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.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina.

OBJECTIVE: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). METHODS: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. RESULTS: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. CONCLUSIONS: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

[Epidemiological study of mental health in the general population of Argentina]. / Estudio epidemiológico de salud mental en población general de la República Argentina.

In this paper we report the findings of the first "Epidemiological study of mental health in the general population of Argentina" in the framework of the World Mental Health Survey Initiative WHO / Harvard, in collaboration with the Faculty of Medicine of the University of Buenos Aires and the Asociación de Psiquiatras Argentinos (APSA) with funding from the Ministry of Health. Methodology: A multistage probabilistic household survey was conducted using the Composite International Diagnostic Interview (CIDI). The survey was conducted on 3,927 people aged 18 and over (no age limit), with fixed residence in one of the eight largest urban areas in the country (Buenos Aires, Córdoba, Corrientes-Resistencia, Mendoza, Neuquén, Rosario, Salta and Tucumán), representing approximately 50.1% of the adults living in the country. The response rate was 77%. Results: The lifetime prevalence of any mental disorder in the general population of Argentina over 18 years of age was 29.1% and the projected life risk up to 75 years of age was 37.1%. The disorders with the highest life prevalence were Major Depressive Disorder (8.7%), Alcohol Abuse Disorder (8.1%) and Specific Phobia (6.8%). Anxiety Disorders were the most prevalent group (16.4%), followed by Mood Disorders (12.3%), Substance Disorders (10.4%), and Impulse Control Disorders (2.5%). The prevalence in the last 12 months of any mental disorder was 14.8%, a quarter of wich were classified as severe. 11.6% received treatment in the previous 12 months and only 30.2% of those who suffered a severe disorder received it. The results provide essential data for health planning and implementation and the training of the mental health workforce.

Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys.

Importance: Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life course or if mental disorders contribute to these associations. Objective: To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations. Design, Setting, and Participants: A total of 33 370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie, ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs. Main Outcomes and Measures: Prevalence and frequency of STBs with PEs, and odds ratios and 95% CIs. Results: Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), and 10.2% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95% CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively. Conclusions and Relevance: Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.

[Argentine psychiatric nosologies and nosographies]. / Nosologías y nosografías psiquiátricas argentinas.

Since the late 19th century, Argentinean psychiatrists have been developing classifcations of psychiatric disorders. Their work has had local originality and fruitful exchange with international controversies on the subject. The thinking of some Argentinean psychiatrists transcended the borders of the country and was adopted in the South American region, as was the case with the classifcation proposed by José T. Borda. There were also historical anticipations of concepts that were not known in other latitudes: "oligotimia", a category created by Enrique Pichon-Rivière, preceded the characterization of early childhood autism by Leo Kanner. In recent decades, Argentinean psychiatrists have adopted current international classifcations (DSM and CIE), but also actively participated in the elaboration of an original regional proposal: the Latin American Guide to Psychiatric Diagnosis (GLADP-VR 2012), and collaborated with the surveys carried out by the World Health Organization (WHO) for the revision of the future ICD 11. This article provides a detailed description of Argentinian classifcations, extensively quoting each author to provide a clear understanding of their thinking, as well as critical reviews of their proposals.

[Present training for specialists in psychiatry: an epistemological challenge]. / La formación actual de especialistas en psiquiatría: un desafío epistemológico.

Teaching theoretical-technical knowledge aimed at training specialists in psychiatry at postgraduate level requires the explicitness of the theoretical model to which the curricula presented to students should be ordered. First, said model should be coherent with the general curricula for the medical training from which candidates to obtain the specialist degree graduate; second, it should serve to transmit theoretical elements, attitudes and skills that allow their work of excellence, which means acquiring the qualities considered relevant and necessary by the consensus among the members of a specialty, discipline or science (in our case, medical specialty in psychiatry) in the present historical moment. Reference points to meet them in the light of the present data concerning medical and psychiatric paradigms are developed. This article refers to those particular aspects with special emphasis on certain epistemological issues, from whose effects the same specialists do not escape, and which also condition their teaching practice, trying to show that an integrative pedagogical model is the one that best fits the contemporary historical conditions.

La formación actual de especialistas en psiquiatría: un desafío epistemológico / [Present training for specialists in psychiatry: an epistemological challenge].

Teaching theoretical-technical knowledge aimed at training specialists in psychiatry at postgraduate level requires the explicitness of the theoretical model to which the curricula presented to students should be ordered. First, said model should be coherent with the general curricula for the medical training from which candidates to obtain the specialist degree graduate; second, it should serve to transmit theoretical elements, attitudes and skills that allow their work of excellence, which means acquiring the qualities considered relevant and necessary by the consensus among the members of a specialty, discipline or science (in our case, medical specialty in psychiatry) in the present historical moment. Reference points to meet them in the light of the present data concerning medical and psychiatric paradigms are developed. This article refers to those particular aspects with special emphasis on certain epistemological issues, from whose effects the same specialists do not escape, and which also condition their teaching practice, trying to show that an integrative pedagogical model is the one that best fits the contemporary historical conditions.

La formación actual de especialistas en psiquiatría: un desafío epistemológico. / [Present training for specialists in psychiatry: an epistemological challenge].

Teaching theoretical-technical knowledge aimed at training specialists in psychiatry at postgraduate level requires the explicitness of the theoretical model to which the curricula presented to students should be ordered. First, said model should be coherent with the general curricula for the medical training from which candidates to obtain the specialist degree graduate; second, it should serve to transmit theoretical elements, attitudes and skills that allow their work of excellence, which means acquiring the qualities considered relevant and necessary by the consensus among the members of a specialty, discipline or science (in our case, medical specialty in psychiatry) in the present historical moment. Reference points to meet them in the light of the present data concerning medical and psychiatric paradigms are developed. This article refers to those particular aspects with special emphasis on certain epistemological issues, from whose effects the same specialists do not escape, and which also condition their teaching practice, trying to show that an integrative pedagogical model is the one that best fits the contemporary historical conditions.