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One important aspect of the societal burden of mental disorders is the extent to which these problems cause disability.
To assess days out of role associated with commonly occurring mental disorders in comparison with physical disorders in Portugal.
National cross-sectional survey, with home interviews carried out with 3849 adult (aged 18+) respondents (57.3% response rate).
Twelve-month prevalence for any mental disorder was 21.8%, any physical disorder 55.1% and any disorder 63.1%, with an average of 2.3 disorders per respondent with a disorder. Close to one out of every 10 respondents (9.2%) reported at least one day totally out of role in the past month (median of 6.4 days/any). The 18 conditions accounted for 78.2% of all days out of role, with 20.2% because of mental disorders and 59.2% because of physical disorders.
Mental disorders account for a substantial proportion of all role disability in the Portuguese population. Early detection and intervention would have a positive societal effect. Owing to highly frequent comorbidity, simultaneous management of mental and physical disorder comorbidities is advised for greater effect.
Although childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.
To examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.
Epidemiological data were analysed from the World Mental Health Surveys (n = 27017).
Four childhood adversities (physical and sexual abuse, neglect, parent psychopathology) were associated with similarly increased odds of PTSD following traumatic experiences (odds ratio (OR)=1.8), whereas the other eight childhood adversities assessed did not predict PTSD. Childhood adversity–PTSD associations did not vary across traumatic experience types, but were stronger in childhood-adolescence and early-middle adulthood than later adulthood.
Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.
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.
The epidemiology of rapid-cycling bipolar disorder in the community is
To investigate the epidemiological characteristics of rapid-cycling and
non-rapid-cycling bipolar disorder in a large cross-national community
The Composite International Diagnostic Interview (CIDI version 3.0) was
used to examine the prevalence, severity, comorbidity, impairment,
suicidality, sociodemographics, childhood adversity and treatment of
rapid-cycling and non-rapid-cycling bipolar disorder in ten countries
(n = 54 257).
The 12-month prevalence of rapid-cycling bipolar disorder was 0.3%.
Roughly a third and two-fifths of participants with lifetime and 12-month
bipolar disorder respectively met criteria for rapid cycling. Compared
with the non-rapid-cycling, rapid-cycling bipolar disorder was associated
with younger age at onset, higher persistence, more severe depressive
symptoms, greater impairment from depressive symptoms, more out-of-role
days from mania/hypomania, more anxiety disorders and an increased
likelihood of using health services. Associations regarding childhood,
family and other sociodemographic correlates were less clear cut.
The community epidemiological profile of rapid-cycling bipolar disorder
confirms most but not all current clinically based knowledge about the
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.
Advocates of expanded mental health treatment assert that mental
disorders are as disabling as physical disorders, but little evidence
supports this assertion.
To establish the disability and treatment of specific mental and physical
disorders in high-income and low- and middle-income countries.
Community epidemiological surveys were administered in 15 countries
through the World Health Organization World Mental Health (WMH) Survey
Respondents in both high-income and low- and middle-income countries
attributed higher disability to mental disorders than to the commonly
occurring physical disorders included in the surveys. This pattern held
for all disorders and also for treated disorders. Disaggregation showed
that the higher disability of mental than physical disorders was limited
to disability in social and personal role functioning, whereas disability
in productive role functioning was generally comparable for mental and
Despite often higher disability, mental disorders are under-treated
compared with physical disorders in both high-income and in low- and
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