Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.

Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.

Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4–1.6) and suicidality (OR = 1.5–2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.

These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.

The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.

Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.

3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.

ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.

Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.

IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.

The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.

The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.

Mental illness results from biological, psychological, social and contextual factors and is influenced by global events such as economic crises.

To describe the profiles of psychiatric admissions in four Portuguese hospitals located in the metropolitan areas of Lisboa and Porto, and to assess their evolution in 2002, 2007 and 2012, and the changes associated with the economic crisis effects.

The information was retrieved from the medical charts of all patients (n= 3,647) admitted at three periods: 2002 (no crisis), 2007 (pre-crisis) and 2012 (crisis). Demographic, social and clinical variables were obtained. The statistical binomial test was used to verify the existence of significantly differences between 2007 and 2012.

The number of admissions increased from 2007 to 2012, with greater variation (22%) in the Disorders related to substance use (ICD-9: 291, 292, 303, 304 e 305). Statistically significant positive changes were found in the admissions of: i) patients aged 50 to 64 years (17%, p=0.022), divorced (25%, p=0.032), and unemployed (58%, p<0.001); ii) patients 50 to 64 that referred having attempted suicide (26%, p=0.067) and suicidal ideation (34%, p=0.022) during that year; iii) women 50 to 64 referring attempted suicide (39% p=0.044) and suicidal ideation (39% p=0.044).

Our findings suggest the influence of the economic crisis in the number and profile of people admitted for mental disorders (greater effect in unemployed patients), and its association with an increase of admissions in people with suicide attempts and suicidal ideation, and particularly in women aged 50 to 64.

Mentally disordered prisoners (MDPs) have an increased vulnerability to victimization and suicide. in the last years, there is a trend to assign their treatment to the civil psychiatric services.

To compare forensic with civil psychiatric services users (FPSUs vs CPSUs) regarding clinical and care needs.

A cross-sectional study of FPSUs and CPSUs from 2 prisons, 1 prison-hospital and 1 general hospital, all located in the Lisbon region, was conducted. the forensic sample was constituted by all users during one year period (2009–2010), and the civil sample was matched for age and gender. the data was collected from users and staff interviews. the instruments included a specific questionnaire, MINI, BPRS and CANFOR.

The samples comprised 114 prisoners and 121 civil patients. FPSUs had better family inclusion and employment status but poorer academic achievement than CPSUs. the FPSUs presented significantly higher prevalence for major depression, suicide risk, anxiety disorders, drugs addiction and anti-social personality disorder than CPSUs. Comparatively, FPSUs had more prescriptions for hypnotics and CPSU had more prescriptions for antidepressants and anxiolytics. the FPSUs rated significantly more needs and unmet needs than CPSUs. However, the staff rated no differences between the two groups.

The FPSUs presented a higher prevalence of non-psychotic pathology than CPSUs. However, it seems that medication is insufficient regarding the clinical severity.

The unmet needs of FPSUs were significantly higher than CPSUs, and cover multiple domains.

The displacement of MDPs to civil psychiatric facilities should consider their specificities and needs.

The burden of neuropsychiatric disorders in the elderly is high, considering patients, their families, and close or extended networks. In Portugal, the 10/66-Dementia Research Group population-based research programmes are running since 2011, with the community prevalence study. The protocol allows for valid diagnoses of dementia and depression, using comprehensive assessments which include the Geriatric Mental State- AGECAT.

We aimed to analyse informal caregiving arrangements and the psychological experience of caregiving in a subsample drawn from the ongoing 10/66 studies.

We report on 580 residents aged 65 + years of a defined catchment area in Portugal (Mora). Assessments included questionnaires on demographic and caregiving issues, the Self-Report Questionnaire (SRQ) on psychological distress and the Zarit Burden Interview (ZBI) on the caregiving experience.

In this subsample, 94 participants were in need of informal caregiving (dementia accounted for 28 cases, depression for 31, and other chronic physical/psychiatric conditions for the remainder). Most primary caregivers were family relatives (mostly wives and daughters) and were living with the patient. A large number were elderly people themselves (mean age 64.1±16.3years). Median scores were 3 on the SRQ (range 0-16) and 8 on the ZBI (range 0-66). Those who were caring for participants with more severe disabilities scored significantly higher on both measures.

These preliminary results of the 10/66 epidemiological community studies support previous suggestions that caregiver strain is also high in subgroups of community samples. Most overburdened families (and individual caregivers) lacked appropriate, tailored interventions. Final results will be available soon.

Evidence shows that the prevalence and severity of mental disorders and the need for psychiatric admission is influenced by socio-demographic and contextual factors.

To characterize the severity of hospital admissions for psychiatric care due to common mental disorders and psychosis in Portugal.

This retrospective study analyses all acute psychiatric admissions for common mental disorders and psychosis in four Portuguese departments of psychiatry in the metropolitan areas of Lisbon and Porto, and investigates the association of their severity with socio-demographic and clinical factors.

Socio-demographic and clinical variables were obtained from the clinical charts of psychiatric admissions in 2002, 2007 and 2012 (n = 2621). The number of hospital admissions per year (>1) and the length of hospital stay (31 days) were defined as measures of hospital admission severity. Logistic regression analysis was used to assess which socio-demographic and clinical factors were associated with both hospital admission severity outcomes.

Results showed different predictors for each outcome. Being widowed, low level of education, being retired, having psychiatric co-morbidity, and a compulsory admission were statistically associated (P < 0.05) with a higher number of hospital admissions. Being single or widowed, being retired, a diagnosis of psychosis, and a compulsory admission were associated with higher length of hospital stay, while having suicidal ideation was associated with a lower length of hospital stay.

Socio-demographic and clinical characteristics of the patients are determinants of hospital admissions for psychiatric care and of their severity.

Funding Fundação para a Ciência e Tecnologia (FCT), Portugal.

The authors have not supplied their declaration of competing interest.

The treatment of psychiatric disorders depends on a combination of different types of care, such as psychiatric treatment and psychosocial interventions. However, there is little research on the factors that determine access to care, particularly to psychosocial interventions.

To characterize the use of psychosocial interventions (psychotherapy, day hospital, and psychosocial rehabilitation) in users of outpatient psychiatric services in Portugal.

This retrospective study analyses all outpatient psychiatric visits in four Portuguese departments of psychiatry in the metropolitan areas of Lisbon and Porto, and aims to evaluate the socio-demographic and clinical determinants of psychosocial interventions.

Socio-demographic and clinical variables were obtained from clinical charts of outpatients’ visits in 2002, 2007 and 2012 (n = 2621). All patients were characterized regarding the use of any psychosocial intervention beyond psychiatric consultations. Logistic regression analysis was performed to evaluate the predictors of psychosocial interventions use.

Being followed in 2012, being single, having no professional activity, and having a diagnosis of psychosis or common mental disorder were significantly associated (P < 0.05) with higher odds of accessing psychosocial interventions. On the other hand, a lower level of education was associated with less use of this type of care.

Socio-demographic and clinical characteristics of psychiatric services, outpatients are determinants of the use of psychosocial interventions. Evidence suggests that social inequalities may influence the access to psychosocial interventions in Portugal.

Fundação para a Ciência e Tecnologia (FCT), Portugal.

Portugal is among the European countries with higher prevalence of mental disorders, associated with substantial unmet needs for treatment. Literature on the impact of the economic recession shows that an increased risk of mental health problems is likely to occur. Despite possible growing needs, the budget cuts at the health system level may have decreased the adequacy of care response. Understanding the impacts of the recession in psychological distress and in access and quality of care is imperative to set public health priorities.

Resorting to a qualitative approach, this study aims to explore the perceptions and experiences of primary health care users and professionals during the recession in the Lisbon Metropolitan Area.

Provide in depth information regarding the specific contexts and subjective experiences of key informants during the economic recession that started in 2008.

This study design resorts to focus groups with primary health care users and semi-structured interviews with health professionals. All interviews were recorded and transcribed verbatim. Inductive approach and thematic analysis were performed, using NVivo 10.

This study explores the views and insights of users and health professionals regarding their socio-economic context, mental health needs, changes in health services and possible solutions to alleviate the impact of the economic recession.

Being based on the perspectives of users and health professionals, this approach will complement epidemiological evidence for policy-making.

The authors have not supplied their declaration of competing interest.

Portugal was one of the European countries most affected by the period of economic recession initiated in 2008. Social inequalities are likely to widen during such periods and disproportionately affect people with mental disorders. The present study aims to compare self-reported changes in indicators of socioeconomic position during the economic recession in Portugal among people with and without mental disorders in the beginning of this period. Three dimensions were assessed, namely employment situation, experiences of financial hardship and subjective social status.

Data from the World Mental Health Survey Initiative Portugal (2008/2009) and from the National Mental Health Survey Follow-up (2015/2016) were used (n = 911). Multinomial and logistic recession models were performed to examine the association between the presence of any 12-month mood or anxiety mental disorder in 2008/2009 and indicators of socioeconomic position in 2015/2016. All analyses were adjusted for gender, age, presence of any physical disorder and education at the baseline.

Participants that had any mental disorder in the beginning of the economic recession reported 2.20 (95% CI 1.31–3.71; P < 0.01) higher odds of financial hardship related to daily life in 2015/2016, when compared with those without any mental disorder, after adjusting for age, gender, education and presence of any physical disorder. The results may also suggest a pattern of increased socioeconomic disadvantage among people with prior mental disorder, despite not reaching statistical significance.

The results of this study suggest that the economic recession may have contributed to wider social inequalities between people with and without mental disorders. Policies to support these individuals, such as access to treatment and alleviation of financial hardship, should be a priority in times of economic downturn.

Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.

In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.

After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).

PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.

A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.

In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.

An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.

CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.

Traumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.

To investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.

We assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.

Respondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR=3.1, 95% CI 2.7–3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.

Exposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.

Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years.

The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18–22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI).

One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders.

Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.

Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.

General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.

Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.

Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.

In many epidemiological studies, women have been observed to consume psychotropic medication more often than men. However, the consistency of this relationship across Europe, with differences in mental health care (MHC) resources and reimbursement policies, is unknown.

Questions on 12-month psychotropic use (antidepressants, benzodiazepines, antipsychotics, mood stabilizers) were asked to 34,204 respondents from 10 European countries of the EU-World Mental Health surveys. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria were used to determine 12-month prevalence of mood/anxiety disorders using the Composite International Diagnostic Interview (v3.0).

For all participating countries, women were significantly more likely than men to use psychotropic medication within the previous 12 months (overall-OR = 2.04, 95% CI: 1.81–2.31). This relationship remained significant after adjusting for common sociodemographic factors (age, income level, employment status, education, marital status) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index). In multivariable gender-stratified risk-factor analysis, both women and men were more likely to have taken psychotropic medication with increasing age, decreasing income level, and mental health care use within the past 12 months, with no significant differences between genders. When only including participants with a mental disorder, gender differences overall were still significant with any 12-month mood disorder but not with any 12-month anxiety disorder, remaining so after adjusting for sociodemographic characteristics and country-level indicators.

Women use psychotropic medication consistently more often than men, yet reasons for their use are similar between genders. These differences also appear to be contingent on the specific mental disorder.