Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries.

BACKGROUND: Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. METHODS: In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. FINDINGS: We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. INTERPRETATION: By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. FUNDING: None.

Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys.

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.

Barriers to treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys.

BACKGROUND: Mental health treatment is scarce and little resources are invested in reducing the wide treatment gap that exists in the Americas. The regional barriers are unknown. We describe the barriers for not seeking treatment among those with mental and substance use disorders from six (four low- and middle-income and two high-income) countries from the Americas. Regional socio-demographic and clinical correlates are assessed. METHODS: Respondents (n = 4648) from seven World Mental Health surveys carried out in Argentina, Brazil, Colombia, Mexico, Peru, and the United States, who met diagnostic criteria for a 12-month mental disorder, measured with the Composite International Diagnostic Interview, and who did not access treatment, were asked about treatment need and, among those with need, structural and attitudinal barriers. Country-specific deviations from regional estimates were evaluated through logistic models. RESULTS: In the Americas, 43% of those that did not access treatment did not perceive treatment need, while the rest reported structural and attitudinal barriers. Overall, 27% reported structural barriers, and 95% attitudinal barriers. The most frequent attitudinal barrier was to want to handle it on their own (69.4%). Being female and having higher severity of disorders were significant correlates of greater perceived structural and lower attitudinal barriers, with few country-specific variations. LIMITATIONS: Only six countries in the Americas are represented; the cross-sectional nature of the survey precludes any causal interpretation. CONCLUSIONS: Awareness of disorder or treatment need in various forms is one of the main barriers reported in the Americas and it specially affects persons with severe disorders.

Dropout from treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys.

OBJECTIVE: To estimate structural and attitudinal reasons for premature discontinuation of mental health treatment, socio-demographic and clinical correlates of treatment dropout due to these reasons, and to test country differences from the overall effect across the region of the Americas. METHODS: World Health Organization-World Mental Health (WMH) surveys were carried out in six countries in the Americas: Argentina, Brazil, Colombia, Mexico, Peru and USA. Among the 1991 participants who met diagnostic criteria (measured with the Composite International Diagnostic Interview (WMHCIDI)) for a mental disorder and were in treatment in the prior 12-months, the 236 (12.2%) who dropped out of treatment before the professional recommended were included. FINDINGS: In all countries, individuals more frequently reported attitudinal (79.2%) rather than structural reasons (30.7%) for dropout. Disorder severity was associated with structural reasons; those with severe disorder (versus mild disorder) had 3.4 (95%CI=1.1-11.1) times the odds of reporting a structural reason. Regarding attitudinal reasons, those with lower income (versus higher income) were less likely to discontinue treatment because of getting better (OR=0.4; 95%CI= 0.2-0.9). Country specific variations were found. LIMITATIONS: Not all countries, or the poorest, in the region were included. Some estimations couldn´t be calculated due to cell size. Causality cannot be assumed. CONCLUSION: Clinicians should in the first sessions address attitudinal factors that may lead to premature termination. Public policies need to consider distribution of services to increase convenience. A more rational use of resources would be to offer brief therapies to individuals most likely to drop out of treatment prematurely.

"I don't need any treatment" - barriers to mental health treatment in the general population of a megacity.

OBJECTIVE: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. METHODS: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. RESULTS: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). CONCLUSION: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.

Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys.

BACKGROUND: Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS: Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS: 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS: Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS: Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.

Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases.

PURPOSE: Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. METHODS: The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). RESULTS: Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. CONCLUSION: Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists. TRIAL REGISTRATION: PROSPERO Systematic Review Registration Number: CRD42018100424.

The epidemiology of drug use disorders cross-nationally: Findings from the WHO's World Mental Health Surveys.

BACKGROUND: Illicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative involves a standardised method for assessing mental and substance use disorders via structured diagnostic interviews in representative community samples of adults. We conducted cross-national comparisons of the prevalence and correlates of drug use disorders (DUDs) in countries of varied economic, social and cultural nature. METHODS AND FINDINGS: DSM-IV DUDs were assessed in 27 WMH surveys in 25 countries. Across surveys, the prevalence of lifetime DUD was 3.5%, 0.7% in the past year. Lifetime DUD prevalence increased with country income: 0.9% in low/lower-middle income countries, 2.5% in upper-middle income countries, 4.8% in high-income countries. Significant differences in 12-month prevalence of DUDs were found across country in income groups in the entire cohort, but not when limited to users. DUDs were more common among men than women and younger than older respondents. Among those with a DUD and at least one other mental disorder, onset of the DUD was usually preceded by the 'other' mental disorder. CONCLUSIONS: Substantial cross-national differences in DUD prevalence were found, reflecting myriad social, environmental, legal and other influences. Nonetheless, patterns of course and correlates of DUDs were strikingly consistent. These findings provide foundational data on country-level comparisons of DUDs.

Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder: Findings From the World Mental Health Surveys.

Importance: Limited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use. Objective: To use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission. Design, Setting, and Participants: The World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018. Main Outcomes and Measures: Data on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions. Results: Among the 90 027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P < .001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P < .001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P = .02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals' experience of substance use and demographics, for each additional 10% of an individual's cohort using alcohol, a person's odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort's use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]). Conclusions and Relevance: Birth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.

Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil.

Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.

Integration of two-stage nanofiltration with arsenic and calcium intermediate chemical precipitation for gold mining effluent treatment.

The aim of this study was to evaluate an innovative treatment route for gold-mining effluents rich in calcium, arsenic, and sulfate. This treatment route comprised two nanofiltration (NF) stages and a two-step intermediate precipitation. Arsenic and iron coprecipitation (first step) and calcium carbonate precipitation (second step) were assessed aiming to treat the first-stage NF concentrate and increase the permeate recovery rate in a second-stage NF. The pH, the molar ratio of Fe/As (first step), and the molar ratio of CO3/Ca (second step) were optimized by using rotational central composite design. Under optimal conditions, the arsenic removal was 99.8% (at pH = 7.0 and Fe/As = 4.0), and the calcium removal was 99.5% (at pH 11.5 and CO3/Ca = 3.5). The supernatant of Ca precipitation had very basic pH and had to be acidified before the second-stage NF. The pH 8.5 proved to be the best one regarding retention efficiency and flux. The flux decay of the second-stage NF was attributed to both osmotic pressure increase and reversible fouling resistance. It was concluded that the proposed treatment system is efficient for the treatment of gold-mining wastewater, ensuring higher production of treated effluent and an easy disposable of the final concentrate.

Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies.

OBJECTIVES: Although clinical evidence suggests important differences between unipolar mania and bipolar-I disorder (BP-I), epidemiological data are limited. Combining data from nine population-based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP-I with both manic and depressive episodes with respect to demographic and clinical characteristics in order to highlight differences. METHODS: Participants were compared for gender, age, age at onset of mania, psychiatric comorbidity, temperament, and family history of mental disorders. Generalized linear mixed models with adjustment for sex and age as well as for each study source were applied. Analyses were performed for the pooled adult and adolescent samples, separately. RESULTS: Within the included cohorts, 109 adults and 195 adolescents were diagnosed with M/Md and 323 adults and 182 adolescents with BP-I. In both adult and adolescent samples, there was a male preponderance in M/Md, whereas lifetime generalized anxiety and/panic disorders and suicide attempts were less common in M/Md than in BP-I. Furthermore, adults with mania revealed bulimia/binge eating and drug use disorders less frequently than those with BP-I. CONCLUSIONS: The significant differences found in gender and comorbidity between mania and BP-I suggest that unipolar mania, despite its low prevalence, should be established as a separate diagnosis both for clinical and research purposes. In clinical settings, the rarer occurrence of suicide attempts, anxiety, and drug use disorders among individuals with unipolar mania may facilitate successful treatment of the disorder and lead to a more favorable course than that of BP-I disorder.

Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Investigating the dimensional diagnosis of ICD-11 nicotine dependence.

We investigated the dimensionality and possible measurement bias of ICD-11 Nicotine Dependence (ND) criteria in a sample of smokers from a middle-income country. Data are from the São Paulo Megacity Project (part of World Mental Health Surveys) collected between 2005 and 2007 (n = 5,037). The current analyses were restricted to the 1,388 participants who smoked at least once a week for 2 months in their lifetime. Item response theory (IRT) was used to investigate the severity and discrimination properties of 8 selected criteria. Additionally, differential criteria functioning (DCF) with sociodemographic characteristics (income, gender, age, employment status, marital status, and education) was investigated. All analyses were performed in Mplus software taking into account complex survey design features. IRT results indicated that the criterion Given Up had the lowest probability of endorsement (highest severity). The criterion Larger/Longer had the highest probability of endorsement (lowest severity), but the highest value of discrimination. Physical Withdrawal had the lowest discrimination property. No DCF was found both at criterion- and disorder-level, which would tear measurement bias. The absence of measurement bias in all sociodemographic, psychiatric, and medical subgroups gives psychometrical support to this set of criteria for ICD-11 ND diagnosis. (PsycINFO Database Record

Gender-related dimensions of childhood adversities in the general population.

OBJECTIVE: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. METHODS: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. RESULTS: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. CONCLUSION: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

The latent trait of ICD-11 nicotine dependence criteria: Dimensional and categorical phenotypes.

We aimed to identify phenotypes of DSM-ICD nicotine dependence among a representative sample of lifetime weekly smokers in the largest metropolitan area in South America. Data came from 1,387 lifetime weekly smokers in the São Paulo Megacity Mental Health Survey. We used exploratory factor analysis (EFA) and latent class analysis (LCA) on ICD-11 nicotine dependence proposed criteria to explore dimensionality and phenotypes profiles, followed by logistic regression models to examine the association between latent classes and socio-demographic, psychiatric and chronic medical conditions. Analyses were performed using Mplus taking into account the complex survey design features. An unidimensional model had the best EFA fit with high loadings on all criteria. Response patterns detected by LCA indicated class differences based on severity continuum: a "non-symptomatic class" (32.0%), a "low-moderate symptomatic class" (34.9%)-with high probability of the criterion "use in larger amounts", and a "high-moderate symptomatic class" (33.1%). We found an association between high-income and the intermediate class that differs from findings in high-income countries, and high likelihood of psychiatric comorbidity among the most symptomatic smokers. The best dimensional model that pulled together nicotine dependence criteria supported a single factor, in concordance with the changes proposed for ICD-11.

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

BACKGROUND: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS: Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS: Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS: Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

The associations between psychotic experiences and substance use and substance use disorders: findings from the World Health Organization World Mental Health surveys.

BACKGROUND AND AIMS: Prior research has found bidirectional associations between psychotic experiences (PEs) and selected substance use disorders. We aimed to extend this research by examining the bidirectional association between PEs and various types of substance use (SU) and substance use disorders (SUDs), and the influence of antecedent mental disorders on these associations. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We used data from the World Health Organization World Mental Health surveys. A total of 30 902 adult respondents across 18 countries were assessed for (a) six types of life-time PEs, (b) a range of types of SU and DSM-IV SUDs and (c) mental disorders using the Composite International Diagnostic Interview. Discrete-time survival analyses based on retrospective age-at-onset reports examined the bidirectional associations between PEs and SU/SUDs controlling for antecedent mental disorders. FINDINGS: After adjusting for demographics, comorbid SU/SUDs and antecedent mental disorders, those with prior alcohol use disorders [odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.2-2.0], extra-medical prescription drug use (OR = 1.5, 95% CI = 1.1-1.9), alcohol use (OR = 1.4, 95% CI = 1.1-1.7) and tobacco use (OR = 1.3, 95% CI = 1.0-1.8) had increased odds of subsequent first onset of PEs. In contrast, those with temporally prior PEs had increased odds of subsequent onset of tobacco use (OR = 1.5, 95% CI = 1.2-1.9), alcohol use (OR = 1.3, 95% CI = 1.1-1.6) or cannabis use (OR = 1.3, 95% CI = 1.0-1.5) as well as of all substance use disorders (ORs ranged between 1.4 and 1.5). There was a dose response relationship between both count and frequency of PEs and increased subsequent odds of selected SU/SUDs. CONCLUSIONS: Associations between psychotic experiences (PEs) and substance use/substance use disorders (SU/SUDs) are often bidirectional, but not all types of SU/SUDs are associated with PEs. These findings suggest that it is important to be aware of the presence of PEs within those with SUDs or at risk of SUDs, given the plausibility that they may each impact upon the other.

Trauma and psychotic experiences: transnational data from the World Mental Health Survey.

BackgroundTraumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.AimsTo investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.MethodWe assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.ResultsRespondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR = 3.1, 95% CI 2.7-3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.ConclusionsExposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.

The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys.

We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.