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Cross-national studies have found, unexpectedly, that mental disorder prevalence is higher in high-income relative to low-income countries, but few rigorous studies have been conducted in very low-income countries. This study assessed mental disorders in Nepal, employing unique methodological features designed to maximize disorder detection and reporting.
In 2016–2018, 10714 respondents aged 15–59 were interviewed as part of an ongoing panel study, with a response rate of 93%. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) measured lifetime and 12-month prevalence of selected anxiety, mood, alcohol use, and impulse control disorders. Lifetime recall was enhanced using a life history calendar.
Lifetime prevalence ranged from 0.3% (95% CI 0.2–0.4) for bipolar disorder to 15.1% (95% CI 14.4–15.7) for major depressive disorder. The 12-month prevalences were low, ranging from 0.2% for panic disorder (95% CI 0.1–0.3) and bipolar disorder (95% CI 0.1–0.2) to 2.7% for depression (95% CI 2.4–3.0). Lifetime disorders were higher among those with less education and in the low-caste ethnic group. Gender differences were pronounced.
Although cultural effects on reporting cannot be ruled out, these low 12-month prevalences are consistent with reduced prevalence of mental disorders in other low-income countries. Identification of sociocultural factors that mediate the lower prevalence of mental disorders in low-income, non-Westernized settings may have implications for understanding disorder etiology and for clinical or policy interventions aimed at facilitating resilience.
Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries.
To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course.
Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder.
Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time.
Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.
Chapter 3 provides an overview of two influential pragmatic approaches to reference: Accessibility theory and the Givenness Hierarchy. Both accounts have been claimed to be compatible with relevance theory. However, it has also been claimed relevance theory alone cannot account for the full range of data and that these auxiliary scales of activation are necessary additions. In this chapter these claims are examined, and some objections are raised. The more general objections relate to the nature of the relevance-theoretic approach to utterance interpretation and how scales of encoded activation might fit with this. More specific objections relate to how the activation scale accounts deal with stylistic or so-called special uses of referring expressions. Finally, some examples of proper names in English are briefly discussed to illustrate how highly context sensitive the choices made by speakers can be, and to demonstrate the crucial role played by considerations of style and genre.
Chapter 5 presents a fully procedural analysis of personal pronouns in English. Pronouns, it is argued encode procedures which operate at a sub-personal level. Features including gender, number and person features function purely syntactically and do not contribute directly to the semantics of the overall message. That is, they are not conceptual. Rather, the cognitive processes triggered by use of a pronoun function to constrain potential referents to a sub-personally identifiable set. The differences in interpretation that arise when a speaker chooses to place contrastive prosodic stress on a pronoun are discussed, along with examples where the choice of pronoun does not play a role in reference resolution but contributes to other aspects of the speaker’s overall meaning. The discussion focuses specifically on the communication of expressive effects and has significance not just for our understanding of pronouns, but for our understanding of procedural meaning more generally.
Chapter 4 outlines a procedural relevance-based analysis of the definite determiner the. The definite article, it is argued, signals to the hearer that he should seek out an existing conceptual file on which to resolve reference. The indefinite article, on the other hand, instructs the hearer to open a new conceptual file. As interpretation proceeds, the hearer seeks to align the conceptual content within the nominal of the definite description with that in the target conceptual file. This approach to the contribution that definite descriptions make to speaker meaning is then applied to cases of misdescription and, it is claimed, it also offers fresh perspective on the referential–attributive distinction. Finally, stylistic effects which may arise from the choice and content of definite descriptions are discussed.
Chapter 2 provides an overview of the main ideas and principles of relevance theory. The cognitive and communicative principles of relevance are introduced, along with the notion of procedural meaning. The roles that these principles and concepts play in utterance interpretation are discussed. Attention then turns to reference with an overview of Wilson’s (1992) relevance-based account. The importance of the role of accessibility of context and referents in understanding the process of reference resolution is highlighted. Focus then turns to the cognitive process of referring itself. The act of resolving reference is presented as the process of mapping argument slots in the logical form of an utterance onto conceptual files. Referring expressions are a means by which a speaker can guide a hearer in this process. That is, they are procedural in nature. As with other interpretive processes, reference resolution is driven by the presumption of optimal relevance. The processes of mapping an argument slot onto a conceptual file and enriching that conceptual file are driven from the bottom-up by the semantics of the verb and constrained from the top-down by considerations of relevance.
The final chapter brings together the themes from across the volume and revisits the research questions which have driven the discussion. The main conclusions are briefly summarized and some suggestions are made for possible implications of the work and for future directions.
Chapter 1 introduces the key aims and objectives for the volume in terms of three main research questions. What motivates a speaker to use one expression rather than another in a particular discourse context? How do the components of a referring expression contribute to communication of the speaker’s meaning? In other words, what do referring expressions encode, and how does this interact with the context? What, beyond reference resolution, do referring expressions contribute to the overall speaker’s meaning, and how? The chapter then provides a brief overview of the main concerns of philosophical and stylistic approaches to reference, making links with the pragmatic approach adopted in this volume. Finally, an overview of the rest of the book is provided.
Chapter 6 applies the relevance-based account of referring expressions to the phenomenon of null subjects in non-pro-drop languages. So-called diary-style nulls, it is argued, are ultimately driven by the interaction of effects and effort and therefore by the speaker’s aim of achieving optimal relevance. Three broad categories of null subject use in English are identified: an informal null subject where the omission leads to extra cognitive effects, a pressurized null subject where the speaker’s abilities are the crucial factor, and finally, an ostensively vague null subject, which is driven by the speaker’s preferences. These three categories are not presented as an exhaustive taxonomy of English null subjects, or as theoretically distinct. Rather they emerge as a result of a speaker aiming at optimal relevance in different discourse contexts, and they represent occasions where different elements in the overall equation of optimal relevance drive lexical omissions.
Chapter 7 presents a context-based unitary analysis of demonstratives in English. Existing work reveals a wide and disparate range of effects associated with choice of demonstrative, and in this chapter, it is argued that these various and wide-ranging communicated effects are derived pragmatically. Procedures are proposed for both the proximal and distal demonstrative determiners, and a range of examples are discussed. It is argued that all of the identified uses and functions of demonstratives derive from the same underlying procedures, and that these procedures can interact with the discourse context to create effects that go beyond simply resolving reference. Examples from advertising and political discourse are discussed along with literary examples, and a range of stylistic effects are identified and explained on the procedural, relevance-based analysis.
Reference is a major theme in the study of language and language use. Providing a relevance-theoretic account of reference resolution, this book develops our understanding of procedurally encoded meaning by exploring its function and role in reference resolution. A range of referring expressions are discussed, including definite descriptions, demonstratives and pronouns. Existing work on the pragmatics of reference has largely focused on how reference is resolved. However, speakers can do much more than just secure reference when they use a referring expression. A speaker's choice of expression might communicate information about their attitudes and their emotions, and referring expressions can also be used to create stylistic and poetic effects. The analyses in this book widen the focus to consider these broader effects, and the discussions and arguments presented take seriously the idea that referring expressions can contribute to meaning and communication in a way that goes beyond reference.
The USA and UK governmental and academic agencies suggest that up to 35% of dementia cases are preventable. We canvassed dementia risk and protective factor awareness among New Zealand older adults to inform the design of a larger survey.
The modified Lifestyle for Brain Health scale quantifying dementia risk was introduced to a sample of 304 eligible self-selected participants.
Two hundred and sixteen older adults (≥50 years), with mean ± standard deviation age 65.5 ± 11.4 years (50–93 years), completed the survey (71% response rate). Respondents were mostly women (n = 172, 80%), European (n = 207, 96%), and well educated (n = 100, 46%, with a tertiary qualification; including n = 17, 8%, with a postgraduate qualification). Around half of the participants felt that they were at a future risk of living with dementia (n = 101, 47%), and the majority felt that this would change their lives significantly (n = 205, 95%), that lifestyle changes would reduce their risk (n = 197, 91%), and that they could make the necessary changes (n = 189, 88%) and wished to start changes soon (n = 160, 74%). Only 4 of 14 modifiable risk or protective factors for dementia were adequately identified by the participants: physical exercise (81%), depression (76%), brain exercises (75%), and social isolation (83%). Social isolation was the commonly cited risk factor for dementia, while physical exercise was the commonly cited protective factor. Three clusters of brain health literacy were identified: psychosocial, medical, and modifiable.
The older adults in our study are not adequately knowledgeable about dementia risk and protective factors. However, they report optimism about modifying risks through lifestyle interventions.
Jary and Kissine examine the meaning of imperative sentences, taking the existing relevance-theoretic semantic analysis, in terms of the desirability and potentiality of the described state of affairs, as their point of departure. In their view, a complete account of the interpretation of imperatives has to explain how they can result in the addressee forming an intention to perform an action, and this requires the theory to make room for ‘action representations’ (in addition to factual representations, such as assumptions). They claim that the imperative form is uniquely specified to interface with such action representations.
The editors provide a brief overview of the interdisciplinary significance of the relevance theory framework, which has developed and deepened considerably since Dan Sperber and Deirdre Wilson published their ground-breaking monograph Relevance: Communication and Cognition in 1986. They then provide an overview of the contents of the chapters of the current volume, situating them within this interdisciplinary context (which spans linguistics, philosophy of language, the psychology of language processing and literary studies, among others). Finally, they present the volume as a set of essays to celebrate and honour Deirdre Wilson’s pioneering work in pragmatics.