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Objective: While it is now recognized that psychotic experiences are associated with an increased risk of later mental disorders, we lack a detailed understanding of the reciprocal time-lagged relationships between first onsets of psychotic experiences and mental disorders. Using data from World Health Organization World Mental Health (WMH) Surveys, the authors assessed the bidirectional temporal associations between psychotic experiences and mental disorders., Method: The WMH Surveys assessed lifetime prevalence and age at onset of psychotic experiences and 21 common DSM-IV mental disorders among 31,261 adult respondents from 18 countries. Discrete-time survival models were used to examine bivariate and multivariate associations between psychotic experiences and mental disorders., Results: Temporally primary psychotic experiences were significantly associated with subsequent first onset of eight of the 21 mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, adult separation anxiety disorder, bulimia nervosa, and alcohol abuse), with odds ratios ranging from 1.3 (95% CI=1.2-1.5) for major depressive disorder to 2.0 (95% CI=1.5-2.6) for bipolar disorder. In contrast, 18 of 21 primary mental disorders were significantly associated with subsequent first onset of psychotic experiences, with odds ratios ranging from 1.5 (95% CI=1.0-2.1) for childhood separation anxiety disorder to 2.8 (95% CI=1.0-7.8) for anorexia nervosa., Conclusions: While temporally primary psychotic experiences are associated with an elevated risk of several subsequent mental disorders, these data show that most mental disorders are associated with an elevated risk of subsequent psychotic experiences. Further investigation of the underlying factors accounting for these time-order relationships may shed light on the etiology of psychotic experiences., Competing Interests: All other authors have no conflict of interest.

Background: Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather 'the worried well'., Aims: To examine the association of past-year mental health treatment with DSM-IV disorders., Method: The World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs., Results: Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment., Conclusions: The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment., (Royal College of Psychiatrists.)

Background: Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada., Aims: To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys., Method: Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted., Results: Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/lower-middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit., Conclusions: Drop out needs to be reduced to ensure effective treatment.

Background: Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries., Aims: To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys., Method: The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated., Results: Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (chi(2)(9) = 5.5-8.1, P = 0.52-0.79). These losses are equivalent to 0.3-0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations., Conclusions: These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.

Objective: To explore the consequences of using the Short-Forum Health Survey (SF-12) and the RAND-12 Health Status Inventory (RAND-12) for estimation of associations between its component scores and the levels of well-being and psychological distress., Methods: Data from a rural community mental health survey of 5641 participants were analysed. Physical and mental health component scores of the SF-12 and RAND-12 were compared between participants with different rating on the Satisfaction with Life Scale and the Kessler-10. Descriptive graphical methods were utilized to explore the relationship between SF-12 and RAND-12 components scores against well-being and psychological distress. Proportional odds model was utilized to estimate the quantitative relationship between component scores of the SF-12 and RAND-12 against categories of well-being and psychological distress., Results: Both SF-12 and RAND-12 component scores were generally positively associated with well-being and negatively associated with psychological distress. Median scores were similar despite scoring techniques used. However, distribution of scores differed whereby the RAND-12 yielded wider spread of scores in measures of well-being and psychological distressed when compared to the SF-12. A larger proportion of participants was classified as having moderate and severe disability under the RAND-12 compared to the SF-12., Conclusion: It is recommended that users of the SF-12 and the RAND-12 are aware of the implications of utilizing either of the scoring techniques. Scoring techniques used should ideally be based on the theoretical basis of the study with consideration of the target population. Researchers may wish to use the SF-12 if distinct uncorrelated physical and mental constructs are required and for studies on clinical populations. In contrast, RAND-12 should be used if correlated physical and mental constructs are required and if the study is on community or general populations.

It is unclear whether differences exist in the prevalence of mood, anxiety and alcohol use disorders among persons with multiple pain conditions compared with those with single pain problems. We conducted population surveys in 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific. Participants were community-dwelling adults (N=85,088). Mental disorders were assessed with the Composite International Diagnostic Interview. Pain was assessed by self-report. Both multiple and single site pain problems were associated with mood and anxiety disorders, but not with alcohol abuse or dependence. In general, the prevalence of specific mood and anxiety disorders followed a linear pattern with the lowest rates found among persons with no pain, intermediate rates among those with one pain, and highest rates among those with multi-site pain problems. Relative to persons not reporting pain, the pooled estimates of the age-sex adjusted odds ratios were 1.8 (1.7-2.0) for mood disorders and 1.9 (1.8-2.1) for anxiety disorders for persons with single site pain; 3.7 (3.3-4.1) for mood disorders and 3.6 (3.3-4.0) for anxiety disorders among those with multi-site pain. Our results indicate that the presence of multiple pain conditions was strongly and comparably associated with mood and anxiety disorders in diverse cultures. This consistent pattern of associations suggests that diffuse pain and psychiatric disorders are generally associated, rather than diffuse pain representing an idiom for expressing distress that is specific to particular cultural settings or diffuse pain solely representing a form of masked depression.

Objective: A recovery-based outreach program for people with severe mental illness in regional Victoria is described. The paper covers a description of the program, the services provided and outcomes achieved. The program emphasized active collaboration between patients and clinicians as outlined in the collaborative recovery model and recognized that recovery from mental illness is an individual, personal process., Conclusions: The program provided service to 108 people over 3 years and had a positive impact on clinicians, patients and carers. The benefits of recovery orientation, multidisciplinary teams, collaborative relationships and carer involvement are discussed. The paper highlights the need for a focus on recovery and comprehensive care for people with severe mental illness.