Social psychiatry

This article tests the hypothesis that remission from substance use disorders is associated with smoking cessation in nicotine dependent young adults. The sample was composed of 976 young adults with lifetime substance use disorders and nicotine dependence who were subjects in the national epidemiologic survey on alcohol abuse and related conditions (NESARC). The Associated Disabilities Interview Schedule-DSM-IV Version was used to assess lifetime and past year psychiatric disorders. Past year nicotine cessation was obtained by self-report. Remission from substance use disorders was defined as the past year absence of DSM-IV substance use disorders . This study found that remission from substance use disorders increased the likelihood of smoking abstinence (OR = 1.7). Our study found that remission from substance use disorders increased the likelihood of smoking abstinence in early adulthood. This finding is congruent with results from longitudinal studies.

The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended “natural experiment” allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied. Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined. In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher’s exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms. Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods.

We sought to replicate (or refute) a previous report of an association between unwantedness of a pregnancy and the risk of schizophrenia in the offspring. The study was conducted using a large, prospectively collected birth cohort as part of the Prenatal Determinants of Schizophrenia study (PDS). Attitude toward the pregnancy was assessed at the time of the mother’s first visit to the prenatal clinic. Cases of schizophrenia and other schizophrenia spectrum disorders in the offspring of these mothers were subsequently ascertained and diagnosed. In univariate and multivariate analyses, we examined the relationship between attitude toward the pregnancy and risk of adult schizophrenia and other schizophrenia spectrum disorders. The unadjusted hazard ratio for the association between ambivalent or negative maternal attitude toward the pregnancy and the risk of schizophrenia spectrum disorders was 1.75, (95% CI = 0.97, 3.17, P = 0.06). This result was unchanged after adjustment for social class, paternal age, race/ethnicity and other potential confounders. Similar results were observed when only cases with schizophrenia were included in the analysis. We did not find a statistically significant association in favor of the hypothesis that unwantedness of pregnancy is a risk factor for adult schizophrenia. On the other hand, the magnitude of the observed association was similar to the findings of the only previous study of this question and the confidence limits overlap those findings. Whether unwantedness of pregnancy is a risk factor for adult schizophrenia remains an open question that may be resolved by future research.

Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level. As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

To (1) highlight the profile of the needs for care among a sample of persons with schizophrenia, using the Camberwell Assessment of Needs (CAN-EU), in comparison with the international data; (2) assess the association of patients’ needs with socio-demographics, clinical characteristics and objective quality of life (QOL); and (3) compare the perceptions of patients with those of the staff. Consecutive outpatients in stable condition were interviewed with the CAN-EU and measures of QOL and psychopathology. There were 130 patients (68.5 % men, mean age 36.8). The highest frequency of unmet needs was for money (29.2 %). About a fifth of the subjects expressed unmet needs for six other items, including accommodation. The mean total needs was 8.67(7.1), the total met needs was 5.29 and total unmet needs was 3.38. The dimension with the highest frequency (40 %) of unmet needs (functioning) is constituted by items that are related to family care at home. Staff identified significantly more needs than patients. Higher levels of needs were significantly associated with severity of psychopathology and negative affect, and not participating in outdoor activities. The mean number of needs was similar to reports from developing countries and higher than those from European countries. The met/unmet need ratio was similar to European data. Despite free health services and family support, a number of our treated community-dwelling persons with schizophrenia had problems meeting basic and health-care needs. The findings call for a consideration of techniques for enhancing the capability of families to cope with the care of patients.

While gender inequality has been a topic of concern for decades, little is known about the relationship between gender discrimination and illicit drug use. Further, whether this association varies by education level is unknown. Among 19,209 women participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004–2005), we used logistic regression to test the association between gender discrimination (measured with four items from the Experiences of Discrimination instrument) and three outcomes: past-year illicit drug use, frequent drug use, and drug use disorders. We then tested whether associations differed by education level. Gender discrimination was reported by 9% of women and was associated with past-year drug use [adjusted odds ratio (aOR) = 2.67; 95% confidence interval (CI) 2.17–3.29], frequent drug use (aOR = 2.82; CI 1.99–4.00), and past-year drug use disorders (aOR = 3.15; CI 2.16–4.61). All specific domains of gender discrimination (on the job, in public, with institutions, being called a sexist name) were associated with all drug use outcomes. The association between gender discrimination and past-year drug use was stronger among women with less than a high school education (aOR = 6.33; CI 3.38–11.85) compared to those with more education (aOR = 2.45; CI 1.97–3.04; p interaction < 0.01). Gender discrimination is consistently and strongly associated with illicit drug use and drug use disorders among U.S. women, with significantly higher odds for drug use among women with less than a high school education. Future research should examine whether explicitly addressing distress from discrimination could benefit women in drug treatment, especially among clients with lower educational attainment.

Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.

We assessed the relationship of self-reported racial discrimination with illicit drug use among US Blacks, and whether this differed by socioeconomic position (SEP). Among 6587 Black participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004–2005), we used multiple logistic regression models to test the association between racial discrimination (measured on the 6-item Experiences of Discrimination scale) and past-year illicit drug use, and whether this differed by SEP. Racial discrimination was associated with past-year drug use [adjusted odds ratio (aOR) 2.32; 95 % confidence interval (CI) 1.70, 3.16] and with frequent drug use (aOR 1.91; 95 % CI 1.22, 2.99). For frequent illicit drug use, this relationship was stronger among higher SEP participants (aOR 3.55; 95 % CI 2.09, 6.02; p interaction < 0.01). The stronger association between racial discrimination and frequent illicit drug use among higher SEP Blacks suggests a complex interplay between disadvantaged and privileged statuses that merits further investigation. The finding of a significant difference by SEP highlights the importance of considering differences within heterogeneous race/ethnic groups when investigating health disparities.

Cardiovascular disease (CVD) is the leading cause of death among Latinos and disproportionately impacts people with psychiatric disorders. The aim of this study was to examine the relationships between CVD and psychiatric disorders among different Latino subgroups using a nationally representative sample. Latinos participants (N = 6359) were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. A structured diagnostic interview was used to determine psychiatric diagnoses for any past-year mood, anxiety, and substance use disorders. A self-reported measure of physician-confirmed CVD was used. The relationships between CVD and psychiatric disorders among Latino subgroups were examined with logistic regression models adjusting for sociodemographics, CVD-risk factors, and acculturation. CVD were highest among Puerto Ricans (12%) and Cubans (11%), followed by Other Latinos (7%) and Mexicans (5%). The relationship between psychiatric disorders and CVD differed by Latino subgroups. Significantly increased odds of CVD were found among Mexicans with any past-year mood and anxiety disorders, Puerto Ricans with any past-year psychiatric disorders, Cubans with any past-year mood and substance abuse disorders, and Other Latinos with any past-year mood, anxiety, and lifetime schizophrenia/psychotic disorders. The associations between CVD and psychiatric disorders are not uniform among Latinos. Efforts to address the need for health and mental health services must carefully consider this heterogeneity.