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How can businesses operate profitably and sustainably while ensuring that they are applying human rights? It is possible to apply human rights while at the same time decreasing cost and making human rights contribute to profits. Yet business efforts alone are insufficient, and states must possess sufficient regulatory power to work together with businesses and investors – not only to improve human rights but also to foster development more broadly. This textbook, the first of its kind, explores all aspects of the links between business operations and human rights. Its twenty-five chapters guide readers systematically through all the particular features of this intersection, integrating legal and business approaches. Thematic sections cover conceptual and regulatory frameworks, remedies and dispute resolution, and practical enforcement tools. Ideal for courses in business, law, policy and international development, the book is also essential reading for managers in large corporations.
Since adoption of the Convention on the Rights of Persons with Disabilities and the interpretive General Comment 1, the topic of legal capacity in mental health settings has generated considerable debate in disciplines ranging from law and psychiatry to public health and public policy. With over 180 countries having ratified the Convention, the shifts required in law and clinical practice need to be informed by interdisciplinary and contextually relevant research as well as the views of stakeholders. With an equal emphasis on the Global North and Global South, this volume offers a comprehensive, interdisciplinary analysis of legal capacity in the realm of mental health. Integrating rigorous academic research with perspectives from people with psychosocial disabilities and their caregivers, the authors provide a holistic overview of pertinent issues and suggest avenues for reform.
Hegel regarded his Enyclopedia of the Philosophical Sciences as the work which most fully presented the scope of his philosophical system and its method. It is somewhat surprising, therefore, that scholars regularly accord it only a secondary status. This Critical Guide seeks to change that, with sixteen newly-written essays from an international group of leading Hegel scholars that shed much-needed light on both the whole and the parts of the Encyclopedia system. Topics include the structure and aim of the Encyclopedia system as a whole, the differences between the greater and lesser Logics, the role of nature in Hegel's thinking, and the shapes of absolute spirit as art, religion, and philosophy. This book will be invaluable to students and scholars with an interest in Hegel and the history of philosophy.
In industrialised countries, it is very likely that there will be a sharp rise in the number of individuals in old age in the upcoming decades. Common characteristics of these individuals include multi-morbidity or frequent doctor visits which are obviously linked to increased healthcare costs.1 Therefore, identifying the determinants associated with increased healthcare costs among individuals in old age is crucial. Knowledge regarding these factors can help to manage healthcare services.
In old age, morbidity and the proportion of chronically ill patients in primary care increase. Because of multi-morbidity, older people belong to the population group with the highest use of medical services, and the general practitioner (GP) is usually the first contact point for older people.1 According to current data, the age group between 70 and 79 years shows the highest levels of utilisation of primary care services (12-month prevalence) in registered doctors’ practices with a population share of 83.4%.2 Because GPs have the highest share of medical care, they play an important role in the care of somatic and mental illness in old age. In the field of mental health in old age, dementia and depression belong to the most common disorders. Further, cardiovascular diseases and musculoskeletal disorders are among the most common physical illnesses in individuals over 75 years of age.3,4 These diseases cause not only great suffering for the affected patients but also high costs for the healthcare system.
Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders.
Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder).
NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6).
NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.
Despite significant progress in business and human rights (BHR) discourse and the practices of multinational corporations (MNCs), persons with disabilities and disability rights are absent from both the key instruments and practice of BHR. This lacuna exists despite the near-universal ratification of the United Nations (UN) Convention on the Rights of Persons with Disabilities, as well as the fact that disabled persons constitute over 15 per cent of the global population and MNC operations impact them greatly and disproportionately. We argue that MNCs have a central role, responsibility and opportunity to foment change globally in fulfilling the human rights of persons with disabilities through their employment practices and by leveraging their economic power to fulfil other aspects of disability-based human rights. Doing so requires the development and self-enforcement of disability-specific human rights due diligence (HRDD) processes, and creating a general culture of diversity, equity and inclusion that encompasses disability.
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are commonly reported co-occurring mental health consequences of psychological trauma exposure. The disorders have high genetic overlap. Trauma is a complex phenotype but research suggests that trauma sensitivity has a heritable basis. We investigated whether sensitivity to trauma in those with MDD reflects a similar genetic component in those with PTSD.
Genetic correlations between PTSD and MDD in individuals reporting trauma and MDD in individuals not reporting trauma were estimated, as well as with recurrent MDD and single-episode MDD, using genome-wide association study (GWAS) summary statistics. Genetic correlations were replicated using PTSD data from the Psychiatric Genomics Consortium and the Million Veteran Program. Polygenic risk scores were generated in UK Biobank participants who met the criteria for lifetime MDD (N = 29 471). We investigated whether genetic loading for PTSD was associated with reporting trauma in these individuals.
Genetic loading for PTSD was significantly associated with reporting trauma in individuals with MDD [OR 1.04 (95% CI 1.01–1.07), Empirical-p = 0.02]. PTSD was significantly more genetically correlated with recurrent MDD than with MDD in individuals not reporting trauma (rg differences = ~0.2, p < 0.008). Participants who had experienced recurrent MDD reported significantly higher rates of trauma than participants who had experienced single-episode MDD (χ2 > 166, p < 0.001)
Our findings point towards the existence of genetic variants associated with trauma sensitivity that might be shared between PTSD and MDD, although replication with better powered GWAS is needed. Our findings corroborate previous research highlighting trauma exposure as a key risk factor for recurrent MDD.
Definition of disorder subtypes may facilitate precision treatment for posttraumatic stress disorder (PTSD). We aimed to identify PTSD subtypes and evaluate their associations with genetic risk factors, types of stress exposures, comorbidity, and course of PTSD.
Data came from a prospective study of three U.S. Army Brigade Combat Teams that deployed to Afghanistan in 2012. Soldiers with probable PTSD (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition ≥31) at three months postdeployment comprised the sample (N = 423) for latent profile analysis using Gaussian mixture modeling and PTSD symptom ratings as indicators. PTSD profiles were compared on polygenic risk scores (derived from external genomewide association study summary statistics), experiences during deployment, comorbidity at three months postdeployment, and persistence of PTSD at nine months postdeployment.
Latent profile analysis revealed profiles characterized by prominent intrusions, avoidance, and hyperarousal (threat-reactivity profile; n = 129), anhedonia and negative affect (dysphoric profile; n = 195), and high levels of all PTSD symptoms (high-symptom profile; n = 99). The threat-reactivity profile had the most combat exposure and the least comorbidity. The dysphoric profile had the highest polygenic risk for major depression, and more personal life stress and co-occurring major depression than the threat-reactivity profile. The high-symptom profile had the highest rates of concurrent mental disorders and persistence of PTSD.
Genetic and trauma-related factors likely contribute to PTSD heterogeneity, which can be parsed into subtypes that differ in symptom expression, comorbidity, and course. Future studies should evaluate whether PTSD typology modifies treatment response and should clarify distinctions between the dysphoric profile and depressive disorders.
Life course theorists posit that sensitive periods exist during life span development where risk and protective factors may be particularly predictive of psychological outcomes relative to other periods in life. While there have been between-cohort studies trying to examine differences in discrimination and depressive symptoms, these studies have not been designed to identify these sensitive periods, which are best modeled by examining intra-individual change across time. To identify sensitive periods where discrimination and shift-&-persist (S&P) – a coping strategy that may protect against the negative impact of discrimination – are most strongly predictive of depressive symptoms, we employed latent growth curve modeling using an accelerated longitudinal design to track intra-individual change in depressive symptoms from ages 20–69. Participants were 3,685 adults measured at three time points ~10 years apart from the Midlife in the United States study (Mage = 37.93, SD = 6.948 at Wave I). Results identified two sensitive periods in development where high levels of S&P interacted with discrimination to protect against depressive symptoms; during the 30s and a lagged effect where 40's S&P protected against depressive symptoms when participants were in their 50s. Implications for the life course study of discrimination, coping, and depression are discussed.
Two prominent risk factors for major depressive disorder (MDD) are childhood maltreatment (CM) and familial risk for MDD. Despite having these risk factors, there are individuals who maintain mental health, i.e. are resilient, whereas others develop MDD. It is unclear which brain morphological alterations are associated with this kind of resilience. Interaction analyses of risk and diagnosis status are needed that can account for complex adaptation processes, to identify neural correlates of resilience.
We analyzed brain structural data (3T magnetic resonance imaging) by means of voxel-based morphometry (CAT12 toolbox), using a 2 × 2 design, comparing four groups (N = 804) that differed in diagnosis (healthy v. MDD) and risk profiles (low-risk, i.e. absence of CM and familial risk v. high-risk, i.e. presence of both CM and familial risk). Using regions of interest (ROIs) from the literature, we conducted an interaction analysis of risk and diagnosis status.
Volume in the left middle frontal gyrus (MFG), part of the dorsolateral prefrontal cortex (DLPFC), was significantly higher in healthy high-risk individuals. There were no significant results for the bilateral superior frontal gyri, frontal poles, pars orbitalis of the inferior frontal gyri, and the right MFG.
The healthy high-risk group had significantly higher volumes in the left DLPFC compared to all other groups. The DLPFC is implicated in cognitive and emotional processes, and higher volume in this area might aid high-risk individuals in adaptive coping in order to maintain mental health. This increased volume might therefore constitute a neural correlate of resilience to MDD in high risk.
MRI-derived cortical folding measures are an indicator of largely genetically driven early developmental processes. However, the effects of genetic risk for major mental disorders on early brain development are not well understood.
We extracted cortical complexity values from structural MRI data of 580 healthy participants using the CAT12 toolbox. Polygenic risk scores (PRS) for schizophrenia, bipolar disorder, major depression, and cross-disorder (incorporating cumulative genetic risk for depression, schizophrenia, bipolar disorder, autism spectrum disorder, and attention-deficit hyperactivity disorder) were computed and used in separate general linear models with cortical complexity as the regressand. In brain regions that showed a significant association between polygenic risk for mental disorders and cortical complexity, volume of interest (VOI)/region of interest (ROI) analyses were conducted to investigate additional changes in their volume and cortical thickness.
The PRS for depression was associated with cortical complexity in the right orbitofrontal cortex (right hemisphere: p = 0.006). A subsequent VOI/ROI analysis showed no association between polygenic risk for depression and either grey matter volume or cortical thickness. We found no associations between cortical complexity and polygenic risk for either schizophrenia, bipolar disorder or psychiatric cross-disorder when correcting for multiple testing.
Changes in cortical complexity associated with polygenic risk for depression might facilitate well-established volume changes in orbitofrontal cortices in depression. Despite the absence of psychopathology, changed cortical complexity that parallels polygenic risk for depression might also change reward systems, which are also structurally affected in patients with depressive syndrome.
The question of ‘what is a mental disorder?’ is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.
Fear and anxiety are common and often transient human responses to stressors, danger, or traumatic events. However, when fear and anxiety persist over time, and result in functional impairment, an anxiety disorder may be present. In both the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (APA, 2013) and the ICD-11 (World Health Organization, 2018) the category of ‘anxiety disorders’ includes a range of conditions that share characteristics of excessive fear or anxiety with consequent distress and impairment. These include generalized anxiety disorder, panic disorder, agoraphobia, and social anxiety disorder (social phobia), among others. This chapter focuses on these conditions with particular reference to how they affect adult men. In addition, obsessive-compulsive disorder (OCD), an anxiety-related disorder placed in a separate DSM-5 and ICD-11 category called ‘Obsessive-Compulsive and Related Disorders’, is also included here due to its historical positioning as an anxiety disorder in earlier editions of the DSM and ICD. Posttraumatic stress disorder (PTSD) has also been reclassified in DSM-5 and ICD-11 from an anxiety disorder to a new diagnostic category known as ‘Trauma and Stressor-Related Disorders’, and is discussed in Chapter 10.
This chapter traces the formation of Middle Eastern regional order from the end of the First World War until the Egyptian Revolution of 1952. It first analyses the role of external powers and forces in shaping the political orders and foreign policies of the Middle East’s emergent pivotal powers. The chapter then discusses the pro-Western foreign policy orientation of Turkey, a relatively ‘hegemonic’ and strategically located state. It examines the role of Arab nationalism in the hegemonic strategies of Britain’s Arab client states, before analysing the more isolationist regional policy of Saudi Arabia – which counterintuitively had much in common with Turkey during this period. The final section of the chapter discusses Iran’s seldom remarked-upon embrace of Arab nationalism during the 1940s and early 1950s.
The American response to 9/11 sharpened the hostility between the two main antagonistic regional blocs and all but eliminated the possibility that either Iran or Syria might retreat from the hegemonic strategy of maintaining an ‘Axis of Resistance’ in favour of pursuing rapprochement with the West. The George W. Bush administration’s Global War on Terror (GWoT), launched in the wake of the attacks, promised assistance to authoritarian regimes that would join the United States in confronting an amorphously defined ‘terrorism’ in the Middle East and beyond. Three central dynamics underpinned regional order in the Middle East during the first decade of the new millennium. The first was the contestation between Iran and Saudi Arabia for Western favour. The second was the Arab–Israeli conflict, in which non-Arab Iran had become a central protagonist. The third was a competitive dynamic for Western support between between Turkey and Egypt. The chapter considers each of these dynamics in turn.
The rise of the Muslim Brotherhood in Egypt and Syria raised the prospect of a Turkish-led regional order, backed by Qatari economic power, and based upon the regional ideological co-dependencies of the AKP. At the same time, the renewed potential for a grand bargain between the United States and Iran held out the possibility that empowered Iranian reformists might substitute integration into Western economic and security frameworks for the Axis of Resistance. This chapter first examines the ways in which Turkey and Qatar sought to consolidate a new regional order based on alignment with Western-friendly Islamist governments. It then elaborates upon the counterrevolutionary forces within the region, emanating from both pro-Western and Axis of Resistance actors, that militated against the realisation of a new regional order. The final section of the chapter sketches the main features of a restored regional order based on authoritarian resurgence and sectarianised antagonisms across all pivotal powers in the region.