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Objective: To use expert consensus to inform the development of policy and guidelines for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness., Method: The Delphi method was used. A systematic search of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on a priori-defined levels of importance written into the expert consensus statement., Results: The participation rate for the clinicians across all three rounds was 65%, with consumers and carers only completing one round due to high endorsement rates. Finally, 386 strategies were endorsed as essential or important by one or all panels. The endorsed strategies provided information on engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side effects; and the role of health professionals., Conclusion: The consensus statement is intended to be used by health professionals, people with an enduring psychotic illness and their families and carers. The next step needed is an implementation strategy by the Royal Australian and New Zealand College of Psychiatrists and other stakeholders.

Background: Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income., Methods: Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income., Results: Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income., Conclusions: Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions., (Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Rapid cycling bipolar disorder has been studied almost exclusively in clinical samples., Methods: A national cross-sectional survey in 2003-2004 in New Zealand used the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis was by DSM-IV. Depression severity was assessed with the Quick Inventory of Depressive Symptoms (QIDS) and role impairment using Sheehan Scales. Complex survey analyses compared percentages and means, and used logistic regression and discrete-time survival analyses. Frequent mood episodes (FMEs) in the past 12 months (4+) were used as an indicator of rapid cycling., Results: The lifetime prevalence of bipolar disorder (I + II) was 1.7%. Twelve-month prevalence was 1.0%: 0.3% with FME and 0.7% with No FME (1-3 episodes). Another 0.7% had no episodes in that period. Age of onset was earliest for FME (16.0 years versus 19.5 and 20.1, p<.05). In the past 12 months, weeks in episode, total days out of role and role impairment in the worst month were all worse for the FME group (p<.0001) but both the FME and No-FME groups experienced severe and impairing depression. Lifetime suicidal behaviours and comorbidity were high in all three bipolar groups but differed little between them. About three-quarters had ever received treatment but only half with twelve-month disorder made treatment contact., Limitations: Recall, not observation of episodes., Conclusions: Even in the community the burden of bipolar disorder is high. Frequent mood episodes in bipolar disorder are associated with still more disruption of life than less frequent episodes. Treatment is underutilized and could moderate the distress and impairment experienced., (Copyright 2010 Elsevier B.V. All rights reserved.)

Background: Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror., Methods: Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys., Results: Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases., Conclusions: Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement., (Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the prevalence, symptom severity, functional impairment and treatment of major depressive episodes in the New Zealand population, in light of recent criticism that depression is 'over-diagnosed', especially in community surveys., Method: Nationally representative cross-sectional household survey of 12 992 adults (aged 16+): The New Zealand Mental Health Survey 2003/4. 12-month major depressive episode measured in face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0)., Results: The 12-month prevalence of major depressive episode (MDE) was 6.6% for the total population, with decreasing prevalence with increasing age, and higher prevalence in females (8.1% versus 4.9% in males). Fewer than 10% of 12-month episodes were classified on a symptom severity rating scale as mild, and 69% of all episodes were accompanied by severe impairment in at least one domain of functioning. Only a third of those with severe impairment received treatment in the mental health sector, and half saw a general medical practitioner., Conclusion: These results offer little support for the suggestion that depression is over-diagnosed and over-treated, and that current diagnostic thresholds allow the inclusion of too many mild episodes in community surveys.

Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people.

Objective: The aim of the present study was to compare two versions of the Kessler 10-item scale (K10), as measures of population mental health status in New Zealand., Method: A nationwide household survey of residents aged > or = 16 years was carried out between 2003 and 2004. The World Mental Health Composite International Diagnostic Interview (CIDI 3.0) was used to obtain DSM-IV diagnoses. Serious mental illness (SMI) was defined as for the World Mental Health Surveys Initiative and the USA National Comorbidity Survey Replication. Participants were randomly assigned to receive the 'past month' K10 or the 'worst month in the past 12 months' K10. There were 12 992 completed interviews; 7435 included the K10. The overall response rate was 73.3%. Receiver operator characteristic (ROC) curves were used to examine the ability of both K10 versions to discriminate between CIDI 3.0 cases and non-cases, and to predict SMI., Results: Scores on both versions of the K10 were higher for female subjects, younger people, people with fewer educational qualifications, people with lower household income and people resident in more socioeconomically deprived areas. Both versions of the K10 were effective in discriminating between CIDI 3.0 cases and non-cases for anxiety disorder, mood disorders and any study disorder. The worst month in the past 12 months K10 is a more effective predictor than the past 1 month K10 of SMI (area under the curve: 0.89 vs 0.80)., Conclusions: Either version of the K10 could be used in repeated health surveys to monitor the mental health status of the New Zealand population and to derive proxy prevalence estimates for SMI. The worst month in the past 12 months K10 may be the preferred version in such surveys, because it is a better predictor of SMI than the past month K10 and also has a more logical relationship to 12 month disorder and 12 month service use.

Background: A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries., Method: Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85,052). Prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria., Results: Lifetime prevalence estimates for GAD lasting 1 month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1-2 months, 3-5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting >or=12 months was the most severe, persistently symptomatic and impaired subgroup., Conclusions: In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.

Objective: To provide a description of the methods and key findings of the 2007 Australian National Survey of Mental Health and Wellbeing., Method: A national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years was carried out using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Diagnoses were made according to ICD-10. Key findings include the prevalence of mental disorder, sex and age distributions of mental disorders, severity of mental disorders, comorbidity among mental disorders, and the extent of disability and health service use associated with mental disorders., Results: The prevalence of any lifetime mental disorder was 45.5%. The prevalence of any 12 month mental disorder was 20.0%, with anxiety disorders (14.4%) the most common class of mental disorder followed by affective disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were disabling. One in four people (25.4%) with 12 month mental disorders had more than one class of mental disorder. One-third (34.9%) of people with a mental disorder used health services for mental health problems in the 12 months prior to the interview., Conclusions: Mental disorders are common in Australia. Many people have more than one class of mental disorder. Mental disorders are associated with substantial disability, yet many people with mental disorders do not seek help for their mental health problems.

Background: Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries., Aims: To examine the association between early-onset mental disorder and subsequent termination of education., Method: Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM-IV mental disorders and subsequent non-attainment of educational milestones., Results: In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4-15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education., Conclusions: Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.

Background: Physical morbidity is a potent risk factor for depression onset and clearly increases with age, yet prior research has often found depressive disorders to decrease with age. This study tests the possibility that the relationship between age and mental disorders differs as a function of physical co-morbidity., Method: Eighteen general population surveys were carried out among household-residing adults as part of the World Mental Health (WMH) surveys initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). The effect of age was estimated for 12-month depressive and/or anxiety disorders with and without physical or pain co-morbidity, and for physical and/or pain conditions without mental co-morbidity., Results: Depressive and anxiety disorders decreased with age, a result that cannot be explained by organic exclusion criteria. No significant difference was found in the relationship between mental disorders and age as a function of physical/pain co-morbidity. The majority of older persons have chronic physical or pain conditions without co-morbid mental disorders; by contrast, the majority of those with mental disorders have physical/pain co-morbidity, particularly among the older age groups., Conclusions: CIDI-diagnosed depressive and anxiety disorders in the general population decrease with age, despite greatly increasing physical morbidity with age. Physical morbidity among persons with mental disorder is the norm, particularly in older populations. Health professionals, including mental health professionals, need to address barriers to the management of physical co-morbidity among those with mental disorders.

Unlabelled: Although there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249). Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions among females and older persons; and chronic pain was similarly associated with depression-anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries., Perspective: Chronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries.

This article briefly reviews the literature on the relationship between social network and mental health, and presents a theoretical framework outlining the role social networks may play in explaining the differential mental health service utilization rates between Maori and European people of New Zealand. By buffering individuals from the ill effects of stressful events, social networks may have a protective effect on people's mental health. In addition, social networks influence the way people with mental illnesses use mental health services. An inverse relationship between the size of an individual's social network and the rate of utilization of in-patient services has been reported. Despite having a larger and presumably more supportive social networks, Maori are over-represented in mental health service utilization statistics. Using the Maori example, we demonstrate that ethnic differences exist in the structure of social networks and the provision of social support to their members. Such differences may be based on the degree of emphasis placed on kinship or on individualism by cultures and on the receptivity or prejudice of the host community. We examine the sources of stress on Maori social networks that may adversely affect the network's ability to support its members experiencing mental illnesses. Caution must be exercised in using service utilization rates as measures of the mental health needs of different ethnic groups because of problems with help seeking and the detection of mental health issues in different ethnic groups.

Objectives: (1) To investigate whether there is an association between obesity and mental disorders in the general populations of diverse countries, and (2) to establish whether demographic variables (sex, age, education) moderate any associations observed., Design: Thirteen cross-sectional, general population surveys conducted as part of the World Mental Health Surveys initiative., Subjects: Household residing adults, 18 years and over (n=62 277)., Measurements: DSM-IV mental disorders (anxiety disorders, depressive disorders, alcohol use disorders) were assessed with the Composite International Diagnostic Interview (CIDI 3.0), a fully structured diagnostic interview. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater; severe obesity as BMI 35+. Persons with BMI less than 18.5 were excluded from analysis. Height and weight were self-reported., Results: Statistically significant, albeit modest associations (odds ratios generally in the range of 1.2-1.5) were observed between obesity and depressive disorders, and between obesity and anxiety disorders, in pooled data across countries. These associations were concentrated among those with severe obesity, and among females. Age and education had variable effects across depressive and anxiety disorders., Conclusions: The findings are suggestive of a modest relationship between obesity (particularly severe obesity) and emotional disorders among women in the general population. The study is limited by the self-report of BMI and cannot clarify the direction or nature of the relationship observed, but it may indicate a need for a research and clinical focus on the psychological heterogeneity of the obese population.

Objective: The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education)., Methods: A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater., Results: Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05)., Conclusion: Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.

Background: Prior research on the association between affective disorders and physical conditions has been carried out in developed countries, usually in clinical populations, on a limited range of mental disorders and physical conditions, and has seldom taken into account the comorbidity between depressive and anxiety disorders., Methods: Eighteen general population surveys were carried out among adults in 17 countries as part of the World Mental Health Surveys initiative (N=42, 249). DSM-IV depressive and anxiety disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions were ascertained via a standard checklist. The relationship between mental disorders and physical conditions was assessed by considering depressive and anxiety disorders independently (depression without anxiety; anxiety without depression) and conjointly (depression plus anxiety)., Results: All physical conditions were significantly associated with depressive and/or anxiety disorders but there was variation in the strength of association (ORs 1.2-4.5). Non-comorbid depressive and anxiety disorders were associated in equal degree with physical conditions. Comorbid depressive-anxiety disorder was more strongly associated with several physical conditions than were single mental disorders., Limitations: Physical conditions were ascertained via self report, though for a number of conditions this was self-report of diagnosis by a physician., Conclusions: Given the prevalence and clinical consequences of the co-occurrence of mental and physical disorders, attention to their comorbidity should remain a clinical and research priority.

Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in seventeen countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk, and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescents, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders.

Background: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. The individual and societal consequences are significant. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences. Pathological gamblers may develop general medical conditions associated with stress. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction. With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments. Consequently quality research into gambling treatment is crucial., Objectives: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports., Search Strategy: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments. Researchers and gambling treatment centres were contacted by letter. Bibliographies of all identified research studies were scanned to identify other relevant references., Selection Criteria: All RCTs of treatments for pathological gambling were eligible for inclusion., Data Collection and Analysis: The data was entered into the Cochrane Review Manager software (REVMAN). The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling. The relative risks were aggregated using both fixed and random effects models. Tests for heterogeneity were undertaken. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered., Main Results: Only four RCTs of psychological treatments were identified. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods. All had small numbers of participants. The studies had poor methodological quality features. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0.81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47)., Authors' Conclusions: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.

Objective: To show the extent and patterning of 12 month mental disorder comorbidity in the New Zealand population, and its association with case severity, suicidality and health service utilization., Method: A nationwide face-to-face household survey was carried out in October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. The measurement of mental disorder was with the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Comorbidity was analysed with hierarchy, consistent with a clinical approach to disorder count., Results: Comorbidity occurred among 37% of 12 month cases. Anxiety and mood disorders were most frequently comorbid. Strong bivariate associations occurred between alcohol and drug use disorders and, to a lesser extent, between substance use disorders and some anxiety and mood disorders. Comorbidity was associated with case severity, with suicidal behaviour (especially suicide attempts) and with health sector use (especially mental health service use)., Conclusion: The widespread nature of mental disorder comorbidity has implications for the configuration of mental health services and for clinical practice.

Objective: To compare ethnic groups for the 12 month prevalence of mental disorders and 12 month treatment contact in Te Rau Hinengaro: The New Zealand Mental Health Survey., Method: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over, including Māori (n = 2595), Pacific people (n = 2236) and a composite Other ethnic group (predominantly European) (n = 8161). Ethnicity was measured using the 2001 census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used to measure disorder. The overall response rate was 73.3%., Results: The 12 month prevalence of any mental disorder was highest in Māori (29.5%; 26.6, 32.4), followed by Pacific people (24.4%; 21.2, 27.6) and Others (19.3%; 18.0, 20.6). Adjustment for age, sex, education and household income reduced differences: Māori (23.9%; 21.3, 26.4), Pacific (19.2%; 16.4, 22.1) and Other (20.3%; 18.9, 21.6). A similar pattern was seen for serious disorder and most individual disorders or disorder groups. After adjustment, Māori were most different from Pacific people and Others for substance use disorder. Both Māori and Pacific people had a higher prevalence of bipolar disorder than Others. Pacific people had the lowest prevalence of major depressive disorder. Among those with disorder, the proportion with a visit for mental health problems to any service was highest among Others (41.1%; 38.1, 44.1), with Māori (32.5%; 28.3, 36.7) intermediate and Pacific (25.4%, 19.4, 31.4) lowest. Adjustment did not alter ethnic differences in service contact., Conclusion: Māori, and to a lesser extent Pacific people, have a higher prevalence of 12 month mental disorders than Others. Differences are reduced after adjusting for sociodemographic correlates. Relative to need, Pacific people in particular and Māori are less likely than Others to have contact with services (health or non-health), regardless of sociodemographic circumstances.

Objective: To show the disability associated with 1 month mental disorders and chronic physical conditions for the New Zealand population, controlling for comorbidity, age and sex., Method: A nationally representative face-to-face household survey was carried out from October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health (WMH) Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Disability was measured with the WMH Survey Initiative version of the World Health Organization Disability Assessment Schedule (WMH WHO-DAS) in the long-form subsample (n = 7435). Outcomes include five WMH WHO-DAS domain scores for those with 1 month mental disorders and with chronic physical conditions., Results: Mood disorders were associated with more disability than anxiety or substance use disorders. Experiencing multiple mental disorders was associated with substantial role impairment. Mental disorders and chronic physical conditions were associated with similar degrees of disability on average. The combination of mental and physical disorders had additive effects on associated disability., Conclusions: Mood disorders are disabling. The investigation of disability in relation to 1 month rather than 12 month disorders is likely to provide a clearer indication of the disability associated with mood disorders. Although some researchers have queried whether negative mood can lead to 'over-reporting' of disability, recent conceptualizations of disability provide a perspective which may ease such concerns. Comorbidity, of mental disorders or of mental and physical disorders, is disabling.

Background: Prior studies providing estimates of the prevalence of postnatal depressive symptoms (PNDS) in New Zealand have been hampered by methodological shortcomings. Aims of this study were to derive an accurate estimate of PNDS prevalence and treatment frequency in an urban population of a major city in New Zealand., Method: This was a one-wave postal survey of a probability, community sample of all women in Auckland who were 4 months postpartum. PNDS was assessed with the Edinburgh Postnatal Depression Scale (EPDS)., Results: There were 225 usable responses (78% response-rate): 36 women (16.0%) scored above the threshold for depressive symptomatology, and nine of them were in treatment. A further 31 women (13.8%) scored just below the threshold region for depressive symptomatology, and none were in treatment., Conclusion: The prevalence rate of PNDS in urban New Zealand is slightly higher than the world-wide average, and goes largely untreated in the community. Health care providers should remain vigilant to the finding that almost one in three mothers with infants is suffering with symptoms of depression and may need strong encouragement to admit they need help.

Psychiatry was one of the first medical specialties to use the tools of evidence-based medicine (EBM)--randomised controlled trials (RCTs), systematic reviews with meta-analyses--and as many treatment decisions in psychiatry are evidence-based as in general medicine. Psychiatrists have some reservations about the EBM approach because of perceived limitations in methodology of RCTs and systematic reviews; gaps in the evidence base; problems interpreting the available evidence; and neglect of individual patient uniqueness in quantitative research based on groups or populations. Research supports the value of psychotherapy and there are now a number of empirically validated efficacious psychotherapies for a range of disorders.

Background: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures., Method: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries., Results: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries., Conclusions: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

There is considerable interest in the relationship between interpersonal relationships and mood disorders. The Intimate Bond Measure (IBM) assesses the respondent's perception of their partner over recent times. IBM care scores have been reported to be independent of depression severity and personality, to distinguish between melancholic and non-melancholic depressives, and to predict treatment outcome. In a sample of 105 depressed patients, IBM care measures were independent of depression severity and personality measures, but they did not distinguish between melancholic and non-melancholic depressives, and did not predict treatment outcome. When the sample was restricted to individuals who had been previously treated, IBM care measures did distinguish between melancholic and non-melancholic depressives, although they still did not predict treatment outcome. Possible implications of these findings are discussed.

Because most published family studies of depression ascertained subjects from treatment settings, the reported familial aggregation of depression could be an artifact if a family history of depression increased the likelihood of seeking treatment. To investigate this possibility, we compared the family history of depression in three groups of probands aged 18-44; 54 women randomly selected from the community with depression in the prior year, 41 women who entered a clinical trial for depression and 37 women randomly selected from the community who had not been depressed in the prior year. The presence of depression in the parents and siblings of the probands was assessed by the family history method and quantified via family history scores which took the age, gender and number of relatives into account. Depressed probands ascertained from clinical sources had markedly higher family history scores of depression than other two groups (P < 0.00005 in each instance). In the absence of direct interviews with relatives, we cannot exclude the impact of differential reporting. A family history of depression might be associated with an increased probability of treatment or the differential reporting of family history. It is thus possible that the familial aggregation of depression observed in probands from treatment settings is an artifact.

Background: Failure to control impulsive behaviour has been postulated as an underlying mechanism common to substance use disorder, sociopathy and to a substantial subgroup of women with bulimia nervosa., Method: Three hundred and one women recruited to a general population study were selected either at random or because they had lifetime substance use disorder, affective disorder or symptoms of bulimia. A subsequent interview determined the existence of problems with impulsivity. Behaviour that is an integral part of a DSM-III axis 1 disorder was excluded from the impulsivity measure., Results: Similar rates of impulsivity were found in all three of these types of disorder, and this was little different from the rate found in the women selected randomly from the general population. However, among those with comorbid disorder there was more impulsivity, and the more comorbid disorders found, the higher the proportion with problems of impulsivity., Conclusions: Because those in treatment facilities are more likely to have other comorbid disorders (Berkson's bias), findings derived from observations of women with bulimia who are in treatment may be compromised by selection bias and may have limited applicability to those with the disorder who are not in treatment.

Objective: The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined., Method: The data were obtained from a community probability sample. Caseness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression., Results: It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had experienced prolonged separation from both parents. Parental loss was significantly associated with lifetime depression, but this effect was no longer significant when adjusted for other factors. However, prolonged separation from both parents was associated with an increased risk of current and lifetime depressive episodes of approximately three to fourfold, even when the risk was adjusted for other factors., Conclusions: The results of this study suggest that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss. Prolonged separation may be a marker for other risk factors and may not be a risk factor on its own.

65 women who had experienced a recent major depressive disorder, and 81 women who had never been depressed, were recruited from a community probability sample. The two groups of women were compared with regard to a number of childhood experiences, including parenting style, which was assessed with the Parental Bonding Instrument (PBI). When all the childhood factors were considered simultaneously in a logistic regression analysis, only low maternal care was significantly associated with recent depressive episodes. Low maternal care increased the risk of recent major depression approximately 4-fold and the estimate of the population attributable risk was 35%. These findings give further weight to the contention that adverse parenting in childhood, particularly a maternal parenting style typified by low care, is a significant risk factor for adult depression.

This study compares rates of comorbidity of lifetime psychiatric disorder in a clinical sample of women with bulimia, with general population base rates, and with rates of comorbidity among bulimic women in the general population. Eighty-four per cent of the clinical sample of bulimic women had a lifetime affective disorder, and 44% a lifetime alcohol or drug disorder. These rates of disorder were significantly higher than the base rates in the general population. Bulimic women in the general population also had more affective and substance-use disorders than the general population base rates, but the rates of these disorders were lower than found in the clinical sample. In the general population, quite similar rates of other disorders including generalized anxiety, panic, phobia and obsessive-compulsive disorder, are found among those with bulimia, substance-use disorder and depression. Furthermore, among those with depression and substance-use disorder in the general population, rates of eating disorder are comparable. Rather than suggesting a specific relationship between bulimia and either depression or substance-use disorder, the data from this study suggest that the presence of any disorder is associated with a non-specific increase in the likelihood of other psychiatric disorder.

This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Respondents were asked about mental health care ever received, any failure to seek care when required, and symptoms of 14 psychiatric disorders according to DSM-III. The frequency with which respondents reported not seeking care and the popularity of specific reasons for not seeking care were almost identical in the two sites. A common reason offered for not seeking care was doubt about the need for professional help; this appeared to be particularly common for people with alcohol disorder. Respondents who said that they had failed to seek care when needed gave reasons that were mainly attitudinal, such as believing they should be strong enough to cope without professional help. Structural characteristics of services such as cost, times open, and travel distance were given less often. Sociodemographic factors had small or negligible effect on care seeking.

Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.

This study reports results from follow-up interviews with 301 women aged 18-44 years who were first identified 2 years earlier in a cross-sectional study of 1498 adults in the general population of the city of Christchurch, New Zealand. The prevalence of intrafamilial sexual abuse was 13%. This incestuous sexual abuse in childhood was associated with an increase in many adult mental symptoms, particularly symptoms of depression, bulimia and generalized anxiety. In this community study the consequences associated with sexual abuse within the family appear to be widespread and not very specific, and show as additional comorbidity rather than as increased severity within a disorder. These results do not support the strong direct causal effects postulated in some theories derived from clinical studies.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained 1498 interviews using the Diagnostic Interview Schedule. Respondents were from a probability sample of adults aged 18-64 years. This article reports results relevant to preventing alcohol problems. The symptoms most likely ever to be experienced were types of heavy drinking (7-22%) and their consequences such as blackouts (13%). Thirty-two percent of men and 6% of women had met criteria for alcohol disorder prior to interview. The predictors of alcohol disorder were gender, childhood conduct disorder symptoms, early drunkenness, family breakdown and age of leaving school. Cohort effects were clear for onset of drunkenness and alcohol problems. The median duration of alcohol problems was at least 10 years, indicating scope for secondary prevention. General practice and hospitals appeared to be the most suitable places for intervention.

Use of health and mental health services by the 1498 adults in the Christchurch psychiatric epidemiology study is reported. Fourteen percent of the sample had visited a health service for help with mental health problems over the preceding six months. Of those with identified psychiatric disorder during the last six months, only 29% had over that period visited a health service or professional for a mental health consultation though 75% had sought health care. Mental health consultations were more commonly with general practitioners than with mental health specialists, the latter seeing only one in seven of those with recent disorder. Those who at some point in their lives had not sought help, even though they or others had considered it necessary, reported the reasons to be attitudinal rather than to do with practical concerns such as finance, time or access to care.

Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.

In a community sample of 1498 urban adults (18-64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.

In a random community survey of 1,498 urban adults age 18 to 64 years who were interviewed using the Diagnostic Interview Schedule (DIS), the lifetime prevalence of panic disorder was 2.2% +/- 0.4%. This was higher in women (3.4% +/- 0.7%) than in men (0.9% +/- 0.6%), and in those under the age of 45 years. Lifetime prevalence for panic attacks was 7.8% +/- 0.7%. Panic attacks and panic disorder had a similar distribution by age and sex, with higher rates in women than men, and also in the under 45 age groups. The panic symptomatology reported by those subjects with panic attacks was similar to that described by subjects meeting full criteria for panic disorder. The lifetime prevalence of phobic disorders was 10.7% +/- 0.9% and was more common in women (14.6% +/- 1.3%) than in men (6.8% +/- 1.3%). The lifetime prevalence of agoraphobia was 3.8% +/- 0.5%. The occurrence of panic attacks and phobic disorders were frequently related, and in agoraphobic subjects those with more severe agoraphobic avoidance reported more panic symptoms. Indeed, among agoraphobic subjects with at least moderate agoraphobic avoidance, nearly all had either panic attacks or major depression. Subjects with panic attacks and moderate agoraphobic avoidance compared with patients with panic attacks alone, especially when panic symptoms appear before the age of 15, are more likely to have grown up in a family where there was parental conflict, are more likely to have left school at a younger age and without school exams, and are likely to have had more symptoms of a childhood conduct disorder.

In a preliminary analysis of data from a community survey of psychiatric disorders in urban Christchurch, 157 of the 1018 adults interviewed met diagnostic criteria for alcohol abuse and/or dependence. The subjects who met the criteria for alcohol abuse and/or dependence were more likely to have used mental health services than the population at large, although 39% of those with an alcohol disorder had never used any form of mental health service. We examined the impact of severity of alcohol disorder, duration of disorder and gender on the use of services among those with an alcohol disorder. Duration of disorder was not related to use of mental health services. Women are more likely than men to use these services. However, the most important finding was that those with the most severe disorders were most likely to have used mental health services.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.

The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.