Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys.

CONTEXT: The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. OBJECTIVE: To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. DESIGN AND SETTING: Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. PARTICIPANTS: Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older. MAIN OUTCOME MEASURES: PD and presence of single and recurrent PAs. RESULTS: Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. CONCLUSIONS: We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.

The Usability of CAT System for Assessing the Depressive Level of Japanese-A Study on Psychometric Properties and Response Behavior.

BACKGROUND: An innovative measurement system using a computerized adaptive testing technique based on the item response theory (CAT) has been expanding to measure mental health status. However, little is known about details in its measurement properties based on the empirical data. Moreover, the response time (RT) data, which are not available by a paper-and-pencil measurement but available by a computerized measurement, would be worth investigating for exploring the response behavior. PURPOSE: We aimed at constructing the CAT to measure depressive symptomatology in a community population and exploring its measurement properties. Also, we examined the relationships between RTs, individual item responses, and depressive levels. METHOD: For constructing the CAT system, responses of 2061 workers and university students to 24 depression scale plus four negatively revised positive affect items were subjected to a polytomous IRT analysis. The stopping rule was set for standard error of estimation < 0.30 or the maximum 15 items displayed. The CAT and non-adaptive computer-based test (CBT) were administered to 209 undergraduates, and 168 of them administered again after 1 week. RESULTS: On average, the CAT was converged by 10.4 items. The θ values estimated by CAT and CBT were highly correlated (r = 0.94 and 0.95 for the 1st and 2nd measurements) and with the traditional scoring procedures (r's > 0.90). The test-retest reliability was at a satisfactory level (r = 0.86). RTs to some items significantly correlated with the θ estimates. The mean RT varied by the item contents and wording, i.e., the RT to positive affect items required additional 2 s or longer than the other subscale items. CONCLUSION: The CAT would be a reliable and practical measurement tool for various purposes including stress check at workplace.

Differences in caregivers' psychological distress and associated factors by care recipients' gender and kinship.

OBJECTIVES: In this study, we examined the level of psychological distress of Japanese caregivers according to various combinations of the gender of care recipients and the kinship of caregivers (spouse, son, daughter, or daughter-in-law). Furthermore, we explored the associated factors that could exacerbate or alleviate psychological distress. METHODS: We utilized a cross-sectional descriptive design and implemented a self-administered questionnaire survey with a two-stage stratified sample of community-dwelling caregivers of frail elderly persons throughout Japan. We surveyed 1279 caregiving families, and 1020 questionnaires were completed by primary caregivers (response rate: 79.8%), with 945 respondents providing data on the Japanese version of the Kessler 6 psychological distress scale (K6). RESULTS: Caregivers' K6 scores varied significantly by care recipients' gender and their relationship with the caregiver. K6 scores were significantly higher among daughters-in-law caring for fathers-in-law than among daughters-in-law caring for mothers-in-law, wives caring for husbands, or daughters or sons caring for mothers. 'Negative influence of caregiving' and 'anxious about continuing caregiving' were factors that commonly exacerbated caregivers' psychological distress. Further analyses involving interactions indicated that the effects of 'anxious about continuing caregiving' and 'personal growth through caregiving' on the psychological distress of daughters-in-law varied by care recipients' gender as did the effects of an alleviating factor, 'keeping their own pace', on daughters. CONCLUSIONS: Psychological distress levels among family caregivers, as well as exacerbating and alleviating factors, varied depending on the gender and kinship of care recipients.

Differences in caregivers' cognitive appraisal, coping strategies, and perceived influence on life by care recipients' sex and kinship with primary caregivers.

Objectives This study was aimed at examining whether caregivers' cognitive appraisal, coping strategies, and perceived influence on life vary according to care recipients' sex and caregivers' kinship (e.g., spouse, son, daughter, or daughter-in-law).Methods We contacted 1,110 relatively large visiting nursing stations in 37 prefectures, 83 of which agreed to participate in the study. Station managers were requested to select up to 20 families with an elderly person to care for. A questionnaire that included measures for caregivers' cognitive appraisal, coping strategies toward family caregiving, and caregivers' perception, which measures the perceptions of negative and positive influences on family life through caregiving, was administered to the 1,278 families selected by the nursing stations. From this pool, 1,020 questionnaires (79.8%) were returned, completed anonymously by primary caregivers.Results Two-way analysis of variance was used to analyze the care recipients' sex and kinship with primary caregivers. The analysis revealed significant interactions regarding the level of care required and approximately half of the scales measuring cognitive appraisal, coping strategies, and perceived influence on life. The level of care required was higher for male care recipients than for female care recipients when recipients were cared for by their daughters. Husbands caring for wives and daughters-in-law caring for fathers-in-law were more likely to feel "restricted in their social life," have difficulty "keeping pace" with caregiving, and have "negative influence on life." Husbands caring for wives felt less "personal growth through caregiving" than wives caring for husbands. Daughters caring for fathers perceived a lower "positive acceptance of caregiving role" than those caring for mothers. Husbands caring for wives tended not to seek "informal support." Care recipients' sex had little influence on caregivers' cognitive appraisal, coping strategies, and caregivers' perceptions of negative and positive influences on family life. Regarding the main effects of caregivers' kinship, spousal caregivers felt more anxious about continuous caregiving but felt more "fulfilled" and "positively accepted" in their caregiving role.Conclusion Cognitive appraisal and coping strategies toward family caregiving, and the caregivers' perceptions of negative and positive influences on life might vary according to care recipients' sex and caregivers' kinship. Our findings suggest the necessity for long-term care insurance services to incorporate not only care for the care recipients but also a strategy to deal with the psychological burden of family caregivers.

Gender Differences in the Motivational Process of the Job Demands-Resources Model.

Background: Achieving gender equality is an important goal in Japan. Consequently, this study aimed to examine gender differences in a series of associations between job demands or resources and job performance mediated by work engagement (WE) in the motivational process of the job demands-resources model. Methods: This study recruited 671 non-manual workers (260 men and 411 women) through an online survey. The measured variables were demographic information, job demands or resources, WE, and job performance. Multiple-group structural equation modeling was used to analyze the data. Results: Regarding the level of job demands or resources and WE, no significant difference was observed between men and women. Whereas, job performance was significantly higher in women than in men. Additionally, multiple-group structural equation modeling indicated that the model that imposed on all path coefficients for equality constraints had a better fit, and consequently, no gender differences. Conclusion: Although the motivational process indicated no gender differences, job performance was higher in women than in men due to the management of a gender-equal and friendly work environment. Further comprehensive examinations, that use other variables not included in the present study, are required to understand women's high job performance.

Job satisfaction of Japanese midwives in the Tokyo metropolitan area.

INTRODUCTION: We explore job satisfaction among Japanese midwives working in different institutions within the Tokyo metropolitan area and relate this to midwives' age. METHODS: The study involved a questionnaire survey of 423 midwives working in 113 general hospitals, 70 clinics, and 58 midwifery centers in the Tokyo Metropolitan Area of Japan. The questionnaire consisted of items related to demographic and job satisfaction. Questionnaires were returned by 199 participants (47%). RESULTS: Of the 199 midwives, 142 worked in general hospitals (71%), 26 worked in maternity clinics (13%), and 31 worked in midwifery centers (16%). Factor analysis extracted six job satisfaction factors labelled as: F1 'midwifery services', F2 'interpersonal relations', F3 'rewarding and autonomy', F4 'working environment', F5 'working conditions', and F6 'collaboration with doctors'. Job satisfaction scores for all factors were the highest among midwives working in midwifery centers, followed by those working in maternity clinics and hospitals. Job satisfaction of F1 and F3 of those working in midwifery centers was significantly higher than those working in hospitals and maternity clinics for the younger age group, while the scores of those working in maternity clinics became higher and closer to those working in midwifery centers for other age groups. CONCLUSIONS: Job satisfaction of midwives varies by different institutions, particularly lowest for those working in hospitals than those working in midwifery clinics and centers. It is necessary to devise useful strategies for midwives in hospitals to enhance their satisfaction with midwifery services and to feel rewarded by and autonomy at work.

The impact of negative and positive affectivity on the relationship between work-related psychological factors and work engagement in Japanese workers: a comparison of psychological distress.

BACKGROUND: A previous study has shown that Japanese individuals generally exhibit behavior that suppresses the expression of positive emotions, which are strongly affected by affectivity traits. In the present study, to clarify the relationship between affectivity traits and work engagement (WE) or work-related psychosocial factors among Japanese workers, we compared it to the association between psychological distress and these same factors. METHODS: A total of 1,000 full-time Japanese regular workers responded to an online survey that measured demographic variables, negative and positive affectivity, job demands and resources, WE, and psychological distress. A hierarchical multiple regression analysis was conducted separately, which used WE and psychological distress as dependent variables. RESULTS: The proportion of variance explained by negative and positive affectivity was lower for WE than for psychological distress. However, the proportion of variance defined by job demands and resources was higher for WE than for psychological distress. The proportion of variance explained by all variables for negative and positive affectivity and job demands and resources, and their interactions was approximately equal for WE and psychological distress. CONCLUSION: These results emphasize when researchers aim to evaluate the change of psychosocial factors in the workplace, such as improving the workplace environment among Japanese workers, it might be beneficial to measure positive indicators in addition to negative indicators. Furthermore, enriching job resources would be effective in improving WE and alleviating psychological distress.

Commitment profiles among nurses: combinations of organizational commitment forms and work engagement, psychological distress, and turnover intention.

To clarify the combined effect of the sub-factors of organizational commitment, this study examined the relationships between organizational commitment profiles and work engagement, psychological distress, and turnover intention among nurses. A cross-sectional survey was conducted; 455 nurses (38 men and 417 women) were included in the statistical analysis. We extracted six clusters through k-means cluster analysis and applied a one-way analysis of variance and χ2 test for work engagement, psychological distress, and turnover intention. Consequently, significant differences were found in work engagement and turnover intention (both p<0.05), and no significant difference was found in psychological distress. These results indicate the formation of affective and normative commitment among nurses in working energetically or preventing turnover. Additionally, no negative effects related to increases in continuance commitment were identified in this study.

Effects of work-family life support program on the work-family interface and mental health among Japanese dual-earner couples with a preschool child: A randomized controlled trial.

OBJECTIVES: This study examined the effectiveness of a newly developed work-family life support program on the work-family interface and mental health indicators among Japanese dual-earner couples with a preschool child(/ren) using a randomized controlled trial with a waitlist. METHODS: Participants who met the inclusion criteria were randomly allocated to the intervention or the control groups (n = 79 and n = 85, respectively). The program comprised two 3-h sessions with a 1-month interval between them and provided comprehensive skills by including self-management, couple management, and parenting management components. The program sessions were conducted on weekends in a community center room with 3-10 participants. Outcomes were assessed at baseline, 1-month, and 3-month follow-ups. Primary outcomes were work-family balance self-efficacy (WFBSE), four types of work-family spillovers (i.e., work-to-family conflict, family-to-work conflict, work-to-family facilitation, and family-to-work facilitation), psychological distress, and work engagement reported by the participants. RESULTS: The program had significantly pooled intervention effects on WFBSE (P = .031) and psychological distress (P = .014). The effect sizes (Cohen's d) were small, with values of 0.22 at the 1-month follow-up and 0.24 at the 3-month follow-up for WFBSE, and -0.36 at the 3-month follow-up for psychological distress. However, the program had nonsignificant pooled effects on four types of work-family spillovers and work engagement. CONCLUSIONS: The program effectively increased WFBSE and decreased psychological distress among Japanese dual-earner couples with a preschool child(/ren).

[Longitudinal study of the lateness as a predictor of absenteeism: a three-year longitudinal study in a public junior high school in Japan].

Although it is generally believed that frequent lateness might lead to absenteeism, the evidence for this has not been ascertained. We investigated the relationship between earlier lateness and subsequent absenteeism in a three-year longitudinal study in a public junior high school in Japan. The participants were 263 students (124 males, 139 females) whose school records were available for three consecutive academic years. Kaplan-Meier survival curves revealed that students who had been late for 30 or more days during their 1st year of junior high school were significantly more likely to show absenteeism during 2nd and 3rd year than students who had been late less than 30 days. Cox's proportional hazards regression model confirmed that frequent lateness was the only significant predictor, after controlling socio-demographics and psychosocial variables including stressors at school and stress responses. The substantial linkage of frequent lateness to absenteeism found in this study suggests the necessity of paying more attention to lateness for the prevention of absenteeism.

Association between the five-factor model of personality and work engagement: a meta-analysis.

The purposes of this meta-analysis were (1) to examine the associations between work engagement (WE) and the personality dimensions of five-factor model and (2) to determine how much variance in WE is explained by these five factors. We performed a database search for studies related to personality traits and WE, and 36 papers that reported correlation coefficients were selected for the meta-analysis. After correcting for publication bias using the trim-and-fill method, conscientiousness had the strongest association with WE (ρ=0.41), followed by extraversion and openness to experience (0.38), neuroticism (-0.36), and agreeableness (0.27). Moreover, 30% of the WE variance could be explained by the five-factor model (R2=0.33, 95%CI=0.26-0.49) according to a path analysis using the weighted average correlation for unreliability. This proportion was higher than that from a previous meta-analysis of job satisfaction and job performance and was lower than that of personality and WE. Thus, to enhance WE, it is necessary to evaluate both the personality and the psychosocial work environment in detail.

Suggestions for new organizational-level item pools for the national Stress Check Program from management philosophy and mission statement: A qualitative study using unsupervised learning.

OBJECTIVE: This study aimed to obtain suggestions for new organizational-level item pools that companies could utilize to accomplish management philosophy and mission statements in the context of survey and work environment improvements for the national Stress Check Program. METHODS: A qualitative study was conducted using unsupervised learning. A large amount of text data related to management philosophy and mission statements were collected, that is, management messages described on the websites of all companies listed on the Tokyo Stock Exchange. For the main analysis, topic modeling was performed on the nouns from the management messages using Latent Dirichlet Allocation (LDA) to build a model consisting of 10 latent topics, each represented by a group of the 10 most frequently reoccurring nouns. Each group of nouns was qualitatively summarized based on the topic model. RESULTS: In total, 22 524 nouns were extracted from the management messages of 3575 companies. A topic model consisting of 10 latent topics was constructed using the LDA. The suggestion for new item pools included new technologies, business plans/strategies, company shareholders, health/happiness/wealth, profits/sales, development of society, a sustainable society, safety and security, customer/consumer satisfaction, corporate social responsibility, fairness, transparency, and human rights. CONCLUSION: The suggestions for potential item pools were derived from management philosophy and mission statement that are not covered in the existing survey. The suggestions could be useful for motivating employers to implement work environment improvement. Future studies need to make definite items and investigate whether they correlate to job stressors and mental health among workers.

Workplace Social Support and Reduced Psychological Distress: A 1-Year Occupational Cohort Study.

OBJECTIVE: There is little evidence that workplace social support can relieve workers' mental health problems. Therefore, we examined whether social support from coworkers and supervisors was associated with reduced serious psychological distress among employees. METHODS: We used two-wave panel data from 13 Japanese companies. The baseline survey was conducted in 2011, and the follow-up survey 1 year later. From 9889 respondents, we selected 759 who had psychological distress at baseline, defined as ≥13 on the Kessler Psychological Distress Scale (K6). RESULTS: Increased coworker support was significantly associated with employees' reduced psychological distress (odds ratio, 3.51; 95% confidence interval, 2.17 to 5.68). The association between increased supervisor support and reduced psychological distress was nonsignificant (odds ratio, 1.32, 95% confidence interval, 0.85 to 2.04). CONCLUSION: Encouraging coworker support may contribute to the secondary prevention of mental health problems among employees.

Cross-national epidemiology of DSM-IV major depressive episode.

BACKGROUND: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative. METHODS: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. RESULTS: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. CONCLUSIONS: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

Low-dose lithium uptake promotes longevity in humans and metazoans.

PURPOSE: Lithium is a nutritionally essential trace element predominantly contained in vegetables, plant-derived foods, and drinking water. Environmental lithium exposure and concurrent nutritional intake vary considerably in different regions. We here have analyzed the possibility that low-dose lithium exposure may affect mortality in both metazoans and mammals. METHODS: Based on a large Japanese observational cohort, we have used weighted regression analysis to identify putative effects of tap water-derived lithium uptake on overall mortality. Independently, we have exposed Caenorhabditis elegans, a small roundworm commonly used for anti-aging studies, to comparable concentrations of lithium, and have quantified mortality during this intervention. RESULTS: In humans, we find here an inverse correlation between drinking water lithium concentrations and all-cause mortality in 18 neighboring Japanese municipalities with a total of 1,206,174 individuals (ß = -0.661, p = 0.003). Consistently, we find that exposure to a comparably low concentration of lithium chloride extends life span of C. elegans (p = 0.047). CONCLUSIONS: Taken together, these findings indicate that long-term low-dose exposure to lithium may exert anti-aging capabilities and unambiguously decreases mortality in evolutionary distinct species.

Cost of depression among adults in Japan in 2005.

AIM: Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden. METHODS: A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database. RESULTS: The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion. CONCLUSION: The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression.

Lifetime prevalence of mental disorders and its relationship to suicidal ideation in a Japanese rural community with high suicide and alcohol consumption rates.

OBJECTIVE: The World Mental Health Survey Japan was conducted to address the current status of mental disorders in Japan. Among the various regions covered by the survey were Tendo City and Kaminoyama City in Yamagata Prefecture. The suicide and alcohol consumption rates in Yamagata are higher than the Japanese national average. Many studies have reported that major depressive disorder (MDD), alcohol use disorders (AUDs), and suicidal ideation are related to suicide risk. The prevalence of MDD, AUDs, and suicidal ideation, as well as the association between suicidal ideation and mental disorders must be investigated in order to implement mental health and suicide prevention measures in our community; however, only a few studies have addressed this issue. METHODS: The survey involved face-to-face interviews. The study population consisted of 1,684 adult residents, of which 770 (mean age 54.0 ± 17.4 years) who completed the interview process. Mental disorders were assessed using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview. RESULTS: Among the study population, lifetime prevalence of MDD was 4.4%, which was similar to values reported in previous studies in Japan. Prevalence of AUDs, however, was 10.2%, which was higher those reported previously. We observed a significant association between suicidal ideation and MDD [odds ratio (OR) 7.6], our results showed precisely the opposite association between AUDs and suicidal ideation (OR 0.5, not significant) compared to previous studies. CONCLUSIONS: Although prevalences of MDD and suicidal ideation were not high, this study revealed a high lifetime prevalence of AUDs and a negative association between suicidal ideation and AUDs.

The Effect of Nurses' Work-Life Balance on Work Engagement: The Adjustment Effect of Affective Commitment.

BACKGROUND: This study aimed to examine the effects of nurses' work-life balance (WLB), job demands and resources, and organizational attachment on their work engagement (WE). The second aim was to shed light on whether the relationships among WLB, job demands, resources, and WE are modulated by organizational attachment. METHODS: In total, 425 nurses working in a university hospital responded to the questionnaire. The primary statistical analysis method was hierarchical multiple regression with WE as the dependent variable. RESULTS: In the model in which all variables were applied, affective commitment (AC) (ß = 0.41), family-to-work positive spillover (ß = 0.25), and number of children (ß = 0.13) were found to have a significant association with WE. Family-to-work negative spillover (FWNS) and AC had significant interaction effects. The result suggests that when AC was low, WE tended to decline further due to FWNS; however, when AC was high, WE did not change due to the effect of FWNS. CONCLUSION: These results confirmed that to improve nurses' WE, hospital organizations should implement initiatives to facilitate WLB that considers nurses' household roles. Furthermore, high organizational attachment buffered the home's negative influence on work, thereby helping nurses work energetically.

Subtyping social anxiety disorder in developed and developing countries.

BACKGROUND: Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. METHODS: The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. RESULTS: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. CONCLUSION: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.

Early childhood adversity and later hypertension: data from the World Mental Health Survey.

BACKGROUND: Although many studies have indicated that psychosocial factors contribute to hypertension, and that early childhood adversity is associated with long-term adverse mental and physical health sequelae, the association between early adversity and later hypertension is not well studied. METHOD: Data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WHM) Surveys (N = 18,630) were analyzed to assess the relationship between childhood adversity and adult-onset hypertension, as ascertained by self-report. The potentially mediating effect of early-onset depression-anxiety disorders, as assessed by the WHM Survey version of the International Diagnostic Interview (WMH-CIDI), on the relationship between early adversity and hypertension was also examined. RESULTS: Two or more early childhood adversities, as well as early-onset depression-anxiety, were significantly associated with hypertension. A range of specific childhood adversities, as well as early-onset social phobia and panic/agoraphobia, were significantly associated with hypertension. In multivariate analyses, the presence of 3 or more childhood adversities was associated with hypertension, even when early-onset depression-anxiety or current depression-anxiety was included in the model. CONCLUSIONS: Although caution is required in the interpretation of self-report data on adult-onset hypertension, the results of this study further strengthen the evidence base regarding the role of psychosocial factors in the pathogenesis of hypertension.