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To complete missing information on the influence of spiritual and religious advisors as informal providers for mental health problems in Europe.
Recourse to religious practice or belief when coping with mental health problems was evaluated using data from the ESEMED survey. This was a stratified, multistage, clustered-area probability sample survey of mental health carried out in six European countries which included 8796 subjects. Between countries differences in sociodemographic characteristics, religious affiliation, and prevalence of mental disorders and management of mental disorders were evaluated.
Religion appears to play a limited role in coping with mental health problems in Europe. Only 7.9% of individuals seeking help for such problems turned to a religious advisor. This proportion differed between countries from 13% in Italy, 12.5% in Germany, 10.5% in the Netherlands, 5.8% in France, 4.7% in Belgium to 4% in Spain. In addition, seeking help exclusively from religion was reported by only 1.3% of subjects. Practicing religion at least once a week and considering religion as important in daily life were predictors of using religion versus conventional health care only. Use of religion was not influenced by gender and age. Non-Christian respondents and individuals with alcohol disorders were more likely to use religion. In Spain, the use of religion is much lower than average.
Unlike the situation in the United States, organised religion does not provide alternative informal mental health care in Europe. At best, it could be considered as an adjunct to conventional care.
To estimate lifetime risk and ages of onset of mental disorders in the adult general population of Belgium.
Method and materials
For the World Mental Health Surveys of the World Health Organization, a representative random sample of non-institutionalized inhabitants from Belgium aged 18 or older (n=2419) were interviewed. The interview took place by means of the CIDI 3.0. Lifetime prevalence, projected lifetime risk, and age of onset were assessed.
Compared to lifetime prevalence rates, projected lifetime risk remains fairly stable for anxiety disorders, but is increased for mood and alcohol disorders: The lifetime risk for any mental disorder was 37.1%: 22.8% for mood disorders, 15.7% for anxiety disorders, and 10.8% for alcohol disorders. Prevalence estimates of mood and alcohol disorders were significantly higher in the cohorts between 18 and 34 years. Age of onset-distribution are presented for mood, alcohol and anxiety disorders.
This is the first study that assessed projected lifetime risks and ages of onset in the Belgian general population. A significant difference is noted between lifetime prevalence rates and projected lifetime risk. Median age of onset varies from disorder to disorder and younger cohorts had higher likelihood for developing mental disorders.
Studies on patients' experience of involuntary admission focused on the patients' retrospective view of the appropriateness of the admission, the perceived coercion during hospitalization and the experienced impact on their relationships and on prospects for future employment. the experiences and opinions of patients and their relatives on the judicial procedure of involuntary admission itself were never investigated in depth.
Objectives and aims:
(1) We aim to systematically gather and analyse the perceptions and views of patients subjected to involuntary admission. Starting from their experiences and perceptions, we will explore their views on the concept and the judicial procedure of involuntary admission in all his aspects.
(2) We aim to investigate the experiences and views of patients' relatives and of
(3) Other stakeholders (psychiatric and judicial) in the same manner in order to constitute a comprehensive experiential knowledge base.
Using semi-structured interviews, a qualitative research approach will be systematically complemented with aggregated views from patient organisations, ombudservices and patients' relatives organisations. To avoid bias, an independent clinician interviews patients and relatives at least one month after termination of involuntary admission. Interviews will be analysed by means of hierarchical cluster analyses.
The themes, concerns, opinions and perceptions of patients, relatives and stakeholders will be presented mainly from a hierarchical perspective distinguishing experiential importance and weight.
Systematical qualitative research on patient' and patients' relatives' views on compulsory admission is an important complement to patient participation initiatives in order to inform clinical and judicial practice and possible reforms.
To provide an effective crisis intervention, there is a need to better understand how these interventions work. The aim of this study was to develop an explanatory theory of therapeutic processes implied in the psychological process of crisis intervention.
We aimed to reduce the gap between clinicians and researchers by showing how a qualitative method may reveal experiences about how professionals explained their clinical practice in crisis intervention and what their representation are of people in crisis.
In depth, semi-structured interviews were conducted, transcribed and independently reviewed by using Grounded Theory Methodology (GTM). Data were analyzed with the constant comparative method. The study was conducted in crisis experts in Psychiatric Emergency Room (PER). A purposive sample of 17 professionals in crisis intervention included in our study.
Results showed that therapeutic processes are managed in multiple interactions and regulations. Crisis intervention is an opportunity to highlight the psychic functioning. There are multiple settings of interventions oriented by the context of the institution and theorical background of professionals. The social realities slow down the possibility to elaborate the end of the intervention.
This study illuminates that clinicians and professionals in crisis intervention need guidelines to better improve their therapeutic interventions. They also need a political support to create specialized training and develop medical and psychological services to take in charge people in crisis. This research contributes to show the discrepancy between what the professional thinks to do in their interventions and what he really do.
Low socio-economic status (SES) is associated with mental disorders and involuntary admission, but the extent to which those associations change over time is unknown.
Objectives and aims:
We aim to investigate (1) to what extent SES is a predictor of initiation of involuntary admission, (2) multivariate predictive associations between mental disorders and involuntary admission, and (3) evolutions of (1) and (2) between 2000 and 2010. Using both bivariate and multivariate models, we will present time trends in the associations between SES and involuntary admission, using mental disorders and service use as covariates.
Data stem from a large epidemiological study on psychiatric emergencies in the University Hospital of Leuven, Belgium. all patients presenting to the psychiatric emergency room were systematically monitored in terms of sociodemographic factors, presenting problems, mental disorders, and service use variables. the subset of all consecutive patients who were involuntary admitted from the emergency room between 2000 and 2010 (N = 1,053) was analysed.
We found an increased rate of involuntary admitted patients between 2000 and 2010 (p = .0140). the number of employed patients decreased significantly (from 29.6% to 15.8%). This was also the case, although to a lesser extent, for those who were living together (from 46.9% to 40.0%). More fine-grained results, SES estimates and associations with mental disorders will be presented.
Our data suggest a significant increase of the number of involuntary admissions, together with differences in SES patterns. Implications on both the clinical and the policy level will be discussed.
The increase of the number of compulsory admissions in several European countries contradicts the growing attention for patient rights, autonomy and the evolution towards community care and deinstitutionalisation. the increase is not substantiated scientifically either: there is little scientific evidence for the effectiveness of coercive measures in reducing risk nor for the accuracy of risk assessment (false positives).
Aims, objectives and methods
Using ethical analysis, our objective is to examine the reasons for this increase and its negative consequences.
The increase reflects a societal shift with growing readiness to sacrifice the values ‘freedom’ and ‘autonomy’ for (perceived) safety and security. Both physical safety of patient and others and juducial safety of the psychiatrist (avoidancing litigation) collude.
On the other hand, the scientific attention for the deleterious consequences of compulsory admissions is growing. Perceived coercion is an important risk factor for PTSD symptoms after psychiatric admission. Coercive measures may also be counterproductive, undermining trust and cooperation and inducing regressive behaviour, care avoidance, resistance and a struggle for power and control. Furthermore, an increased association of mental health care with coercion in the public perception might induce fear, aversion and avoidance in those who need help, thus impairing early intervention and raising the threshold for voluntarily seeking help. It also reduces the openness of patients to freely talk about symptoms, feelings and thoughts thus undermining assessment and therapy.
Long term negative consequences of coercion might outweigh short term safety benefits, justifying greater reticence initiating compulsory admissions.
Epidemiological data regarding compulsory admission are mainly limited to unpublished reports and databases, often gathered unsystematically with great heterogeneity in both definitions and data recording methods. the scarcity of scientifically validated and published data is in sharp contrast with the societal relevance of coercion. Therefore the Flemish Community implemented since 2007 a uniform data collection and recording method inspired by the Dutch registration, resulting in a database of incident cases of compulsory admission.
Objectives and aims:
(a) to investigate the epidemiology of compulsory admission in Flanders in terms of sociodemographic and psychiatric characteristics, past use of services, and temporal trends;
(b) to compare Flemish epidemiological profiles with Belgian population-representative data (N = 7,821; 1997–1998) and data gathered from a Belgian university teaching hospital (N = 1,501; 2000–2010).
Data were systematically collected and quality controlled by a government agency, supervised by a scientific committee. all incident cases of compulsory admission were included prospectively (2007–2009, N = 10,607, response rate=100%). Descriptive statistics, advanced uni- And multivariate regression models and time-trend models were applied.
Epidemiological profiles of prevalence and incidence data comprising data from all three sources will be presented. Data will be disaggregated by sociodemographic profiles (e.g. gender/age comparisons), psychiatric disorders, severity estimates, correlates of compulsory admissions, and temporal trends in these disaggregation variables.
This is the first study investigating the epidemiology of compulsory admissions in Belgium using large and longitudinal databases. Our findings will be placed into an international context relating to implications for further epidemiological research, legislative issues, and methodological improvements.
Compulsory admission is controversial and highly relevant to society. Nevertheless, epidemiological European data are scarce and of limited reliability and comparability. in several countries including Belgium and the Netherlands, the incidence of compulsory admissions seems to increase despite legislative amendments aiming to reduce coercion.
Objectives and aims:
By pooling and analysing available epidemiological data, we estimated the incidence and evolution of compulsory admission in Belgium and the Netherlands within the 7-year timeframe of most recent available data.
We ran a systematic literature review including relevant epidemiological data, either published or from grey literature (e.g. unpublished governmental, regional or health care reports and databases). all data were (re)calculated into incidence rates per 100,000 inhabitants per year. Statistical testing (e.g. trend analyses) was performed when applicable.
Incidence of compulsory admission increased with 38% (Belgium, 1999–2006) and 39% (2002–2009, Netherlands), respectively (all p < .01), culminating in incidence rates of 45/100,000/y (Belgium, 2006) and 113/100,000/y (Netherlands, 2009). in between country differences can be partially explained by legal differences (type and duration of compulsory admissions). More fine-grained results, regional differences (e.g. urban versus rural areas), and incidence comparisons within a European context will be presented.
Our data suggest a significant increase of the incidence of compulsory admissions in both Belgium and the Netherlands. Uniformity and standardization in registration of compulsory admission throughout Europe is needed to enhance the comparability and quality of the data. Substantial differences in legal frameworks and the structure and organisation of healthcare further limit international comparability
Despite increased awareness that non-suicidal self-injury (NSSI) poses a significant public health concern on college campuses worldwide, few studies have prospectively investigated the incidence of NSSI in college and considered targeting college entrants at high risk for onset of NSSI.
Using data from the Leuven College Surveys (n = 4,565; 56.8%female, Mage = 18.3, SD = 1.1), students provided data on NSSI, sociodemographics, traumatic experiences, stressful events, perceived social support, and mental disorders. A total of 2,163 baseline responders provided data at a two-year annual follow-up assessment (63.2% conditional response rate).
One-year incidence of first onset NSSI was 10.3% in year 1 and 6.0% in year 2, with a total of 8.6% reporting sporadic NSSI (1–4 times per year) and 7.0% reporting repetitive NSSI (≥ 5 times per year) during the first two years of college. Many hypothesized proximal and distal risk factors were associated with the subsequent onset of NSSI (ORs = 1.5–18.2). Dating violence prior to age 17 and severe role impairment in daily life were the strongest predictors. Multivariate prediction suggests that an intervention focused on the 10% at highest risk would reach 23.9% of students who report sporadic, and 36.1% of students who report repetitive NSSI during college (cross-validated AUCs =.70–.75).
The college period carries high risk for the onset of NSSI. Individualized web-based screening may be a promising approach for detecting young adults at high risk for self-injury and offering timely intervention.
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.
The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.
Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).
The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
Adolescence and young adulthood carry risk for suicidal thoughts and behaviours (STB). An increasing subpopulation of young people consists of college students. STB prevalence estimates among college students vary widely, precluding a validated point of reference. In addition, little is known on predictors for between-study heterogeneity in STB prevalence.
A systematic literature search identified 36 college student samples that were assessed for STB outcomes, representing a total of 634 662 students [median sample size = 2082 (IQR 353–5200); median response rate = 74% (IQR 37–89%)]. We used random-effects meta-analyses to obtain pooled STB prevalence estimates, and multivariate meta-regression models to identify predictors of between-study heterogeneity.
Pooled prevalence estimates of lifetime suicidal ideation, plans, and attempts were 22.3% [95% confidence interval (CI) 19.5–25.3%], 6.1% (95% CI 4.8–7.7%), and 3.2% (95% CI 2.2–4.5%), respectively. For 12-month prevalence, this was 10.6% (95% CI 9.1–12.3%), 3.0% (95% CI 2.1–4.0%), and 1.2% (95% CI 0.8–1.6%), respectively. Measures of heterogeneity were high for all outcomes (I2 = 93.2–99.9%), indicating substantial between-study heterogeneity not due to sampling error. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.12–1.67). Higher STB estimates were also found in samples with lower response rates, when using broad definitions of suicidality, and in samples from Asia.
Based on the currently available evidence, STB seem to be common among college students. Future studies should: (1) incorporate refusal conversion strategies to obtain adequate response rates, and (2) use more fine-grained measures to assess suicidal ideation.
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
Sexual assault is a global concern with post-traumatic stress disorder (PTSD), one of the common sequelae. Early intervention can help prevent PTSD, making identification of those at high risk for the disorder a priority. Lack of representative sampling of both sexual assault survivors and sexual assaults in prior studies might have reduced the ability to develop accurate prediction models for early identification of high-risk sexual assault survivors.
Data come from 12 face-to-face, cross-sectional surveys of community-dwelling adults conducted in 11 countries. Analysis was based on the data from the 411 women from these surveys for whom sexual assault was the randomly selected lifetime traumatic event (TE). Seven classes of predictors were assessed: socio-demographics, characteristics of the assault, the respondent's retrospective perception that she could have prevented the assault, other prior lifetime TEs, exposure to childhood family adversities and prior mental disorders.
Prevalence of Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD associated with randomly selected sexual assaults was 20.2%. PTSD was more common for repeated than single-occurrence victimization and positively associated with prior TEs and childhood adversities. Respondent's perception that she could have prevented the assault interacted with history of mental disorder such that it reduced odds of PTSD, but only among women without prior disorders (odds ratio 0.2, 95% confidence interval 0.1–0.9). The final model estimated that 40.3% of women with PTSD would be found among the 10% with the highest predicted risk.
Whether counterfactual preventability cognitions are adaptive may depend on mental health history. Predictive modelling may be useful in targeting high-risk women for preventive interventions.
Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.
We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.
Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).
Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
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.
This study examines: (1) the prevalence of Non-Suicidal Self-Injury (NSSI) among Dutch and Belgian adolescents, (2) the associations between Big Five personality traits and NSSI engagement/versatility (i.e., number of NSSI methods), and (3) whether these associations are mediated by perceived stress and coping.
A total of 946 Flemish (46%) and Dutch (54%) non-institutionalized adolescents (Mean age = 15.52; SD = 1.34, 44% females) were surveyed. Measures included the NSSI subscale of the Self-Harm-Inventory, the Dutch Quick Big Five Personality questionnaire, the Perceived Stress Scale and the Utrecht Coping List for Adolescents. Examination of zero-order correlations was used to reveal associations, and hierarchical regression analysis was used to reveal potential mediators which were further examined within parallel mediation models by using a bootstrapping-corrected procedure.
Lifetime prevalence of NSSI was 24.31%. Neuroticism; perceived stress; and distractive, avoidant, depressive, and emotional coping were positively associated with NSSI engagement, whereas Agreeableness, Conscientiousness; and active, social, and optimistic coping were negatively associated with NSSI engagement. Observed relationships between personality traits and NSSI engagement were consistently explained by perceived stress and depressive coping. A higher versatility of NSSI was not associated with any Big Five personality trait, but was associated with higher scores on perceived stress and depressive coping and with lower scores on active and optimistic coping.
Our study suggests that a specific personality constellation is associated with NSSI engagement via high stress levels and a typical depressive reaction pattern to handle stressful life events.