Keeping your sanity
National suicide rates and mental health system indicators: An ecological study of 191 countries
A.P. Rajkumar et al.
International Journal of Law and Psychiatry, forthcoming
Purpose: The relative contributions of psychiatric morbidity and psychosocial stress to suicide, and the efficacy of mental health systems in reducing population suicide rates, are currently unclear. This study, therefore, aimed to investigate whether national suicide rates are associated with their corresponding mental health system indicators.
Methods: Relevant data were retrieved from the following sources: the World Health Organization, the United Nations Statistics Division and the Central Intelligence Agency World Fact book. Suicide rates of 191 countries were compared with their mental health system indicators using an ecological study design and multivariate non-parametric robust regression models.
Results: Significant positive correlations between suicide rates and mental health system indicators (p < 0.001) were documented. After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p = 0.006) and mental health beds (p < 0.001) were significantly positively associated with population suicide rates.
Conclusions: Countries with better psychiatric services experience higher suicide rates. Although these associations should be interpreted with caution, as the issues are complex, we suggest that population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals.
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Depression and aggression in never-married men in China: A growing problem
Xudong Zhou, Zheng Yan & Hesketh Therese
Social Psychiatry and Psychiatric Epidemiology, July 2013, Pages 1087-1093
Purpose: China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. The impact on the psychological well-being of the large numbers of men who will never marry is unclear. This study was carried out to test the hypothesis that older never-married men are more predisposed to depression, low self-esteem and aggression.
Methods: The study was a cross-sectional survey using a self-completion questionnaire conducted in high sex ratio rural areas of Yunnan and Guizhou provinces. The tools used were the Beck Depression Inventory, Rosenberg's Self-Esteem Scale and the Bryant-Smith Aggression questionnaire.
Results: A total of 1,059 never-married men and 1,066 married men aged 30-40 completed questionnaires. Never-married men were financially poorer and had lower education levels than married ones. After adjusting for age, education and income, never-married men were significantly more likely to have lower self-esteem scores (P < 0.001), higher depression scores (P < 0.001), higher aggression scores (P < 0.001) and were more likely to have suicidal thoughts or wishes (P < 0.001) than married men.
Conclusion: The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services.
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Breastfeeding, retinoids, and postpartum depression: A new theory
Anthony Mawson & Wang Xueyuan
Journal of Affective Disorders, forthcoming
Abstract:
Postpartum depression (PPD) is an international public health problem affecting at least 1 in 8 mothers. Known risk factors include: giving birth to a preterm or low birth weight infant, babies with greater symptoms of illness at age 4-6 weeks, formula feeding, younger maternal age, smoking, and fatigue. Prolonged breastfeeding is associated with a reduced risk of PPD but the mechanisms are not well understood. Interventions for PPD focusing on psychosocial risk factors have been largely unsuccessful, suggesting that the condition has a mainly biological basis. The hypothesis proposed for consideration is that breastfeeding protects against PPD by maintaining endogenous retinoids (vitamin A-related compounds) below a threshold concentration. In fact, breast milk is rich in retinoids; pregnant women accumulate retinoids in liver and breast in preparation for lactation; there is increasing evidence that retinoids in higher concentration are associated with cognitive disturbances and mood disorders, including depression and suicide; and prolonged lactation reduces maternal stores of retinoids. Consistent with this hypothesis, it is estimated that an amount of vitamin A is transferred from mother to infant during the first six months of exclusive breastfeeding equivalent to 76% of a dose known to cause acute vitamin A poisoning in an adult. Breastfeeding may thus have evolutionary-adaptive functions for both mother and infant, transferring vital nutrients to an infant unable to feed itself, yet at the same time providing a natural means of reducing potentially toxic concentrations of retinoids in the mother.
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Deniz Yucel
Social Science Journal, forthcoming
Abstract:
Most prior sociological research on siblings explores their effects on educational, cognitive and social outcomes. This study focuses on personality traits and extends its scope to early adolescence. Using the eighth-grade data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), it tests the relationship between number of siblings and three personality traits: internalizing problem behavior, self-concept, and locus of control. The results suggest that sibship size has only a modest effect on personality traits among early adolescents. Specifically, only those adolescents who have at least four siblings are found to have significantly worse internalizing problem behaviors, worse self-concept, and worse locus of control compared to only children. In addition, this study finds little evidence that adolescents benefit more from sisters than brothers. Lastly, compared to having older siblings, having younger siblings is more beneficial for personality traits in predicting self-concept and locus of control.
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The Impact of Mental and Substance-Use Disorders on Employment Transitions
Marjorie Baldwin & Steven Marcus
Health Economics, forthcoming
Abstract:
The cyclic nature of serious mental illness (SMI) and substance-use disorders (SUD) suggests that persons with these conditions may experience high rates of transitions among employment states (full-time, part-time, and no employment). This study uses longitudinal data from two waves of the National Epidemiologic Survey of Alcoholism and Related Conditions to examine employment transitions for persons with SMI/SUD relative to a no-disorder control group. Conditional on employment status in Wave I, we estimate conditional odds ratios and marginal effects of each diagnosis on the probabilities of part-time or full-time employment in Wave II, holding constant other characteristics that influence employment decisions. The results show transitions across employment states are common for all groups but more frequent for persons with SMI/SUD than the controls. Persons with SMI are less likely, and persons with SUDs more likely, to transition out of no employment than the controls. Part-time employment is a relatively transitory state, particularly for persons with SMI/SUD, but full-time employment brings a measure of job stability to all groups. After controlling for differences in observable characteristics, the marginal effects of SMI and alcohol disorders on employment transitions are largely significant, but the effects of drug disorders are not.
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Trends in Depressive Symptom Burden Among Older Adults in the United States from 1998 to 2008
Kara Zivin et al.
Journal of General Internal Medicine, forthcoming
Objective: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.
Design: Serial cross-sectional analysis of six biennial assessments.
Main outcome measure: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.
Results: Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.
Conclusions: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.
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Cindy Meston, Tierney Lorenz & Kyle Stephenson
Journal of Sexual Medicine, forthcoming
Introduction: Women with a history of childhood sexual abuse (CSA) have high rates of depression, posttraumatic stress disorder, and sexual problems in adulthood.
Aim: We tested an expressive writing-based intervention for its effects on psychopathology, sexual function, satisfaction, and distress in women who have a history of CSA.
Methods: Seventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus.
Main Outcome Measures: Validated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months.
Results: Women in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction.
Conclusions: Expressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. Both treatments are accessible, cost-effective, and acceptable to patients.
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The Cost of Assisted Outpatient Treatment: Can It Save States Money?
Jeffrey Swanson et al.
American Journal of Psychiatry, forthcoming
Objective: The authors assessed a state's net costs for assisted outpatient treatment, a controversial court-ordered program of community-based mental health services designed to improve outcomes for persons with serious mental illness and a history of repeated hospitalizations attributable to nonadherence with outpatient treatment.
Method: A comprehensive cost analysis was conducted using 36 months of observational data for 634 assisted outpatient treatment participants and 255 voluntary recipients of intensive community-based treatment in New York City and in five counties elsewhere in New York State. Administrative, budgetary, and service claims data were used to calculate and summarize costs for program administration, legal and court services, mental health and other medical treatment, and criminal justice involvement. Adjusted effects of assisted outpatient treatment and voluntary intensive services on total service costs were examined using multivariate time-series regression analysis.
Results: In the New York City sample, net costs declined 50% in the first year after assisted outpatient treatment began and an additional 13% in the second year. In the five-county sample, costs declined 62% in the first year and an additional 27% in the second year. Psychotropic drug costs increased during the first year after initiation of assisted outpatient treatment, by 40% and 44% in the city and five-county samples, respectively. Regression analyses revealed significant declines in costs associated with both assisted outpatient treatment and voluntary participation in intensive services, although the cost declines associated with assisted outpatient treatment were about twice as large as those seen for voluntary services.
Conclusions: Assisted outpatient treatment requires a substantial investment of state resources but can reduce overall service costs for persons with serious mental illness. For those who do not qualify for assisted outpatient treatment, voluntary participation in intensive community-based services may also reduce overall service costs over time, depending on characteristics of the target population and local service system.
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Maeve O'Leary-Barrett et al.
Journal of the American Academy of Child & Adolescent Psychiatry, forthcoming
Objective: To assess the 2-year impact of teacher-delivered, brief, personality-targeted interventions on internalizing and externalizing symptoms in an adolescent U.K. sample.
Method: This cluster-randomized trial was run in 19 London schools (N = 1,024 adolescents). Trained school-based professionals delivered two 90-minute, CBT-based group interventions targeting 1 of 4 personality-risk profiles: anxiety sensitivity, hopelessness, impulsivity, or sensation seeking. Self-report depression, anxiety, and conduct disorder symptoms were assessed at 6-month intervals.
Results: Interventions were associated with significantly reduced depressive, anxiety, and conduct symptoms (p < .05) over 2 years in the full sample, reduced odds of severe depressive symptoms (odds ratio [OR] = 0.74, CI = 0.58-0.96), and conduct problems (OR = 0.79, CI = 0.65-0.96), and a nonsignificant reduction in severe anxiety symptoms (OR = 0.79, CI = 0.59-1.05). Evaluating a priori personality-specific hypotheses revealed strong evidence for impulsivity-specific effects on severe conduct problems, modest evidence of anxiety sensitivity-specific effects on severe anxiety, and no evidence for hopelessness-specific effects on severe depressive symptoms.
Conclusions: Brief, personality-targeted interventions delivered by educational professionals can have a clinically significant impact on mental health outcomes in high-risk youth over 2 years, as well as personality-specific intervention effects in youth most at risk for a particular problem, particularly for youth with high levels of impulsivity.
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Kate Mason et al.
Social Science & Medicine, October 2013, Pages 91-97
Abstract:
There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001-2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with housing becoming unaffordable, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters whose housing became unaffordable experienced a small but statistically significant decline in mental health score (change in MCS=-1.18 or about 20% of one S.D. of the MCS score; 95% CI:-1.95,-0.41; p=0.003) while home purchasers experienced no change on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p=0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p=0.020), and between the 30th and 50th percentile (p=0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate.
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Misbehavior, Education, and Labor Market Outcomes
Carmit Segal
Journal of the European Economic Association, August 2013, Pages 743-779
Abstract:
Using data on young men from the National Education Longitudinal Survey, this paper investigates the relationship between childhood misbehavior and later education and labor market outcomes. The main finding is that eighth-grade misbehavior is important for earnings over and above eighth-grade test scores. Moreover, controlling for educational attainment, childhood misbehavior is associated with earnings at all educational levels, whereas achievement test scores are related to earnings only for young men with postsecondary degrees. Possible explanations for the association between eighth-grade misbehavior and economic success are explored.
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Wagner Birgit, Andrea Horn & Maercker Andreas
Journal of Affective Disorders, forthcoming
Background and aims: In the past decade, a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression. However, only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a randomized non-inferiority trial.
Method: A total of 62 participants suffering from depression were randomly assigned to the therapist-supported internet-based intervention group (n=32) and to the face-to-face intervention (n=30). The 8 week interventions were based on cognitive-behavioral therapy principles. Patients in both groups received the same treatment modules in the same chronological order and time-frame. Primary outcome measure was the Beck Depression Inventory-II (BDI-II); secondary outcome variables were suicidal ideation, anxiety, hopelessness and automatic thoughts.
Results: The intention-to-treat analysis yielded no significant between-group difference (online vs. face-to-face group) for any of the pre- to post-treatment measurements. At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention. Within group effect sizes for depression in the online group (d=1.27) and the face-to-face group (d=1.37) can be considered large. At 3-month follow-up, results in the online group remained stable. In contrast to this, participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment (t=-2.05, df=19, p<.05).
Conclusions: This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group.