Browsing by Author "Uestuen, T. Bedirhan"

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Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys
(Royal College of Psychiatrists, British Journal of Psychiatry 17 Belgrave Square, London SW1X 8PG, England, 2010) Kessler, Ronald C.; McLaughlin, Katie A.; Green, Jennifer Greif; Gruber, Michael J.; Sampson, Nancy A.; Zaslavsky, Alan M.; Aguilar-Gaxiola, Sergio; Alhamzawi, Ali Obaid; Alonso, Jordi; Angermeyer, Matthias; Benjet, Corina; Bromet, Evelyn; Chatterji, Somnath; De Girolamo, Giovanni; Demyttenaere, Koen; Fayyad, John; Florescu, Silvia; Gal, Gilad; Gureje, Oye; Maria Haro, Josep; Hu, Chi-yi; Karam, Elie G.; Kawakami, Norito; Lee, Sing; Lepine, Jean-Pierre; Ormel, Johan; Posada-Villa, José; Sagar, Rajesh; Tsang, Adley; Uestuen, T. Bedirhan; Vassilev, Svetlozar; Viana, María Carmen; Williams, David R.; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
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.
Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative
(ELSEVIER MASSON, VIA PALEOCAPA 7, 20121 MILANO, ITALY, 2007) Wang, Philip S.; Angermeyer, Matthias; Borges, Guilherme; Bruffaerts, Ronny; Chiu, Wai Tat; De Girolamo, Giovanni; Fayyad, John; Gureje, Oye; Maria Haro, Josep; Huang, Yueqin; Kessler, Ronald C.; Kovess, Viviane; Levinson, Daphna; Nakane, Yoshibumi; Browne, Mark A. Oakley; Ormel, Johan H.; Posada-Villa, José; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Lee, Sing; Heeringa, Steven; Pennell, Beth-Ellen; Chatterji, Somnath; Uestuen, T. Bedirhan; NIMH, Div Serv & Intervent Res, Bethesda, MD 20892 USA
Data are presented on patterns of failure and delay in making initial treatment contact after first onset of a mental disorder in 15 countries in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Representative face-to-face household surveys were conducted among 76,012 respondents aged 18 and older in Belgium, Colombia, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, People's Republic of China (Beijing and Shanghai), Spain, and the United States. The WHO Composite International Diagnostic Interview (CIDI) was used to assess lifetime DSM-IV anxiety, mood, and substance use disorders. Ages of onset for individual disorders and ages of first treatment contact for each disorder were used to calculate the extent of failure and delay in initial help seeking. The proportion of lifetime cases making treatment contact in the year of disorder onset ranged from 0.8 to 36.4% for anxiety disorders, from 6.0 to 52.1 % for mood disorders, and from 0.9 to 18.6% for substance use disorders. By 50 years, the proportion of lifetime cases making treatment contact ranged from 15.2 to 95.0% for anxiety disorders, from 7.9 to 98.6% for mood disorders, and from 19.8 to 86.1% for substance use disorders. Median delays among cases eventually making contact ranged from 3.0 to 30.0 years for anxiety disorders, from 1.0 to 14.0 years for mood disorders, and from 6.0 to 18.0 years for substance use disorders. Failure and delays in treatment seeking were generally greater in developing countries, older cohorts, men, and cases with earlier ages of onset. These results show that failure and delays in initial help seeking are pervasive problems worldwide. Interventions to ensure prompt initial treatment contacts are needed to reduce the global burdens and hazards of untreated mental disorders.
Development of Lifetime Comorbidity in the World Health Organization World Mental Health Surveys
(AMER MEDICAL ASSOC, 515 N STATE ST, CHICAGO, IL 60610-0946 USA, 2011) Kessler, Ronald C.; Ormel, Johan; Petukhova, María; McLaughlin, Katie A.; Green, Jennifer Greif; Russo, Leo J.; Stein, Dan J.; Zaslavsky, Alan M.; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Andrade, Laura; Benjet, Corina; De Girolamo, Giovanni; De Graaf, Ron; Demyttenaere, Koen; Fayyad, John; Haro, Josep Maria; Hu, Chi Yi; Karam, Aimee; Lee, Sing; Lepine, Jean-Pierre; Matchsinger, Herbert; Mihaescu-Pintia, Constanta; Posada-Villa, José; Sagar, Rajesh; Uestuen, T. Bedirhan; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
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.
Disability and treatment of specific mental and physical disorders across the world
(ROYAL COLLEGE OF PSYCHIATRISTS, BRITISH JOURNAL OF PSYCHIATRY 17 BELGRAVE SQUARE, LONDON SW1X 8PG, ENGLAND, 2008) Ormel, Johan; Petukhova, María; Chatterji, Somnath; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Angermeyer, Matthias C.; Bromet, Evelyn J.; Burger, Huibert; Demyttenaere, Koen; De Girolamo, Giovanni; Maria Haro, Josep; Hwang, Irving; Karam, Elie; Kawakami, Norito; Lepine, Jean Pierre; Medina-Mora, María Elena; Posada-Villa, José; Sampson, Nancy; Scott, Kate; Uestuen, T. Bedirhan; Von Korff, Michael; Williams, David R.; Zhang, Mingyuan; Kessler, Ronald C.; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
Background: Advocates of expanded mental health treatment assert that mental disorders are as disabling as physical disorders, but little evidence supports this assertion. Aims: To establish the disability and treatment of specific mental and physical disorders in high-income and low- and middle-income countries. Method: Community epidemiological surveys were administered in 15 countries through the World Health organization World Mental Health (WMH) Survey Initiative. Results: Respondents in both high-income and low- and middle-income countries attributed higher disability to mental disorders than to the commonly occurring physical disorders included in the surveys. This pattern held for all disorders and also for treated disorders. Disaggregation showed that the higher disability of mental than physical disorders was limited to disability in social and personal role functioning, whereas disability in productive role functioning was generally comparable for mental and physical disorders. Conclusions: Despite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.
Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys
(CAMBRIDGE UNIV PRESS, 32 AVENUE OF THE AMERICAS, NEW YORK, NY 10013-2473 USA, 2011) Alonso, J.; Vilagut, G.; Chatterji, S.; Heeringa, S.; Schoenbaum, M.; Uestuen, T. Bedirhan; Rojas-Farreras, S.; Angermeyer, M.; Bromet, E.; Bruffaerts, R.; De Girolamo, G.; Gureje, O.; Haro, J.M.; Karam, A.N.; Kovess, V.; Levinson, D.; Liu, Z.; Medina-Mora, M.E.; Ormel, J.; Posada-Villa, J.; Uda, H.; Kessler, R.C.; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; Kessler@hcp.med.harvard.edu
Background. The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. Method. Face-to-face interviews in 13 countries (six developing, nine developed; n = 31 067; response rate = 69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results. The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions. Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.
Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative
(ELSEVIER MASSON, VIA PALEOCAPA 7, 20121 MILANO, ITALY, 2007) Kessler, Ronald C.; Angermeyer, Matthias; Anthony, James C.; De Graaf, Ron; Demyttenaere, Koen; Gasquet, Isabelle; De Girolamo, Giovanni; Gluzman, Semyon; Gureje, Oye; Haro, Josep Maria; Kawakami, Norito; Karam, Aimee; Levinson, Daphna; Medina-Mora, María Elena; Browne, Mark A. Oakley; Posada-Villa, José; Stein, Dan J.; Tsang, Cheuk Him Adley; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Lee, Sing; Heeringa, Steven; Pennell, Beth-Ellen; Berglund, Patricia; Gruber, Michael J.; Petukhova, María; Chatterji, Somnath; Uestuen, T. Bedirhan; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in seventeen countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescents, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders.