Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys.

PURPOSE: To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample. METHODS: The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD. RESULTS: In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders. CONCLUSIONS: The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

Perceived helpfulness of bipolar disorder treatment: Findings from the World Health Organization World Mental Health Surveys.

OBJECTIVES: To examine patterns and predictors of perceived treatment helpfulness for mania/hypomania and associated depression in the WHO World Mental Health Surveys. METHODS: Face-to-face interviews with community samples across 15 countries found n = 2,178 who received lifetime mania/hypomania treatment and n = 624 with lifetime mania/hypomania who received lifetime major depression treatment. These respondents were asked whether treatment was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Patterns and predictors of treatment helpfulness were examined separately for mania/hypomania and depression. RESULTS: 63.1% (mania/hypomania) and 65.1% (depression) of patients reported ever receiving helpful treatment. However, only 24.5-22.5% were helped by the first professional seen, which means that the others needed to persist in help seeking after initial unhelpful treatments in order to find helpful treatment. Projections find only 22.9% (mania/hypomania) and 43.3% (depression) would persist through a series of unhelpful treatments but that the proportion helped would increase substantially if persistence increased. Few patient-level significant predictors of helpful treatment emerged and none consistently either across the two components (i.e., provider-level helpfulness and persistence after earlier unhelpful treatment) or for both mania/hypomania and depression. Although prevalence of treatment was higher in high-income than low/middle-income countries, proportional helpfulness among treated cases was nearly identical in the two groups of countries. CONCLUSIONS: Probability of patients with mania/hypomania and associated depression obtaining helpful treatment might increase substantially if persistence in help-seeking increased after initially unhelpful treatments, although this could require seeing numerous additional treatment providers. In addition to investigating reasons for initial treatments not being helpful, messages reinforcing the importance of persistence should be emphasized to patients.

Mental health of the old- and new-generation migrant workers in China: who are at greater risk for psychological distress?

Rural-to-urban migrant workers (MWs) are a large vulnerable population in China and, recently, the new-generation MWs (those born in 1980 or later) have become the majority of this population. Examining difference in the epidemiology of poor mental health between the new- and old-generation (those born before 1980) MWs would facilitate mental health promotion efforts. However, very few related studies are available and they produced conflicting findings. This study investigated intergenerational difference in prevalence and correlates of psychological distress (PD) in MWs. A total of 3031 MWs (691 old- and 2340 new-generation MWs) completed a standardized questionnaire containing socio-demographic, migration-related, and work-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of 3 or higher was used to denote PD. PD was more prevalent in the new- than old-generation MWs (36.2% versus 28.2%, P < 0.001). The elevated risk of PD in the new- versus old-generation remained significant after controlling for potential confounders (OR=1.51, P < 0.001). For the new-generation, correlates for PD included low monthly income, recent two-week physical morbidity, migrating alone, poor Mandarin proficiency and long working hours; while for the old-generation, correlates for PD included low education, recent two-week physical morbidity, and having worked in many cities. The new-generation MWs are at higher risk for PD than the old-generation MWs. Mental health services for addressing the generation-specific needs may be an effective way to prevent or reduce PD of MWs.

Prevalence and correlates of major depressive disorder among rural-to-urban migrant workers in Shenzhen, China.

BACKGROUND: In China, rural-to-urban migrant workers (MWs) are a large and vulnerable population that may be at high risk for depression, but previous studies focused on depressive symptoms of MWs and no study has investigated the epidemiology of major depressive disorder (MDD). The objective of this study was to determine the prevalence and correlates of one-month and lifetime MDD among MWs in Shenzhen, China, and mental health services utilization of MWs with lifetime MDD. METHODS: A total of 3031 MWs were recruited from 10 manufacturing factories and interviewed with the Chinese version of the Mini International Neuropsychiatric Interview. RESULTS: The one-month and lifetime prevalence rates of MDD were 1.39% (95% CI: 0.97%, 1.80%) and 5.08% (95% CI: 4.30%, 5.86%), respectively. No significant gender and age-group differences were found in these rates. The risk factors for lifetime MDD included lower education, worse living condition, poorer self-perceived physical health, migration before adulthood, infrequently calling family members, and having done lots of jobs. Only 3.25% of the respondents with lifetime MDD had sought professional help prior to the interview. LIMITATIONS: The MW sample was selected from manufacturing factories, we should be cautious in generalizing our findings to MWs of other industries. CONCLUSIONS: Compared with the Chinese general population, MWs may have a similar prevalence of MDD, but the rate of lifetime mental health services use of MWs with lifetime MDD is extremely low. MDD is a major public health concern for this population. There is an urgent need to improve mental health services for MWs.

Prevalence of psychological symptoms in contemporary Chinese rural-to-urban migrant workers: an exploratory meta-analysis of observational studies using the SCL-90-R.

PURPOSE: (1) To estimate the pooled prevalence of psychological symptoms in Chinese migrant workers (CMWs), as measured using the Symptom Checklist-90-R (SCL-90-R) in observational studies conducted in China, and (2) to explore the potential variables associated with the SCL-90-R Global Severity Index (GSI), the overall mental health indicator of CMWs. METHODS: We performed a comprehensive literature search of the major English and Chinese databases (to June 2012). Cross-sectional surveys and case-control studies of CMWs (and controls where appropriate) that reported at least one subscale score of the SCL-90-R were included. Multilevel meta-analysis was used to pool the symptom scores of cross-sectional surveys and mean differences of symptom scores ("Cohen's d" values) between CMWs and controls of case-control studies. Multilevel meta-analysis with ecological- or study-level covariates was used to explore the associations between variables and SCL-90-R GSI score. RESULTS: The search yielded 48 cross-sectional surveys (comprising 42,813 CMWs) and seven surveys that included control samples. The pooled psychological symptom scores (95% confidence interval) of CMWs were statistically higher than those of norms from Chinese general population on all scales of SCL-90-R, except for obsessive-compulsive subscale in study quality subgroup analysis. CMWs also scored statistically higher than those of urban counterpart controls on all scales of SCL-90-R. Multilevel regression meta-analysis model revealed that four covariates that accounted for 33.9% of SCL-90-R GSI heterogeneity across all surveys, including: "mean age of study sample," "geographic area," "per capita GDP," and "statutory minimum monthly wage" of study site in implementation year. CONCLUSION: CMWs have more severe psychological symptoms than the general population, and thus, appear to experience higher level of psychological distress. Macro-economic factors may have impact on the overall mental health of CMWs, but the factors that contribute to mental health and mental distress among CMWs remain to be explored and understood.

Development of lifetime comorbidity in the World Health Organization world mental health surveys.

CONTEXT: Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity. OBJECTIVE: To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys. DESIGN: Nationally or regionally representative community surveys. SETTING: Fourteen countries. PARTICIPANTS: A total of 21 229 survey respondents. MAIN OUTCOME MEASURES: First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview. RESULTS: Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables. CONCLUSIONS: The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study.

Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys.

BACKGROUND: Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. AIMS: To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries. METHOD: Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI). RESULTS: Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. CONCLUSIONS: Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative.

Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a six-item scale developed to provide a brief valid screen for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined N = 41,770 respondents). Twelve-month prevalence of DSM-IV SMI was assessed with the fully-structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores, taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve, was generally substantial (median 0.83; range 0.76-0.89; inter-quartile range 0.81-0.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied.

[Survey on mental disorders among registered residents and non-registered residents in Shenzhen].

OBJECTIVE: To study the prevalence and distribution of mental disorders among registered and non-registered residents in Shenzhen. METHODS: An epidemiological survey on mental disorders were carried out in Shenzhen by stratified multi-stage randomized sampling method; 7134 respondents were assessed through face-to-face interview, using the WHO standardized version on World Mental Health (WMH) Survey Initiative of the Composite International Diagnostic Interview (CIDI3.1). RESULTS: (1) The weighting prevalence of mental disorders was 21.87%. The prevalence of non-registered residents was significantly higher than that of the registered residents (22.34% vs. 19.99%; OR=1.15, 95%CI: 1.03-1.29; P<0.05) and the prevalence of females was significantly higher than that of males (22.68% vs. 19.67%; OR= 1.20, 95%CI: 1.07-1.34; P<0.05). The weighting prevalence of mood disorders, anxiety disorders and psychoses were 9.62%, 14.45% and 1.40%, respectively. (2) The weighting twelve-month incidence of mental disorders was 13.42%. The incidence of non-registered residents was significantly higher than that of the registered residents (13.80% vs. 11.90%; OR=1.19, 95%CI: 1.03-1.36; P<0.05). (3)The co-morbidity rate between mental disorders was 35.76%. (4)The prevalence and severity of mental disorders were associated with sex, household situation of registration, marital status, education, economic condition and occupation status. CONCLUSION: Mental disorders have become common diseases and serious public health problem in Shenzhen, with non-registered residents and females deserve more attention.