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Increased post-traumatic stress disorder (PTSD) rates have been documented in children exposed to war. However, the contribution of childhood adversities and environmental sensitivity to children's responses to adversities and trauma are still far from settled.
To evaluate the relative roles of war, childhood adversities and sensitivity in the genesis of PTSD.
Data on childhood adversities and sensitivity was collected from 549 Syrian refugee children in Lebanon. PTSD symptoms were assessed using the PTSD Reaction Index.
Although childhood adversities, war events and sensitivity were all significantly related to PTSD in bivariate analyses, multivariate analyses showed that childhood adversities were the most important variable in predicting PTSD. The effect of war on PTSD was found to be dependent on the interplay between childhood adversities and sensitivity, and was most prominent in highly sensitive children with lower levels of adversities; in sensitive children experiencing high levels of adversities, the effects of war exposure on PTSD were less pronounced.
When considering the effects of war on PTSD in refugee children, it is important to take account of the presence of other adversities as well as of children's sensitivity. Sensitive children may be more vulnerable to the negative effects of war exposure, but only in contexts that are characterised by low childhood adversities.
Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.
We tested the benefits of adding telephone support to cCBT.
We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.
Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.
Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
Major depressive disorder (MDD) is a leading cause of disability worldwide.
To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.
Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.
Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.
Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
Epiphytes are known to respond sensitively to environmental changes. Because of the tight coupling of epiphytes to atmospheric conditions, changes in the chemical and physical conditions of the atmosphere may be expected to have direct effects on epiphytes (Farmer et al. 1992; Benzing 1998; Zotz & Bader 2009). In temperate regions, non-vascular epiphytes (bryophytes, lichens) have frequently been used as bioindicators of air quality (Hawksworth & Rose 1970). Owing to the lack of a protective cuticle in many bryophytes and lichens, solutions and gases may enter freely into the living tissues of these plants causing sensitive reactions to changes in the environment. By mapping and monitoring the distribution and abundance of non-vascular epiphytes, changes in environmental conditions can be assessed (Van Dobben & De Bakker 1996; Szczepaniak & Biziuk 2003).
Tropical moist forests, especially mountain forests, are very rich in epiphytes, both vascular and non-vascular. In the Reserva Biológica San Francisco, a small mountain rain forest reserve of approximately 1000 hectares in the Andes of southern Ecuador, about 1200 species of epiphytes have been recorded, with more than half of these bryophytes and lichens (Liede-Schumann & Breckle 2008). About one of every two species of plant in the forests is an epiphyte. The almost constantly saturated air in these mountain forests, due to orographic clouds, mist, and frequent rainfall, allows the epiphytic plants to thrive year-round high up on the trees, favoring high species diversity.
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.
Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries.
To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys.
The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated.
Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (χ2(9) = 5.5–8.1, P = 0.52–0.79). These losses are equivalent to 0.3–0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations.
These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.
1. Biogeographical patterns of ferns and angiosperms are the result of a combination of vicariance and long distance dispersal, but due to their more effective dispersal via spores, the latter is more frequent among ferns. Therefore, fern species tend to have wider ranges and the relative number of fern species compared with seed plants is highest on remote, mountainous tropical islands such as Hawaii and the Mascarenes. Also, fern communities on different continents are more similar compositionally than those of seed plants.
2. Despite their potential for long distance spore dispersal, many fern species have localized ranges as a result of low frequency of successful long distance dispersal, habitat specialization, geographical isolation and competitive interactions between species.
3. Species richness of ferns follows a latitudinal gradient that peaks in the tropics, where ferns are especially diverse and abundant in wet habitats with moderate temperatures at elevations of about 1000–2500 m. On average, species in tropical mountains have elevational amplitudes of about 1000 m. The peak of endemism is located at higher elevations than that of species richness.
Biogeography deals with the distribution patterns of species and communities, and their causal relationships with factors such as climate, soil and evolutionary history (Humboldt, 1805; Lomolino et al., 2006). Specific topics addressed by biogeographers include the sizes of geographical ranges and their spatial placement, the way individual species attain their distribution ranges (dispersal, extinction and vicariance), the distribution of species numbers (alpha diversity), changes in species composition (beta diversity) and the spatial distribution of species traits (macroecology).
This chapter deals with disaster mental health research in children, and systematically examines the extant literature, focusing on methodological issues. Children represent the ideal age group to study in order to gain insight into the etiology of psychopathology in the aftermath of disaster. Any postdisaster child assessment should necessarily involve a two-step process, including a detailed characterization of the child's exposure and the possible related reactions. The chapter proposes a three-category disaster typology based on the distribution of different types of disaster exposures. The chapter focuses on reports of reactions related to posttraumatic stress disorder (PTSD) in children after mass traumatic events, with studies being reviewed within the context of the proposed typology. Psychiatric disorders observed in children after large-scale traumatic events include a range of disorders, with PTSD and depression being the most commonly assessed.