Diana Paksarian

The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort Study

BACKGROUND There are only a small number of prospective studies that have systematically evaluated standardised diagnostic criteria for mental disorder for more than a decade. The aim of this study is to present the approximated overall and sex-specific cumulative incidence of mental disorder in the Zurich cohort study, a prospective cohort study of 18-19 years olds from the canton of Zurich, Switzerland, who were followed through age 50. METHOD A stratified sample of 591 participants were interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology, a semi-structured interview that uses a bottom-up approach to assess the past-year presence of 15 psychiatric syndromes. Seven interview waves took place between 1979 and 2008. Approximated cumulative incidence was estimated using Kaplan-Meier methods. RESULTS Rates of mental disorder were considerably higher than those generally reported in cross-sectional surveys. We found rates ranging from 32.5% for major depressive disorder to 1.2% for Bipolar I disorder. The cumulative probability of experiencing any of the mental disorders assessed by age 50 was 73.9%, the highest reported to date. We also found that rates differed by sex for most disorders, with females generally reporting higher rates of mood, anxiety and phobic disorder, and males reporting higher rates of substance- and alcohol-related disorders. CONCLUSIONS These findings confirm those of other long-term prospective studies that indicate the nearly universal nature of disturbances of emotion and behaviour across the life span. Greater community awareness of the normative nature of these experiences is warranted. An important area of future research is study long-term course and stability to determine who among those with such disturbances suffer from chronic disabling mental disorders. Such longitudinal studies may aid in directing services and intervention efforts where they are most needed.

Sleep Patterns and Mental Health Correlates in US Adolescents

Objective To investigate systematically the associations of sleep patterns with a range of mental disorders and other outcomes among a nationally representative sample of US adolescents. Study design Using the National Comorbidity Survey Adolescent Supplement, a nationally representative cross‐sectional survey of 10 123 US adolescents 13‐18 years of age, we assessed associations between adolescent‐reported sleep patterns (tertiles of weeknight bedtime, weeknight sleep duration, weekend bedtime delay, and weekend oversleep) and past‐year mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, smoking, injury, suicidality, and perceived mental and physical health, assessed via direct diagnostic interview. Results The average weeknight bedtime was at 22:37 and sleep duration was 7.72 hours. Average weekend bedtime delay was 1.81 hours and average weekend oversleep was 1.17 hours. Later weeknight bedtime, shorter weeknight sleep duration, greater weekend bedtime delay, and both short and long periods of weekend oversleep were associated with increased odds of mood, anxiety, substance use, and behavioral disorders, as well as suicidality, tobacco smoking, and poor perceived mental and physical health. ORs ranged from 1.27 to 2.15. The only outcomes not associated with any sleep patterns were past‐year injury and eating disorder. Conclusions Suboptimal sleep patterns were associated with an array of mental disorders and other health‐related outcomes among adolescents. Abnormal sleep patterns may serve as markers of prodromal or untreated mental disorders among adolescents, and may provide opportunities for prevention and intervention in mental disorders.

Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort

Importance Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period. Objectives To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period. Design, Setting, and Participants A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016. Main Outcomes and Measures Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria. Results Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men. Conclusions and Relevance Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.

Olfactory processing in bipolar disorder, major depression, and anxiety

Although olfactory abnormalities are well established in schizophrenia, considerably less work has examined olfactory performance in other neuropsychiatric conditions. In the current study, we examined odor identification, odor discrimination, detection threshold, and odor hedonic processing performance in individuals with bipolar I disorder (n = 43; n = 13 with psychotic features), bipolar II disorder (n = 48), major depressive disorder (MDD) (n = 134), anxiety (n = 48), and no mental disorder (n = 72) who participated in a community‐based family study.

Physical Activity and Mental Disorder Among Adolescents in the United States

OBJECTIVE To estimate associations between physical activity (PA) and a broad range of lifetime mental disorders among adolescents, and to evaluate whether the context of sports participation impacts these associations. METHODS The sample included 6,483 13-18 year-olds from the National Comorbidity Survey Adolescent Supplement. Adolescents completed face-to-face psychiatric interviews and a parent provided diagnostic and other family-level information on the participating adolescent by completing a self-administered questionnaire. PA was measured by adolescent self-report and dichotomized to indicate vigorous exercise several times a week. Nineteen psychiatric disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria. Multiple logistic regression analyses were used to estimate associations of PA with mental disorders, suicidality, and psychological distress. RESULTS Two thirds of adolescents reported being physically active. Active adolescents had significantly lower odds of mood disorder (Odds ratio[OR] = .74, 95% confidence interval [CI]=.58-.94), bipolar II disorder (OR = .54, 95% CI=.30-.99), and general psychological distress (OR = .71, 95% CI=.52-.96) than less/inactive adolescents. In contrast, adolescents who engaged in PA were more likely to have lifetime alcohol use disorder (OR = 1.78, 95% CI = 1.11-2.85), bulimia (OR = 5.84, 95% CI = 2.48-13.79), generalized anxiety disorder (OR = 2.04, 95% CI = 1.16-3.58), and posttraumatic stress disorder (OR = 1.65, 95% CI = 1.07-2.55). The direct associations between PA and alcohol use disorder and bulimia appeared to be specific to adolescents who participated in organized sports. DISCUSSION Associations between PA and lifetime mental disorder among adolescents may differ according to both disorder type and the context in which PA occurs. Longitudinal studies that assess the context of PA may be able to explain apparent discrepant associations between PA and mental disorder.