PDSE are common (19.6%) in the local stroke population. Both premorbid factors as well as stroke-related factors contribute to the development of PRSD and PSDE. The application of different diagnostic criteria for PSDE will affect the frequency and the associated radiological characteristics. As regards the screening methods of PSDE, a more specific instrument should supplement the IQCODE or MDRS-IP in a two-stage screening procedure. / PSD is also common (16--17%) among local stroke survivors. Both psychosocial factors and the location of cerebrovascular lesions play an important role in the development of PSD. PSD in local Chinese seems to have a favorable short-term outcome in comparison with their Caucasian counterparts. With regard to the screening of PSD in Chinese, we found that both the GDS and HADS depression subscale have a satisfactory response rate and accuracy in detecting PSD. However, due to the relative low frequency of PSD in the local stroke population, a more specific instrument should supplement the GDS in a two-stage screening procedure. Finally, the familiarity of the rater with the subjects based on a preexisting therapeutic relationship did not influence the accuracy of screening for PSD in Chinese patients. / There has been a paucity of data on the frequency, clinical correlates and methods of screening of poststroke dementia (PSDE) and depression (PSD) in Chinese populations. The objective of this thesis is to examine the prevalence, diagnostic criteria and clinical correlates of PSDE and PSD in Chinese stroke patients in Hong Kong. A series of studies were all carried out; the author of the thesis had interviewed all the subjects 1--3 months after their index stroke and made the diagnosis of dementia and depression according to the DSM-IV criteria. / Tang Wai Kwong. / "July 2005." / Adviser: Gabor S. Ungvari. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0177. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 136-191). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Nach Befunden des Bundes-Gesundheitssurveys 1998/99 (Zusatzsurvey „Psychische Störungen“) litten im Jahr der Erhebung 32% (=15,6 Millionen) der erwachsenen deutschen Bevölkerung im Alter von 18–65 unter einer oder mehreren psychischen Störungen. Jeder dritte Betroffene (36%) steht oder stand im Jahr vor der Erhebung wegen der psychischen Störung in Kontakt mit ambulanten oder stationären psychiatrisch/psychotherapeutischen Diensten oder seinem Hausarzt. Der Anteil von Betroffenen, die eine im weitesten Sinne adäquate Therapie nach modernen wissenschaftlichen Kriterien erhalten, kann konservativ auf ca.10% geschätzt werden. Die niedrige Versorgungsquote betrifft dabei nicht alle spezifischen Störungsgruppen in gleichem Ausmaß; niedrige Versorgungsraten ergaben sich insbesondere für somatoforme und Suchterkrankungen. Ferner ergaben sich zum Teil markante regionale Unterschiede (z.B. besonders schlechte Versorgungslage in Regionen, die weder über eine nahe Universität noch über psychotherapeutische Weiterbildungsinstitutionen verfügen).Ungeachtet unterschiedlich weiter oder enger Definitionen des Begriffs Behandlungsbedarf, zeigt sich eine gravierende Unterversorgung von Personen mit psychischen Erkrankungen. Quantitativ bedeutsame Hinweise auf eine Fehl- oder Überversorgung von Betroffenen lassen sich nicht aufzeigen. / Data from the German Health Interview and Examination Survey, Mental Health Supplement (N=4181) reveal that 32% (15,6 million people) of the adult population between 18 and 65 years of age suffer from one or more mental disorders. Among those only 36% receive treatment which also varies in type, duration, and adequacy. The proportion of cases receiving “adequate evidence- based treatments” was estimated to be about 10%.Lowest treatment rates were found for somatoform disorders and substance abuses, highest for psychotic disorders, panic disorder, generalised anxiety disorder, and dysthymia. The data reveal substantial regional differences with regard to treatment rates (e.g. lower rates in regions without universities or institutions offering postgraduate mental health education).The paper concludes that, depending on the diagnosis, a considerable degree of unmet medical needs exist for the majority of people affected by mental disorders. No evidence was found for an excessive supply of health care for the patients suffering from mental disorders or for treatments without an existing clinical need.

Background: When assessing the association between a factor X and a subsequent outcome Y in observational studies, the question that arises is what are the variables to adjust for to reduce bias due to confounding for causal inference on the effect of X on Y. Disregarding such factors is often a source of overestimation because these variables may affect both X and Y. On the other hand, adjustment for such variables can also be a source of underestimation because such variables may be the causal consequence of X and part of the mechanism that leads from X to Y. Methods: In this paper, we present a simple method to compute control variables in the presence of age at onset data on both X and a set of other variables. Using these age at onset data, control variables are computed that adjust only for conditions that occur prior to X. This strategy can be used in prospective as well as in survival analysis. Our method is motivated by an argument based on the counterfactual model of a causal effect. Results: The procedure is exemplified by examining of the relation between panic attack and the subsequent incidence of MDD. Conclusions: The results reveal that the adjustment for all other variables, irrespective of their temporal relation to X, can yield a false negative result (despite unconsidered confounders and other sources of bias).

Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo" (p < 0,005) e “características especiais de depressão" (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning" (p < 0.005) and “special features of depression" (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo” (p < 0,005) e “características especiais de depressão” (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning” (p < 0.005) and “special features of depression” (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.