Showing papers in "Social Psychiatry and Psychiatric Epidemiology in 2010"

Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends

Abstract: Objective The aim of this study was to identify quantitative data on the use of seclusion and restraint in different countries and on initiatives to reduce these interventions. Methods Combined literature review on initiatives to reduce seclusion and restraint, and epidemiological data on the frequency and means of use in the 21st century in different countries. Unpublished study was detected by contacting authors of conference presentations. Minimum requirements for the inclusion of data were reporting the incidence of coercive measures in complete hospital populations for defined periods and related to defined catchment areas. Results There are initiatives to gather data and to develop new clinical practice in several countries. However, data on the use of seclusion and restraint are scarcely available so far. Data fulfilling the inclusion criteria could be detected from 12 different countries, covering single or multiple hospitals in most counties and complete national figures for two countries (Norway, Finland). Both mechanical restraint and seclusion are forbidden in some countries for ethical reasons. Available data suggest that there are huge differences in the percentage of patients subject to and the duration of coercive interventions between countries. Conclusions Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.

Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders

Abstract: Objective To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems.

What do predict anxiety and depression in breast cancer patients? A follow-up study

Abstract: Introduction Psychological adjustment following cancer occurrence remains a key issue among the survivors. This study aimed to investigate psychological distress in patients with breast cancer following completion of breast cancer treatments and to determine its associated factors.

Emotional and behavioral problems of Chinese left-behind children: a preliminary study

Abstract: To examine the behavioral and emotional problems and their correlates in left-behindchildren (LBC) in the Hunan Province of China. A sample of 1,274 schoolchildren (48.7% girls; 12.4 ± 2.2 years old) completed the Strength and Difficulties Questionnaire and their current caregivers completed questionnaires about caregiver/bio-parent’s demographics and teachers’ involvement with the family. There were 629 (49%) children with a history of being left behind, of which 486 were currently cared for by a relative (RLC) and 41 by a non-relative (NRC). As much as 102 had a past history of being left behind, but were currently living with one or more biological parents at the time of the survey (PLB). A total of 645 (51%) children had no history of being left behind and were included as controls. LBC had significantly more psychopathology and less pro-social behaviors than the controls. These differences, with the exception of more hyperactivity and less pro-social behaviors, disappeared after adjusting for age, education and socioeconomic status of the children, parents/caregivers, and the involvement of the teachers. The psychopathology of LBC was significantly inversely correlated with these variables. Long duration and being left behind at a younger age were significantly associated with more psychopathology. Overall, NRC showed more psychopathology, followed by PLB and then RLC. However, with the exception of pro-social behaviors, after adjusting for demographic variables and duration of being left behind, all differences disappeared. LBC are at risk to develop emotional/behavior problems, particularly if they are left behind early in life, for longer periods, in the care of young caregivers or nonrelatives with poor education and low socioeconomic status, and with less teacher support. Strategies to prevent the development of psychopathology and its amelioration, and governmental policies to decrease the rates of LBC are warranted.

Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications

Abstract: Background There is growing recognition that mental health is an important public health issue in South Africa. Yet mental health services remain chronically under-resourced. The aim of this study was to document levels of current public sector mental health service provision in South Africa and compare services across provinces, in relation to current national policy and legislation.

Brief measure of posttraumatic stress reactions: Impact of Event Scale-6

Abstract: Background The Impact of Event Scale-revised (IES-R) is one of the most widely used measures of posttraumatic stress reactions. However, for some purposes, such as large epidemiological studies, there is a need for briefer instruments. The aim of this study was to develop and validate an abbreviated version of the IES-R that could capture the three current symptom clusters of posttraumatic stress disorder (PTSD). Methods Stepwise multiple regression was applied to abbreviate the IES-R in one sample. The abbreviated version was then tested in three separate samples of individuals exposed to different kinds of potentially traumatic events. Agreement with a reference measure of PTSD, the PTSD checklist (PCL), was calculated for the abbreviated and the full-scale versions of IES. Results The abbreviation procedure resulted in a subset of six items (the IES-6), which correlated highly (pooled correlation = 0.95) with the IES-R across samples. Correlations between the IES-6 and IES-R subscales were somewhat lower (r = 0.78–0.94). Both the IES-6 and IES-R were in high agreement with the PCL. Conclusion The IES-6 appears to be a robust brief measure of posttraumatic stress reactions. It may be useful for research in epidemiological studies, and it may also have a role as a screening instrument in clinical practice.

The mental health of young children with intellectual disabilities or borderline intellectual functioning

Abstract: Objective To determine within a nationally representative sample of young Australian children: (1) the association amongst intellectual disability, borderline intellectual functioning and the prevalence of possible mental health problems; (2) the association amongst intellectual disability, borderline intellectual functioning and exposure to social disadvantage; (3) the extent to which any between-group differences in the relative risk of possible mental health problems may be attributable to differences in exposure to disadvantageous social circumstances.

Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP).

Abstract: Previous epidemiological studies have revealed a high prevalence of mental disorders among primary care (PC) patients. However, most studies have methodological limitations (e.g. absence of structured clinical interviews, two-phase designs) that affect the generalizability of their results. The main objective of the present study was to estimate the lifetime and 12-month prevalence of mental disorders in the PC of Catalonia (Spain), using structured clinical interviews and a one-phase design. One-phase cross-sectional survey. A representative probability sample without replacement of individuals aged 18 years or older attending PC for a medical visit were interviewed between October 2005 and March 2006. The interviews included SCID-I for depressive and anxiety disorders and the MINI interview for other mental disorders. A total of 3,815 patients from 77 PC centres were included in the statistical analyses. 45.1% of respondents reported at least one lifetime mental disorder and 30.2% reported at least one mental disorder in the previous 12 months. The most common mental disorders were major depression (9.6%), panic disorder (7.0%), specific phobia (6.6%), and generalized anxiety disorder (3.8%). There was a high comorbidity between mood and anxiety disorders, as well as between mental disorders and some chronic physical conditions. There is a high prevalence and comorbidity of mental disorders in the PC of Catalonia. Public health policies should reinforce the role of family physicians in the detection and treatment of persons with mental disorders.

Mental illness stigma and willingness to seek mental health care in the European Union.

Abstract: It is often assumed that individual stigmatizing attitudes toward the mentally ill are linked to stigmatizing attitudes in the social milieu and that both, individual and social stigmatizing attitudes are major barriers to mental health treatment seeking. This study aims to examine these assumptions. Data from the 2005–2006 Eurobarometer general population survey (N = 29,248) are used to examine the association of social stigmatizing attitudes assessed in a random half of the sample with individual stigmatizing attitudes assessed in the other half of the sample, and to examine the association of both individual and social stigmatizing attitudes with willingness to seek professional help. Social stigmatizing attitudes are specifically and strongly associated with individual stigmatizing attitudes. Both social and individual stigmatizing attitudes are associated with willingness to seek professional help. Believing the mentally ill to be dangerous or not likely to recover, or living in a community with such beliefs, are associated with increased willingness to seek help; whereas, believing the mentally ill to be unpredictable or blameworthy for their illness, or living in a community with strong beliefs in blameworthiness of the mentally ill, are associated with decreased willingness to seek professional help. The view that all stigmatizing attitudes toward mental illness are associated with reluctance to seek professional help may be naive as some stigmatizing attitudes may be associated with increased willingness to seek help. The complex association of different stigmatizing attitudes with professional help seeking should be carefully considered in planning anti-stigma campaigns.

Does the prevalence of CD and ODD vary across cultures

Abstract: Purpose The worldwide prevalence of conduct disorder (CD) and oppositional defiant disorder (ODD) is presented to examine the first of four criteria used in other studies to determine the validity of psychiatric disorders across cultures. Methods The authors searched Medline and PsycINFO from 1987 to 2008. Studies were included if they were representative of specific communities or countries and reported point prevalence of CD or ODD according to DSM-III-R or DSM-IV criteria for children 18 years or younger. Results Only methodological and not geographic factors were associated with variability of the prevalence estimates. Conclusions The results are discussed in terms of their significance for the classification of disorders and the need for further research to establish the validity of these two disorders across cultures.

Validation of the Chinese version of the strengths and difficulties questionnaire in Hong Kong.

Abstract: The strengths and difficulties questionnaire (SDQ) is now one of the most commonly used instruments for screening child psychiatric morbidities. Psychometric studies in the West affirm its reliability and validity, but similar studies are scarce among non-Western populations. This is an important gap because cultural differences can influence how children’s behaviours are perceived and rated. This study explores the psychometric properties of the Chinese version of the SDQ among children in Hong Kong. The SDQ was translated into Chinese. A community sample of 3,722 students between 6 and 12 years were recruited by stratified random sampling from across the whole of Hong Kong. Comparison group consisted of 494 consecutive children attending a general child psychiatric clinic. SDQ and basic socio-demographic data were collected from parents and teachers. Reliability was determined by internal consistency and test–retest stability. Validity was assessed by the questionnaire’s ability to discriminate between community and clinic samples, and ROC curves. Cutoff scores and their sensitivity, specificity, positive predictive value and negative predictive value were calculated. Our results confirm the questionnaire’s reliability and validity. The total difficulties scale and hyperactivity subscale are potentially the most useful in discriminating between community and clinic children. The emotional subscale was relatively weaker, especially with respect to teachers’ ratings. Of note also is that our normative scores are significantly higher than those reported in the West, highlighting once again the importance of examining a questionnaire’s cultural applicability. Our data support the use of the Chinese version of the SDQ, especially the total difficulties scale, as a screening instrument for psychiatric morbidities among children in Hong Kong.

Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking.

Abstract: Few studies have explored the prevalence of psychiatric disorders (PD) among university students. This article aims to study 12-month prevalence of PD in university students, their socio-economic correlates, impairment in daily life and help-seeking behaviours. Cross-sectional study of randomly selected first-year students aged 18–24 years, enrolled in one of the six universities in south-eastern France in 2005–2006. We used the WHO CIDI-Short Form to derive DSM-IV diagnoses and the Sheehan disability scale to evaluate impairment. We studied their correlates with multiple logistic regressions. The 12-month prevalence of major depressive disorder (MDD), anxiety disorders (AD) and substance use disorders (SUD) were 8.9% (95% CI: 7.2–10.9), 15.7% (95% CI: 13.5–18.2) and 8.1% (95% CI: 6.7–9.8), respectively. MDD was associated with precarious economic situation (OR = 1.83; 95% CI: 1.03–3.23), AD with a precarious job or unemployment of the father (OR = 2.08; 95% CI: 1.04–4.14) and SUD with higher educational level of father (OR = 2.17; 95% CI: 1.28–3.67) or having a paid job (OR = 1.82; 95% CI: 1.06–3.13). “Marked” or “extreme” impairment (score ≥7 for at least one of the domains in the Sheehan scale) was noted for 51.7% of students presenting a PD and was even more frequent in the presence of MDD/AD comorbidity. Only 30.5% of the students with a PD had sought professional help in the past 12 months. This study provides new results regarding university students suggesting a link between precarious economic situations and MDD. The frequent impairment arising from PD alongside low rates of help-seeking suggests that PD could be one of the factors in academic failure in first year of university. These results should be used to improve prevention and care of PD in university students in France.

Parents’ mental health and children’s cognitive and social development

Abstract: The development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children’s cognitive and social development. The study uses survey data from the Millennium Cohort Study linked with the Foundation Stage Profile assessment for children in the primary year of school in England between 2005 and 2006. The study includes 4,781 families from England where both parents’ mental health had been assessed using the Kessler 6 scale. Associations between parents’ mental health and children’s cognitive and social development were estimated using regression models. Multivariate models were used to explore the mediating role of the families’ socioeconomic resources. Gender interaction models were used to explore whether effects of parents’ mental health differ for girls and boys. The study finds lower attainment in communication, language and literacy, mathematical development and personal, social and emotional development among children whose parents were experiencing high levels of psychological distress. Parents’ age and qualifications and families’ socioeconomic resources strongly mediated the effects of parents’ psychological distress on children’s attainment, and although independent effects of mother’s mental health were maintained, effects of father’s mental health were not. Stronger effects of mothers’ mental health were found for boys than for girls. These findings highlight the interplay between the mental health of parents, families’ socioeconomic resources and children’s development which speaks for the need for close integration of mental health and social interventions to improve the well being of families.

Non-adherence with psychotropic medications in the general population

Abstract: Background Non-adherence with medications is a general medical issue that has received much attention. However, the majority of studies have been on various clinical populations and the relevance of their results to the general population is unknown. In this study, we sought to determine the degree of non-adherence with antidepressants, antipsychotics, anxiolytics, mood stabilizers and sedative hypnotics, and to determine the reasons for non-adherence, in the general population of Canada.

Adolescent risk factors for excessive alcohol use at age 32 years. A 16-year prospective follow-up study

Abstract: To examine which socioeconomic, family, personal and lifestyle risk factors in adolescence were the strongest independent predictors of excessive alcohol use in adulthood. In a prospective longitudinal study, all 16-year-olds of one Finnish city completed questionnaires at school, and were followed up by postal questionnaires at 32 years of age [n = 1,471, (females n = 805, males n = 666); response rate 70.3%). The alcohol use disorders identification test (AUDIT) was used to assess alcohol use in adulthood. AUDIT scores of 8 or more for females and 10 or more for males were classified as excessive alcohol use. Adolescent risk factors examined were parental social class, school performance, depressive symptoms, self-esteem, impulsiveness, parental divorce, relationships with parents, parental trust, health behaviour, leisure-time spent with friends, dating, and problems with the law. All the socioeconomic, family, personal, and lifestyle variables in adolescence, except parental social class in both genders and self-esteem among females, showed significant univariate associations with excessive alcohol use at age 32 years. Multivariate logistic regression analysis showed that among adolescent males, parental divorce, moderate and high level of depressive symptoms, leisure-time spent daily among friends and moderate and drunkenness-orientated drinking were the strongest predictors of excessive alcohol use in adulthood. Among females, the strongest adolescent predictors of excessive alcohol use in adulthood were drunkenness-orientated drinking and frequent smoking. Early interventions for adolescent substance use and a set of specific psychosocial risk factors should be tailored and evaluated as methods for identifying those at high risk of and preventing excessive alcohol use in adulthood.

The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams

Abstract: Personality status is seldom assessed in community mental health teams except at a rudimentary level This study challenges the assumption that this policy is either prudent or wise To measure the prevalence of personality disorder within community mental health teams and to investigate its relationship to mental state disorders and overall pathology A cross-sectional survey of 2,528 of 2,567 psychiatric patients (985%) managed by community mental health teams in four urban settings in the UK in which diagnoses of personality and mental state pathology were assessed separately Of these, a sample of 400 was interviewed, with a 705% completion rate for more in depth information In total, 40% of all patients in secondary care suffered from at least one personality disorder Regression modelling showed personality pathology accounted for a greater degree of global psychopathology than psychosis, alcohol or drug dependence, but was associated with anxiety disorders Comorbid personality pathology contributes greatly to overall psychopathology in secondary psychiatric care It should be both recognised and managed

Community conversation: addressing mental health stigma with ethnic minority communities.

Abstract: Stigma associated with mental health problems is a significant public health issue. Patterns of stigma and discrimination vary between and within communities and are related to conceptualisations of, and beliefs about, mental health. Population approaches to addressing stigma rarely consider diverse cultural understandings of mental health. 257 members of the major black and minority ethnic communities in Scotland participated in 26 mental health awareness workshops that were designed and delivered by community organisations. Questionnaires measuring knowledge, attitudes and behavioural intent were completed before and after the intervention. Community led approaches that acknowledge cultural constructs of mental health were received positively by community groups. The study found significant reported stigma in relation to public protection, marriage, shame and contribution, but also high levels of recovery optimism. The workshops resulted in significant positive change in relation to knowledge, attitudes and behavioural intent amongst participants, with most aspects of stigma showing significant improvement, with the exception of dangerousness. The paper argues community approaches to tackling stigma are more valuable than top-down public education and could form the basis of national initiatives. Refinements to the evaluation framework are considered.

Pain associated with specific anxiety and depressive disorders in a nationally representative population sample

Abstract: Objective To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use. Method A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18‐65 years using the DSMIV/M-CIDI. Results Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9‐2.0), to unexplained pain symptoms (UPS; OR range: 2.4‐7.3), to PD (OR range: 3.3‐14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates. Conclusions Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status?

Abstract: Objective The negative association between religiosity (religious beliefs and church attendance) and the likelihood of substance use disorders is well established, but the mechanism(s) remain poorly understood. We investigated whether this association was mediated by social support or mental health status.

The prevalence of autism spectrum disorders: impact of diagnostic instrument and non-response bias.

Abstract: A large part of the variability in rates of autism spectrum disorders (ASD) across studies is non-aetiologic, and can be explained by differences in diagnostic criteria, case-finding method, and other issues of study design. To investigate the effects on ASD prevalence of two methodological issues; non-response bias and case ascertainment. We compared the findings of using a semi-structured parent interview versus in-depth clinical assessment, including an ASD specific interview. We further explored whether including information on non-responders affected the ASD prevalence estimate. A total population of 7- to 9-year olds (N = 9,430) was screened for ASD with the autism spectrum screening questionnaire (ASSQ) in the Bergen Child Study (BCS). Children scoring above the 98th percentile on parent and/or teacher ASSQ were invited to participate in the second and subsequently in the third phase of the BCS where they were assessed for ASD using the Development and Well-Being Assessment (DAWBA), and the Diagnostic Interview for Social and Communication disorders (DISCO), respectively. Clinical assessment using DISCO confirmed all DAWBA ASD cases, but also diagnosed additional cases. DISCO-generated minimum prevalence for ASD was 0.21%, whereas estimated prevalence was 0.72%, increasing to 0.87% when adjusting for non-responders. The DAWBA estimate for the same population was 0.44%. Large variances in prevalence rates across studies can be explained by methodological differences. Both information about assessment method and non-response are crucial when interpreting prevalence rates of ASD.

Suicide and marital status in Northern Ireland

Abstract: Introduction Studies show marriage to be protective against suicide though with variation in the extent to which suicide rates are higher among the never married, separated or divorced and widowed. We examined suicide in Northern Ireland by marital status and examined whether the observed variation differed by sex and age.

The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country

Abstract: Deinstitutionalization has led to a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds. Another consequence of deinstitutionalization has been the phenomenon of the revolving door patient; high-frequency users (HFUs) admitted to hospital repeatedly, remaining well for only short periods of time. The purpose of the study was to determine factors that contribute to HFU of inpatient psychiatric services by schizophrenia and schizo-affective disorder subjects in a developing country with a view to understanding this phenomenon better. Subjects were divided into HFU and low-frequency user (LFUs) groups for comparison with regard to selected variables. HFUs had higher PANSS scores (p < 0.01), were more likely to admit to lifetime substance use (p = 0.01), be on mood stabilizers (p < 0.01) and also to have been crisis (premature) discharges (p < 0.01). LFUs were more likely to have been treated with depot medication (p < 0.01). Multivariate analysis showed crisis discharge (p = 0.03) and depot use (p = 0.03) to be the only remaining significant predictors of HFU versus LFU status. Our findings suggest HFUs’ characteristics to be similar across different settings, with under-utilization of depot antipsychotics and early discharge from hospital as particular contributors to high-frequency use of services in our sample. Results seem to indicate that HFU-specific interventions are vital to addressing these issues.

First episode psychosis and the trail to secondary care: help-seeking and health-system delays

Abstract: People experience delays in receiving effective treatment for many illnesses including psychosis. These delays have adverse consequences in heart disease and cancer, and their causes have been the subject of much research but only in recent years have pathways to care in psychosis received such attention. We sought to establish if, when and where people seek help in the early phase of psychosis in a representative sample. One hundred and sixty-five people with first episode psychosis, referred from community-based psychiatric services and a private psychiatric facility to an early intervention service over 18 months, were interviewed with the Structured Clinical Interview for DSM-IV diagnoses. Symptoms were measured using the Schedule for the Assessment of Positive Symptoms, Schedule for the Assessment of Negative Symptoms and the Calgary Scale. Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were established using the Beiser Scale. Pathways to mental health services were systematically detailed through interviews with patients and their families. The final sample consisted of 142 (88M, 54F) cases after those with psychosis due to a general medical condition and those without pathway and DUP data were excluded. Less than half of participants initiated help seeking themselves. Of those who did seek help (n = 57) 25% did so during the DUI. Those who had a positive family history of mental illness and poorer premorbid adjustment were significantly less likely to seek help for themselves and those who did not seek help were more likely to require hospitalisation. Families were involved in help seeking for 50% of cases and in 1/3 of cases did so without the affected individual participating in the contact. Being younger and having more negative symptoms were associated with having one’s family involved in help seeking. Delays to effective treatment from the onset of psychosis were evenly split between “help-seeking delays” and “health-system delays”. Having a family member involved in help seeking and better premorbid adjustment were independently associated with shorter help-seeking delays when measured from the onset of psychosis. Being female, having better premorbid adjustment and fewer negative symptoms were associated with shorter help-seeking delays from the onset of illness. Those with a non-affective psychosis had significantly longer system delays. Many people with first episode psychosis do not initiate help-seeking for themselves particularly those with a relative affected by mental illness. Those with poor premorbid adjustment are at particular risk of longer delays. Poor premorbid adjustment compounded by long delays to effective treatment reduces the likelihood of a good outcome. Families play a vital role in hastening receipt of effective treatment.

'Hidden' suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan

Abstract: Objective To identify cause-of-death categories in which suicides might be misclassified in Taiwan.

The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample

Abstract: The stigma of mental illness has been shown to be affected by personal contact with mental illness and by a belief in the genetic heritability of mental illness. We use data from a nationally representative survey to test whether the relationship of stigma with contact remains after taking into account the effects of genetic beliefs and other background characteristics. Contact was defined as a history of psychiatric hospitalization among respondents themselves, their family members, or their friends. Respondents answered questions about a vignette character with a mental illness. We found that respondents with contact felt less anger and blame toward the character, thought that the character had a more serious problem, and would want less social distance from the character, including both casual and intimate aspects of social distance. Respondents with contact were not significantly different from the general population in the degree to which they expressed sympathy, thought the problem would last a lifetime, or wanted to restrict reproduction. Thus, contact is associated with having a less ostracizing, critical attitude toward a stranger with mental illness. The results underscore the importance of this experienced group as a resource in fighting stigma in society. Since many people who have had a psychiatric hospitalization have not told their friends or family members about it, this lower-stigma group could be enlarged.

Sri Lankan doctors' and medical undergraduates' attitudes towards mental illness.

Abstract: Background Stigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by Sri Lankan doctors and medical students and compared these with equivalent UK and other international data.

Family factors and children’s disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD

Abstract: Oppositional defiant disorder behaviours (ODD) and attention deficit/hyperactivity disorder symptoms (ADHD) are common disruptive childhood problems and co-occur to a large extent. In this study, prime questions were the specificity of relations between demographic factors and negative life events, respectively, and ADHD and ODD symptoms, and the role of negative life events in the relations between demographic factors and ODD and ADHD symptoms. Concurrent relations between maternal education, family structure, ethnicity/immigrant background and symptoms of ADHD and ODD were investigated in a Swedish population sample of 1,200 10-year-old children (52% boys). Parents completed questionnaires containing information about demographic characteristics and negative life events and rated the child’s ADHD and ODD symptoms using DSM-IV criteria. Low maternal education, single/step-parenthood and non-European descent were associated with higher numbers of ODD and ADHD symptoms. Regression analyses identified ethnicity as specifically associated with ODD symptoms and single/step-parenthood as specific to ADHD symptoms, while there was no specificity with regard to negative life events. Experiences of multiple negative life events were more common in families in non-optimal circumstances. Negative life events had mainly additive effects on the level of ODD and ADHD symptoms above effects of the demographic stressors and especially conflicts between adults around the child were related to high symptom levels. The few gender effects pointed to boys as being more vulnerable than girls to non-optimal family factors expressed in relations to ODD and ADHD symptoms. Even in an affluent and egalitarian society, children’s life circumstances are related to their mental health. Further, there seems to be some specificity in the demographic risk factors associated with ODD and with ADHD symptoms, while negative life events act as general stressors.

Prevalence of psychiatric disorders in a Brazilian birth cohort of 11-year-olds

Abstract: Objective To estimate the prevalence of psychiatric disorders in preadolescents aged 11–12 years from a birth cohort in a southern Brazilian city.

Self-stigma, stages of change and psychosocial treatment adherence among Chinese people with schizophrenia: a path analysis

Abstract: Mental illness stigma is one of the key causes for poor psychosocial treatment adherence. The objective of this study was to explore the link between self-stigmatization and adherence via path analysis with insight and readiness for change conceptualized as the possible mediators. The direct effects of psychopathology causing non-adherence were also tested. One hundred and five participants with schizophrenia were recruited from five psychiatric settings in Hong Kong. Data concerning their level of stigma, insight, stages of change, psychopathology, and psychosocial treatment adherence were collected. Path analysis was used to test two hypothetical models. The findings supported the direct effects of self-stigma on reducing psychosocial treatment adherence, and its indirect influences mediated by insight and stages of change on treatment adherence. Psychopathology was also found to have a direct effect on undermining adherence. This model showed better model fit than the one which did not consider the direct effects of self-stigmatization and psychopathology. To conclude, this study deepened our understanding on the mechanism explaining how self-stigmatization undermines psychosocial treatment adherence. The findings provide direct implications on ways of formulating a self-stigma reduction program to combat self-stigma and its negative consequences.

Involuntary admission from the patients' perspective.

Abstract: Involuntary admission legislation and rates differ greatly throughout the European Union Member States. In Ireland, the Mental Health Act 2001 has introduced significant changes in the care for patients admitted involuntarily, including mental health tribunals that review the involuntary admission orders. To investigate (1) people's perception of the involuntary admission, (2) awareness of legal rights and perception of tribunal, (3) the impact of being admitted involuntarily on the relationship with their family, consultant psychiatrist and prospects for future employment. Over a 15-month period patients admitted involuntarily to a Dublin Hospital were interviewed using a semi structured interview. Eighty-one people participated in the study. Seventy-two percent of patients believed that their involuntary admission was necessary at the time and this was associated with greater insight into illness. A total of 77.8% of patients felt that the treatment they received had been beneficial. A total of 86.4% of patients were aware that they had been admitted involuntarily and 45.5% of patients found it easier to accept that they had been admitted involuntarily as their case was reviewed by a tribunal. A total of 27.5% experienced a negative impact upon the relationship with their family as a result of the involuntary admission, while for 15% there was a positive impact. For 26.6% of patients the doctor-patient relationship was negatively impacted upon and a third felt their prospects for employment could be affected. The majority of patients reflect positively on their involuntary admission and this opportunity should be used to engage patients in follow-up treatment.