Impact of the mental health reform in Israel on health care and mortality among people with severe mental illness.

OBJECTIVE: Reports show disparities in the health care of people with severe mental illness (SMI). Yet, the moderating effect of mental health reforms on the health care disparities remain unexplored. The current study aimed to investigate the outcomes of the mental health reform in Israel on the use of health services among people with SMI. METHOD: A case-control epidemiological study comparing the use of health services 3.5 years before and after the mental health reform for service users diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder. Data on health services included: blood cholesterol test (LDL), hemogalobin-A1C test, and visits to general practitioners (GPs) and specialists. Mortality was recorded. RESULTS: Following the reform the number of visits to GPs was decreased among service users of the three SMI groups, as well as visits to specialists among service users with a schizoaffective or bipolar disorder. Following the reform service users of the three SMI groups showed no-change in the performance of LDL test. Complex findings were noted with regard to the performance of Hemoglobin-A1C test. Mortality rates were higher among service users with SMI and the relative risk were similar before and after the reform. CONCLUSIONS: Users of the three SMI groups showed no benefits of the mental health reform in terms of use of health services. Improved health care can be attained by a closer collaboration between the primary physicians and community mental health services.

Early adulthood psychiatric diagnoses and the subsequent risk of life-time incarceration: a cohort study.

BACKGROUND: The association between incarceration and psychiatric disorders has been noted. Yet, existing studies are cross-sectional or examine the risk of recidivism, which has limited the predictive validity of psychiatric disorders as a risk factor for incarceration. To overcome this limitation, this study used a prospective cohort to examine whether psychiatric diagnoses in early adulthood predicted incarceration throughout a 30-year follow-up. It tested the association between psychiatric diagnoses with future incarcerations, their number and durations, controlling for education and ethnic status. METHODS: This study merged data from three sources in Israel: a prospective 10-year birth cohort study of young adults aged 25-34, conducted in the 1980s (N = 4914) that included a psychiatric interview; data from the Prison Service, including the cause, number and duration of incarcerations; and from the Vital Statistics Registry on death records. RESULTS: Multivariate analysis showed that substance-use disorders, antisocial personality and lower levels of education predicted future incarceration, their number and maximum duration. The remainder diagnoses were not significantly associated with future incarceration. CONCLUSIONS: Results limited the prediction of future incarcerations to persons diagnosed with substance use and antisocial personality, and do not support an independent predictive association between additional psychiatric diagnoses and future incarceration.

Exposure to Genocide and the Risk of Dementia.

Competing hypotheses stating that past genocide exposure reduces (owing to resilience) versus increases (owing to vulnerabilities) the risk of dementia are yet to receive empirical support. This study tested these competing hypotheses. Registry data were extracted on 51,752 Israeli residents without dementia from September 2002 to January 2012; individuals were born between 1901 and 1945, alive on January 2012, and followed-up for the risk of dementia between January 2013 and October 2017. Groups were classified as exposed to the European Holocaust, based on government recognition, or unexposed. Hazard ratios (HRs) from Cox regression models were used to quantify the risk of dementia between the groups, adjusting for demographic and diagnostic covariates; additionally, 12 sensitivity analyses were computed. In total 10,780 participants (20.8%) were exposed to the Holocaust and 5,584 (10.8%) were diagnosed with dementia during follow-up. Dementia rates were 16.5% in the Holocaust-exposed group and 9.3% in the unexposed group. In the primary analysis, the estimated unadjusted HR of dementia for the exposed compared to the unexposed group was 1.77, 95% CI [1.67, 1.87], and the adjusted HR was 1.21, 95% CI [1.15, 1.28]. Sensitivity analyses significantly replicated the primary results with similar point estimates, adjusted HRs = 1.18-1.28, all ps < .001; all HRs had a small effect size. The current study results are consistent with the hypothesis that exposure to the extreme adversities of genocide heightens vulnerability to the risk of dementia in later life.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Exposición al Genocidio y el Riesgo de Demencia EXPOSICIÓN A GENOCIDIOS Y RIESGO DE DEMENCIA Existen hipótesis contradictorias que indican que la exposición pasada al genocidio, por un lado, reduce (debido a la resiliencia), y por otro, aumenta (debido a las vulnerabilidades) el riesgo de demencia, aún no han recibido apoyo empírico. Este estudio puso a prueba estas hipótesis en competencia. Los datos fueron tomados de un registro de 51,752 residentes israelíes, sin demencia, desde Septiembre del 2002 hasta Enero del 2012; los individuos nacieron entre 1901 y 1945, y se encontraban vivos a Enero del 2012, y con un seguimiento de riesgo de demencia entre Enero del 2013 y Octubre de 2017. Los grupos fueron clasificados como expuestos al Holocausto Europeo, basado en el reconocimiento del gobierno, o no expuestos. Se utilizaron cocientes de riesgos instantáneos (Hazard Ratio, HR en delante de acuerdo con su sigla en inglés) de modelos de regresión de Cox para cuantificar el riesgo de demencia entre los grupos, ajustándolo a las covariables demográficas y diagnósticas. Adicionalmente, se computaron 12 análisis de sensibilidad. Un total de 10,780 participantes (20.8%) fueron expuestos al Holocausto y 5,584 (10.8%) fueron diagnosticados con demencia durante el seguimiento. Las tasas de demencia fueron del 16.5% en el grupo expuesto al Holocausto y el 9.3% en el grupo no expuesto. En el análisis primario, el HR estimado no ajustado de demencia fue de 1.77, IC del 95% [1.67, 1.87], para el grupo expuesto en comparación con el grupo no expuesto, y el HR ajustada fue de 1.21, IC del 95% [1.15, 1.28]. Los análisis de sensibilidad replicaron significativamente los resultados primarios con estimaciones puntuales similares, HR ajustadas = 1.18-1.28, todos los ps <.001; todos los HR tuvieron un tamaño efecto pequeño. Los resultados del presente estudio son consistentes con la hipótesis de que la exposición a las adversidades extremas como el genocidio aumenta la vulnerabilidad para el riesgo de demencia en edad avanzada.

Mental Health Care Gap: The Case of the Slovak Republic.

This study explored unmet mental health and social care needs in the Slovak Republic and their adverse human rights consequences. We estimated treatment gap for persons aged 15-64 years in year 2015 affected by depressive, anxiety, substance use and schizophrenic disorders by comparing local treated prevalence rates with population estimated rates for Europe. Two-thirds of people with depressive disorders and over 80% of those with anxiety disorders and alcohol dependence were not receiving treatment. There was no treatment gap for persons with schizophrenia. Fifty-one percent of those eligible for disability pension on the grounds of mental disorders failed to receive it. We discuss the implications of the estimated gaps in mental health and social care and consequent human rights violations that may result from the current system of mental health care in Slovakia.

Health Care and Mortality among Persons with Severe Mental Illness.

OBJECTIVE: Reports show disparities in the health care of persons with severe mental illness (SMI), including in countries with universal health insurance. However, the moderating effect on disparities of specific mental health legislation is yet to be studied. The study aimed to investigate equality of health care for people with SMI in a country with a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities. METHOD: A case-control epidemiological study compared health services (laboratory tests, visits to specialists, and medications) provided to users with and without a history of schizophrenia and bipolar disorder ( N = 52,131) and with regard to a subgroup of users with diabetes ( n = 16,280). In addition, we examined the mortality rates of the study population. RESULTS: While service users with schizophrenia were somewhat less likely to meet the same indexes of care as controls, those with bipolar disorder did not differ from their counterparts. Yet, mortality risk among service users with schizophrenia and bipolar disorder was 2.4 and 1.7 times higher, respectively. Rates of services to persons with SMI and comorbid diabetes did not differ from their counterparts. CONCLUSIONS: In Israel, a country with a national health insurance and a rehabilitation law for persons with mental disabilities, service users with bipolar disorder receive equitable levels of general health care. For users with schizophrenia, the disparities exist in some of the health care measures but to a smaller extent than in other countries with universal health insurance. In contrast, mortality rates are elevated in persons with SMI.

Holocaust exposure and subsequent suicide risk: a population-based study.

OBJECTIVES: To examine the association between the extent of genocide exposure and subsequent suicide risk among Holocaust survivors. METHODS: Persons born in Holocaust-exposed European countries during the years 1922-1945 that immigrated to Israel by 1965 were identified in the Population Registry (N = 209,429), and followed up for suicide (1950-2014). They were divided into three groups based on likely exposure to Nazi persecution: those who immigrated before (indirect; n = 20,229; 10%), during (partial direct; n = 17,189; 8%), and after (full direct; n = 172,061; 82%) World War II. Groups were contrasted for suicide risk, accounting for the extent of genocide in their respective countries of origin, high (>70%) or lower levels (<50%). Cox model survival analyses were computed examining calendar year at suicide. Sensitivity analyses were recomputed for two additional suicide-associated variables (age and years since immigration) for each exposure group. All analyses were adjusted for confounders. RESULTS: Survival analysis showed that compared to the indirect exposure group, the partial direct exposure group from countries with high genocide level had a statistically significant (P < .05) increased suicide risk for the main outcome (calendar year: HR 1.78, 95% CI 1.09, 2.90). This effect significantly (P < .05) replicated in two sensitivity analyses for countries with higher relative levels of genocide (age: HR 1.77, 95% CI 1.09, 2.89; years since immigration: HR 1.85, 95% CI 1.14, 3.02). The full direct exposure group was not at significant suicide risk compared to the indirect exposure group. Suicide associations for groups from countries with relative lower level of genocide were not statistically significant. DISCUSSION: This study partly converges with findings identifying Holocaust survivors (full direct exposure) as a resilient group. A tentative mechanism for higher vulnerability to suicide risk of the partial direct exposure group from countries with higher genocide exposure includes protracted guilt feelings, having directly witnessed atrocities and escaped death.

Predictors of mental health care stigma and its association with the therapeutic alliance during the initial intake session.

OBJECTIVE: We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake. METHOD: Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory - Bond Scale. RESULTS: Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = -.22), but not with those of clients. CONCLUSIONS: Care stigma is present among service-users and may affect outcomes of the intake.

Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys.

OBJECTIVE: This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. METHODS: Data were derived from the World Mental Health Surveys (N = 66,387; n = 357 active cancer, n = 1373 cancer survivors, n = 64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12 months. Cancer status was ascertained by self-report of physician's diagnosis. RESULTS: Twelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE = 2.1) than cancer-free respondents (13.3%, SE = 0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR) = 1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE = 0.9) compared with cancer-free respondents did not differ significantly (AOR = 0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12 months, 59% sought services for mental health problems (SE = 5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE = 6.0; 41.2%, SE = 3.0; 35.6%, SE = 0.6) and low-middle-income countries (46.4%, SE = 11.0; 22.5%, SE = 9.1; 17.4%, SE = 0.7). CONCLUSIONS: Community respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors.

Cancer incidence and mortality following exposures to distal and proximal major stressors.

PURPOSE: Severe psychological trauma has been shown to leave psychological and biological sequelae, including compromise of the neuro-hormonal and immunological systems. Despite much research, the putative effect of such stressor on cancer remains ambiguous. This study maximized the exploration of cancer incidence and mortality by combining a proximal (parental bereavement) with a distal major stressor (Holocaust exposure) on both risks. METHODS: Subjects were bereaved Holocaust survivors (n = 904) and comparison individuals (n = 933) selected from the total cohort of 6,284 Jewish-Israeli parents who lost an adult son in war or from non-self-inflicted external causes. Cox regression was used to examine the differential risk for cancer between the two bereaved samples, adjusting for potential confounders. RESULTS: No difference in cancer incidence or mortality was observed between both groups of bereaved parents. However, prior to bereavement, Holocaust survivors had an increased cancer risk compared with their counterparts in the general population. CONCLUSIONS: Individuals who faced both a proximal (bereavement) and distal (Holocaust) major stressors had no additive risk for cancer incidence and mortality.

The effect of cancer on suicide in ethnic groups with a differential suicide risk.

This study examined the suicide risk among persons with cancer in ethnic groups with differential suicide mortality in the general population. We calculated the suicide standardized incidence ratios (SIRs) among Europe-America and Asia-North Africa-born Israelis with cancer, relative to the respective rates in the general population. The SIRs were higher in the European-American group [men: 1.96, 95% confidence interval (CI) 1.62-2.30; women: 2.03, 95% CI 1.51-2.56], but not significantly different in the Asian-North African group (men: 0.86, 95% CI 0.52-1.20; women: 0.80, 95% CI 0.10-1.50). Assessment of suicide risk must consider the 'suicide culture' of the person with cancer.

Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries.

OBJECTIVE: To outline mental health service accessibility, estimate the treatment gap and describe service utilization for people with schizophrenic disorders in 50 low- and middle-income countries. METHODS: The World Health Organization Assessment Instrument for Mental Health Systems was used to assess the accessibility of mental health services for schizophrenic disorders and their utilization. The treatment gap measurement was based on the number of cases treated per 100,000 persons with schizophrenic disorders, and it was compared with subregional estimates based on the Global burden of disease 2004 update report. Multivariate analysis using backward step-wise regression was performed to assess predictors of accessibility, treatment gap and service utilization. FINDINGS: The median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100,000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap. CONCLUSION: The treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries.

Ethnic differentials in mental health needs and service utilization among persons with cancer.

PURPOSE: Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n = 1,430) and Arab-Israeli (n = 141) persons with cancer. METHODS: We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010-April 2011). RESULTS: While 12% of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5% of the charts of the Arab-Israeli sample had a similar record (χ² = 4.4, p < .05). Similarly, in a higher percentage of the charts of the Jewish-Israeli sample, the current utilization of psychotropics (18.2 and 5.6%, respectively; χ² = 6.7; p < .01) and/or psychotherapy (7.8 and 1.4%, respectively; χ² = 3.6; p < .05) was noted compared with the Arab-Israeli sample. Also, in a higher percentage of the charts of the Jewish-Israeli patients, a referral for psychotherapy was recorded compared with their Arab counterparts (9.1 and 4.3% respectively; χ² = 6.3; p < .05). In contrast, 19.1% of the Arab-Israelis were recommended with welfare assistance compared to their Jewish-Israeli counterparts, 10.5% (χ² = 5.35; p < .05). CONCLUSIONS: Despite methodological limitations, findings confirm past research showing that disadvantaged ethnic minorities may receive differential recommendations for mental health problems among persons with cancer. This may contribute to the differential treatment gap in mental health care among persons with cancer of contrasting ethnic groups.

The association between depression and parental ethnic affiliation and socioeconomic status: a 27-year longitudinal US community study.

PURPOSE: This study examined the extent to which parental SES and ethnic affiliation during adolescence are associated with Center for Epidemiologic Studies Depression Scale (CES-D) scores compatible with depression during adulthood. METHODS: The data were extracted from the US National Longitudinal Survey of Youth (NLSY79) conducted in 1979 on several ethnic groups (African-Americans, Hispanics and Others). These data included paternal socio-economic status (SES) when respondents (N = 8,331) were on average aged 18. The CES-D was re-administered 27 years later to assess the presence of depression. RESULTS: Adjusted for age, binary logistic regression modeling showed that parental low SES increased the risk of CES-D of scores compatible with depression across ethnic groups for both genders. A gradient was observed of an increased likelihood of depression scores with lower parental SES levels: among African-American respondents, depression scores were highest at the lowest parental SES levels (OR = 3.25, 95% CI 2.19-4.84) and the risk dropped at medium (OR = 3.00, 95% CI 1.96-4.59), and highest SES levels (OR = 1.85, 95% CI 1.12-3.07). An analogous pattern was generally found for each ethnic group. CONCLUSIONS: Low parental SES during adolescence significantly increases the likelihood of CES-D scores compatible with depression during adulthood across US ethnic groups and in both genders.

Suicidal behavior among Muslim Arabs in Israel.

PURPOSE: Countries with Muslim populations report relatively lower rates of suicide. However, authors have noted methodological flaws in the data. This study examined reliable rates of completed suicide, suicide ideation, planning and attempts among Muslims as compared to Jews in Israel. METHODS: For completed suicide, information was extracted from death certificates (2003-2007); the National Emergency Room Admissions Database (NERAD) provided data on suicide attempts (2003-2007); and the Israel National Health Survey (INHS) (2003-2004) was used for self reports on lifetime suicide ideation, planning and attempts. RESULTS: Completed suicide rates among Muslim-Israelis (3.0 per 100,000) were lower compared to Jewish-Israelis (8.2 per 100,000). Based on NERAD, attempted suicide rates among men were lower for Muslims compared to Jews, while among women aged 15-44 no differences were found. In the INHS, the rate of self-reported lifetime suicide attempts was significantly higher among Muslims (2.8%) compared to Jews (1.2%), while lifetime prevalence rates of suicide ideation (6.6%) and planning (2.1%) in Muslims did not differ from Jews (5.2 and 1.9%, respectively). CONCLUSIONS: Conceivably, the lower rate of completed suicide among Muslim-Israelis might be explained by the strenuous proscription of suicide by the Koran. However, its extension to suicide attempts is equivocal: attempts were higher among Muslims than among Jews according to self-reports but lower in the NERAD records. Social pressures exerted on the reporting agents may bias the diagnosis of self-harm in both the latter data source and in the death certificates.

Psychopathology among adults abused during childhood or adolescence: results from the Israel-based World Mental Health Survey.

Childhood and adolescence abuse is a risk factor for later psychopathology. We examined the association between the age when sexual (SA) and physical (PA) abuse first occurred and mood and anxiety disorders and their respective age of onset, emotional distress, and sleep disturbances. Data were gathered from the Israel-based component of the World Mental Health Survey (N = 4859). Abuse was elicited by direct questions. Psychiatric disorders were diagnosed with the Composite International Diagnostic Interview, emotional distress with the 12-item General Health Questionnaire, and sleep disturbances by self-report. Multivariate analyses indicated an increased risk for psychopathology among subjects who reported childhood SA and PA. SA was associated with lifetime mood (odds ratio [OR] = 1.7) and anxiety (OR = 2.3) disorders; PA with lifetime anxiety disorder (OR = 2.8); and any abuse with increased risk for lifetime mood (OR = 1.7) and 12-month anxiety disorders (OR = 1.8). Earlier onset of SA or PA was associated with increased risk for later psychopathology.

Smoking behaviour under intense terrorist attacks.

BACKGROUND: Smoking is one of the varied psychological reactions to stress. This study examined the rate and changes in cigarette smoking among former Gaza and current West Bank Jewish settlers subjected to direct and indirect terrorist attacks during the Al-Aksa Intifada. The relationship with degree of religious observance and emotional distress was explored as well. METHODS: In this cross-sectional study, the respondents were settlers randomly selected and interviewed by telephone (N = 706). The interview schedule included socio-demographic items, information on direct exposure to terrorist attacks (e.g. threat to life or physical integrity, personal losses, property damage) and on steady and changes in smoking habits, and a scale to measure emotional distress. RESULTS: In contrast with the country population, a larger percentage of settlers who smoked increased the number of cigarettes consumed with exposure to terrorism (10 and 27%, respectively). Respondents who were injured or had their home damaged reported a higher rate of smoking during the preceding year (30 and 20%, respectively). Emotional distress was related to cigarette smoking, but not in the controlled analysis. Religious observance had no effect. CONCLUSION: Direct or indirect exposure to terrorist attacks had an impact on smoking prevalence rates and on changes in smoking habits. Studies investigating reactions to traumatic events should include a detailed section on smoking while mental health interventions should address the needs of smokers.

Suicidal behavior among immigrants.

INTRODUCTION: This paper explores the association between suicidal behavior and immigrant status among Israeli residents from the former USSR (FSU). METHOD: The Israeli component of the World Mental Health Survey (INHS) provided information on suicide ideations, plans and attempts. The INHS samples included Israel-born Jews (n = 2,114) and post-1990 immigrants from the FSU (n = 814). Data on completed suicide were extracted from the countrywide report of the Ministry of Health. RESULTS: The controlled lifetime rates of suicidal behavior among FSU immigrants were significantly higher than among their Israel-born counterparts. A higher risk was found in the first years following immigration among young adults with higher education and without a spouse. Completed suicide rates were higher among the FSU immigrants than in the general Israeli population with the largest risk among young-adult immigrant men. DISCUSSION: The findings are consistent with previous studies and are discussed in the context of both suicide rates in the country of origin and migratory stressors. Preventive measures are suggested.

Prevalence and correlates of mental disorders in Israeli adolescents: results from a national mental health survey.

BACKGROUND: The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence-based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004-2005 in a representative sample of 957 adolescents aged 14-17 and their mothers. METHODS: The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio-demographic and health correlates. Disorders were ascertained with the Development and Well-Being Assessment inventory and verified by child psychiatrists. RESULTS: The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. CONCLUSIONS: The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society.

Psychiatric disorders and other health dimensions among Holocaust survivors 6 decades later.

BACKGROUND: No previous community-based epidemiological study has explored psychiatric disorders among those who survived the Holocaust. AIMS: To examine anxiety and depressive disorders, sleep disturbances, other health problems and use of services among individuals exposed and unexposed to the Holocaust. METHOD: The relevant population samples were part of the Israel World Mental Health Survey. The interview schedule included the Composite International Diagnostic Interview and other health-related items. RESULTS: The Holocaust survivor group had higher lifetime (16.1%; OR = 6.8, 95% CI 1.9-24.2) and 12-month (6.9%; OR = 22.5, 95% CI 2.5-204.8) prevalence rates of anxiety disorders, and more current sleep disturbances (62.4%; OR = 2.5, 95% CI 1.4-4.4) and emotional distress (P<0.001) than their counterparts, but did not have higher rates of depressive disorders or post-traumatic stress disorder. CONCLUSIONS: Early severe adversity was associated with psychopathological disorder long after the end of the Second World War, but not in all survivors. Age during the Holocaust did not modify the results.

Enhanced cancer risk among patients with bipolar disorder.

BACKGROUND: In contrast to numerous epidemiological studies that explored the risk for cancer among persons with schizophrenic psychoses, analogous studies conducted on people with bipolar disorder are rarer, despite some commonalities in biological, treatment-related variables and unhealthy lifestyles. This study investigates the risk for cancer among psychiatric inpatients diagnosed with bipolar disorder. METHODS: Linkage analysis was conducted based on the psychiatric and the cancer national databases. Standardized incidence ratios (SIR) for both aggregated sites and for breast cancer were calculated by comparing the incidence rates among hospitalized patients with bipolar disorder with the incidence rates in the Jewish-Israeli general population. RESULTS: An enhanced cancer risk was found for bipolar disorder in both genders: men, SIR 1.59 (95% CI 1.01-2.17); women, SIR 1.75 (95% CI 1.31-2.18). The risk for breast cancer was higher, but not significantly, than in the general female population, SIR 1.70 (95% CI 0.99-2.41). LIMITATIONS: Our sample was derived from psychiatric inpatients, thus it is likely that the bipolar disorder cases had greater severity. Putative factors such as diet, smoking and medications were not investigated. CONCLUSIONS: Our study showed an enhanced risk for cancer among patients with bipolar disorder. Clinicians might note this risk for timely diagnosis and treatment.