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Epidemiological data on the association between mental disorders and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) severity are limited.
To evaluate the association between mental disorders and the risk of SARS-CoV-2 infection and severe outcomes following COVID-19.
We performed a cohort study using the Korean COVID-19 patient database based on national health insurance data. Each person with a mental or behavioural disorder (diagnosed during the 6 months prior to their first SARS-CoV-2 test) was matched by age, gender and Charlson Comorbidity Index with up to four people without mental disorders. SARS-CoV-2-positivity risk and the risk of death or severe events (intensive care unit admission, use of mechanical ventilation and acute respiratory distress syndrome) post-infection were calculated using conditional logistic regression analysis.
Among 230 565 people tested for SARS-CoV-2, 33 653 (14.6%) had mental disorders; 928/33 653 (2.76%) tested SARS-CoV-2 positive and 56/928 (6.03%) died. In multivariable analysis using the matched cohort, there was no association between mental disorders and SARS-CoV-2-positivity risk (odds ratio OR = 0.95; 95% CI 0.87–1.04); however, a higher risk was associated with schizophrenia-related disorders (OR = 1.50; 95% CI 1.14–1.99). Among confirmed COVID-19 patients, the mortality risk was significantly higher in patients with than in those without mental disorders (OR = 1.99, 95% CI 1.15–3.43).
Mental disorders are likely contributing factors to mortality following COVID-19. Although the infection risk was not higher for people with mental disorders overall, those with schizophrenia-related disorders were more vulnerable to infection.
There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE).
The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico.
A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model.
In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE.
Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.
To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact. Via Danish registers, we identified all 56 640 individuals from the Central and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000–2016 as well as 315 694 age- and sex-matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the 5 years prior to the onset of T2D were not included. For this cohort, we first assessed the 2-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score-matched controls – taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact. A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age- and sex-matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score-matched controls (HR = 1.51, 95% CI = 1.43–1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR = 1.14, 95% CI = 0.98–1.32). Older age, somatic comorbidity, and being divorced/widowed were associated with both psychopharmacological treatment and psychiatric hospital contact following T2D. Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.
The study aimed to examine differences in, and characteristics of psychiatric care utilization in young refugees who came to Sweden as unaccompanied or accompanied minors, compared with that of their non-refugee immigrant and Swedish-born peers.
This register-linkage cohort study included 746 688 individuals between 19 and 25 years of age in 2009, whereof 32 481 were refugees (2896 unaccompanied and 29 585 accompanied) and 32 151 non-refugee immigrants. Crude and multivariate Cox regression models yielding hazard ratios (HR) and 95% confidence intervals (CI) were conducted to investigate subsequent psychiatric care utilization for specific disorders, duration of residence and age at migration.
The adjusted HRs for psychiatric care utilization due to any mental disorder was significantly lower in both non-refugee and refugee immigrants when compared to Swedish-born [aHR: 0.78 (95% CI 0.76–0.81) and 0.75 (95% CI 0.72–0.77, respectively)]. Within the refugee group, unaccompanied had slightly lower adjusted risk estimates than accompanied. This pattern was similar for all specific mental disorders except for higher rates in schizophrenia, reaction to severe stress/adjustment disorders and post-traumatic stress disorder. Psychiatric health care utilization was also higher in immigrants with more than 10 years of residency in Sweden entering the country being younger than 6 years of age.
For most mental disorders, psychiatric health care utilization in young refugees and non-refugee immigrants was lower than in their Swedish-born peers; exceptions are schizophrenia and stress-related disorders. Arrival in Sweden before the age of 6 years was associated with higher rates of overall psychiatric care utilization.
Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs.
To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model.
Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons.
Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners.
The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.
The trajectory of the anthropology of Irish psychiatry, like the trajectory of Irish psychiatry itself, is indelibly shaped by the history of Irelandʼs mental hospitals. This paper focuses on three works concerning the anthropology of psychiatry in Ireland: Nancy Scheper-Hughesʼs book, Saints Scholars and Schizophrenics: Mental Illness in Rural Ireland, an anthropological study (1977/2001); Eileen Kaneʼs paper, ‘Stereotypes and Irish identity: mental illness as a cultural frame’, from Studies: An Irish Quarterly Review (1986) and Michael D’Arcyʼs conference paper, ‘The hospital and the Holy Spirit: psychotic subjectivity and institutional returns in Dublin, Ireland’ (2015), based on his PhD dissertation. All three publications explore the relationship between institutional and community psychiatric care in Ireland, concluding with the work of D’Arcy which, like much good anthropology, is rooted in the lived experience of mental illness and combines deep awareness of the past with tolerance of multiple, ostensibly contradictory narratives in the present.
Although hallucinations have been studied in terms of prevalence and its associations with psychopathology and functional impairment, very little is known about sensory modalities other than auditory (i.e. haptic, visual and olfactory), as well the incidence of hallucinations, factors predicting incidence and subsequent course.
We examined the incidence, course and risk factors of hallucinatory experiences across different modalities in two unique prospective general population cohorts in the same country using similar methodology and with three interview waves, one over the period 1996–1999 (NEMESIS) and one over the period 2007–2015 (NEMESIS-2).
In NEMESIS-2, the yearly incidence of self-reported visual hallucinations was highest (0.33%), followed by haptic hallucinations (0.31%), auditory hallucinations (0.26%) and olfactory hallucinations (0.23%). Rates in NEMESIS-1 were similar (respectively: 0.35%, 0.26%, 0.23%, 0.22%). The incidence of clinician-confirmed hallucinations was approximately 60% of the self-reported rate. The persistence rate of incident hallucinations was around 20–30%, increasing to 40–50% for prevalent hallucinations. Incident hallucinations in one modality were very strongly associated with occurrence in another modality (median OR = 59) and all modalities were strongly associated with delusional ideation (median OR = 21). Modalities were approximately equally strongly associated with the presence of any mental disorder (median OR = 4), functioning, indicators of help-seeking and established environmental risk factors for psychotic disorder.
Hallucinations across different modalities are a clinically relevant feature of non-psychotic disorders and need to be studied in relation to each other and in relation to delusional ideation, as all appear to have a common underlying mechanism.
In this paper, I explain why evolutionary psychiatry is not where the next revolution in psychiatry will come from. I will proceed as follows. Firstly, I will review some of the problems commonly attributed to current nosologies, more specifically to the DSM. One of these problems is the lack of a clear and consensual definition of mental disorder; I will then examine specific attempts to spell out such a definition that use the evolutionary framework. One definition that deserves particular attention (for a number of reasons that I will mention later), is one put forward by Jerome Wakefield. Despite my sympathy for his position, I must indicate a few reasons why I think his attempt might not be able to resolve the problems related to current nosologies. I suggest that it might be wiser for an evolutionary psychiatrist to adopt the more integrative framework of “treatable conditions”. As it is thought that an evolutionary approach can contribute to transforming the way we look at mental disorders, I will provide a brief sketch of the basic tenets of evolutionary psychology. The picture of the architecture of the human mind that emerges from evolutionary psychology is thought by some to be the crucial backdrop to identifying specific mental disorders and distinguishing them from normal conditions. I will also provide two examples of how evolutionary thinking is supposed to change our thinking about some disorders. Using the case of depression, I will then show what kind of problems evolutionary explanations of particular psychopathologies encounter. In conclusion, I will evaluate where evolutionary thinking leaves us in regard to what I identify as the main problems of our current nosologies. I’ll then argue that the prospects of evolutionary psychiatry are not good.
The aim of this study was to find relationship between life events stress, mental disorders and irritable bowel syndrome.
This descriptive and cross sectional study was performed during six months on the 76 patients IBS. The life events stress or Paykel, GHQ-28 and Rome III criteriaand clinical interview was used assessment.
The differences were statistically significant between life events stress and mental disorders with IBS (P< 0/05).
Psychology distress and life events stressor is important component of the IBS symptom experience and shoud be considered when treatment strategies are designed.
The Val158Met polymorphism of the COMT gene is functional, easily detectable, and significantly related to metabolism of catecholamines, which underlie pathogenesis of a significant number of mental disorders. Evidence for the role of this polymorphism in schizophrenia, substance dependence, bipolar disorder, obsessive-compulsive disorder, anorexia nervosa and attention deficit hyperactivity disorder is summed up in this review article. The results make it unlikely that the COMT gene plays an important role in these mental disorders, although a minor effect can not be excluded. Future studies on the COMT gene in mentally ill subjects should be stratified by clinical subtypes of the disorder, gender and ethnicity. Studies of endophenotypes instead of the complex disorder seem to be another promising research strategy. Gene-gene and gene-environment interactions should also be considered. The COMT gene is probably not “a gene for” any mental disorder, but the Val158Met polymorphism appears to have pleiotropic effects on human behavior.
Screening scales can be useful in searching for common mental disorders in primary care and in tracking relevant prevalence and correlates in community surveys. However, it is important to document their validity, before using them. We developed Italian versions of the widely-used K10 and K6 screening scales following the WHO forward-translation and back-translation protocol. To evaluate their effectiveness as screens for DSM-IV 12-month mood or anxiety disorders and “serious mental illness” (SMI), the scales were validated in a two-stage clinical reappraisal survey. In the first-phase, the scales were administered to 605 people. In the second-phase, a sub-sample of 147 first-phase respondents over-sampling screened positives was administered the 12-month version of the Structured Clinical Interview for DSM-IV Axis I Disorders as a clinical gold standard. Performance of the scales in screening for chosen disorders was assessed by calculating area under the receiver operating characteristic curve and stratum-specific likelihood ratios. Both the K10 and K6 performed well in detecting DSM-IV mood disorders, anxiety disorders, and serious mental illness (SMI), with areas under the curve (AUCs) (95% CIs) between 0.82 (0.75–0.89) and 0.91 (0.85–0.96). The Italian versions of the K6 and K10 scales have good psychometric properties, making them attractive inexpensive screens for mood disorders, anxiety disorders, and SMI.
The review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK).
Peer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed.
Thirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria.
Despite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK.
Overall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.
To compare Emergency Room (ER) utilisation by subjects diagnosed as suffering from a mental disorder, who were born in Strong Migratory Pressure Countries (SMPC) or in Italy. To evaluate the predictors of admission to psychiatric and to non-psychiatric wards.
Data collected from Information System of Emergency Rooms were analysed. ER contacts in the years 2000–2004 pertaining to subjects who received a psychiatric diagnosis (ICD9-CM codes), and who were born in SMPC or in Italy were examined. “Contacts” included a total of 68,867 assessments made in the ER of all general hospitals in Rome having an acute psychiatric ward. Gender, age and clinical information on SMPC-born and Italian-born patients were compared. A multinomial logistic regression analysis was performed in order to determine risk factors for admission to a psychiatric or to a non-psychiatric ward.
At the end of follow-up, 11.7% of ER contacts concerned patients born in SMPC. Compared to the Italian-born group, these patients were younger and received more frequently a diagnosis of “Alcohol and substance abuse and dependencies”, while admissions to a psychiatric ward were significantly less common.
Monitoring health service utilisation may provide relevant information for the delivery of culturally sensitive mental health services.
This study analysed the association between country of birth and psychotic, affective, and neurotic disorders in seven immigrant categories, after adjustment for demographic and socioeconomic factors. A 2-year national cohort study of 4.5 million individuals in the age group 25–64 years was performed. Swedish national registers including individual demographic and socioeconomic data were linked to the hospital discharge register. Cox regression was used in the analysis. Several groups of immigrants, both men and women, had risks of hospital admission for psychotic, affective, or neurotic disorders compared to the Swedish-born reference group. The impact of demographic and socioeconomic factors on these risks seemed to be larger for men than for women. For foreign-born men, several of the risks no longer remained significant after adjustment for income and marital status. In contrast, most of the risks for foreign-born women remained significant after adjustment for income and marital status. Low income and being single were associated with an increased risk of psychiatric hospital admission. These results represent important knowledge for clinicians and public health planners who are involved in treatment and prevention of mental disorders among certain groups of immigrants, and among low income men and women irrespective of immigrant status.
– It is commonly assumed that reforms in the sector of psychiatric care have contributed to reducing the stigma attached to mental illness. In order to examine whether a relation between the psychiatric care set-up and stigmatisation of the patients exists we compared public attitudes towards mental patients in three countries at differing stages of progress in psychiatric reform.
– Population surveys on public attitudes towards mental patients were conducted in Novosibirsk (Russia) and Bratislava (Slovakia). The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys the same sampling procedure and fully structured interview were used. Public attitude towards mental patients was elicited using a perceived devaluation-discrimination measure.
– Psychiatric patients face considerable rejection in all three locations in question. Overall, the degree of perceived devaluation and discrimination was similar in all countries with a significant, but marginal tendency towards stronger devaluation of mental patients in Germany.
– Our results do not support a strong relationship between psychiatric reform and mental illness stigma.
The purpose of this study is to examine the association between non-psychotic serious mental disorders and earnings in the general population of Belgium on both the individual- and society-level.
Subjects and methods
Data stem from a cross-sectional population study of the non-institutionalized adult (between 18 and 64) population from Belgium (N = 863). The third version of the Composite International Diagnostic Interview (CIDI-3.0) was administered to assess 12-month non-psychotic serious mental disorders and annual earnings. Multivariate approaches were used to estimate the observed and estimated annual earnings for persons with serious mental disorders, controlling for sociodemographic variables and alcohol disorders.
On the individual-level, 12-month serious mental disorders significantly predicted the probability of having any earnings (OR = 0.32; 95%CI = 0.14–0.74). Respondents with serious mental disorders had 12-month earnings of 5969€ less than expected in the absence of serious mental disorders. Taking into account the prevalence of serious mental disorders (i.e. 4.9%), the society-level effects of serious mental disorders in 2002 can be estimated at about 1797 million € per year for the Belgian general population.
Non-psychotic serious mental disorders had considerable impact on annual earnings.
This is the first study in Belgium that addresses the association between mental illness and earnings. Serious mental disorders are associated with individual- and societal-level impairments and loss of human capital.
To document long-term prevalence trends and changes in Post-Traumatic Stress Disorder (PTSD), Current Major Depression (MD), Agoraphobia, Generalized Anxiety Disorder (GAD), and Panic Disorder, in two groups of people with different levels of exposure to a massive terrorist attack.
Cohort study. Two random samples of people exposed to a terrorist attack, the injured (n = 127) and community residents (n = 485) were followed and assessed, 2 and 18 months after the event.
Among the injured, 2 and 18 months after the attack, the prevalences were respectively, PTSD: 44.1% and 34%, MD: 31.5% and 23.7%, Agoraphobia: 23.8% and 20.7%, GAD: 13.4% and 12.4% and Panic Disorder: 9.4% and 11.3%. The corresponding figures among residents were PTSD: 12.3% and 3.5%, MD: 8.5% and 5.4%, Agoraphobia: 10.5% and 8.7%, GAD: 8.6%, and 8.2% and Panic Disorder 2.1% and 2.7%.
Two months after the event, the prevalence of mental disorders among both injured and residents was higher than expected levels at baseline conditions. Eighteen months after the event, psychopathological conditions did not change significantly among the injured but returned to the expected baseline rates among community residents.
To assess the social disability of people with different psychiatric disorders.
Cross-site survey in five psychiatric hospitals (Dresden, Wrocław, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n = 969) and 3 months after discharge (n = 753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability.
During acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points.
Severity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.
Population-based studies on the relationship between stalking and mental health outcomes in victims are scarce. The aim of the present study was to assess associations between stalking victimization and specific DSM-IV mental disorders in a community sample.
A postal survey was conducted in a middle-sized German city (sample size = 675). Lifetime stalking victims and non-victims were compared regarding rates of any mental disorder, comorbid mental disorders, and specific disorders assessed by the Patient Health Questionnaire (PHQ).
Victims had a higher incidence of mental disorders and comorbid mental disorders. Sex- and age-adjusted rates of specific disorders were increased, with the most robust associations identified for major depression (OR 4.8, 95% CI 1.8–12.8) and panic disorder (OR 4.1, 95% CI 1.1–14.9). Victims also reported higher current use of psychotropic medication (20.8% versus 5.6%).
Our study indicates substantial associations between stalking victimization and impaired mental health that can be quantified at diagnostic levels in the general population. To confirm these findings, larger community studies are needed, which also include an assessment of lifetime psychopathology and of factors potentially mediating the associations between stalking victimization and mental health.