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Yang Y, Fang F, Arnberg FK, Kuja-Halkola R, D'Onofrio BM, Larsson H, Brikell I, Chang Z, Andreassen OA, Lichtenstein P, Valdimarsdóttir UA, Lu D. Sex differences in clinically diagnosed psychiatric disorders over the lifespan: a nationwide register-based study in Sweden. THE LANCET REGIONAL HEALTH. EUROPE 2024; 47:101105. [PMID: 39726722 PMCID: PMC11670697 DOI: 10.1016/j.lanepe.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 10/04/2024] [Accepted: 10/07/2024] [Indexed: 12/28/2024]
Abstract
Background Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan. Methods We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated. Findings During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status. Interpretation Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies. Funding Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.
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Affiliation(s)
- Yihui Yang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filip K. Arnberg
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ole A. Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Monshouwer K, Ten Have M, Tuithof M, van Dorsselaer S, Bak M, Gunter N, Delespaul P, van Os J, de Graaf R. Prevalence, incidence, and persistence of psychotic experiences in the general population: results of a 9-year follow-up study. Psychol Med 2023; 53:3750-3761. [PMID: 36117284 DOI: 10.1017/s0033291722002690] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) frequently occur and are associated with a range of negative health outcomes. Prospective studies on PEs are scarce, and to date no study investigated PE prevalence, incidence, persistence, their risk indicators, and psychiatric comorbidity, in one dataset. Furthermore, most studies are based on self-report, and it is unclear how this compares to clinical interviews. METHODS Data are used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric cohort study among a representative sample of adults (baseline characteristics: N = 6646; 49.6% female; 18-64 years). Results are presented for self-reported and clinically validated PEs. Associations are assessed for mental disorders, socio-demographic, vulnerability, physical health, and substance use factors. RESULTS Based on self-report, at baseline 16.5% of respondents had at least one PE in their lifetime, of those, 30.1% also reported a PE at 3-year follow-up. 4.8% had a first PE at 3-year follow up. The 3-year prevalence of PE was associated with almost all studied risk indicators. Generally, the strongest associations were found for mental health disorders. Prevalence and incidence rates were two to three times higher in self-report than in clinical interview but results on associated factors were similar. CONCLUSIONS Validated prevalence and incidence estimates of PE are substantially lower than self-reported figures but results on associated factors were similar. Therefore, future studies on associations of PEs can rely on relatively inexpensive self-reports of PEs. The associations between PE and mental disorders underline the importance of assessment of PE in general practice.
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Affiliation(s)
- Karin Monshouwer
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Margreet Ten Have
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan, Heerlen/Maastricht, The Netherlands
| | - Nicole Gunter
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Philippe Delespaul
- School for Mental Health & Neurosciences, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Heerlen, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
- King's Health Partners Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ron de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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3
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Lasserre AM, Imtiaz S, Roerecke M, Heilig M, Probst C, Rehm J. Socioeconomic status, alcohol use disorders, and depression: A population-based study. J Affect Disord 2022; 301:331-336. [PMID: 34986374 PMCID: PMC8849577 DOI: 10.1016/j.jad.2021.12.132] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in "deaths of despair" among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions. METHODS The National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001-2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria. RESULTS The risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD. LIMITATIONS The absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories. CONCLUSIONS This result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being.
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Affiliation(s)
- Aurélie M Lasserre
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Rue du Bugnon 23, 1011 Lausanne, Switzerland.
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Campbell Family Mental Health Research Institute, CAMH, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Linköping University, SE-581 83 Linköping, Sweden
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Campbell Family Mental Health Research Institute, CAMH, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation; Agència de Salut Pública de Catalunya, 81-95 Roc Boronat St., 08005 Barcelona, Spain; Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Östberg D, Nordin S. Three-year prediction of depression and anxiety with a single self-rated health item. J Ment Health 2022; 31:402-409. [PMID: 35272543 DOI: 10.1080/09638237.2021.2022610] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a single question with which general health status is assessed. AIMS To study whether SRH (i) is associated with depression and anxiety symptoms, concurrently and after three years, (ii) predicts the course over time for meeting a cutoff for depression and anxiety, and (iii) predicts development of depression and anxiety after three years. METHOD Population-based questionnaire data from northern Sweden were used. In total, 2336 individuals participated at baseline and three-year follow-up. The Hospital Anxiety and Depression Scale was used to quantify symptoms of depression and anxiety. Categorical and continuous data were used for analyses to complement each other. RESULTS Regarding prevalence, the analyses showed three- to four-fold increased odds for depression and anxiety at three-year follow-up, and two- to three-fold odds for their development at three-year follow-up. SRH at baseline was also found to be a significant, but weak, predictor of depression and anxiety severity and worsening at follow-up as well as being a predictor over time for meeting a cutoff for depression and anxiety. CONCLUSIONS Assessment of SRH may be used in general practice to identify individuals who qualify for further evaluation of depression and anxiety.
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Affiliation(s)
- David Östberg
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312786. [PMID: 34886512 PMCID: PMC8657712 DOI: 10.3390/ijerph182312786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2-64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2-72.4) in women and 37.3 (95% CI: 23.6-58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16-3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46-7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.
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Robinson DL, Amodeo LR, Chandler LJ, Crews FT, Ehlers CL, Gómez-A A, Healey KL, Kuhn CM, Macht VA, Marshall SA, Swartzwelder HS, Varlinskaya EI, Werner DF. The role of sex in the persistent effects of adolescent alcohol exposure on behavior and neurobiology in rodents. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 160:305-340. [PMID: 34696877 DOI: 10.1016/bs.irn.2021.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Alcohol drinking is often initiated during adolescence, and this frequently escalates to binge drinking. As adolescence is also a period of dynamic neurodevelopment, preclinical evidence has highlighted that some of the consequences of binge drinking can be long lasting with deficits persisting into adulthood in a variety of cognitive-behavioral tasks. However, while the majority of preclinical work to date has been performed in male rodents, the rapid increase in binge drinking in adolescent female humans has re-emphasized the importance of addressing alcohol effects in the context of sex as a biological variable. Here we review several of the consequences of adolescent ethanol exposure in light of sex as a critical biological variable. While some alcohol-induced outcomes, such as non-social approach/avoidance behavior and sleep disruption, are generally consistent across sex, others are variable across sex, such as alcohol drinking, sensitivity to ethanol, social anxiety-like behavior, and induction of proinflammatory markers.
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Affiliation(s)
- Donita L Robinson
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Leslie R Amodeo
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Psychology, California State University, San Bernardino, CA, United States
| | - L Judson Chandler
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Fulton T Crews
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cindy L Ehlers
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Neuroscience, Scripps Research, La Jolla, CA, United States
| | - Alexander Gómez-A
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kati L Healey
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Cynthia M Kuhn
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Pharmacology and Cancer Biology, School of Medicine, Duke University, Durham, NC, United States
| | - Victoria A Macht
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - S Alexander Marshall
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Biological and Biomedical Sciences Department, North Carolina Central University, Durham, NC, United States
| | - H Scott Swartzwelder
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Elena I Varlinskaya
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Center for Development and Behavioral Neuroscience, Department of Psychology, Binghamton University, Binghamton, NY, United States
| | - David F Werner
- Neurobiology of Adolescent Drinking in Adulthood Consortium (NADIA), United States; Center for Development and Behavioral Neuroscience, Department of Psychology, Binghamton University, Binghamton, NY, United States
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The Prognostic Role of DSM-5 Alcohol Use Disorder Severity and Age of Onset in Treatment Outcome Among Adults Aged 60. J Addict Med 2021; 16:303-309. [PMID: 34282079 DOI: 10.1097/adm.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To investigate among older adults with DSM-5 alcohol use disorder (AUD) the relevance of (1) baseline DSM-5 AUD severity, (2) age of DSM-5 AUD onset, and (3) the interactions of DSM-5 AUD severity*treatment condition and age of DSM-5 AUD onset*treatment condition for the prediction of AUD treatment outcomes. METHODS The international multicenter RCT "ELDERLY-Study" compared outpatient motivational enhancement therapy (4 sessions) with outpatient motivational enhancement therapy followed by community reinforcement approach for seniors (8 sessions) in adults aged 60+ with DSM-5 AUD. Baseline and 1-, 3-, and 6-month follow-up data from the German and Danish ELDERLY-sites (n = 544) were used (6-month participation rate: 75.9%). DSM-5 AUD diagnoses were obtained using the Mini International Neuropsychiatric Interview and alcohol use using Form 90. Associations between DSM-5 AUD severity and age of onset and AUD treatment outcomes were investigated using multiple logistic regression and generalized linear models. RESULTS The sample was diverse in AUD severity (severe: 54.9%, moderate: 28.2%, mild: 16.9%) and age of onset (median: 50 years; 12-78 years). Overall, with few exceptions, neither AUD severity, nor age of onset, nor their respective interactions with treatment condition significantly predicted drinking outcomes at the different follow-ups (P ≥ 0.05). CONCLUSIONS No indication was found for the need to tailor treatment content according to DSM-5 AUD severity and earlier onset in older adults.
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Rexand-Galais F, Pithon L, Le Goff J. Assessment of Borderline Personality Disorder in Geriatric Institutions. Front Psychol 2021; 12:629571. [PMID: 33868094 PMCID: PMC8044763 DOI: 10.3389/fpsyg.2021.629571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franck Rexand-Galais
- BePsyLab and Spaces and Societies Research Team, Department of Psychology, University of Angers, Angers, France
| | - Lucas Pithon
- Korian Bollée-Chanzy Nursing Home, Le Mans, France.,St Vincent de Paul Nursing Home, Yvré-L'Évêque, France.,BePsyLab, University of Angers, Angers, France
| | - Johane Le Goff
- Gerontological Center of Lucien Hussel Hospital Center, Vienne, France.,Research Center in Psychopathology and Clinical Psychology, University of Lyon 2, Lyon, France
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Behrendt S, Kuerbis A, Bilberg R, Braun-Michl B, Mejldal A, Bühringer G, Bogenschutz M, Andersen K, Nielsen AS. Impact of comorbid mental disorders on outcomes of brief outpatient treatment for DSM-5 alcohol use disorder in older adults. J Subst Abuse Treat 2020; 119:108143. [PMID: 33138927 DOI: 10.1016/j.jsat.2020.108143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Relatively little is known about the prognostic value of comorbid mental disorders in alcohol use disorder (AUD) treatment for older adults (OA). AIMS This article aimed to investigate 1) the impact of current unipolar mood and anxiety disorders in AUD treatment success in OA, 2) the timing of this putative comorbidity impact over six months, and 3) the role of treatment length in comorbidity effects. METHODS We analyzed baseline and one-, three-, and six-month follow-up data from the international multicenter RCT "ELDERLY-Study" (baseline n = 693, median age: 64.0 years) using mixed effects regression models. In adults aged 60+ with DSM-5 AUD "ELDERLY" compared outpatient motivational enhancement therapy (MET, four sessions) with outpatient MET plus community reinforcement approach for seniors (MET & CRA-S; up to 12 sessions). Aiming for abstinence or minimal alcohol use (AU), both conditions included CBT-elements. We assessed AU with Form 90, and mental disorders with the Mini International Neuropsychiatric Interview (M.I.N.I.). RESULTS Mood-related disorders were associated with more drinks per day at baseline and greater reductions in drinks per day at one and six months (main effect mood disorder: Coef. 2.1, 95% CI 0.6-3.6; one month interaction effect: Coef. -1.9, 95% CI -3.3- -0.5; six months interaction effect: Coef. -2.1, 95% CI -3.5 - -0.6). These results were replicated within MET & CRA-S but not within MET. CONCLUSION Comorbid mental disorders had modest effects on short-term outpatient treatment outcomes. OA with AUD and unipolar mood-related disorders may profit from short interventions based on motivational interviewing and CBT-elements. ClinicalTrials.gov:NCT02084173.
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Affiliation(s)
- Silke Behrendt
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute for Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Alexis Kuerbis
- Silberman School of Social Work at Hunter College, 2180 Third Avenue, New York, NY 10035, United States
| | - Randi Bilberg
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Barbara Braun-Michl
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gerhard Bühringer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany; IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany; Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Bogenschutz
- Bellevue Hospital Center, 462 First Avenue, New York, NY 10016, United States
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark; OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Vasiliadis HM, Desjardins F, Roberge P, Grenier S. Sex Differences in Anxiety Disorders in Older Adults. Curr Psychiatry Rep 2020; 22:75. [PMID: 33125590 DOI: 10.1007/s11920-020-01203-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Anxiety disorders are the most prevalent mental disorders. Although prevalence estimates are lower in males than females, the disability associated with anxiety disorders has been increasing in males. This review focuses on recent research studying sex differences in anxiety disorders and associated symptoms in older adults. RECENT FINDINGS Females are close to three times more likely than males to report most anxiety disorders. Heterogeneity exists in sex-specific lifetime and past-year estimates. Age-appropriate instruments such as the CIDI65+ show higher estimates than previous research. The profiles of females and males with anxiety with respect to depressive and somatization symptoms are different. Age-appropriate standardized mental disorder instruments have been developed and may be useful to overcome the challenges of observed heterogeneity in anxiety disorders and allow for future cross-country comparisons and a better description of the epidemiology and biopsychosocial factors associated with different types of anxiety disorders in older adults.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, Quebec, Canada.
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les Innovations en Santé, Longueuil, Quebec, Canada.
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Centre de recherche -CSIS, Campus Longueuil,150 Place Charles-Le Moyne, Longueuil, Quebec, J4K 0A8, Canada.
| | - Frédérique Desjardins
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Département de psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Montreal, Quebec, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Sebastien Grenier
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Département de psychologie, Université de Montréal, Montreal, Quebec, Canada
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11
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Astutik E, Hidajah AC, Tama TD, Efendi F, Li CY. Prevalence and determinants of depressive symptoms among adults in Indonesia: A cross-sectional population-based national survey. Nurs Forum 2020; 56:37-44. [PMID: 32964484 DOI: 10.1111/nuf.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS To analyze the association between personal health conditions (self-rated health, physical function, and chronic conditions) and symptoms of depression in Indonesia. METHODS Data were collected from the Indonesian family life survey 5. This study used a cross-sectional study design with a sample size of 17,734 respondents. We included depressive symptoms, self-rated health, physical function, chronic conditions, demographics and socioeconomic variables. The center for epidemiologic studies depression scale was used to measure symptoms of depression. Multivariate logistic regression analysis was used to analyze the data. RESULTS The results showed that 23.47% of respondents had depressive symptoms, 20.04% had poor self-rated health, 55.93% had a poor physical function, and 32.37% had at least one chronic disease. Respondents who had poor self-rated health, had poor physical function, or had a chronic condition were all had a significantly higher odds of experiencing symptoms of depression after controlling for demographic variables (age, sex, married, and education level), social-economic, and smoking status. CONCLUSION Depressive symptoms were significantly associated with personal health conditions including self-rated health, physical functioning, and chronic conditions among community residents. Strategies that can improve personal health conditions needed to be studied at the community level to improve the level of mental health.
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Affiliation(s)
- Erni Astutik
- Research Group for Health and Wellbeing of Women and Children, Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Atik Choirul Hidajah
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Tika Dwi Tama
- Department of Public Health, Faculty of Sport Science, Universitas Negeri Malang, Malang, East Java, Indonesia
| | - Ferry Efendi
- Department of Community Health and Mental Health Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia.,Visiting Fellow, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Chung-Yi Li
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.,Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Li J, Wang H, Li M, Shen Q, Li X, Zhang Y, Peng J, Rong X, Peng Y. Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies. Addiction 2020; 115:1224-1243. [PMID: 31837230 DOI: 10.1111/add.14935] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/23/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Alcohol use disorders (AUD) are often comorbid with depressive symptoms. Cohort studies on the association between AUD and subsequent depressive symptoms have produced inconsistent results. Moreover, regarding alcohol intake, the risk of developing depressive symptoms might vary with alcohol intake level. We aimed to investigate the association between AUD, alcohol intake and subsequent depressive symptoms. DESIGN AND SETTING We conducted a systematic search in PubMed, Embase and PsycINFO for cohort studies on the association between AUD or alcohol intake and subsequent depressive symptoms. PARTICIPANTS We included 338 426 participants from 42 studies. Six and four studies analyzed only females and males, respectively. MEASUREMENTS We combined risk estimates for developing depressive symptoms using a random-effects model. We divided alcohol intake into abstinence, light (0-84 g/week), moderate (85-168 g/week) and heavy drinking (> 168 g/week or > 48 g/day at least weekly). We conducted a categorical analysis to compare the risk of depressive symptoms between abstinence and different intake categories. Further, we conducted a dose-response analysis to investigate the alcohol-depression association. FINDINGS We analyzed 42 studies (follow-up time: 1-40 years). AUD was associated with significantly increased risk of subsequent depressive symptoms [relative risk (RR) = 1.57, 95% confidence interval (CI) = 1.41-1.76]. Regarding alcohol intake, heavy drinking had an increased risk of depressive symptoms; however, the association was only significant when controls were limited to non-heavy drinkers (RR = 1.13, 95% CI = 1.05-1.22). Taking into consideration the possibility of publication bias and confounding factors made the association non-significant. We observed J-shaped associations in both categorical and dose-response analyses where light-moderate drinking had a significantly decreased risk of depression, while heavy drinking did not show a significant association with depressive symptoms compared with non-drinkers. CONCLUSION Alcohol use disorders are associated with increased the risk of subsequent depressive symptoms. Heavy drinking does not significantly predict occurrence of depressive symptoms after adjusting for potential confounders.
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Affiliation(s)
- Jiande Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Mei Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xiangpen Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yuanpei Zhang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jialing Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
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13
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Behrendt S. Research is needed to understand substance use disorders in old adulthood. Addiction 2020; 115:600-602. [PMID: 31502317 DOI: 10.1111/add.14811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Silke Behrendt
- Institute for Psychology, University of Southern Denmark, Odense, Denmark.,Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, and OPEN Patient Data Explorative Network, Odense University Hospital, and BRIDGE, BrainResearch, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Mejldal A, Andersen K, Bilberg R, Braun B, Bogenschutz M, Bühringer G, Nielsen AS, Silke B. The Alcohol Dependence Scale and DSM-5 alcohol use disorder: Severity ratings correspond insufficiently in older patients. Int J Methods Psychiatr Res 2020; 29:e1811. [PMID: 31808602 PMCID: PMC7051836 DOI: 10.1002/mpr.1811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/10/2019] [Accepted: 10/08/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM-5 AUD symptom counts. METHODS Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM-5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM-5 criteria endorsed. RESULTS Internal consistency of the ADS (α = 0.81) was good. EFA revealed a three-factor structure. Factor 1 ("Severe withdrawal symptoms") consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 ("Loss of control") consisted of acute physical reactions of intoxication, and Factor 3 ("Obsessive-compulsive drinking") described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM-5 symptom score and drinking behavior. CONCLUSION Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment-seeking older adults as ADS scores are low and not closely related to DSM-5 AUD.
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Affiliation(s)
- Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Barbara Braun
- IFT, Institut für Therapieforschung, Munich, Germany
| | | | - Gerhard Bühringer
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,IFT, Institut für Therapieforschung, Munich, Germany.,Institute of Clinical Psychology and PsychotherapyTechnische Universität Dresden, Dresden, Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Behrendt Silke
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
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15
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Yeung EW, Lee MR, McDowell Y, Sher KJ, Gizer IR. The Association Between Alcohol Consumption and Pain Interference in a Nationally Representative Sample: The Moderating Roles of Gender and Alcohol Use Disorder Symptomatology. Alcohol Clin Exp Res 2020; 44:645-659. [PMID: 31957038 DOI: 10.1111/acer.14282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prior research on alcohol consumption and pain has yielded inconsistent results regarding the directionality of effects for both consumption-to-pain and pain-to-consumption relations. The present study sought to examine directionality of these relations by testing bidirectional longitudinal associations between consumption and pain interference, a crucial aspect of pain that captures pain-related disability and has been regarded as a valuable measure of treatment outcome. In addition, this study explored possible moderation of these bidirectional longitudinal associations by gender and alcohol use disorder (AUD) symptomatology. METHODS Analyses included 29,989 current/former drinkers who were interviewed at both waves (2001 and 2004) of the U.S. National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Analyses used self-report data from both waves on past-year average daily volume of alcohol consumed and past-month pain interference (1 item from the Medical Outcomes Study 12-item Short-Form Health Survey [MOS-SF-12]). AUDADIS-IV data from Wave 1 were used to index baseline AUD symptomatology (i.e., symptom count). Cross-lagged panel modeling and multigroup analyses were employed. RESULTS Regarding the consumption-to-pain-interference relation, in general, higher baseline alcohol consumption was associated with lower subsequent pain interference at follow-up. However, among men with higher AUD-symptom counts, the opposite pattern emerged, with higher baseline alcohol consumption being significantly related to higher subsequent pain interference at follow-up. Regarding the pain-interference-to-consumption relation, higher baseline pain interference was significantly associated with lower subsequent alcohol consumption at follow-up, and no moderating effects were observed. CONCLUSIONS The distinctive patterns of the consumption-to-pain-interference relation observed among men with elevated AUD symptomatology suggest that this relation might be driven by different mechanisms across different groups of individuals. Specifically, the detrimental effect of alcohol on pain interference might emerge at relatively advanced stages of AUD among men, consistent with Koob's Dark Side of Alcohol Addiction theory in human research.
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Affiliation(s)
- Ellen W Yeung
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri.,Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, California.,Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia
| | - Matthew R Lee
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri.,Center of Alcohol and Substance Use Studies (CAS), Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Yoanna McDowell
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Ian R Gizer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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16
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Brunoni AR, Santos IS, Passos IC, Goulart AC, Koyanagi A, Carvalho AF, Barreto SM, Viana MC, Lotufo PA, Benseñor IM. Socio-demographic and psychiatric risk factors in incident and persistent depression: An analysis in the occupational cohort of ELSA-Brasil. J Affect Disord 2020; 263:252-257. [PMID: 31818786 DOI: 10.1016/j.jad.2019.11.155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/28/2019] [Accepted: 11/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a main source of disability worldwide. Identifying risk factors associated with incident and persistent episodes could inform clinical practice and hence mitigate their burden. However, previous research has focused on populations from developed countries. Thus, we evaluated sociodemographic risk factors and psychiatric comorbidities associated with incident and persistent depression in a large Brazilian occupational cohort. METHODS We examined baseline (2008-2010, n = 15,105) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Based on the presence of depression diagnosis at two timepoints, we diagnosed persistent and incident depression. Simple and multiple logistic regression analyses were employed to explore risk factors associated with incident and persistent depression. As gender is associated with the exposure and outcome variables, analyses stratified by gender were also conducted. RESULTS Presence of any anxiety disorder, obsessive-compulsive disorder, and female gender were significant (p < 0.001) risk factors for depression incidence (odds ratios of 2.59, 3.6, and 1.82, respectively) and persistence (odds ratios of 6.94, 14.37, and 2.85, respectively) in multiple models, whereas having university degree decreased the odds of depression incidence (0.74) and persistence (0.45). In stratified analyses, the effects of low education were only evident in women. LIMITATIONS Brief depressive episodes could not be measured by our assessments. CONCLUSION In this occupational cohort, female gender, low education and psychiatric comorbidities were associated with unfavorable depression courses. Interventions targeting comorbidities could prevent depression incidence and persistence.
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Affiliation(s)
- Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil.
| | - Itamar S Santos
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Ives C Passos
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, 08830 Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
| | - Andre F Carvalho
- Department of Psychiatry, Faculty of Medicine, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Sandhi M Barreto
- School of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Brazil
| | - Maria Carmen Viana
- Departamento de Medicina Social, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
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17
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Faedda GL, Baldessarini RJ, Marangoni C, Bechdolf A, Berk M, Birmaher B, Conus P, DelBello MP, Duffy AC, Hillegers MHJ, Pfennig A, Post RM, Preisig M, Ratheesh A, Salvatore P, Tohen M, Vázquez GH, Vieta E, Yatham LN, Youngstrom EA, Van Meter A, Correll CU. An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder. Bipolar Disord 2019; 21:720-740. [PMID: 31479581 DOI: 10.1111/bdi.12831] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To clarify the clinical features preceding the onset of bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years. METHODS We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies. The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective, and prospective studies. RESULTS Cyclothymic features, a family history of BD, retrospectively reported attenuated manic symptoms, prospectively identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention. CONCLUSIONS The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment.
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Affiliation(s)
- Gianni L Faedda
- Mood Disorders Center, New York, NY, USA.,International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Mailman Research Center, McLean Hospital, Boston, MA, USA
| | - Ciro Marangoni
- Department of Psychiatry-District 3, ULSS 9 Scaligera, Verona, Italy
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichschain, Charite Universitätsmedizin, Berlin, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, University Hospital Geelong, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Center of Excellence in Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anne C Duffy
- Department of Psychiatry, Student Wellness Services, Queen's University, Kingston, ON, Canada
| | - Manon H J Hillegers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA.,Department of Psychiatry, George Washington University School of Medicine, Washington, DC, USA
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Aswin Ratheesh
- IMPACT Strategic Research Centre, University Hospital Geelong, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Center of Excellence in Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Paola Salvatore
- Department of Psychiatry, Harvard Medical School, Mailman Research Center, McLean Hospital, Boston, MA, USA.,Psychiatry Section, Department of Neuroscience, School of Medicine, University of Parma, Parma, Italy
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gustavo H Vázquez
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Psychiatry, Queen's University, Kingston, ON, Canada
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Lakshmi N Yatham
- Department of Psychiatry, Mood Disorders Centre, University of British Columbia, Vancouver, BD, Canada
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Van Meter
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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18
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Just-Østergaard E, Flensborg-Madsen T, Knop J, Sørensen HJ, Becker U, Mortensen EL. Intelligence in young adulthood and alcohol use disorders in a prospective cohort study of Danish men: the role of psychiatric disorders and parental psychiatric history. BMJ Open 2019; 9:e028997. [PMID: 31488478 PMCID: PMC6731796 DOI: 10.1136/bmjopen-2019-028997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aims were to estimate the association between intelligence measured in young adulthood and risk of alcohol use disorders (AUD) in men and to investigate the potential modification of this association by psychiatric disorders, parental AUD and parental psychiatric disorders. DESIGN Prospective cohort study based on a linkage of intelligence test scores from draft board examinations and register data on AUD diagnoses during 36 years of follow-up. SETTING Denmark. PARTICIPANTS 3287 Danish men from the Copenhagen Perinatal Cohort (born 1959-1961) who appeared before the draft board at a mean age of 18.7 years. PRIMARY OUTCOME MEASURE First registration with AUD during follow-up was the primary outcome. Information on AUD was based on diagnoses retrieved from national hospital and outpatient treatment registers, defined according to the International Classification of Diseases. RESULTS 361 (11.0%) men were registered with AUD during follow-up. Low intelligence scores were associated with increased odds of AUD adjusting for parental AUD, parental psychiatric disorders, maternal smoking during pregnancy, birth weight, maternal age at birth, parity and childhood socioeconomic position (OR per SD decrease in intelligence=1.69, 95% CI 1.49 to 1.92). Separate analyses indicated significant interaction (p<0.001) between intelligence and psychiatric disorders. The adjusted OR per SD decrease in intelligence score was 2.04 (95% CI 1.67 to 2.49) in men without other psychiatric disorders whereas the OR was 1.21 (95% CI 1.01 to 1.46) in men with other psychiatric disorders. No interaction was found between intelligence and parental AUD or between intelligence and parental psychiatric disorders. CONCLUSIONS The association between intelligence in young adulthood and AUD is modified by other psychiatric disorders as low intelligence is primarily a risk factor for men without other psychiatric disorders. Future studies should take other psychiatric disorders into account when investigating associations between intelligence and AUD.
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Affiliation(s)
| | | | - Joachim Knop
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Jenness JL, Peverill M, King KM, Hankin BL, McLaughlin KA. Dynamic associations between stressful life events and adolescent internalizing psychopathology in a multiwave longitudinal study. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:596-609. [PMID: 31368736 PMCID: PMC6802743 DOI: 10.1037/abn0000450] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Associations between stressful life events (SLEs) and internalizing psychopathology are complex and bidirectional, involving interactions among stressors across development to predict psychopathology (i.e., stress sensitization) and psychopathology predicting greater exposure to SLEs (i.e., stress generation). Although stress sensitization and generation theoretical models inherently focus on within-person effects, most previous research has compared average levels of stress and psychopathology across individuals in a sample (i.e., between-person effects). The present study addressed this gap by investigating stress sensitization and stress generation effects in a multiwave, prospective study of SLEs and adolescent depression and anxiety symptoms. Depression, anxiety, and SLE exposure were assessed every 3 months for 2 years (8 waves of data) in a sample of adolescents (n = 382, aged 11 to 15 at baseline). Multilevel modeling revealed within-person stress sensitization effects such that the association between within-person increases in SLEs and depression, but not anxiety, symptoms were stronger among adolescents who experienced higher average levels of SLEs across 2 years. We also observed within-person stress generation effects, such that adolescents reported a greater number of dependent-interpersonal SLEs during time periods after experiencing higher levels of depression at the previous wave than was typical for them. Although no within-person stress generation effects emerged for anxiety, higher overall levels of anxiety predicted greater exposure to dependent-interpersonal SLEs. Our findings extend prior work by demonstrating stress sensitization in predicting depression following normative forms of SLEs and stress generation effects for both depression and anxiety using a multilevel modeling approach. Clinical implications include an individualized approach to interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jessica L. Jenness
- Department of Psychiatry and Behavioral Sciences,
University of Washington
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Hellwig S, Domschke K. Anxiety in Late Life: An Update on Pathomechanisms. Gerontology 2019; 65:465-473. [DOI: 10.1159/000500306] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/14/2019] [Indexed: 11/19/2022] Open
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Abstract
After participating in this activity, learners should be better able to:• Evaluate factors that have been identified in prospective studies as predicting the onset of bipolar disorder ABSTRACT: The prodromal phase of bipolar disorder (BD) remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity and disability. Retrospective and family-risk studies have consistently found evidence of prodromal psychopathology in subjects later diagnosed with BD. Here, we review prospective studies of clinical risk factors and exposures identified before diagnosis of BD: our findings are consistent with those from retrospective and family-risk studies. Affective psychopathology often precedes diagnosis to suggest a homotypic trajectory in developing BD. Early non-affective (heterotypic) psychopathological disturbances, including anxiety and disruptive behavior disorders, as well as environmental factors and exposures, have been found in prospective studies to increase the risk of BD, but tend to lack specificity in predicting BD. Findings from prospective studies are encouragingly similar to those of retrospective and family-risk studies.
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Abstract
OBJECTIVES Examine the association of income poverty and material deprivation with depression in old age. METHODS Our data contains a survey of 1,959 older Chinese adults in Hong Kong. We used the Geriatric Depression Scale - Short Form to assess their depressive symptoms. Income poverty was defined as having household income below half the median household income (adjusted by household size); material deprivation was measured by a validated 28-item material deprivation. In addition to income poverty and material deprivation, we also assessed the effect of socio-demographic variables, financial strain, health indicators, and social and community resources on depressive symptoms. RESULTS Those who experienced material deprivation reported a significantly more severe depressive symptoms, even after income poverty and all other covariates were controlled for; the bivariate association between income poverty and depressive symptoms disappeared once material deprivation was controlled for. Further, we found a significant interaction effect between income poverty and material deprivation on depressive symptoms; and both engagement in cultural activities and neighborhood collective efficacy moderated the impact of being materially deprived on depressive symptoms. CONCLUSION Our results have important policy implications for the measurement of poverty and for the development of anti-poverty measures for materially deprived older adults.
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Affiliation(s)
- Kelvin Chi Kin Cheung
- a Department of Asian and Policy Studies , The Education University of Hong Kong , Tai Po , Hong Kong , China
| | - Kee-Lee Chou
- a Department of Asian and Policy Studies , The Education University of Hong Kong , Tai Po , Hong Kong , China
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23
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Vital exhaustion and risk of alcohol use disorders: A prospective cohort study. J Psychosom Res 2018; 114:25-30. [PMID: 30314575 DOI: 10.1016/j.jpsychores.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Vital exhaustion is an emotional state characterized by fatigue and depressive symptoms. We examined the prospective association between vital exhaustion and risk of alcohol use disorders (AUD). Furthermore, we investigated whether cohabitation status modifies the effect of this potential association. METHODS Vital exhaustion was assessed by a condensed, 17 item, version of the Maastricht Questionnaire as part of the Copenhagen City Heart Study in 1991-93. The study population consisted of 8956 individuals aged 21-93 years, who were followed for a first-time diagnosis of AUD in national registers until 2016. The mean length of follow-up was 16.6 years. RESULTS During follow-up, AUD was diagnosed in 146 men and 103 women. For both sexes, the risk of AUD increased dose-dependently with increasing vital exhaustion. Individuals who reported high vital exhaustion had a 2- to 3-fold higher risk of AUD in both men (HR = 2.46, 95% CI: 1.40-4.29) and women (HR = 3.34, 95% CI: 1.62-6.85). A potential modifying effect of cohabitation status on the relation between vital exhaustion and AUD was found for men. CONCLUSION The results showed that vital exhaustion is significantly associated with a higher risk of AUD in both men and women and that living with a cohabitee may have a protective effect among men.
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Ennis N, Bryant V, Mannes Z. Value of perceived support on depressive symptoms and hazardous drinking among underserved HIV+ adults 50 and older. PSYCHOL HEALTH MED 2018; 24:355-361. [PMID: 30293456 DOI: 10.1080/13548506.2018.1529327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The current study examined the association between perceived social support, depressive symptoms and alcohol use among people living with HIV (PLWH) 50 and older who identified as Black. Participants included 96 men and women ages 50 and older. Participants completed an interviewer-administered assessment examining mental and behavioral health functioning. Mediation analyses examined whether perceived support mediated the association between depressive symptoms and hazardous drinking. Depressive symptoms were significantly associated with hazardous drinking (B = .068, SE = .035, t = 1.92, p = 0.05) and negatively associated with having the desired amount of contact with a primary supporter (B = -.072, SE = .018, z = -3.96, p < 0.001). In addition, having the desired amount of contact with a confidant was negatively associated with hazardous drinking (B = -.543, SE = .208, t = -2.61, p 0 < .01). The effect of depressive symptoms on hazardous drinking when controlling for having adequate contact with a primary supporter was not significant (B = .033, SE = .04, t = .829, p = 0.41). Having a valued confidant mediated the association between depressive symptoms and hazardous drinking. Thus, social support interventions may be an effective method of reducing hazardous drinking among older PLWH.
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Affiliation(s)
- Nicole Ennis
- a Department of Clinical and Health Psychology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
| | - Vaughn Bryant
- a Department of Clinical and Health Psychology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
| | - Zachary Mannes
- a Department of Clinical and Health Psychology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
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Carvalho AF, Stubbs B, Maes M, Solmi M, Vancampfort D, Kurdyak PA, Brunoni AR, Husain MI, Koyanagi A. Different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms among older adults in Ireland: A prospective community-based study. J Affect Disord 2018; 238:651-658. [PMID: 29957483 DOI: 10.1016/j.jad.2018.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear. METHODS Data on 6095 adults aged ≥ 50 years old from the Irish Longitudinal Study on Aging (TILDA) was analyzed. Participants completed the CAGE instrument to screen for problematic alcohol use at baseline between October 2009 and February 2011. Outcomes were incident (assessed by the CES-D scale) and anxiety (assessed by the Hospital Anxiety and Depressive scale) symptoms after a two-year follow-up as well as persistence of probable depression and anxiety among those with a positive screen for those disorders at baseline. Associations were adjusted for potential confounders through multivariable models. RESULTS In the overall sample, problem drinking did not predict incident and persistent depression and anxiety in this sample. Among females, problem drinking increased the risk for incident depression (OR = 2.11; 95%CI = 1.12-4.00) and anxiety (OR = 2.22; 95%CI = 1.01-4.86). In addition, problem drinking increased the risk of persistent depressive symptoms (OR = 2.43; 95%CI = 1.05-5.06) among females. CONCLUSION Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms.
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Affiliation(s)
- Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center, KU Leuven, Leuven, Kortenberg, Belgium
| | - Paul A Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Andre R Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Muhammad I Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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Handforth A, Parker GA. Conditions Associated with Essential Tremor in Veterans: A Potential Role for Chronic Stress. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2018; 8:517. [PMID: 29971194 PMCID: PMC6026277 DOI: 10.7916/d8vd8ff5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/06/2018] [Indexed: 02/06/2023]
Abstract
Background Increased depression, hearing loss, dementia, alcoholism, and mortality in essential tremor patients remain unexplained. We investigated whether conditions associated with tremor are linked to chronic stress. Methods The FY2013 Veterans Affairs database was queried for 38 selected dual diagnosis combinations in 5,854,223 veterans aged 21–95 years. Results Post-traumatic stress disorder, anxiety, and depression were the most common psychiatric diagnoses in tremor patients, with the odds ratio exceeding 2 in all 15-year cohorts. Depending on age, patients with essential tremor were more likely than those without to have obsessive–compulsive disorder, bipolar illness, schizophrenia, use tobacco and abuse alcohol, have hypertension, obesity, hyperlipidemia, diabetes, vitamin D deficiency, coronary and cerebrovascular diseases, congestive heart failure, stroke, asthma, hypothyroidism, irritable bowel syndrome, renal insufficiency, alcoholic liver disease, hearing loss, glaucoma, macular degeneration, migraine, epilepsy, idiopathic polyneuropathy, history of head trauma, and ‘Alzheimer’s dementia. In contrast, lung and colorectal cancer, amyotrophic lateral sclerosis, psychostimulant abuse, and rheumatoid arthritis were not more common. Discussion Post-traumatic stress disorder, anxiety, and depression, strongly associated with essential tremor, are known risk factors for poor health habits, tobacco use and alcohol abuse; collectively these are risk factors for vascular disease, with further negative health consequences for multiple organ systems. As essential tremor is associated with all these conditions, we propose that chronic stress is not only responsible for the conditions associated with tremor but in some cases itself directly and indirectly induces essential tremor, so that tremor and poor health share a common cause.
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Affiliation(s)
- Adrian Handforth
- Neurology Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gail A Parker
- Knowledge Management, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Physical Activity and the Development of Substance Use Disorders: Current Knowledge and Future Directions. PROGRESS IN PREVENTIVE MEDICINE 2018; 3. [PMID: 30345414 PMCID: PMC6192057 DOI: 10.1097/pp9.0000000000000018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Physical activity and exercise are positive health behaviors that have been shown to reduce the risk of physical and psychological diseases. There is a strong rationale that physical activity could be a protective factor against the development of substance use disorders (SUDs), which include some of the most common mental health conditions such as tobacco and alcohol use disorder. This review examined the epidemiological literature to describe the associations of physical activity and substance use across the lifespan. The findings indicated that physical activity is positively associated with current and future alcohol use but negatively associated with tobacco and other drug use, with the strongest support originating from adolescent and young adult samples. Considerably less data exist on physical activity and other drug use in later life. Limitations in previous studies, such as the indeterminate measurement of physical activity and absence of clinical substance use disorder endpoints, should be addressed in future investigations to provide clarity regarding the strength and directions of these relationships among different substances and populations.
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Creighton AS, Davison TE, Kissane DW. The Factors Associated With Anxiety Symptom Severity in Older Adults Living in Nursing Homes and Other Residential Aged Care Facilities. J Aging Health 2018; 31:1235-1258. [DOI: 10.1177/0898264318767781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to identify the biopsychosocial factors associated with anxiety among a residential aged care sample. Method: A total of 178 residents ( M age = 85.4 years, SD = 7.4 years) with mild cognitive impairment or normal cognition participated. Participants completed the Geriatric Anxiety Inventory (GAI) and a set of measures assessing cognition, depression, self-perceived health, mastery, attachment, perceived social support, social engagement, functional status, the experience of a fall, and other negative life events. Results: Unique correlates of GAI scores were depression, a preoccupied attachment style, lower mastery, cognitive impairment, and lower self-perceived health. Discussion: Most correlates that were uniquely associated with anxiety had little to do with the current environment. More variance was accounted for by stable and lifelong factors. This provides new insights into the characteristics of anxiety within aged care populations, and although preliminary, provides possible targets to prevent and treat anxiety within this setting.
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Affiliation(s)
| | - Tanya E. Davison
- Monash University, Clayton, Victoria, Australia
- Australian Catholic University, Melbourne, Victoria, Australia
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Harris D, McNicoll L, Epstein-Lubow G, Thomas KS. Association between anxious symptoms and sleeping medication use among US older adults. Int J Geriatr Psychiatry 2018; 33:e307-e313. [PMID: 28960462 PMCID: PMC5773373 DOI: 10.1002/gps.4795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the relationship between anxiety symptoms and sleeping medication use among a nationally representative sample of US older adults. DESIGN Cross-sectional design using data from the 2011 National Health and Aging Trends Study to examine the relationship between anxiety symptoms as rated by the Generalized Anxiety Disorder-2 and self-reported sleeping medication use. Survey weights were applied to account for complex survey design. Logistic regression was used to measure the association between anxiety symptoms and sleeping medication use after adjusting for sociodemographic factors, physical health, and other sleep-related issues. RESULTS In 2011, 13.1% of respondents experienced high anxiety symptoms and 29.0% reported taking a sleeping medication at least once a week during the last 30 days. Results estimate that approximately 4 million US older adults have clinically significant anxiety symptoms and approximately 10 million US older adults used a sleeping medication in the last 30 days. Adjusted results revealed that high anxiety symptoms are significantly associated with sleeping medication use compared to low anxiety symptoms (AOR = 1.57; 95% CI, 1.29-1.91). Depression symptoms were also associated with sleeping medication (AOR = 1.29; 95% CI, 1.08-1.55). CONCLUSIONS Results demonstrated that anxiety symptoms are significantly associated with sleeping medication use among US older adults. We also found that depressive symptoms, chronic conditions, and worse self-rated health are associated with sleeping medication use. As sleeping medications are associated with adverse health events, these results have clinical implications for treating anxiety symptoms among older patients.
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Affiliation(s)
- Daniel Harris
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Lynn McNicoll
- Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Gary Epstein-Lubow
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
- Alpert School of Medicine, Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
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Just-Østergaard E, Mortensen EL, Flensborg-Madsen T. Major life events and risk of alcohol use disorders: a prospective cohort study. Addiction 2018; 113:25-33. [PMID: 28734057 DOI: 10.1111/add.13947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
AIMS To estimate associations of individual major life events as well as accumulated major life events in childhood, adult private life and adult work life with risk of alcohol use disorders (AUD). DESIGN Prospective cohort study with baseline examination in 1991-93 and linkage to national registers to identify AUD at follow-up. SETTING Copenhagen, Denmark. PARTICIPANTS Individuals (aged 21-93 years) who participated in the Copenhagen City Heart Study in 1991-93 (n = 8758). MEASUREMENTS The primary outcome was first registration with AUD during follow-up (n = 249). AUD was identified in the Danish National Patient Register, in the Danish Psychiatric Central Register and in an outpatient treatment register. Major life events were assessed by a questionnaire in the Copenhagen City Heart study. Data were analysed by Cox proportional hazards models adjusted for age, sex, educational level, household income, cohabitation status and psychiatric comorbidity. FINDINGS Serious family conflicts in childhood [hazard ratio (HR) = 1.35; 95% confidence interval (CI) = 1.00, 1.83] and serious economic problems in adult life (HR = 2.22; 95% CI = 1.64, 3.01) were associated significantly with increased risk of AUD. Prospective analyses did not show consistent effects of accumulation of major life events in childhood or adult life, but an additional analysis based on all AUD registrations suggested an association between accumulated childhood events and risk of AUD. CONCLUSIONS Serious economic problems in adult life are associated strongly with risk of alcohol use disorders, and there may be an influence of accumulated childhood events on risk of alcohol use disorders.
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Affiliation(s)
- Emilie Just-Østergaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. Am J Geriatr Psychiatry 2018; 26:107-122. [PMID: 28735658 DOI: 10.1016/j.jagp.2017.06.011] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.
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Barry DT, Pilver Glenn CE, Hoff RA, Potenza MN. Pain Interference and Incident Medical Disorders in the General Population. PAIN MEDICINE 2017; 18:1209-1217. [PMID: 28339518 DOI: 10.1093/pm/pnw252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To investigate the longitudinal relationship between pain interference and incident general medical conditions in a nationally representative sample. Methods Secondary data analysis comprising chi-square tests and binomial logistic regression analyses were performed on data obtained from the US National Epidemiologic Survey on Alcohol and Related Conditions from 34,465 adult respondents who completed wave 1 (2000-2001) and wave 2 (2004-2005) data collection. Models were adjusted for multiple potentially confounding factors. Respondents were categorized at wave 1 according to past-month pain interference (i.e., no or low pain interference, moderate pain interference, severe pain interference). Results In multivariate analyses, moderate or severe pain interference (as compared to no or low pain interference) was associated with the incidence of any medical condition; any heart condition, including angina, tachycardia and other heart disease; any stomach condition, including stomach ulcer and gastritis; arthritis; and hypertension (all P < 0.05). Severe (but not moderate) pain interference as compared with no or low pain interference was additionally associated with new occurrences of myocardial infarction, any liver disease, other liver disease, and arteriosclerosis (all P < 0.05). Conclusions These findings suggest that the relationship between pain interference and general medical conditions is complex. A more complete understanding of this relationship is likely to involve further exploration of possible mechanisms, including whether it is the pain itself, the ascertainment of pain etiology, or pain treatment that is associated with incident general medical conditions.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry.,APT Foundation Pain Treatment Services, New Haven, Connecticut
| | - Corey E Pilver Glenn
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rani A Hoff
- Department of Psychiatry.,Department of Neurobiology
| | - Marc N Potenza
- Department of Psychiatry.,Department of Neurobiology.,Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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Aguglia A, Di Stefano A, Maina G. A 10-year evaluation on adolescents with anxiety disorders: are they at risk of bipolarity? Int J Psychiatry Clin Pract 2017; 21:125-130. [PMID: 27997262 DOI: 10.1080/13651501.2016.1268163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Anxiety disorders are the most frequent disorders comorbid with bipolar disorder (BD) often preceding the BD onset. The presence of comorbid anxiety in patients diagnosed with BD is associated with worsening of their BD symptoms, increased risky behaviour, decreased response to pharmacological treatment and deterioration in their quality of life and global functioning. The aim of this study was to investigate if anxiety disorders in adolescence could be considered as predictors of BD. METHODS Adolescents with a primary anxiety disorder were recruited consecutively from the Mood and Anxiety Disorders Unit, Department of Neuroscience, University of Turin. Subjects were evaluated for Axis I psychiatric disorders, family history and global functioning, and followed up on average 10 years later. RESULTS A total of 29 patients (59.2%) were male and the mean age at the onset of anxiety disorder was 16.3 (±0.8). Ten years following recruitment, 11 (22.4%) patients fulfilled the criteria for BD. Of them, 10 (90.9%) had a family history of BD and four (36.4%) presented a comorbid substance use disorder. CONCLUSIONS Our study shows that both family history of BD and substance use disorder, in adolescent patients with a primary anxiety disorder, should be considered as potential predictors of BD onset.
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Affiliation(s)
- Andrea Aguglia
- a Department of Neuroscience, Psychiatric Unit , S Luigi Gonzaga Hospital Orbassano (Turin), University of Turin , Turin , Italy
| | - Andrea Di Stefano
- b Department of Clinical and Experimental Medicine, Psychiatric Unit , AOU Policlinico Hospital, University of Catania , Catania , Italy
| | - Giuseppe Maina
- a Department of Neuroscience, Psychiatric Unit , S Luigi Gonzaga Hospital Orbassano (Turin), University of Turin , Turin , Italy
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Lam RW, McIntosh D, Wang J, Enns MW, Kolivakis T, Michalak EE, Sareen J, Song WY, Kennedy SH, MacQueen GM, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:510-23. [PMID: 27486151 PMCID: PMC4994789 DOI: 10.1177/0706743716659416] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. RESULTS In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. CONCLUSIONS The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - JianLi Wang
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Theo Kolivakis
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Wei-Yi Song
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Martínez-Vispo C, Becoña E. La sensibilidad a la ansiedad y el consumo de tabaco: una revisión. ANSIEDAD Y ESTRES-ANXIETY AND STRESS 2016. [DOI: 10.1016/j.anyes.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weinberger AH, Kashan RS, Shpigel DM, Esan H, Taha F, Lee CJ, Funk AP, Goodwin RD. Depression and cigarette smoking behavior: A critical review of population-based studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:416-431. [DOI: 10.3109/00952990.2016.1171327] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel S. Kashan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | | | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Farah Taha
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY, USA
| | - Christine J. Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Allison P. Funk
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Renee D. Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Abstract
Humans spend approximately one-third of their lives asleep. Whether due to evolutionary or ontogenetic factors, sleep and psychiatric disorders change with age. Although much of sleep remains an enigma, sleep research is experiencing an exponential increase in its understanding of the causes, correlates, and consequences of sleep disturbances. Although the relationship between age-related sleep and psychiatric conditions is a common clinical observation, empirical investigations remain scarce. Thus, treating patients with symptoms of sleep disorders in the context of psychiatric conditions remains a challenge. This article reviews the state-of-the-science of sleep disorders in the context of psychiatric conditions in late-life.
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Machado MB, Ignácio ZM, Jornada LK, Réus GZ, Abelaira HM, Arent CO, Schwalm MT, Ceretta RA, Ceretta LB, Quevedo J. Prevalência de transtornos ansiosos e algumas comorbidades em idosos: um estudo de base populacional. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Avaliar a prevalência de transtornos ansiosos e fatores associados em uma amostra populacional de idosos do Sul de Santa Catarina. Métodos Estudo transversal com base em dados populacionais, que avaliou 1.021 indivíduos idosos entre 60 e 79 anos. Foram realizadas entrevistas domiciliares para aferição de variáveis sobre transtornos ansiosos, por meio do questionário MINI, dados sociodemográficos, hipertensão arterial sistêmica (HAS), infarto agudo do miocárdio (IAM) e dosagem de colesterol. Resultados As prevalências entre os transtornos ansiosos foram de 22,0% para o transtorno de ansiedade generalizada (TAG); 14,8% para fobia social (FS); 10,5% para transtorno do pânico (TP); e 8,5% para o transtorno obsessivo-compulsivo (TOC). Além disso, 40,5% dos indivíduos apresentaram pelo menos um transtorno de ansiedade. A distribuição dos transtornos foi semelhante nos dois gêneros; TAG foi mais prevalente nos indivíduos de menor escolaridade; TOC foi mais presente em indivíduos casados ou em união estável. Em relação às variáveis clínicas, HAS foi associada à presença de TOC; FS foi associada com IAM; TOC e FS foram associados com HDL > 40 mg/dL. Conclusão Os dados demonstram que os quadros de ansiedade são muito frequentes em idosos da comunidade, se sobrepõem de forma significativa e estão associados a algumas variáveis clínicas cardiovasculares.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João Quevedo
- Universidade do Extremo Sul Catarinense; The University of Texas Health Science Center at Houston, USA; The University of Texas Health Science Center at Houston, USA; The University of Texas, USA
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Kang HJ, Bae KY, Kim SW, Shin IS, Yoon JS, Kim JM. Anxiety symptoms in Korean elderly individuals: a two-year longitudinal community study. Int Psychogeriatr 2016; 28:423-33. [PMID: 26299311 DOI: 10.1017/s1041610215001301] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although late-life anxiety occurs frequently and is associated with higher morbidity, few longitudinal studies have been concerned with the evaluation thereof. We investigated the prevalence, incidence, and persistence of anxiety and related factors over a two-year period in community-dwelling Korean elderly individuals. METHODS A total of 1,204 Korean elderly individuals were evaluated at baseline, and 909 were followed up two years later. The community version of the Geriatric Mental State Schedule was used to estimate anxiety at both baseline and follow-up interviews. We defined "prevalence" as the rate of anxiety symptoms (for both anxiety cases and sub-threshold anxiety) at baseline; "incidence" as the rate of anxiety symptoms at follow-up in those without baseline anxiety symptoms; and "persistence" as the rate of anxiety symptoms at follow-up in those with baseline anxiety symptoms. Associations between various covariates and anxiety status were examined using multivariate logistic regression models. RESULTS The prevalence, incidence, and persistence of anxiety symptoms were 38.1%, 29.3%, and 41.1%, respectively. Prevalent anxiety symptoms were associated independently with female, rented housing, more stressful life event and medical illness, physical inactivity, depression, insomnia, and lower cognitive function. Incident anxiety symptoms were predicted by older age, female gender, depression, and insomnia; persistent anxiety symptoms were predicted by older age, more medical illness, and baseline depression. CONCLUSIONS Since depression was associated with prevalent, incident, and persistent anxiety symptoms, effective detection and management thereof is important in older adults to reduce anxiety. Furthermore, preventive collaborative care should be considered, particularly for older, female, insomniac patients.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
| | - Sung-Wan Kim
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
| | - Il-Seon Shin
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
| | - Jin-Sang Yoon
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
| | - Jae-Min Kim
- Department of Psychiatry,Chonnam National University Medical School,Gwangju,South Korea
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Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World J Psychiatry 2015; 5:366-378. [PMID: 26740928 PMCID: PMC4694550 DOI: 10.5498/wjp.v5.i4.366] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/02/2014] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models: (1) “the avoidance model”; (2) “the intolerance of uncertainty model”; (3) “the meta-cognitive model”; (4) “the emotion dysregulation model”; and (5) “the acceptance based model”. For depression, the following theoretical models are explicated: (1) “the cognitive model”; (2) “the behavioral activation model”; and (3) “the interpersonal model”. Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines (BZDs) are an important “bridging strategy” to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a “stacking approach” not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression.
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Miloyan B, Byrne GJ, Pachana NA. Threshold and subthreshold generalized anxiety disorder in later life. Am J Geriatr Psychiatry 2015; 23:633-41. [PMID: 25240936 DOI: 10.1016/j.jagp.2014.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/22/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD. METHODS Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study. RESULTS Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up. CONCLUSION These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.
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Affiliation(s)
- Beyon Miloyan
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
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Bromberger JT, Schott L, Kravitz HM, Joffe H. Risk factors for major depression during midlife among a community sample of women with and without prior major depression: are they the same or different? Psychol Med 2015; 45:1653-1664. [PMID: 25417760 PMCID: PMC4414245 DOI: 10.1017/s0033291714002773] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women's vulnerability for a first lifetime-onset of major depressive disorder (MDD) during midlife is substantial. It is unclear whether risk factors differ for first lifetime-onset and recurrent MDD. Identifying these risk factors can provide more focused depression screening and earlier intervention. This study aims to evaluate whether lifetime psychiatric and health histories, personality traits, menopausal status and factors that vary over time, e.g. symptoms, are independent risk factors for first-onset or recurrent MDD across 13 annual follow-ups. METHOD Four hundred and forty-three women, aged 42-52 years, enrolled in the Study of Women's Health Across the Nation in Pittsburgh and participated in the Mental Health Study. Psychiatric interviews obtained information on lifetime psychiatric disorders at baseline and on occurrences of MDD episodes annually. Psychosocial and health-related data were collected annually. Cox multivariable analyses were conducted separately for women with and without a MDD history at baseline. RESULTS Women without lifetime MDD at baseline had a lower risk of developing MDD during midlife than those with a prior MDD history (28% v. 59%) and their risk profiles differed. Health conditions prior to baseline and during follow-ups perception of functioning (ps < 0.05) and vasomotor symptoms (VMS) (p = 0.08) were risk factors for first lifetime-onset MDD. Being peri- and post-menopausal, psychological symptoms and a prior anxiety disorder were predominant risk factors for MDD recurrence. CONCLUSIONS The menopausal transition warrants attention as a period of vulnerability to MDD recurrence, while health factors and VMS should be considered important risk factors for first lifetime-onset of MDD during midlife.
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Affiliation(s)
- J. T. Bromberger
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Schott
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - H. M. Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - H. Joffe
- Department of Psychiatry, Brigham and Women’s Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
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Zhang X, Norton J, Carrière I, Ritchie K, Chaudieu I, Ancelin ML. Risk factors for late-onset generalized anxiety disorder: results from a 12-year prospective cohort (the ESPRIT study). Transl Psychiatry 2015; 5:e536. [PMID: 25826111 PMCID: PMC4429171 DOI: 10.1038/tp.2015.31] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/19/2014] [Accepted: 01/27/2015] [Indexed: 01/19/2023] Open
Abstract
Generalized anxiety disorder (GAD) is a chronic and highly prevalent disorder associated with increased disability and mortality in the elderly. Treatment is difficult with low rate of full remission, thus highlighting the need to identify early predictors for prevention in elderly people. The aim of this study is to identify and characterize incident GAD predictors in elderly people. A total of 1711 individuals aged 65 years and above and free of GAD at baseline were randomly recruited from electoral rolls between 1999 and 2001 (the prospective ESPRIT study). The participants were examined at baseline and five times over 12 years. GAD and psychiatric comorbidity were diagnosed with a standardized psychiatric examination, the Mini-International Neuropsychiatry Interview on the basis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria and validated by a clinical panel. During the follow-up, 8.4% (95% confidence interval=7.1-9.7%) of the participants experienced incident GAD, 80% being first episodes; the incident rate being 10 per 1000 person-years. The principal predictors of late-onset incident GAD over 12 years derived from a multivariate Cox model were being female, recent adverse life events, having chronic physical (respiratory disorders, arrhythmia and heart failure, dyslipidemia, cognitive impairment) and mental (depression, phobia and past GAD) health disorders. Poverty, parental loss or separation and low affective support during childhood, as well as history of mental problems in parents were also significantly and independently associated with incident GAD. GAD appears as a multifactorial stress-related affective disorder resulting from both proximal and distal risk factors, some of them being potentially modifiable by health care intervention.
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Affiliation(s)
- X Zhang
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
- Tianjin Mental Health Center, Tianjin, China
| | - J Norton
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
| | - I Carrière
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
| | - K Ritchie
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
- Faculty of Medicine, Imperial College, London, UK
| | - I Chaudieu
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
| | - M-L Ancelin
- Inserm, U1061, Hopital La Colombiere, Montpellier, France
- University Montpellier, U1061, Montpellier, France
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Zhang X, Norton J, Carrière I, Ritchie K, Chaudieu I, Ancelin ML. Generalized anxiety in community-dwelling elderly: Prevalence and clinical characteristics. J Affect Disord 2015; 172:24-9. [PMID: 25451391 DOI: 10.1016/j.jad.2014.09.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/29/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a chronic and disabling disorder with a low rate of full remission. As it is commonly assumed that cases in the elderly principally represent the continuing chronic course of early onset illness, there has been little research into the clinical characteristics, including comorbid psychiatric and physical conditions, which may be specific to older people. METHODS Lifetime GAD and psychiatric comorbidity were diagnosed in 1974 community-dwelling elderly people aged 65 or over using a standardized psychiatric examination, the MINI, based on DSM-IV criteria. Multivariate regression analyses were adjusted for socio-demographic, lifestyle, biological, and clinical variables, as well as adverse life events. RESULTS The lifetime prevalence of GAD was 11% (95% CI=9.6-12.4%) of whom 24.6% reported a late onset with a first episode after 50 years of age. The 6-month current prevalence was 4.6% (95% CI=3.7-5.5%). Most of the prevalent cases were recurrent but only 36.3% were receiving treatment. Fourteen percent were comorbid with major depression and 34% with phobia but their associated factors differed. The factors associated with pure GAD were being female, having cognitive impairment, lower body mass index, reporting low affective support during childhood, taking a high number of somatic medications independently of other mental health factors, e.g. psychotropic medication use, major depression, and phobia. LIMITATIONS The study is limited by cross-sectional design. CONCLUSIONS Our data indicate that GAD prevalence is high in elderly people with a late-life onset of GAD in 25% of cases. GAD in the elderly is not just a severity marker of depression and is clinically distinct from phobia, the other major anxiety disorder of the elderly.
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Affiliation(s)
- Xiaobin Zhang
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France; Tianjin Mental Health Center, Tianjin, China
| | - Joanna Norton
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Isabelle Carrière
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France; Faculty of Medicine, Imperial College, London, UK
| | - Isabelle Chaudieu
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France
| | - Marie-Laure Ancelin
- Inserm, U1061, Montpellier F-34093, France; Univ Montpellier 1, U1061, Montpellier, France.
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Jiang F, Li S, Pan L, Zhang N, Jia C. Association of anxiety disorders with the risk of smoking behaviors: a meta-analysis of prospective observational studies. Drug Alcohol Depend 2014; 145:69-76. [PMID: 25456325 DOI: 10.1016/j.drugalcdep.2014.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Published articles reported controversial results about the association of anxiety disorders with the risk of smoking behaviors. A meta-analysis was performed to assess this association between anxiety disorders and smoking behaviors. METHODS A comprehensive search was performed to identify prospective observational studies (from January, 1990 to March, 2014) of the aforementioned association. The Q test and I(2) statistic were used to examine between-study heterogeneity. Fixed or random effect model was selected based on heterogeneity test among studies. Meta-regression and the "leave one out" sensitive analysis were used to explore potential sources of between-study heterogeneity. Publication bias was estimated using Egger's regression asymmetry test. RESULTS Fifteen articles were included. After excluding studies that were the key contributors to between-study heterogeneity, the meta-analysis showed a significant association of anxiety disorders with increased risk of regular smoking (OR = 1.41, 95% CI: 1.23-1.62) and nicotine dependence (OR = 1.58, 95% CI: 1.45-1.73). No significant influence and publication bias were observed both before and after excluding the key contributors to heterogeneity. CONCLUSION This meta-analysis suggested that anxiety disorders had significant positive effect on the risk of smoking behaviors. This association needs to be confirmed by further studies.
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Affiliation(s)
- Fan Jiang
- Department of Epidemiology and Biostatistics, Shandong University, Jinan 250012, Shandong, PR China
| | - Suyun Li
- Department of Epidemiology and Biostatistics, Shandong University, Jinan 250012, Shandong, PR China
| | - Lulu Pan
- Department of Epidemiology and Biostatistics, Shandong University, Jinan 250012, Shandong, PR China
| | - Nan Zhang
- Department of Epidemiology and Biostatistics, Shandong University, Jinan 250012, Shandong, PR China
| | - Chongqi Jia
- Department of Epidemiology and Biostatistics, Shandong University, Jinan 250012, Shandong, PR China.
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Manetti A, Hoertel N, Le Strat Y, Schuster JP, Lemogne C, Limosin F. Comorbidity of late-life depression in the United States: a population-based study. Am J Geriatr Psychiatry 2014; 22:1292-306. [PMID: 23988281 DOI: 10.1016/j.jagp.2013.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to determine the clinical and sociodemographic correlates and the treatment-seeking rate of major depressive disorder (MDD), diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, among older adults and its association with comorbid psychiatric disorders and perceived health status. METHODS Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey (N = 43,093) representative of the US population. RESULTS Compared with participants aged 65 years and older without a 12-month diagnosis of MDD, those with MDD were more likely to have lifetime and 12-month comorbid psychiatric disorders. Except for lifetime dysthymia, we found no significant interaction between rates of current somatic comorbidity, lifetime and 12-month psychiatric comorbidity, and age groups. Compared with younger participants with a 12-month MDD, they had an older age at onset, reported a similar number of lifetime major depressive episodes and perceived health status, and had lower mental health service utilization rates. CONCLUSIONS Current major depression in the elderly seems to be as disabling as in younger adults in terms of comorbid psychiatric disorders and impaired quality of life. Poorer prognosis of MDD in older adults might be explained by a lower perceived need of treatment, resulting in a lower rate of treatment-seeking behavior.
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Affiliation(s)
- Aude Manetti
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France.
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Yann Le Strat
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France
| | - Jean-Pierre Schuster
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
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Faedda GL, Serra G, Marangoni C, Salvatore P, Sani G, Vázquez GH, Tondo L, Girardi P, Baldessarini RJ, Koukopoulos A. Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J Affect Disord 2014; 168:314-321. [PMID: 25086290 DOI: 10.1016/j.jad.2014.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early phases and suspected precursor states of bipolar disorder are not well characterized. We evaluate the prevalence, duration, clinical features and predictive value of non-affective psychopathology as clinical risk factors for bipolar disorder in prospective studies. METHODS We screened PubMed, CINAHL, PsycINFO, Embase, SCOPUS, and ISI-Web of Science databases from inception up to January 31, 2014, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and searched: bipolar disorder AND [antecedent⁎ OR predict⁎ OR prodrom⁎ OR prospect⁎ OR risk⁎] AND [diagnosis OR development]. We included only English language reports on prospective, longitudinal studies with two structured clinical assessments (intake and follow-up); no DSM intake diagnosis of bipolar-I or -II; diagnostic outcome was bipolar-I or -II. Details of study design, risk factors, and predictive value were tabulated. RESULTS We found 16 published reports meeting selection criteria, with varying study design. Despite heterogeneity in methods, findings across studies were consistent. Clinical risk factors of bipolar disorder were early-onset panic attacks and disorder, separation anxiety and generalized anxiety disorders, conduct symptoms and disorder, ADHD, impulsivity and criminal behavior. LIMITATIONS Since risk factors identified in some prospective studies are predictive of other conditions besides bipolar disorder, these preliminary findings require replication, and their sensitivity, specificity and predictive value need to be assessed. CONCLUSIONS Clinical risk factors for bipolar disorder typically arise years prior to syndromal onset, include anxiety and behavioral disorders with unclear sensitivity and specificity. Prospectively identified clinical risk factors for bipolar disorder are consistent with retrospective and family-risk studies. Combining clinical risk factors with precursors and family-risk may improve early identification and timely and appropriate treatment of bipolar disorder.
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Affiliation(s)
- Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York, NY, United States; New York University Medical Center & Child Study Center, New York, NY, United States; International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States.
| | - Giulia Serra
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ciro Marangoni
- Section of Neurological, Psychiatric and Psychological Sciences, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Italy
| | - Paola Salvatore
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy
| | - Gabriele Sani
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, "La Sapienza" University School of Medicine, Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Neuroscience, University of Palermo, Buenos Aires, Argentina
| | - Leonardo Tondo
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Centro Lucio Bini, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Centro Lucio Bini, Cagliari, Italy
| | - Paolo Girardi
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults. Exp Gerontol 2014; 60:46-56. [PMID: 25245888 DOI: 10.1016/j.exger.2014.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/07/2014] [Accepted: 09/18/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND There has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population. METHODS A total of 10,409 U.S. adults aged 55+ participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2. RESULTS Past-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions. CONCLUSION Results of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.
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Mackenzie CS, El-Gabalawy R, Chou KL, Sareen J. Prevalence and predictors of persistent versus remitting mood, anxiety, and substance disorders in a national sample of older adults. Am J Geriatr Psychiatry 2014; 22:854-65. [PMID: 23800537 PMCID: PMC4284958 DOI: 10.1016/j.jagp.2013.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Relatively little is known about whether mental disorders other than depression remit versus persist in later life, especially within nationally representative samples. Our objectives were to examine the prevalence of persistent mood, anxiety, and substance disorders in older adults and to explore a range of physical and mental health predictors of disorder chronicity. METHODS This study involved a 3-year follow-up design using Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants included 1,994 adults aged 55 years and older who had a past-year mental disorder at Wave 1 and who completed Wave 2. The primary outcome was the prevalence of persistent mood, anxiety, and substance disorders at Wave 2. Potential predictors of persistence included sociodemographic variables, physical health (chronic health conditions and physical health-related quality of life), and mental health (childhood adversity, suicide attempts, mental health-related quality of life, comorbid mental disorders, personality disorders, and lifetime treatment-seeking). RESULTS With the exception of nicotine dependence, the prevalence of persistent mood, anxiety, and substance disorders ranged from 13% to 33%. Only younger age predicted substance disorder chronicity. Significant predictors of persistent mood and anxiety disorders included physical and mental health comorbidity, physical health- and mental health-related quality of life, suicide attempts, comorbid personality disorders, and treatment-seeking. CONCLUSIONS At least two-thirds of mental disorders in these older adults were not persistent. Sociodemographic variables had little influence on chronicity, whereas a number of markers of mental disorder severity and complexity predicted persistent mood and anxiety disorders. The findings have important treatment and prevention implications.
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Affiliation(s)
| | | | - Kee-Lee Chou
- Department of Social Work and Social Administration, University of Hong Kong
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Jayasinghe N, Rocha LP, Sheeran T, Wyka K, Bruce ML. Anxiety symptoms in older home health care recipients: prevalence and associates. Home Health Care Serv Q 2014; 32:163-77. [PMID: 23937710 DOI: 10.1080/01621424.2013.813885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the prevalence and associates of anxiety symptoms in older home health care recipients (N = 249) who completed structured interviews assessing sociodemographic, cognitive, medical and disability, and psychosocial variables--including anxiety (assessed by the Clinical Anxiety Scale). Mild or moderate anxiety was reported by 3.6% of the sample. No anxiety symptoms whatsoever were reported by 63.9%, while the remaining endorsed at least one symptom. Binary logistic regression analysis revealed that the odds of having any anxiety were elevated among participants who had had a recent fall, OR = 2.81, 95% CI [1.46, 5.43]; and those with major depression, OR = 4.78, 95% CI [1.46, 15.68]. These findings point to the importance of conducting studies to clarify whether the mild severity of anxiety found in this sample is best accounted for by protective factors inherent to the home health care setting or assessment factors that diminish the reporting of anxiety symptoms.
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