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Individuals with prenatal alcohol exposure (PAE) commonly experience co-occurring diagnoses, which are often overlooked and misdiagnosed and have detrimental impacts on accessing appropriate services. The prevalence of these co-occurring diagnoses varies widely in the existing literature and has not been examined in PAE without an FASD diagnosis. A search was conducted in five databases and the reference sections of three review papers, finding a total of 2180 studies. 57 studies were included in the final analysis with a cumulative sample size of 29,644. Bayesian modeling was used to determine aggregate prevalence rates of co-occurring disorders and analyze potential moderators. 82 % of people with PAE had a co-occurring diagnosis. All disorders had a higher prevalence in individuals with PAE than the general population with attention deficit hyperactivity disorder, learning disorder, and intellectual disability (ID) being the most prevalent. Age, diagnostic status, and sex moderated the prevalence of multiple disorders. While prevalence of disorders is crucial information, it does not provide a direct representation of daily functioning and available supports. Results should be interpreted in collaboration with more individualized research to provide the most comprehensive representation of the experience of individuals with PAE. Co-occurring diagnoses are extremely prevalent in people with PAE, with older individuals, females, and those diagnosed with FASD being most at risk for having a co-occurring disorder. These findings provide a more rigorous examination of the challenges faced by individuals with PAE than has existed in the literature, providing clinicians with information to ensure early identification and effective treatment of concerns to prevent lifelong challenges. • No study has examined mental health prevalence rates in individuals with PAE but not FASD. • 57 articles including 29,644 individuals with alcohol exposure were found and analyzed. • 82 % of individuals with alcohol exposure have at least one co-occurring disorder • Older individuals, females, and those with an FASD diagnosis had higher prevalences of multiple disorders.. • These findings help inform both the diagnosis and support of individuals with alcohol exposure [ABSTRACT FROM AUTHOR]

As is now well-known, COVID-19 is a highly contagious disease, which for some can cause symptoms that last long after initial infection. In 2021, a clinical set of symptoms referred to as long-COVID was identified. For many patients, long-COVID is a confusing and frightening multisystem disease, with the potential for myriad negative psychosocial effects, including significant impacts on employment and mental health, and requiring ongoing care. Research and treatment of long-COVID will be facilitated by a sound measure that addresses aspects of well-being, symptom experiences, and psychosocial impacts among long-COVID patients. The present work addresses this need by presenting the results of the development and preliminary psychometrics for the Long-COVID Well-Being Scale (LCOVID-WBS). In an exploratory factor analysis with a panel of 236 participants, researchers identified four factors: Emotional Strain, Physical Ability Strain, Control of Life, and Overall Evaluation of Health. The nascent measure represents the first step to measuring the impacts of long-COVID. • Long-COVID is a multisystem disease, with negative psychosocial effects • A sound measure of long-COVID is needed • This paper presents the Long-COVID Well-Being Scale (LCOVID-WBS) • Researchers identified four factors: Emotional Strain, Physical Ability Strain, Control of Life, and Overall Evaluation of Health [ABSTRACT FROM AUTHOR]

Digital mental health interventions (DMHIs) offer potential solutions for addressing mental health care gaps, but often suffer from low engagement. Text messaging is one promising medium for increasing access and sustaining user engagement with DMHIs. This paper examines the Small Steps SMS program, an 8-week, automated, adaptive text message-based intervention for depression and anxiety. We conducted an 8-week longitudinal usability test of the Small Steps SMS program, recruiting 20 participants who met criteria for major depressive disorder and/or generalized anxiety disorder. Participants used the automated intervention for 8 weeks and completed symptom severity and usability self-report surveys after 4 and 8 weeks of intervention use. Participants also completed individual interviews to provide feedback on the intervention. Participants responded to automated messages on 70 % of study days and with 85 % of participants sending responses to messages in the 8th week of use. Usability surpassed established cutoffs for software that is considered acceptable. Depression symptom severity decreased significantly over the usability test, but reductions in anxiety symptoms were not significant. Participants noted key areas for improvement including addressing message volume, aligning message scheduling to individuals' availability, and increasing the customizability of content. This study does not contain a control group. An 8-week automated interactive text messaging intervention, Small Steps SMS, demonstrates promise with regard to being a feasible, usable, and engaging method to deliver daily mental health support to individuals with symptoms of anxiety and depression. • Daily interactive SMS is acceptable for supporting affective self-management skills. • A personalized automated SMS intervention supports sustained engagement (8 weeks). • An SMS-based mental health intervention is associated with reductions in depression. [ABSTRACT FROM AUTHOR]

Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals). • Barriers, such as stigma, are experienced by patients before engaging with services. • Primary care is not viewed as where common mental health disorders are supported. • The patient-healthcare professional relationship is pivotal to accessing support. [ABSTRACT FROM AUTHOR]

Background: Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period.Methods: We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials).Results: Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample.Limitations: No experimental investigations were eligible for inclusion in the review.Conclusions: Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety. [ABSTRACT FROM AUTHOR]

Background: Suicidality is a common concern for people with mental health problems. The interpersonal nature of suicidality suggests that therapeutic alliance may be important when working clinically with suicidal patients. This paper is a systematic review of studies investigating the association between alliance and treatment outcome relating to suicidal ideation and behaviours.Methods: Systematic searches of PsychINFO, MEDLINE, AMED, EMBASE, Web of Science and CINAHL were completed using words that captured the concepts of alliance and suicidality. Eligible studies: involved participants aged 18-years-old or over; used a validated measure of therapeutic alliance; and reported associations between alliance and suicidality. Abstracts, qualitative studies and articles not written in English were excluded.Results: Twelve studies were included. Findings indicated that alliance is associated with suicidality. Alliance was related to suicidality in eleven of the papers. Self-harming behaviours had the strongest association with patient-rated alliance. Suicide attempts had the weakest association, possibly due to the infrequency of suicide attempts in the studies reviewed.Limitations: The twelve studies were heterogeneous in terms of the measure of alliance used, method of assessing suicidality, clinical setting and professional-type. This variability limited the degree to which findings could be synthesised.Conclusion: Therapists, care-coordinators and mental health teams should recognise the importance of building a strong therapeutic alliance with suicidal patients. Researchers should use consistent methods of measuring alliance and assessing suicidality in future studies. Clinicians and researchers should note that suicidal thoughts, self-harm and suicide attempts may be related to alliance in different ways and therefore should be assessed as separate constructs. [ABSTRACT FROM AUTHOR]

Background: Metrics of journal's impact factor may suggest the journal's influence in a particular field, but they have been used inadvertently as a measure of the journal and individual publications' scientific quality.Methods: We assessed how scientific journals in the field of psychiatry and mental health are ranked (top 20) according to the scores of distinct metrics (Eigenfactor score, Google Scholar Metrics, Journal Citation Reports, Scimago Journal & Country Rank, and Source Normalized Impact per Paper), described their main characteristics and perfomed a spearman's correlation analyses to investigate to which extent these metrics are associated. We also discussed the limitations of dealing with these metrics and the rankings they provide as a proxy of the journal's quality.Results: Only 5 (12.5%) journals appear in all metrics (JAMA Psychiatry, American Journal of Psychiatry, Molecular Psychiatry, Schizophrenia Bulletin, and the Journal of Child Psychology and Psychiatry), more than one-third of the journals show up in only one and less than half (42.5%) appear in three or more. Only JAMA Psychiatry is in one of the first five positions of all metrics. No journal ranked in the same position across the metrics. On the other hand, we found the correlations between all the metrics were statistically significant.Limitations: The metrics included are not exhaustive.Conclusions: Although each metric provides a particular ranking, they are highly correlated. Rankings also change according to distinct subject categories in which they are assessed. We suggest less emphasis should be given to Journal Metrics to infer journal's quality. [ABSTRACT FROM AUTHOR]

Background: People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world's HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms among PLWHA in South Africa.Methods: A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria.Results: Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations.Limitations: Few studies conducted prospective analyses or tested mediation/moderation.Conclusions: Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: Men's experiences of anxiety within the perinatal period can adversely impact themselves, their partner and infant. However, we know little about the prevalence and course of men's anxiety across the perinatal period. The current review is one of the first to systematically review the published literature.Methods: Five databases (PubMed, PsycINFO, Cochrane, SCOPUS, and Web of Science) were searched to identify relevant papers published prior to April 2015. The literature search identified articles with data for expectant fathers (prenatal period) and/or fathers of an infant aged between 0 and 1 (postnatal period). The following data were extracted: (a) anxiety disorder prevalence (diagnostic clinical interviews), (b) 'high' anxiety symptom prevalence (above thresholds/cut-points on anxiety symptom scales) and (c) mean anxiety levels (anxiety symptom scales). Initially, 537 unique papers were identified. Subsequently, 43 papers met criteria for inclusion in the review.Results: Prevalence rates for 'any' anxiety disorder (as defined by either diagnostic clinical interviews or above cut-points on symptom scales) ranged between 4.1% and 16.0% during the prenatal period and 2.4-18.0% during the postnatal period. The data reviewed suggest the course of anxiety across the perinatal period is fairly stable with potential decreases postpartum.Limitations: Wide variation in study measurement and methodology makes synthesis of individual findings difficult. Anxiety is highly comorbid with depression, and thus measures of mixed anxiety/depression might better capture the overall burden of mental illness.Conclusions: Anxiety disorders are common for men during the perinatal period. Both partners should be included in discussions and interventions focused on obstetric care and parent mental health during the perinatal period. [ABSTRACT FROM AUTHOR]

Background: Though visual impairment is a strong predictor for late-life depression, the underlying mechanisms remain unclear. This paper investigated the contribution of material, psychosocial and behavioural pathways in mediating a vision-depression association.Methods: The study used cross-sectional data from the WHO Study on Global AGEing and Adult Health (SAGE), including 11,531 older Chinese adults. Depression was assessed based on an adaptation of the ICD-10 diagnostic criteria. Causal mediation analyses using inverse odds ratio weighting (IORW) approach were conducted to assess the mediating roles of material (wealth quintiles and perceived income inadequacy), behavioural (leisure activity, BMI and sleep) and psychosocial factors (social participation, trust and sense of safety).Results: The participants with visual impairment had a 43% higher odds of depression than those with normal vision. In the mediation analysis, the material pathway contributed the most to the total effect, accounting for 31.7% of it. The proportion of the total effect which was mediated by psychosocial and behavioural factors was 24.2% and 22.5% respectively. When these three mediators were considered together in the full model, they accounted for 43.5% of the total effect of visual impairment on depression.Limitations: There still existed unexamined mediating factors. The cross-sectional study design might restrict temporal sequence.Conclusion: Visually-impaired population as high-risk group should be provided better access to screening, diagnosis and treatment of depression. Material, behavioural and psychosocial factors may serve as relevant points of entry for developing intervention programmes to improve the mental health conditions of visually-impaired people. [ABSTRACT FROM AUTHOR]

Background: Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes.Methods: This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8-15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding.Results: Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms.Limitations: The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment.Conclusions: While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice. [ABSTRACT FROM AUTHOR]

Background: Emotional distress (defined as any negative mood state, including anxiety, depression, trauma symptoms and global distress) is common in people with multiple sclerosis (PwMS). To develop more integrated care for PwMS requires a better understanding of causal variables underlying persistent emotional distress. This systematic review critically appraised and synthesised the findings of prospective studies investigating predictors of emotional distress in PwMS.Method: CINAHL, Medline, and PsycINFO, were systematically searched for: i) prospective cohort studies with ≥1-month follow-up period, which; ii) evaluated baseline clinical and demographic, social and/or psychosocial predictors of emotional distress; iii) presented results for adults with MS; and iv) used validated measures to assess emotional distress. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale.Results: Thirteen studies, reported in 17 papers, were included. A wide range of outcome measures and statistical methods were used. The most reliable finding was that baseline emotional distress and stress-coping variables predicted emotional distress. Less robust support was found for income, negative cognitive illness appraisals and poor social support. No other variables often predicted emotional distress.Limitations: Lack of consistency across included studies may limit confidence in the results obtained.Conclusions: Little is currently known about how or why some people become and remain distressed following a diagnosis of MS, whilst others do not. However, psychological and social factors such as emotional distress and stress-coping variables appear to be important. A better understanding of the psychological factors underpinning distress in PwMS is needed. [ABSTRACT FROM AUTHOR]

Background: Postpartum anxiety (PPA) and postpartum depression (PPD) are associated with immediate and long-term health risks for both mothers and babies. The purpose of this paper was to evaluate relationships between sociodemographic, perinatal variables, and PPA and PPD symptoms of parturients 6 weeks postpartum.Methods: A cross-sectional survey with 1204 women who had a healthy and term birth in a baby-friendly hospital, Shanghai, China. PPA and PPD symptoms were measured by using the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS).Results: The mean score of SAS and EPDS was 40.79 ± 8.48 and 8.18 ± 5.80, respectively. The estimated prevalence of PPA and PPD symptoms was 15.2% and 23.2%, respectively. Multivariable logistic regression analysis showed that the presence of fatigue and PPD symptoms were risk factors for PPA symptoms, whereas having support from family and being satisfied with labor experience were protective factors. In terms of PPD symptoms, its risk factors included smoking before pregnancy, maternal separation from baby, fatigue, encountering difficulties in breastfeeding, and the presence of PPA symptoms. In contrast, the protective factors for PPD symptoms were having support from family and having support from colleagues or friends.Limitations: Convenience sampling and voluntary participation may have led to a selection bias.Conclusion: PPA and PPD symptoms occur commonly among parturients in Shanghai, China. The findings from this research provide a better understanding of factors associated with PPA and PPD symptoms and will help guide personalized approaches to the management of postpartum anxiety and depression. [ABSTRACT FROM AUTHOR]

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing. The protection hypothesis predicts increased risk of depression in 2016 for clergy who were flourishing in 2014 but went down to 'not flourishing' in 2016. The reference group is clergy who stayed flourishing. We used modified Poisson regression models for binary outcomes to estimate Prevalence Ratios (PR) and to estimate Incidence Rate Ratios (IRR) of depression in 2016 associated with changes in mental health status. Results support both hypotheses. Compared to clergy who stayed flourishing, clergy who improved to flourishing were as likely, while clergy who stayed not flourishing were nearly seven times more likely, to have depression in 2016. Clergy who declined to not flourishing were six times more likely to have depression in 2016 compared to those who stayed flourishing. Similar patterns were observed when the sample was restricted to clergy without depression in 2014. These findings suggest focusing on MHPP as a complementary approach to treatment to reduce the incidence, prevalence and burden of depression. [ABSTRACT FROM AUTHOR]

Background: There is extensive lack of awareness of maternal mental health and its impact on child development in low- and middle-income countries (LAMICs). The aim of this systematic review was to analyze evidence for various maternal perinatal mental health disorders and their association with different domains of infant and toddler neurodevelopment during the first two postnatal years in LAMICs.Methods: A comprehensive literature search was conducted within six databases from Jan 1990-April 2019. All included studies were narratively synthesized.Results: Twenty-four studies, nine cross sectional and 15 longitudinal cohort studies, were included. Three studies were conducted in low-income, 11 in lower-middle-income and ten in upper-middle-income countries. The majority of studies assessed maternal mental health postnatally and 14 of these 22 studies found a significant association with infant and toddler neurodevelopment. Five of the ten studies reporting on exposure to prenatal mental health found a significant association. The most common maternal mental health disorder studied was depression, while the main neurodevelopmental outcomes assessed were motor, cognitive and language development.Limitations: Meta-analysis could not be conducted due to the variability in the reported maternal mental health disorders and the different times of assessment of exposures and outcomes.Conclusions: Maternal perinatal mental health disorders and their association with different domains of neurodevelopment in LAMICs is still inconclusive due to a limited number of papers. Mother-infant dyads in LAMICs are exposed to multiple and cumulative risk factors and causal pathways between maternal mental health and infant neurodevelopment are still poorly understood. [ABSTRACT FROM AUTHOR]

Background: With conflict driving millions of refugees away from their homes worldwide, there has been an increase in interest in the field of refugee trauma. However, while trauma and bereavement interlink, prior studies have focused on trauma and its related disorders (PTSD) and predictive factors. This paper reviewed up-to-date literature on the prevalence rates of prolonged grief disorder (PGD), its comorbidities, and associated risk factors among adult refugees.Method: We systematically reviewed the literature using five databases (PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Academic Search Elite, and PubMed). The process of study selection was designed according to PRISMA guidelines.Results: The initial search generated 126 articles, of which 12 met the inclusion criteria. The pooled prevalence of PGD was 33.2% (95% CI: 15.2-54.2%). Being an older refugee, traumatic and multiple losses implying the death of first-degree relatives appeared to be consistent risk factors for PGD, combined PTSD/PGD, depression, idioms of distress, and functional impairment. PGD, PTSD, and PTSD/PGD intersect on PTSD-intrusions and painful memories.Limitations: All included studies adopted a cross-sectional design, thus limiting the understanding of causal pathways.Conclusions: Our findings showed that the high prevalence of PGD and related comorbidities were influenced by the load of traumatic circumstances surrounding the death(s). The findings shed light on the current proposed grief-related diagnostic criteria . Psychopathological and transcultural aspects are discussed, and we provide concrete recommendations for improvements to future research in this field. [ABSTRACT FROM AUTHOR]

Objective: Despite a vast evidence-base advocating the psychological benefits of physical activity, relatively little is understood about how combining physical activity with psychological therapies may influence these positive effects. The aim of this paper is to systematically analyse evidence from studies adopting a combined approach, and identify potential mechanisms of action on clinical outcomes.Methods: The Embase, PsycINFO and Medline (PubMed and OVID) databases were searched for applicable trials published up to December 2018. Relevant data was extracted from eligible studies, and the Effective Public Health Practice Project (EPHPP) tool was utilised to objectively assess the quality of each study.Results: Twenty-two studies met the inclusion criteria, seven of which were rated as methodologically `strong'. Combining physical activity with psychological therapy consistently engendered positive effects on outcomes compared with treatment as usual. Similar improvements in psychological outcomes were observed in most (7/8) groups receiving physical activity alone. Increased levels of physical activity were observed in psychologically-informed interventions, however this effect was unrelated to changes in psychological outcomes.Limitations: Clinical and methodological heterogeneity precluded meta-analyses of results, while risk of bias detected in the studies may compromise overall validity of the findings.Conclusions: Physical activity interventions may be a viable alternative to psychological therapies, provided psychological approaches are incorporated into the implementation design (i.e. behavioural activation). Improved psychological outcomes may be observed regardless of `dose' received, however further research is required to ascertain whether psychosocial mechanisms of change mediate positive effects. [ABSTRACT FROM AUTHOR]

Abstract: Background: Various consequences including suicidal behaviours can arise in the aftermath of natural disasters. The aim of the present review was to systematically analyse the existing literature on the potential impact of natural disasters on suicidal behaviours. Methods: A systematic search of English-language articles indexed in electronic databases was conducted. The current review covers 42 papers containing empirical analyses of the relationship between natural disasters and suicidal behaviours. Results: In total, 19 papers analysed suicide mortality and 23 non-fatal suicidal behaviours. The effects of earthquakes on suicidal behaviours are the most frequently studied among natural disasters (n=20), followed by hurricanes (n=11). Further, there were four papers about tsunamis, three about floods, three about heat waves and drought, and one investigating the effects of multiple natural disasters. The studies show different directions in suicide mortality following natural disasters. Nevertheless, there seems to be a drop in non-fatal suicidal behaviours in the initial post-disaster period, which has been referred to as the ‘honeymoon’ phase. A delayed increase in suicidal behaviours has been reported in some studies. However, other factors increasing the risk of suicidal behaviours after natural disasters have been reported, such as previous and current mental health problems. Furthermore, contributing factors, such as economic conditions, should also be considered. Limitations: The exclusion of non-English articles. Conclusions: In light of the various methodological limitations observed, there is a need for further studies using proper designs. Mental health and suicidal behaviours should continue to be monitored for several years after the disaster. [Copyright &y& Elsevier]

Background: The established relationship between vision impairment and depression is limited by the examination of depression only as a unidimensional construct. The present study explores the vision-depression relationship using a dimensional approach.Methods: 9036 participants aged 65 years and above enrolled in the Three-City study were included. Relationships between baseline near Vision Impairment (VI) or self-reported distance Visual Function (VF) loss with trajectory of four dimensions of depression - depressed affect, positive affect, somatic symptoms and interpersonal problems - over 12 years were examined using mixed-effects models. Depression dimensions were determined using the four-factor structure of the Centre for Epidemiology Studies-Depression Scale (CESD).Results: In the fully adjustment models, mild near VI predicted poorer depressed affect (b = 0.04, p = .002) and positive affect (b = -0.06, p < 0.001) over time, with evidence of longer term adjustment. Distance VF loss was associated with poorer depressed affect (b = 0.27, p ≤ .001), positive affect (b = -0.15, p = .002), and somatic symptoms (b = 0.18, p ≤ .001) at baseline, although only the association with depressed affect was significant longitudinally (b = 0.01, p = .001). Neither near VI nor distance VF loss was associated with interpersonal problems.Limitations: This paper uses a well-supported model of depression dimensions, however, there remains no definite depression dimension model. Distance VF loss was self-reported, which can be influenced by depression symptoms.Conclusions: Vision impairment in older adults is primarily associated with affective dimensions of depression. A reduction in social connectedness and ability to engage in pleasurable activities may underlie the depression-vision relationship. Older adults with vision impairment may benefit from targeted treatment of affective symptoms, and pleasant event scheduling. [ABSTRACT FROM AUTHOR]

Abstract: Background: Perinatal mental health disorders are recognised as an important public health issue in low-income countries as well as in developed countries. This paper reviews evidence on the prevalence and risk factors of maternal mental health disorders in African women living in Africa. Methods: A systematic review of the literature was conducted. Studies were mainly located through computerised databases, and additionally through hand searching references of identified articles and reviews. Thirty-five studies, with a total of 10,880 participants, were identified that reported prevalence rates of maternal psychological health in eight African countries. Results: Depression was the most commonly assessed disorder with a weighted mean prevalence of 11.3% (95% CI 9.5%–13.1%) during pregnancy and 18.3% (95% CI 17.6%–19.1%) after birth. Only a small number of studies assessed other psychological disorders. Prevalence rates of pre- and postnatal anxiety were 14.8% (95% CI 12.3%–17.4%) and 14.0% (95% CI 12.9%–15.2%), respectively; and one study reported the prevalence of PTSD as 5.9% (95% CI 4.4%–7.4%) following childbirth. Lack of support and marital/family conflict were associated with poorer mental health. Evidence relating sociodemographic and obstetric variables to mental health was inconclusive. Limitations: Most studies included in this review were cross-sectional and measures of mental health varied considerably. Conclusions: This paper demonstrates that maternal mental health disorders are prevalent in African women, and highlights the importance of maternal mental health care being integrated into future maternal and infant health policies in African countries. [Copyright &y& Elsevier]

Abstract: Background: Temperament relates to both emotional dimensions and prevailing mood, but these different views are rarely integrated. Based on a model where temperament works as a system with activation, inhibition and control (inspired in Cloninger''s and Rothbart''s models), which produce the affective tone (inspired by Akiskal''s and Kraepelin''s model), we developed and validated the Combined Emotional and Affective Temperament Scale (CEATS). Methods: 1007 subjects (28% males) from the general population and university students filled in the instrument either in the Internet or in a pen and paper version. The CEATS has an emotional section (dimensional only), an Affective section (both dimensional and categorical) and an evaluation of problems and benefits related to temperament. The data was analyzed with standard psychometric batteries and different sections were compared. Results: In the emotional section, 4 factors with Eingenvalue >1 explained 46% of the variation. These factors were interpreted as drive, control, disinhibition-fear and anger, had a normal distribution and had satisfactory Chronbach''s alphas (0.70–0.82). Anger was particularly associated with problems and drive with benefits. In the Affective section, all 10 categorical affective temperaments were selected, being euthymic and hyperthymic the most prevalent (18–23%), followed by cyclothymic and irritable (11–13%), anxious and depressive (8–9%) and dysphoric, disinhibited, labile and apathetic temperaments (3–7%). The dimensional evaluation of affective temperaments showed 95% of the sample was able to ascribe to at least one affective temperament. Only the euthymic and hyperthymic temperaments were clearly associated with a favorable problem/benefit profile. The comparison between the emotional and affective sections revealed that each affective temperament had a particular emotional configuration. Limitations: Both computerized and pen and paper versions were used. The sample was not evaluated for psychiatric symptoms. Quantification of the dimensional assessment of affective temperament is limited. Conclusions: The CEATS is a brief and adequate instrument to evaluate emotional and affective aspects of temperament simultaneously. [Copyright &y& Elsevier]

Background: The Youth Anxiety Measure-I for DSM-5 has recently been developed to assess youth's anxiety symptomatology. As social anxiety is one of the most common disorders in adolescence, this scale includes a subscale measuring social anxiety. However, psychometric properties of the YAM-5-I social anxiety subscale (YAM-5-I-SAD) in clinical samples are lacking. This paper aims to bridge the gap.Methods: The sample comprised 24 clinically diagnosed and 24 healthy control Spanish-speaking adolescents aged 14-17 years.Results: Data revealed that the YAM-5- I-SAD yielded excellent sensitivity, which makes it particularly useful as a screening tool to early detect socially anxious adolescents. In addition, the YAM-5-I-SAD evidenced good internal consistency and construct validity.Limitations: Data are limited to the social anxiety subscale.Conclusions: The YAM-5-I-SAD is a sensitive and specific measure to screen for adolescents with social anxiety. [ABSTRACT FROM AUTHOR]

Background: Most longitudinal or treatment studies in bipolar disorder have used symptomatic or syndromal status as the primary outcome variable. More recently, psychosocial functioning has been highlighted as a key domain of outcome. Patients with bipolar disorder appear to be impaired in all functional domains, although the factors that cause impairment have not been clearly specified.Methods: This paper reviews cross-sectional and longitudinal studies on functional impairment and its relationship to symptomatic, neurocognitive, personality, and stress variables in bipolar disorder; and the implications of these relationships for defining treatment targets. 93 articles were located through comprehensive MEDLINE, SCOPUS and Web of Science searches.Results and Discussion: Functional recovery following a mood episode consistently lags behind symptomatic and syndromal recovery. Longer term functional impairment is only partly explained by the number of manic/hypomanic episodes. Depression (including subsyndromal states) and persistent neurocognitive impairment are the strongest correlates of functional impairment in bipolar disorder, with personality and psychosocial stressors playing secondary roles. Possible treatment options include: more aggressive treatment of subthreshold depressive states, pharmacotherapies that target cognition (e.g., stimulants), and adjunctive psychotherapies including cognitive remediation. [ABSTRACT FROM AUTHOR]

Background Minorities comprise more than one third of the U.S., and research on the correlates and causes of depression, anxiety, and other mental illnesses have yielded mixed results in minority groups necessitating an understanding of causes and correlates of health. Thus, the aim of this paper is to evaluate the relationship between minority status, contextual factors, and lifetime Generalized Anxiety Disorder. Methods Logistic regression models were implemented, comparing immigrants to their American-born counterparts as well as to American-born Whites. Results Foreign-born Afro-Caribbeans exhibited lower rates of lifetime GAD. A lower percentage of foreign-born minorities met the criteria for GAD as compared to their American-born counterparts, and all racial and ethnic groups met the criteria for lifetime GAD at a lower rate as compared to American-born Whites. Discussion By using theory proactively and including contextual factors, this multi-faceted approach to health disparities research yielded findings which both supported historic beliefs but created opportunities for supplemental research looking at immigrants and GAD. Key findings were that health lifestyle choices and exposure to discrimination significantly affected the chance of having GAD. Nativity was protective; however, its effect was ameliorated by exposure to discrimination or engagement in alcohol abuse. Thus, this study offers practical insight into environmental factors for clinicians caring for racial and ethnic minorities diagnosed with GAD. [ABSTRACT FROM AUTHOR]

Background: The rate of switching from major depression to bipolar disorder is high in children. Predicting who is at risk for switching poses unique challenges and is of high clinical relevance. Our aim was to examine the existing scientific literature elucidating if certain clinical correlates predict ultimate bipolar switches in children initially presenting with a depressive episode.Methods: We conducted a systematic literature search of studies assessing the risk factors for bipolar switching in youth. In all, seven studies fit our a priori criteria and were thus included in our qualitative review.Results: Together, these papers found that manic switches in pediatric depression can be predicted by several risk factors, including positive family history of mood disorders, emotional and behavioral dysregulation, subthreshold mania, and psychosis.Limitations: We identified only seven prospective informative studies for our review. The majority of subjects included in these studies were referred and Caucasian. Thus, the results may not generalize to other community samples and other ethnicities.Conclusions: These findings can help alert clinicians of the risk of manic switches. [ABSTRACT FROM AUTHOR]

Abstract: Background: High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. Methods: In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. Results: 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. Limitations: Community-level assessment with no control. Conclusions: Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking. [Copyright &y& Elsevier]

Abstract: Background: Existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental and physical health in patients with bipolar disorder. The present review evaluates systematically quantitative studies of correlates of physical activity in patients with bipolar disorder. Methods: We searched EMBASE, PsycINFO, PubMed, and CINAHL from their inception, combining the medical subject headings ‘bipolar disorder’ or ‘mania’ or ‘manic depression’ with ‘physical activity’ or ‘physical inactivity’ or ‘exercise’. Results: Out of 40 potentially eligible studies, 11 papers evaluating 26 correlates were included. Correlates that were associated with lower physical activity participation were lower self-efficacy, presence of medical co-morbidity, lower educational status and social isolation. Less consistent variables associated with lower physical activity participation included higher BMI, older age, financial strains, not being connected to a health care service, and minority ethnicity. A larger study sample size was related to a higher proportion of significant associations (p=0.04). Current gaps in literature which need to be examined more in detail are the role of psychiatric symptoms, environmental and policy-level factors. Limitations: The diversity of physical activity measures and subject samples prevented us to perform a meta-analysis. Conclusions: All significant correlates should be confirmed in prospective studies and interventions to improve the modifiable variables should be developed and evaluated. The reviewed data also demonstrate that validation studies on physical activity measurements are highly needed. [Copyright &y& Elsevier]

Abstract: Background: Pattern analysis can aid understanding of trajectories of symptom evolution. However, most studies focus on relatively homogeneous disorders with a restricted range of outcomes, prescribed a limited number of classes of medication. We explored the utility of pattern analysis in defining short-term outcomes in a heterogeneous clinical sample with acute bipolar disorders. Method: In a naturalistic observational study, we used Group-based trajectory modeling (GBTM) to define trajectories of symptom change in 118 bipolar cases recruited during an acute DSM IV episode: major depression (56%), (hypo)mania (26%), and mixed states (18%). Symptoms were assessed weekly for a month using the MATHYS, which measures symptoms independent of episode polarity. Results: Four trajectories of symptom change were identified: Persistent Inhibition, Transient Inhibition, Transient Activation and Over-activation. However, counter to traditional predictions, we observed that bipolar depression shows a heterogeneous response pattern with cases being distributed approximately equally across trajectories that commenced with inhibition and activation. Limitations: The observational period focuses on acute outcomes and so we cannot use the findings to predict whether the trajectories lead to stable improvement or whether the clinical course for some clusters is cyclical. As in all GBTM, the terms used for each trajectory are subjective, also the modeling programme we used assumes dropouts are random, which is clearly not always the case. Conclusion: This paper highlights the potential importance of techniques such as GBTM in distinguishing the different response trajectories for acutely ill bipolar cases. The use of the MATHYS provides further critical insights, demonstrating that clustering of cases with similar response patterns may be independent of episodes defined by mood state. [Copyright &y& Elsevier]

Abstract: Background: Religious belief is an important determinant of mental health, depression is the mental illness responsible for the largest disease burden globally, and Islam is the fastest growing world religion. Here we systematically review the literature on the engagement of Muslim patients in the treatment of depression. Method: A search of electronic databases, including non-traditional sources, was conducted and content experts were contacted in order to identify qualitative studies, quantitative studies and opinion pieces. A standardised data extraction pro forma and thematic analysis were applied to included studies. Results: 25 studies met the inclusion criteria. Muslims hold many beliefs about depression relevant to its treatment. Advice about how to identify and respond to such beliefs was contradictory and rarely based upon research evidence. The literature is generally of poor quality and rarely distinguishes between religion and culture. Limitations: Many studies do not distinguish between beliefs and values that are religious and those that are cultural. The majority of papers identified are English language, suggesting that literature from predominantly Muslim countries is underrepresented, despite our strategy of searching for literature from all relevant countries. Conclusion: Much of the evidence identified by this review is methodologically weak or includes assertions made without qualification. This evidence provides important perspectives, but should be interpreted with caution. High-quality research is needed to improve our understanding of the treatment of depression in Muslim clients, to determine how existing therapies can be modified to meet the needs of Muslim clients, and to evaluate the effectiveness of such modified therapies. [Copyright &y& Elsevier]

Abstract: Objective: There have been relatively few studies of the relationship between anxiety and menopause. Despite the paucity of clear evidence, some authors have suggested that the menopausal transition is a time of heightened risk for onset or exacerbation of anxiety symptoms. There is also controversy as to whether anxiety predates or is a consequence of hot flashes. The aim of this paper is to examine the evidence as to the relationship between menopause and anxiety, and between anxiety and hot flushes, one of the core symptoms of menopause. Method: A systematic review was undertaken based on literature published between 1960 and 2011, using the Medline, Web of Science and PsychINFO databases. The key terms ‘anxiety’, ‘anxiety symptoms’, ‘anxiety disorder’, ‘menopause’, ‘menopausal transition’, ‘midlife’, ‘hot flushes or flashes’ and ‘vasomotor symptoms’ were entered into the search. Studies were included if they reported original research using a clearly described measure of anxiety or investigated the relationship between anxiety and vasomotor symptoms. Results: Nine studies reporting the relationship between menopause and anxiety, two studies reporting the prevalence of panic disorder, and eight studies investigating the relationship between anxiety and vasomotor symptoms were identified. Overall, anxiety symptom levels were low throughout the menopausal transition, but the studies were characterised by poor measurement of both menopausal status and anxiety symptoms and relied heavily on the use of brief, largely nonvalidated measures of anxiety symptoms, which are of unknown clinical significance. In the studies that also measured factors such as attitude to menopause, and dispositional optimism or changes in family life these emerged as important predictors of vasomotor symptom severity. Conclusions: None of the available studies provides solid data on the prevalence of anxiety disorders that meet diagnostic criteria, and the present state of knowledge does not be no justify the inclusion of “menopausal anxiety” as a reproductive-related disorder. With respect to the relationship between hot flashes and anxiety, studies need to ensure that somatic and psychological symptoms are not confounded by the use of unsuitable anxiety measures, and that psychological variables are given serious consideration. [Copyright &y& Elsevier]

Abstract: Background: This paper presents a new psychological model of why low income increases risk of mental distress. Consistent with evolutionary perspectives on disorder, income was predicted to relate to mental distress only through acting as an indirect proxy for social rank. Methods: Participants were part of a longitudinal cohort sample of 30,000 people who were representative of the British population and who completed measures annually for up to 17years. Mental distress was assessed via the General Health Questionnaire which measures anxiety, depression, and general functioning. Results: Both income and the rank of the income within the region (and the rank of income within other comparison groups, such as similar individuals) predicted current and future distress. However, when distress was jointly regressed on income and income rank, only income rank remained a significant predictor. Limitations: The outcome measure was self-report (although the predictor was objective). Conclusions: The results support psychosocial rather than material explanations of why income relates to distress, and suggest that a concern for social rank is the mechanism through which these effects occur. This mechanism is consistent with an evolutionarily based “involuntary defeat syndrome” where hard wired responses to low social rank increase risk for disorder and the Decision by Sampling model of how people make relative judgments. Negative cognitions associated with low social rank (particularly defeat and entrapment) may be clinically targetable in both prevention and treatment programs to reduce socio-economic mental health disparities. [Copyright &y& Elsevier]

Abstract: Background: The rate of psychiatric disorders in motherhood is often estimated on the percentage of women scoring high on validated self-report mood measures such as the Edinburgh Depression Scale. Screening for possible current or likely future distress also uses self-report mood measures, as well as additional psychosocial questions. Methods: This paper critically questions whether such prevalence rates, and percentage of women with high risk status following screening, are being overestimated. The properties of the Edinburgh Scale are examined, along with the validity of diagnostic criteria. In addition a consideration as to the percentage of women classified as ‘at-risk’ is considered. Results: The properties of the Edinburgh Scale show that around 50% of women scoring high are not in fact depressed. Revised estimates of prevalence rates are therefore given that take the properties of the scale into account which are more conservative than current estimates. Repeat testing of the scale after just two weeks to help differentiate transient from enduring distress will also lower the possibility of overpathologising motherhood, as will the use of correct cut-off scores. The DSM IV diagnostic criteria for depression are also questioned in relation to perinatal women and men. Finally, classifying women to be ‘at-risk’ based upon the presence of a single risk factor is questionable given that the majority of women with risks do not become depressed, and also the rate of women reported to have at least one risk (up to 88%) is so high as to negate the usefulness of this concept. Conclusions: Current estimates of the prevalence of perinatal distress, and of women with risks, are an overestimation of the true rates. The clinical practice of using the presence of a single risk factor, or a single high score on a self-report mood scale, to form part of the assessment to determine whether or not to actively intervene may also overpathologise the situation. A more thorough understanding of these issues will improve our assessment procedures so that resources can be appropriately targeted to those women, and their families, who really need specialist mental health intervention. [Copyright &y& Elsevier]

Abstract: In Arab communities, several cultural factors, derived mainly from the subordinate position of women, have been shown to affect the prevalence, clinical picture, health seeking behaviour, course and management of psychopathology in women. Women are definitely at a greater risk of developing mental disorders such as depressive, somatoform, anxious or eating disorders, as well as suicidal behaviors. Furthermore, mentally ill women are more stigmatized, have less access to care and suffer from a worse social outcome. This paper describes a series of culture-related risk factors such as education, work, sexuality, marriage, and infertility, which significantly contribute to triggering mental disorders in females, or to worsen their course and outcome. The authors recommend that mental health providers should play a critical role by addressing the cultural as well as psychological conditions that create and maintain threats to women''s mental health. [Copyright &y& Elsevier]

Abstract: Background: The Temperament Evaluation of Memphis Pisa Paris and San Diego Auto-questionnaire (TEMPS-A) has been translated and validated into several languages, and used in different subgroups (e.g. clinical, students, company, employees and those with different educational levels). Methods: Lebanon is the only country that has validated the TEMPS-A in a national cohort, as part of the Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (LEBANON). In this paper, we test the suitability of the TEMPS-A for large scale epidemiologic population-based studies. Results: 82.1% of the respondents found the TEMPS-A to be easy to understand. The global reports of the Lebanese of their own temperaments paralleled those of the formal sub-scores on the five affective temperament subscales. The majority of respondents (90.3%) felt that their answers on the Lebanese–Arabic TEMPS-A scale represented them throughout their adulthood; the minority who did not were more likely to be older, and to have scored higher on the cyclothymic, and lower on the hyperthymic subscales. Limitation: Although the TEMPS-A has been designed for self-administration (auto-questionnaire), this was not practical in all subjects. We nonetheless feel that the interview format is viable as it introduces flexibility with certain subjects in population studies. Conclusions: The TEMPS-A appears to be suitable for use in epidemiologic surveys and research. [Copyright &y& Elsevier]

Abstract: Background: Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. Methods: The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N =266) from those with major depressive disorder (MDD; N =160). The samples were adult psychiatry patients recruited in Italy (N =186) and Sweden (N =240). Results: The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as “active/elated” hypomania and “risk-taking/irritable” hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%. Limitations: Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders. Conclusions: Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes. [Copyright &y& Elsevier]

Abstract: Background: High levels of public spending, rising costs of treatments and scarcity of mental health resources have intensified the need for information on the cost-effectiveness of interventions for depression. There have been few reviews that consider the cost-effectiveness of all treatments for depression together. Methods: Systematic review of published economic evaluations of interventions for depression to identify where evidence of cost-effectiveness exists and where ambiguity remains. Results: Fifty-eight papers met the criteria and were included in the review. The quality of the evaluations varied greatly. Evidence establishing the cost-effectiveness of interventions for depression is accumulating; selective serotonin reuptake inhibitors (SSRI) and the newer antidepressants venlafaxine, mirtazepine and nefazodone appear cost-effective compared with older drugs. Despite the availability of high quality economic evaluations of psychological therapies compared to usual care, there is limited evidence of their cost-effectiveness particularly when compared directly to pharmacotherapies. Changes to health systems have been found to be cost-effective in some patient groups, but there is no evidence that screening in primary care populations is a cost-effective strategy. Limitations: Vastly different interventions, outcome measures and cost perspectives meant a meta-analysis of costs and effects was not considered possible. Conclusions: On the basis of available evidence, it is not possible to identify the most cost-effective strategy for alleviating the symptoms of depression, although the SSRIs and newer antidepressants consistently appear more cost-effective than tricyclic antidepressants in many patient groups. Better quality economic evidence is needed. [Copyright &y& Elsevier]

Background: The role of psychosocial and clinical variables in the prediction of major depression is controversial. In a previous paper, we obtained a one-year predictive multivariate model of non-remission for major depression, based on the presence of a personality disorder, a low self-esteem and a low satisfaction with social support. Objective: To evaluate more in depth both personality disorders and psychosocial variables as predictors of outcome. Methods: A prospective study on 57 consecutive outpatients with major depressive episodes were followed-up monthly during one year. Clinical and psychosocial variables were registered, including personality (DSM-IV criteria and IPDE structured interview), previous quality of life, self-esteem, social support and dyadic adjustment. Remission was defined as a HDS score less than 8. Univariate and multivariate (logistic regression) analyses were applied. Results: 68% of the patients reached remission at 12 months. Personality disorder (diagnosed clinically but not according to IPDE), and previous quality of life were the variables more consistently associated to remission at 12 months. Among follow-up variables, remission at 3 months was strongly associated with remission. Conclusions: Our findings confirm the importance of the clinical diagnosis of personality disorder in the major depression outcome. However, more studies are needed to clarify the divergence between clinical and structured interview guided diagnosis. With the exception of quality of life, psychosocial variables had a weak and non consistent relationship with outcome. [Copyright &y& Elsevier]