EPA guidance on mental health and economic crises in Europe.

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

PURPOSE: To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. METHODS: Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. DATA SOURCE: Spanish Hospital Morbidity Survey. RESULTS: The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. CONCLUSIONS: After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study.

BACKGROUND: Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited. The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors. METHOD: A 2-year randomized controlled trial with blind assessments. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and/or previous clinical relapse were allocated to psychosocial family intervention, individual counselling and standard treatment versus individual counselling and standard treatment. RESULTS: Family intervention was associated with fewer clinical relapses, hospitalizations and major incidents, and an improvement in positive and negative symptoms, social role performance, social relations, employment and family burden. The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group. The effects of family intervention were independent of compliance and prognostic factors. CONCLUSIONS: Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors.

Prevalence, comorbidity, risk factors and service utilisation of disruptive behaviour disorders in a community sample of children in Valencia (Spain).

BACKGROUND: The importance of cultural and adverse family-environment variables as risk factors for Disruptive Behaviour Disorder has been repeatedly shown, and hence a variation in rates and risk factors between cultures could be expected. Lower rates should be found in countries with strong and stable family ties, such as Spain. OBJECTIVE: Prevalence rate, severity and comorbidity of Disruptive Behaviour Disorder, as well as risk factors and help-seeking behaviour relating to this disorder, were studied in a general population random sample of 387 10 year-old children living in Valencia (Spain). METHODS: DSM-III-R diagnosis was established by means of the KIDDY-SADS (Kiddy Schedule for affective diseases and Schizophrenia (epidemiological version)) interview and severity of the disorder was evaluated with the General Assessment Functioning (GAF) Scale. Other variables measured were: sex, number of siblings, parental occupation, single-parent home, school failure, socioeconomic level, chronic somatic ailments and use of mental health services. RESULTS: Prevalence and severity parameters were low (for GAF70, prevalence = 11.1; for GAF60, prevalence = 4.9), albeit falling within the range reported in other countries. Morbidity profile and use of services did not substantially depart from the findings reported in other cultures. Different risk factors were associated with Attention Deficit Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder, thus confirming the validity of considering them as separate dimensions. CONCLUSIONS: The findings did not support the hypothesis of lower rates and different risk factors and morbidity patterns in the Spanish sample studied.