The public use version of the National Comorbidity Survey - Replication (NCS-R) dataset was used (N = 995) to investigate risk factors for recurrent major depressive disorder (MDD) that are evident before recovery from the first major depressive episode (MDE) by comparing persons diagnosed with MDD who experienced a single MDE to persons with recurrent MDD. Multiple logistic regression analyses assessed the independent risk of recurrent MDD for each of the following risk factors: an early age of onset (old), absence of a life stress trigger, chronic first episode, childhood parental loss, parental maltreatment, parental depression, comorbid anxiety disorder, and comorbid substance disorder. The relative excess risk due to interaction (RERI) assessed the risk of recurrent MDD associated with the interaction of an early onset with three childhood-based vulnerabilities: a) parental depression, b) parental loss, and c) parental maltreatment. There was a statistically significant risk of recurrent MDD found for the following risk factors: early onset, stress trigger absent, childhood parental loss, parental maltreatment, parental depression, and anxiety disorder; marginally significant results suggested an increased risk of recurrent MDD for substance disorder. There was a significant increased risk found for the interaction of an early onset with parental depression and similar non-significant trends were found for the interactions of early onset with parental loss and early onset with parental maltreatment. An early onset, the absence of a life stress trigger, and the presence of parental loss, parental maltreatment, parental depression, a comorbid anxiety disorder, and a comorbid substance disorder each confer greater risk of recurrent MDD among persons that have not yet recovered from their first lifetime MDE. The presence of an early onset combined with a childhood-based vulnerability such as parental depression, parental loss, or parental maltreatment, indicate an especially high risk of recurrent MDD. These findings may inform the development of a screening tool to assess risk for recurrent MDD and early intervention to prevent recurrent MDD. Future research should employ a longitudinal research design to replicate and expand upon these findings.

It is estimated that one in five Australians are affected by a mental disorder, and the associated burden of living with a mental illness will become one of the greatest health care issues during the next 20 years. Since the 1960s, the care of people with mental disorders has been transferred to community settings including to rural areas of Australia through the process of deinstitutionalisation. However, research on young adults living with a mental illness in rural communities is limited, and the multidimensional experience of this group of young adults has not been previously explored. This study, guided by grounded theory methodology, explored young adults' experience of living with a mental illness in rural Western Australia. This thesis presents the findings of interviews with nine participants aged between 18 and 30 and places the findings within the context of relevant scientific literature. The constant comparative method used in grounded theory analysis identified that the basic social psychological problem experienced by all participants was "being shut out". The problem of being shut out consisted of two aspects: "being excluded" and "withdrawing from society". In order to manage the problem of being shut out, participants engaged in the basic social psychological process of "seeking normality". In seeking normality participants moved from a state of being shut out to one whereby they sought to take part in ordinary social activities taken for granted by other members of society. The process of seeking normality consisted of three phases: "floundering", "taking charge", and "moving forward. Phase one of the process occurred primarily in the period prior to experiencing a turning point, which changed the participants' willingness to take control of their life and to take effective steps in reducing their isolation. / Participants' experience of being shut out was not related to the duration of their illness but to their experience of seeking normality and the three conditions identified as influencing that experience. The findings, while supporting existing scientific literature, also present a new insight into young adults' experience of living with a mental illness in rural Western Australia. The findings of this study highlight the importance of health professionals' understanding young adults' experience of being shut out and to incorporate the increased knowledge and understanding into their clinical practice. Finally, the findings have implications on public education, healthcare services and healthcare policy in relation to young adults living with a mental illness.

The present study was conducted to examine the effects of early orientation of counseling related students to the two most prevalent paradigms of psychodiagnostic decision-making on first, the integration of the model, and second, on the ability to make proficient diagnostic decisions while in training. Using an experimental, pretest posttest design, 60 participants from two higher educational sites were randomly assigned to two treatment groups. Participants in each group were oriented to one of two treatment conditions -- a binary decision tree model or a problem-solving model (multiple competing hypotheses). Participants were then introduced to DSM Axis II diagnostic categories utilizing a computer assisted learning laboratory. Results suggested that participants learned diagnosis during the experiment. However, no significant difference in diagnostic proficiency occurred as a result of the two treatment conditions. Additional analyses raised questions about use of case studies as a means of assessing diagnostic proficiency. Item difficulty appeared to be linked to diagnostic clusters and individual diagnoses. Item difficulty factors influenced the internal consistency and validity of test instruments. The assumption of the unidimensial weight of syndromes in the construction of assessment instruments is suspect. Considering the preponderance of case study use for counselor training assessment, caution during instrument construction and use is advised. Evidence also existed that treatment groups responded differently to particular DSM diagnostic clusters and items. This suggested that cluster and item difficulty may be important to consider for instruction of diagnosis in the classroom. Results also suggested that as diagnoses become more complex, problem-solving diagnostic decision-making may become more important. Secondary analysis of computer assisted learning resulted in significant evidence that nonsequential, user-friendly computer assisted instruction may overcome teaching-study style mismatch, resulting in more even distribution of learning over the sample population. / Graduation date: 1998

Background. As part of a longitudinal study, prevalence findings of DSM-IV disorders are presented for a random sample of 3021 respondents aged 14 to 24, with response rate 71%. Method. Assessment included various subtypes of disorders, subthreshold conditions and disorders that have only rarely been studied in other epidemiological surveys. The computer-assisted Munich-Composite International Diagnostic Interview (M-CIDI) was used to derive DSM-IV diagnoses. Results. Substance disorders were the most frequent (lifetime 17·7%; 12-month 11·4%), with abuse being considerably more frequent than dependence. Other mental disorders had a lifetime prevalence of 27·5% (12-month, 17·5%) with depressive disorders (16·8%) being more frequent than anxiety disorders (14·4%). Eating disorders (3·0%) and threshold somatoform disorders (1·2%) were rare disorders. Subthreshold anxiety and somatoform disorders, however, were more frequent than threshold disorders. Prevalence of disorders was equally high for males and females, although specific disorder prevalence varied significantly by gender. The co-occurrence of disorders (co-morbidity) was substantial and was significantly related to greater reductions in work productivity and increased rates of professional helpseeking behaviour. Conclusions. Findings underline that mental disorders in young adults are frequent and impairing, limiting work and education ability and social interaction. Given the fact that adolescents and young adults are in a key phase of socialization in terms of professional career and interpersonal relationships, our findings indicate a considerable risk potential for an accumulation of complicating factors and future chronicity. This paper is the first report of this ongoing longitudinal study about early developmental conditions of mental disorders.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 144-151).

Theoretical assumptions and emerging research point to possible mechanisms of change in acceptance and commitment therapy (ACT) for psychosis. However, the specific processes by which change occurs remain unclear and under-researched. No current research has explored processes facilitating change in the group format of an ACT intervention for psychosis. Participant perspectives were sought to help elucidate potential mechanisms of change. Nine participants of ACT groups for people with psychosis were interviewed about their experiences of the intervention. Interviews were analysed using methods and techniques informed by grounded theory. A proposed model outlined key mechanisms of awareness, relating differently and reconnecting with life, which led to reductions in distress and behavioural change. Leaning on others highlighted the importance of the group context in supporting change processes. The processes identified, and the mechanisms through which these were achieved, as articulated by participants, were consistent with proposed change processes. Participants also offered additional insights based on experiential accounts. Contributions to theoretical understandings and clinical practice are discussed.

The link between mental health and income of military personnel remains relatively understudied in Canada. This research sought to determine whether household income is associated with poor mental health in terms of suicide ideation, suicide attempts, depression, post-traumatic stress disorder (PTSD), and mood and anxiety disorders in various military samples. First, associations of household income and several DSM-IV diagnosed mental disorders were examined in active military personnel and the Canadian general population using the Canadian Community Health Survey Cycle 1.2 (CCHS-1.2; a representative sample of Canadians ages 16-64, n=28,688) and corresponding Canadian Forces Supplement (CCHS-CFS; a representative sample of active duty personnel ages 16-64, n=8,441). Second, associations of household income with categories of mental health conditions were examined in Canadian veterans using the Survey on Transition to Civilian Life (STCL; a representative survey of 3,154 former regular force personnel released from the military between 1998 to 2007, ages 15-67). Multiple logistic regression analyses, adjusted for sociodemographic variables, were used to determine associations between household income and mental health conditions in the three populations. Military characteristics (such as rank, branch, years of service, and previous deployment) were examined for potential influence on the household income-mental health relationship in the military and veteran samples. The primary hypothesis for this study was that lower income would be concomitant with poorer mental health in all three populations. This hypothesis was confirmed in the Canadian veteran population and general population. With respect to active service members, the results were less definitive; although trends in the data suggest that household income is associated with mental disorders, statistical tests were non-significant. The results of this study have important implications for future policy formulation and program development for military and veteran personnel; for active personnel, more thorough mental health screening procedures and prevention strategies focused on those in lower income brackets may have significant health and economic implications. For veteran personnel, the incorporation of knowledge and understanding of the impact of income on mental health into transition to civilian life policies and support programs may provide similar benefits.

Mėginimai žudytis – vienas iš reikšmingiausių savižudybės rizikos veiksnių. Tyrimo metu buvo įvertinti išgyvenusių po mėginimo žudytis ir gydytų psichiatrijos stacionare pacientų mėginimo žudytis ypatumai, pobūdis, jų sąsajos su psichikos sutrikimais ir socialinėmis-demografinėmis charakteristikomis. Mėginimas žudytis apibrėžtas kaip sąmoningas, savo noru pasirinktas veiksmas, kurį, nebūdamas tikras dėl mirtinos baigties, atliko asmuo, siekdamas susižaloti arba pasitraukti iš gyvenimo, ir kuris nesibaigė mirtimi.Tyrimas atliktas Lietuvos sveikatos mokslų universiteto ligoninės (LSMUL) Kauno klinikų (KK) Psichiatrijos klinikoje ir Respublikinės Kauno ligoninės (RKL) padalinio Psichiatrijos ligoninėje (PL). Tyrime dalyvavo išgyvenę po mėginimo žudytis pacientai, kurie dėl tokio poelgio buvo hospitalizuoti į LSMUL Kauno klinikų Psichiatrijos kliniką arba į RKL padalinį PL. Apklausti 240 suaugusių pacientų. Moterys dažniau mėgino žudytis apsinuodydamos medikamentais negu vyrai. Mėginusių žudytis vyrų sveikatos būklė po mėginimo žudytis buvo sunkesnė negu moterų. Mėginimo žudytis metu alkoholį dažniau vartojo vyrai ir dirbantys asmenys, palyginti su moterimis ir bedarbiais. Gyvenantys poroje dažniau mėgino žudytis pavartoję alkoholio, palyginti su gyvenančiais vienumoje. Vyresnio amžiaus, taip pat ir aukštesnio išsilavinimo pacientai buvo linkę mėginti žudytis nuošalyje nuo kitų žmonių, palyginti su jaunesnio amžiaus ar žemesnio išsilavinimo pacientais. Žemesį išsilavinimą... [toliau žr. visą tekstą] / Failed suicide attempts comprise one of the most significant suicide risk factors.The goal of the studywas toanalyze the particularities and nature of failed suicide attempts and their links to mental disorders and socio-demographic characteristics of suicide attempt survivors treated at psychiatric hospitals. The respondents were comprised of patients who survived their suicide attempts and were thus hospitalized at the Psychiatric Clinic of Kaunas Clinics (KC) of the Lithuanian University of Health Sciences Hospital (LUHSH) or the Psychiatric Hospital of theNational Kaunas Hospital(NKH). A failed suicide attempt is defined as a conscious action chosen of one’s free will which was performed by a person who was unsure of the fatality of such action in an attempt to do self-harm or take his/her own life and which did not result in the said person’s death. 240 adult patients complying with the sampling criteria. The health status of the males who attempted to commit suicide after a failed suicide attempt was twice as poor as that of the females. Compared to the females and unemployed people, the males and employed respondents were under the influence of alcohol at the time of attempted suicide more often. Also, the respondents living with a partner attempted to commit suicide under the influence of alcohol more frequently than the single ones.Compared to the younger respondents and patients with lower level of education, the older and better educated ones were more inclined to... [to full text]

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.