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Etheldreda Nakimuli-Mpungu1,3, Ramin Mojtabai1, Pierre K Alexandre1, Elly Katabira4, Seggane Musisi3, Jean B Nachega2,5, Judith K Bass11Department of Mental Health, 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Department of Psychiatry, 4Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 5Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Faculty of Health Sciences, Cape Town, South AfricaBackground: HIV treatment programs are in need of brief, valid instruments to identify common mental disorders such as depression.Aim: To translate and culturally adapt the Self-Reporting Questionnaire (SRQ-20) for use in Uganda and to investigate its psychometric properties in this setting.Methods: Following an initial translation of the SRQ-20 from English to Luganda, key informant interviews and focus-group discussions were used to produce a culturally adapted version of the instrument. The adapted SRQ-20 was administered to 200 HIV-positive individuals in a rural antiretroviral therapy program in southern Uganda. All study participants were also evaluated by a psychiatric clinical officer with the Mini International Neuropsychiatric Interview (MINI). Receiver-operating-characteristic analysis was used to examine the sensitivity and specificity of the SRQ-20 compared to the clinical diagnosis generated by the MINI.Results: The prevalence estimates of any depressive disorder and current depression were 24% (n = 48) and 12% (n = 24), respectively. The SRQ-20 scores discriminated well between subjects with and without current depression based on the MINI, with an area under the curve of 0.92, as well as between subjects with and without any current or past depressive disorder, with an area under the curve of 0.75. A score of 6 or more had 84% sensitivity and 93% specificity for current depression, and 75% sensitivity and 90% specificity for any depressive disorder.Conclusion: The SRQ-20 appears to be a reliable and valid screening measure for depression among rural HIV-positive individuals in southern Uganda. The use of this screening instrument can potentially improve detection and management of depression in this setting.Keywords: depression, HIV/AIDS, Self-Reporting Questionnaire, cross-cultural adaptation and validation, Uganda

Objective: This study examined the prevalence of sleep problems and their association with the use of inpatient and emergency department services by Medicaid recipients with serious mental illness.Methods: The sample consisted of 1,560 psychiatric patients with Medicaid coverage who were identified in a ten-state random survey of psychiatrists. Sleep problems were assessed by clinician ratings.Results: Over 75% of the patients experienced a sleep problem, and approximately 50% of these patients had problems that were moderate to severe. Greater sleep problem severity was associated with an increased risk of psychiatric hospitalization and emergency department visits for mental health reasons.Conclusions: Sleep problems were highly prevalent among Medicaid patients with serious mental illness and were associated with greater inpatient and emergency mental health service use. More careful monitoring and management of sleep problems in this patient population could address a common clinical need and might help to reduce costly service use. [ABSTRACT FROM AUTHOR]

Objectives: This study examined recent changes in attitudes toward psychiatric medications in the U.S. general population.Methods: Samples of adult participants in the U.S. General Social Surveys of 1998 (N=1,387) and 2006 (N=1,437) were compared for opinions on the benefits and risks of psychiatric medications as well as willingness to take them in hypothetical situations, including experiencing symptoms of panic attacks or major depression and difficulty in coping with stress or having trouble in personal life.Results: Public opinions regarding benefits of psychiatric medications became more favorable between 1998 and 2006. More participants in 2006 than in 1998 thought that medications help people to deal with day-to-day stresses (83.4% versus 77.8%), make things easier in relation with family and friends (75.9% versus 68.4%), and help people feel better about themselves (68.0% versus 60.1%). The public expressed a greater willingness to take medications in 2006 compared with 1998 for trouble in personal life (29.1% versus 23.3%), to cope with stresses of life (46.6% versus 35.5%), for depression (49.1% versus 41.2%), and for panic attacks (63.7% versus 55.6%). Opinions regarding the risks of medications did not change between 1998 and 2006.Conclusions: Americans' opinions toward psychiatric medications became more favorable over the past decade, and people became more willing to take these medications. These changes have likely contributed to the increased use of psychiatric medications in recent years and will continue to do so in the coming years. [ABSTRACT FROM AUTHOR]

The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio=1.84) or to perceive an unmet need for such help (adjusted odds ratio=1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need-as measured by non-compared distress-and help-seeking in the general population. [ABSTRACT FROM AUTHOR]

Objective: This study examined recent trends in Americans' attitudes toward mental health treatment seeking and beliefs about the effectiveness of such treatment.Methods: Data on attitudes and beliefs from two representative surveys of the U.S. general population were compared. Samples included 5,388 participants from the National Comorbidity Survey (NCS) in 1990-1992 and 4,319 from the National Comorbidity Survey-Replication (NCS-R) in 2001-2003.Results: Participants in the 2001-2003 survey were more willing than those in the 1990-1992 survey to seek professional help for mental health problems (41.4% reported that they would "definitely go" for professional help in 2001-2003, compared with 35.6% in 1990-1992). Participants in the more recent survey were also more comfortable talking with a professional about personal problems (32.4% in 2001-2003 reported feeling "very comfortable," compared with 27.1% in 1990-1992) and were less likely to say that they would be embarrassed if others found out about it (40.3% reported being "not at all embarrassed" in 2001-2003, compared with 33.7% in 1990-1992). Attitudes of younger participants improved more than attitudes of middle-aged participants. Public beliefs about the effectiveness of mental health treatment and the likelihood of recovery without treatment changed little across surveys.Conclusions: Mental health treatment seeking has become more acceptable over the past decade, and perceived stigma associated with it has declined. These changes in public attitudes have likely contributed to the growing demand for mental health services in the United States and will continue to do so in the coming years. [ABSTRACT FROM AUTHOR]

Background. Military samples provide an excellent context to systematically ascertain hospitalization for severe psychiatric disorders. The National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a collaborative study of psychiatric disorders in the US Armed Forces, estimated rates of first hospitalization in the military for three psychiatric disorders: bipolar disorder (BD), major depressive disorder (MDD) and schizophrenia.Method. First hospitalizations for BD, MDD and schizophrenia were ascertained from military records for active duty personnel between 1992 and 1996. Rates were estimated as dynamic incidence (using all military personnel on active duty at the midpoint of each year as the denominator) and cohort incidence (using all military personnel aged 18-25 entering active duty between 1992 and 1996 to estimate person-years at risk).Results. For all three disorders, 8723 hospitalizations were observed in 8120136 person-years for a rate of 10.7/10000 [95% confidence interval (CI) 10.5-11.0]. The rate for BD was 2.0 (95% CI 1.9-2.1), for MDD, 7.2 (95% CI 7.0-7.3), and for schizophrenia, 1.6 (95% CI 1.5-1.7). Rates for BD and MDD were greater in females than in males [for BD, rate ratio (RR) 2.0, 95% CI 1.7-2.2; for MDD, RR 2.9, 95% CI 2.7-3.1], but no sex difference was found for schizophrenia. Blacks had lower rates than whites of BD (RR 0.8, 95% CI 0.7-0.9) and MDD (RR 0.8, 95% CI 0.8-0.9), but a higher rate of schizophrenia (RR 1.5, 95% CI 1.3-1.7).Conclusions. This study underscores the human and financial burden that psychiatric disorders place on the US Armed Forces. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Cross-country comparisons of patterns of mental health treatment seeking provide insights into the impact of contextual factors on mental health service use. This study aimed to compare prevalence and predictors of mental health treatment seeking among adults with major depression in Canada and the United States. METHODS: Data for 751 participants with a probable major depressive episode in the past 12 months were drawn from the 2002-2003 Joint Canada/United States Survey of Health: 304 were from Canada and 447 were from the United States. Probable major depressive episodes were ascertained by the Composite International Diagnostic Interview-Short-Form. Patterns of contacts with mental health and general health providers for mental health reasons were compared. RESULTS: Prevalence of contacts with any provider for mental health problems was similar among participants with a probable major depressive episode in Canada and the United States (181 Canadians, or 56 percent, compared with 245 Americans, or 52 percent). Canadian participants were more likely than those in the United States to seek treatment for mental health problems from family doctors and general practitioners, and among participants who sought such treatment, Canadians were more likely to also seek treatment from mental health professionals. In both countries, racial or ethnic minorities were less likely than Caucasians to seek treatment. Depression severity was more closely associated with treatment seeking in Canada than in the United States. CONCLUSIONS: Although studies from the early 1990s showed higher rates of treatment seeking for depression in Canada than in the United States, the more recent data presented here do not show such a gap. However, differences persist in the use of various providers. Compared with the United States, Canada had a closer match between depression severity and treatment, which suggests more efficient allocation of mental health care resources for treatment of depression in Canada. [ABSTRACT FROM AUTHOR]

Objectives: To examine and compare non-compliance with mental health and other specialty referrals among low-income elderly. Methods: A survey of 2,128 community-dwelling elderly assessed mental health and other specialty referral in the past year and compliance with these referrals. Non-compliant participants and those who had encountered difficulties in arranging referral appointments were asked about the barriers. Results: 16.7% with mental health referrals vs. 4.8% with other specialty referrals did not comply (p < .001). The main reason for non-compliance with mental health referrals was lack of perceived need. Discussion: Lack of perceived need for professional help is a major barrier to specialty mental health care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults. METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline. CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is now well documented that both black and white patients with severe mental illness are likely to use different types of treatment facilities, have different lengths of hospital stays, and receive different types and dosages of psychotropic medications. It is still uncertain, however, whether these differences exist at the early stages of treatment. METHOD: We examined treatment patterns for a countywide sample of patients with psychotic disorders recruited at their initial psychiatric hospitalization. Illness characteristics, prior treatment histories, admission conditions, and psychotropic medication use during this hospitalization were compared for both black and white patients. RESULTS: Black patients were less likely to have had out-patient treatment prior to their first hospitalization and were more likely to be hospitalized in public than in community psychiatric units than were white patients. Black patients were also more likely to be hospitalized primarily for a behavioral disturbance and escorted to the hospital by the emergency medical services or police, while white patients were more often hospitalized primarily for subjective suffering. These patterns were particularly significant for those with a non-schizophrenia diagnosis. However, there were few statistically significant differences between black and white patients on psychotropic medication use during the first hospitalization. CONCLUSIONS: Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness and cost-effectiveness of four treatment modalities for substance abuse.Data Sources: The study used data from the Services Research Outcomes Study (SROS), a survey of 3,047 clients in a random sample of 99 drug treatment facilities across the United States. Detailed sociodemographic, substance use, and clinical data were abstracted from treatment records. Substance abuse outcome and treatment history following discharge from index facilities were assessed using a comprehensive interview with 1,799 of these individuals five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use.Study Design: Effectiveness and cost-effectiveness of four modalities were compared: inpatient, residential, outpatient detox/methadone, and outpatient drug-free. Clients were stratified based on propensity scores and analyses were conducted within these strata. Sensitivity analyses examined the impact of future substance abuse treatment on effectiveness and cost-effectiveness estimates.Principal Findings: Treatment of substance disorders appears to be cost-effective compared to other health interventions. The cost per successfully treated abstinent case in the least costly modality, the outpatient drug-free programs, was 6,300 dollars (95 percent confidence intervals: 5,200-7,900 dollars) in 1990 dollars. There were only minor differences between various modalities of treatment with regard to effectiveness. However, modalities varied considerably with regard to cost-effectiveness. Outpatient drug-free programs were the most cost-effective. There was little evidence that relative effectiveness or cost-effectiveness of programs varied according to factors that were associated with selection into different programs.Conclusions: Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment. [ABSTRACT FROM AUTHOR]

Background: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied.Aims: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course.Method: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups.Results: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types.Conclusions: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients. [ABSTRACT FROM AUTHOR]

Background: The acute and transient psychotic disorders (ATPD) in ICD-10 advanced the nosology of remitting psychoses with acute onset. But the proposed criteria for ATPD--especially in regard to duration--are tentative and need to be validated.Aims: To evaluate: (a) the duration of remitting psychoses with acute onset; (b) the applicability of the ATPD criteria for these cases; and (c) differences in duration and ATPD diagnoses across sociocultural settings.Method: Data from the World Health Organization Determinants of Outcome study were used.Results: The 98 cases of remitting psychoses with acute onset had a modal duration of 2-4 months, with 43% falling in this range. Mainly because of this, few met the ATPD criteria. Duration and diagnostic findings were similar across settings.Conclusions: ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed. [ABSTRACT FROM AUTHOR]

Background: This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis.Aims: To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis.Method: The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Health Organization Determinants of Outcome study. The cases (n = 17) met criteria for acute brief psychosis; controls (n = 40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever.Results: The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P = 0.004). The odds ratio in a logistic regression analysis--adjusted for site, gender and CATEGO classification--was 11.2 (P = 0.003).Conclusions: Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis. [ABSTRACT FROM AUTHOR]