Scholarly works in Psychiatry

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    Recovery from DSM-IV post-traumatic stress disorder in the WHO world mental health surveys
    (Cambridge University Press, 2018) Rosellini, A.; Liu, H.; Petukhova, M. V.; Sampson, N. A.; Aguilar-Gaxiolam, S.; Alonso, J.; Borges, G.; Bruffaerts, R.; Bromet, E. J.; de Girolamo, G.; de Jonge, P.; J. Fayyad, J.; Florescu, S.; Gureje, O.; Haro, J. M.; Hinkov, H.; Karam, E. G.; Kawakami, N.; Koenen, K. C.; Lee, S.; Lépine, J. P.; Levinson, D.; Navarro-Mateu, F.; Oladeji, B. D.; O'Neill, S.; Pennell, B. E.; Piazza, M.; Posada-Villa, J.; Scott, K. M.; Stein, D. J.; Torres, Y.; Viana, M. C.; Zaslavsky, A. M.; Kessler, R. C.
    Background. Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. Methods. The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. Results. 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%). Conclusions. We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
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    Parental psychopathology and the risk of suicidal behavior in their offspring: results from the world mental health surveys
    (Macmillan Publishers Limited, 2011) Gureje, O.; Oladeji, B.; Hwang, I.; Chiu, W. T.; Kessler, R. C.; Sampson, N. A.; Alonso, J.; Andrade, L. H.; Beautrais, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Gal, G.; He, Y.; Hu, C.; Iwata, N.; Karam, E. G.; Kovess-Masféty, V.; Matschinger, H.; Moldovan, M. V.; Posada-Villa, J.; Sagar, R.; Scocco, P.; Seedat, S.; Tomov, T.; Nock, M. K.
    Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N= 55 299; age 18þ) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.
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    Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys
    (BioMed Central (BMC), 2019) de Vries, Y. A.; Al-Hamzawi, A.; Alonso, J.; Borges, G.; Bruffaerts, R.; Bunting, B.; Caldas-de-Almeida, J. M.; Cia, A. H.; De Girolamo, G.; Dinolova, R. V.; Esan, O. B.; Florescu, S.; Gureje, O.; Haro, J. M.; Hu, C.; Karam, E. G.; Karam, A.; Kawakami, N.; Kiejna, A.; Kovess-Masfety, V.; WHO World Mental Health Survey Collaborators
    Background: Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. Methods: We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. Results: Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR=2.4, 95% CI 2.3–2.5, p< 0.001). Conclusions: This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
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    The association between childhood adversities and subsequent first onset of psychotic experiences: a cross- national analysis of 23 998 respondents from 17 countries
    (Cambridge University Press, 2017) McGrath, J.J.; McLaughlin, K.A.; Saha, S.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Bruffaerts, R.; de Girolamo, G.; de Jonge, P.; Esan, O.B.; Florescu, S.; Gureje, O.; Haro, J.M.; Hu, C.; Karam, E.G.; Kovess-Masfety, V.; Lee, S.; Lepine, J.P.; Lim, C.C.; Medina-Mora, M.E.; Mneimneh, Z.; Pennell, B. E.; Pennell, B. E.; Piazza, M.; Posada-Villa, J.; Sampson, N.; Viana, M.C.; Xavier, M.; Bromet, E.J.; Kendler, K.S.; Kessler, R.C.
    Background—Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. Methods—We assessed CAs, PEs and DSM-IV mental disorders in 23,998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. Results—Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs (OR =2.3, 95%CI=1.9–2.6). CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR= 8.5, 95%CI=3.6–20.2), whereas other CA types were associated with PE onset in adolescence. Associations of Other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF). Conclusions—Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.