To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
We aimed to investigate the relationships between use of media to obtain information on radiation and radiation anxiety among community residents in Fukushima, 5.5 years after the nuclear power plant accident.
A questionnaire survey was administered between August and October 2016 to 2000 randomly sampled residents in Fukushima prefecture. Radiation anxiety toward health and regarding discrimination and prejudice were assessed with 4- and 3-item scales, respectively. Participants nominated their most-used media for acquiring information on radiation by choosing up to 3 sources from 12 information sources listed (eg, local newspaper, TV news, websites, social networking sites [SNS], local government newsletter, word of mouth). We investigated associations of most-used media types and radiation anxiety, controlling for sociodemographic characteristics and anxiety regarding radiation’s health effects immediately after the accident, using multivariate linear regression analyses.
Valid responses were obtained from 790 (39.5%) residents. Acquiring information about radiation by word of mouth was related to higher radiation anxiety toward health. Regarding radiation anxiety concerning discrimination and prejudice, SNS use was related to higher anxiety, whereas acquiring information through Nippon Hoso Kyokai (NHK) TV news was related to lower anxiety.
Interpersonal interactions rather than gaining information from media – characterized by unidirectional information exchange – may increase radiation anxiety.
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 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.
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.
Healthcare access and outcomes in cancer patients with schizophrenia
To investigate the likelihood of early diagnosis and treatment in
patients with schizophrenia who have cancer and their prognosis.
A retrospective matched-pair cohort of gastrointestinal cancer patients
was identified using a national in-patient database in Japan.
Multivariable ordinal/binary logistic regressions was modelled to compare
cancer stage at admission, invasive treatments and 30-day in-hospital
mortality between patients with schizophrenia (n = 2495)
and those without psychiatric disorders (n = 9980).
The case group had a higher proportion of stage IV cancer (33.9%
v. 18.1%), a lower proportion of invasive treatment
(56.5% v. 70.2%, odds ratio (OR) = 0.77, 95% CI
0.69–0.85) and higher in-hospital mortality (4.2% v.
1.8%, OR = 1.35, 95% CI 1.04–1.75).
Patients with schizophrenia who had gastrointestinal cancer had more
advanced cancer, a lower likelihood of invasive treatment and higher
in-hospital mortality than those without psychiatric disorders.
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.
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
Email your librarian or administrator to recommend adding this to your organisation's collection.