The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

/pdf/canadian-clinical-practice-guidelines-for-the-management-of-3kjxn44j0v.pdf

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

The world is now in the midst of a major policy debate about the objectives of public policy. What should be the world’s Sustainable Development Goals for the period 2015-2030? The World Happiness Report 2013 is offered as a contribution to that crucial debate. In July 2011 the UN General Assembly passed a historic resolution.1 It invited member countries to measure the happiness of their people and to use this to help guide their public policies. This was followed in April 2012 by the first UN high-level meeting on happiness and well-being, chaired by the Prime Minister of Bhutan. At the same time the first World Happiness Report was published,2 followed some months later by the OECD Guidelines setting an international standard for the measurement of well-being. The present Report is sponsored by the Sustainable Development Solutions Network.

http://kstp.com/kstpimages/repository/cs/files/worldhappinessreport2013_online.pdf

World happiness report 2013

Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis.

Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.

/pdf/implementation-of-the-calm-intervention-for-anxiety-1p2vinadvl.pdf

Implementation of the CALM intervention for anxiety disorders: a qualitative study.

Objective: This study examined the unadjusted and adjusted prevalence estimates of depression and anxiety at the state level and examined the odds ratios of depression and anxiety for selected risk behaviors, obesity, and chronic diseases. Methods: The 2006 Behavioral Risk Factor Surveillance Survey, a random-digit-dialed telephone survey, collected depression and anxiety data from 217,379 participants in 38 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Current depressive symptoms were assessed with the standardized and validated eight-item Patient Health Questionnaire, and lifetime diagnosis of depression and anxiety was assessed by two additional questions (one question for each diagnosis). Results: The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%–13.7%); of a lifetime diagnosis of depression, 15.7% (range, 6.8%–21.3%); and of a lifetime diagnosis of anxiety, 11.3% (range, 5.4%–17.2%). After sociodemographic characteristics, adverse health behaviors, and chronic illnesses were adjusted for, cardiovascular disease, diabetes, asthma, smoking, and obesity were all significantly associated with current depressive symptoms, a lifetime diagnosis of anxiety, and a lifetime diagnosis of depression. Physically inactive adults were significantly more likely than those who were physically active to have current depressive symptoms or a lifetime diagnosis of depression, whereas those who drank heavily were significantly more likely than those who did not to have current depressive symptoms or a lifetime diagnosis of anxiety. Conclusions: Depression and anxiety were strongly associated with common chronic medical disorders and adverse health behaviors. Examination of mental health should therefore be an integral component of overall health care. (Psychiatric Services 59:1383–1390, 2008)

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2008.59.12.1383

Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System.

OBJECTIVE National surveys have shown dramatic declines in the number of residents in state psychiatric hospitals since the 1950s and in the number of admissions since the 1970s. However, data from 2002 and 2005 indicate a reversal of these long-term trends. The objective of this study was to present the new data and to advocate for research on the factors contributing to these changes. METHODS This study is based on state-level data submitted annually to the Center for Mental Health Services. The 11 states showing increases in admissions and residents between 2002 and 2005 were surveyed by telephone about the factors leading to the changes. RESULTS Between 2002 and 2005, the number of admissions nationwide increased 21.1%, and the number of residents increased by 1.0%. State mental health agency staff attributed the increases principally to one factor-the increase in the number of forensic admissions and residents. Staff also identified increases in the number of admissions with schizophrenia (increased 23.2%) and affective disorders (increased 16.3%) as a second factor, plus declines in the availability of housing and community-based care providers. CONCLUSIONS The reversal of long-term trends may signal threats to the goal of community-based mental health care. Research is urgently needed to examine the factors associated with these increases. Potential factors to be investigated include the increase in the number of forensic admissions and the antecedents of this phenomenon, increases in the number of admissions with schizophrenia, the changing capacity of general hospital inpatient psychiatric services in the community, and changes in the demographic makeup of American society, reflected in an aging population and increased racial-ethnic diversity.

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.1.29

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

In the United States, schools offer special education services to children who are diagnosed with a learning or neurodevelopmental disorder and have difficulty meeting their learning goals. Pediatricians may play a key role in helping children access special education services. The number of children ages 6-21 in the United States receiving special education services increased 10.4% from 2006 to 2021. Children receiving special education services under the autism category increased 242% during the same period. The demand for special education services for children under the developmental delay and other health impaired categories increased by 184% and 83% respectively. Although student enrollment in American schools has remained stable since 2006, the percentage distribution of children receiving special education services nearly tripled for the autism category and quadrupled for the developmental delay category by 2021. Allowable heavy metal residues remain persistent in the American food supply due to food ingredient manufacturing processes. Numerous clinical trial data indicate heavy metal exposures and poor diet are the primary epigenetic factors responsible for the autism and attention deficit hyperactivity disorder epidemics. Dietary heavy metal exposures, especially inorganic mercury and lead may impact gene behavior across generations. In 2021, the United States Congress found heavy metal residues problematic in the American food supply but took no legislative action. Mandatory health warning labels on select foods may be the only way to reduce dietary heavy metal exposures and improve child learning across generations.

Raquel A. Crider

Papers

Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System.

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

Higher rates of autism and attention deficit/hyperactivity disorder in American children: Are food quality issues impacting epigenetic inheritance?