the risk for first onset of hazardous use and alcohol dependence between the ages of 14–17, and for an earlier onset of the alcohol outcomes in offspring. The impact of parental alcohol use disorders was comparable for male and female offspring. Conclusions. Parental alcoholism predicts escalation of alcohol use, development of alcohol use disorders and onset of alcohol outcomes in offspring

Calculating control variables with age at onset data to adjust for conditions prior to exposure

Background: When assessing the association between a factor X and a subsequent outcome Y in observational studies, the question that arises is what are the variables to adjust for to reduce bias due to confounding for causal inference on the effect of X on Y. Disregarding such factors is often a source of overestimation because these variables may affect both X and Y. On the other hand, adjustment for such variables can also be a source of underestimation because such variables may be the causal consequence of X and part of the mechanism that leads from X to Y. Methods: In this paper, we present a simple method to compute control variables in the presence of age at onset data on both X and a set of other variables. Using these age at onset data, control variables are computed that adjust only for conditions that occur prior to X. This strategy can be used in prospective as well as in survival analysis. Our method is motivated by an argument based on the counterfactual model of a causal effect. Results: The procedure is exemplified by examining of the relation between panic attack and the subsequent incidence of MDD. Conclusions: The results reveal that the adjustment for all other variables, irrespective of their temporal relation to X, can yield a false negative result (despite unconsidered confounders and other sources of bias)

Physical diseases among persons with obsessive compulsive symptoms and disorder: a general population study

Purpose: This study aimed at evaluating the comorbidity between DSM-IV obsessive compulsive disorder (OCD) and subthreshold forms and physical diseases in the general population as well as disability associated with comorbidity. Methods: We used data from the 1998 German Mental Health Survey, a representative survey of the German population. Mental disorders and physical diseases of 4181 subjects (aged 18-65) were cross-sectionally assessed. Mental disorders were diagnosed using the M-CIDI/DIA-X interview. Physical diseases were assessed through a self-report questionnaire and a standardized medical interview. We created three groups of obsessive-compulsive symptoms: (1) no obsessive compulsive symptoms (n=3,571); (2) obsessive compulsive symptoms (OCS, n=371; endorsement of OCS (either obsession or compulsion) without fulfilling any core DSM-IV criteria); (3) subthreshold OCD/OCD (n=239; fulfilling either some or all of the core DSM-IV criteria). Results: In comparison to subjects without OCS, subjects with subthreshold OCD/OCD showed higher prevalence rates of migraine headaches (OR 1.7; 95% CI 1.1-2.5) and respiratory diseases (OR 1.7; 95% CI 1.03-2.7); subjects with OCS showed higher prevalence rates of allergies (OR 1.6; 95% CI 1.1-2.8), migraine headaches (OR 1.9; 95% CI 1.4-2.7) and thyroid disorders (OR 1.4; 95% CI 1.01-2.0). Subjects with both OCS and physical disease reported the highest number of days of disability due to physical or psychological problems during the past 30days compared to subjects with only OCS, only physical disease or neither of them. Conclusions: OCD and subthreshold forms are associated with higher comorbidity rates with specific physical diseases and higher disability than subjects without OCS. Possible etiological pathways should be evaluated in future studies and clinicians in primary care should be aware of these associations

Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study

Objective To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis)

Physical activity and prevalence and incidence of mental disorders in adolescents and young adults

ABSTRACT Background Although positive effects of physical activity on mental health indicators have been reported, the relationship between physical activity and the development of specific mental disorders is unclear. Method A cross-sectional (12-month) and prospective-longitudinal epidemiological study over 4 years in a community cohort of 2548 individuals, aged 14-24 years at outset of the study. Physical activity and mental disorders were assessed by the DSM-IV Composite International Diagnostic Interview (CIDI) with an embedded physical activity module. Multiple logistic regression analyses controlling for age, gender and educational status were used to determine the cross-sectional and prospective associations of mental disorders and physical activity. Results Cross-sectionally, regular physical activity was associated with a decreased prevalence of any and co-morbid mental disorder, due to lower rates of substance use disorders, anxiety disorders and dysthymia. Prospectively, subjects with regular physical activity had a substantially lower overall incidence of any and co-morbid mental disorder, and also a lower incidence of anxiety, somatoform and dysthymic disorder. By contrast, the incidence of bipolar disorder was increased among those with regular physical activity at baseline. In terms of the population attributable fraction (PAF), the potential for preventive effects of physical activity was considerably higher for men than for women. Conclusions Regular physical activity is associated with a substantially reduced risk for some, but not all, mental disorders and also seems to reduce the degree of co-morbidity. Further examination of the evidently complex mechanisms and pathways underlying these associations might reveal promising new research targets and procedures for targeted preventio