We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.org
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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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 growing interest in using composite individualized treatment rules (ITRs) to guide depression treatment selection, but best approaches for doing this are not widely known. We develop an ITR for depression remission based on secondary analysis of a recently published trial for second-line antidepression medication selection using a cutting-edge ensemble machine learning method.
Methods
Data come from the SUN(^_^)D trial, an open-label, assessor blinded pragmatic trial of previously-untreated patients with major depressive disorder from 48 clinics in Japan. Initial clinic-level randomization assigned patients to 50 or 100 mg/day sertraline. We focus on the 1549 patients who failed to remit within 3 weeks and were then rerandomized at the individual-level to continuation with sertraline, switching to mirtazapine, or combining mirtazapine with sertraline. The outcome was remission 9 weeks post-baseline. Predictors included socio-demographics, clinical characteristics, baseline symptoms, changes in symptoms between baseline and week 3, and week 3 side effects.
Results
Optimized treatment was associated with significantly increased cross-validated week 9 remission rates in both samples [5.3% (2.4%), p = 0.016 50 mg/day sample; 5.1% (2.7%), p = 0.031 100 mg/day sample] compared to randomization (30.1–30.8%). Optimization was also associated with significantly increased remission in both samples compared to continuation [24.7% in both: 11.2% (3.8%), p = 0.002 50 mg/day sample; 11.7% (3.9%), p = 0.001 100 mg/day sample]. Non-significant gains were found for optimization compared to switching or combining.
Conclusions
An ITR can be developed to improve second-line antidepressant selection, but replication in a larger study with more comprehensive baseline predictors might produce stronger and more stable results.
One important aspect of the societal burden of mental disorders is the extent to which these problems cause disability.
Aims
To assess days out of role associated with commonly occurring mental disorders in comparison with physical disorders in Portugal.
Method
National cross-sectional survey, with home interviews carried out with 3849 adult (aged 18+) respondents (57.3% response rate).
Results
Twelve-month prevalence for any mental disorder was 21.8%, any physical disorder 55.1% and any disorder 63.1%, with an average of 2.3 disorders per respondent with a disorder. Close to one out of every 10 respondents (9.2%) reported at least one day totally out of role in the past month (median of 6.4 days/any). The 18 conditions accounted for 78.2% of all days out of role, with 20.2% because of mental disorders and 59.2% because of physical disorders.
Conclusions
Mental disorders account for a substantial proportion of all role disability in the Portuguese population. Early detection and intervention would have a positive societal effect. Owing to highly frequent comorbidity, simultaneous management of mental and physical disorder comorbidities is advised for greater effect.
Although childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.
Aims
To examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.
Method
Epidemiological data were analysed from the World Mental Health Surveys (n = 27017).
Results
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.
Conclusions
Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.
Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries.
Aims
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.
Method
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.
Results
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.
Conclusions
These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.
The epidemiology of rapid-cycling bipolar disorder in the community is
largely unknown.
Aims
To investigate the epidemiological characteristics of rapid-cycling and
non-rapid-cycling bipolar disorder in a large cross-national community
sample.
Method
The Composite International Diagnostic Interview (CIDI version 3.0) was
used to examine the prevalence, severity, comorbidity, impairment,
suicidality, sociodemographics, childhood adversity and treatment of
rapid-cycling and non-rapid-cycling bipolar disorder in ten countries
(n = 54 257).
Results
The 12-month prevalence of rapid-cycling bipolar disorder was 0.3%.
Roughly a third and two-fifths of participants with lifetime and 12-month
bipolar disorder respectively met criteria for rapid cycling. Compared
with the non-rapid-cycling, rapid-cycling bipolar disorder was associated
with younger age at onset, higher persistence, more severe depressive
symptoms, greater impairment from depressive symptoms, more out-of-role
days from mania/hypomania, more anxiety disorders and an increased
likelihood of using health services. Associations regarding childhood,
family and other sociodemographic correlates were less clear cut.
Conclusions
The community epidemiological profile of rapid-cycling bipolar disorder
confirms most but not all current clinically based knowledge about the
illness.
This chapter deals with disaster mental health research in children, and systematically examines the extant literature, focusing on methodological issues. Children represent the ideal age group to study in order to gain insight into the etiology of psychopathology in the aftermath of disaster. Any postdisaster child assessment should necessarily involve a two-step process, including a detailed characterization of the child's exposure and the possible related reactions. The chapter proposes a three-category disaster typology based on the distribution of different types of disaster exposures. The chapter focuses on reports of reactions related to posttraumatic stress disorder (PTSD) in children after mass traumatic events, with studies being reviewed within the context of the proposed typology. Psychiatric disorders observed in children after large-scale traumatic events include a range of disorders, with PTSD and depression being the most commonly assessed.
Advocates of expanded mental health treatment assert that mental
disorders are as disabling as physical disorders, but little evidence
supports this assertion.
Aims
To establish the disability and treatment of specific mental and physical
disorders in high-income and low- and middle-income countries.
Method
Community epidemiological surveys were administered in 15 countries
through the World Health Organization World Mental Health (WMH) Survey
Initiative.
Results
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
physical disorders.
Conclusions
Despite often higher disability, mental disorders are under-treated
compared with physical disorders in both high-income and in low- and
middle-income countries.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.