Hisateru Tachimori

The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan

Two new screening scales for psychological distress, the K6 and K10, have been developed using the item response theory and shown to outperform existing screeners in English. We developed their Japanese versions using the standard backtranslaton method and included them in the World Mental Health Survey Japan (WMH‐J), which is a psychiatric epidemiologic study conducted in seven communities across Japan with 2436 participants. The WMH‐J used the WMH Survey Initiative version of the Composite International Diagnostic Interview (CIDI) to assess the 30‐day Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM‐IV). Performance of the two screening scales in detecting DSM‐IV mood and anxiety disorders, as assessed by the areas under receiver operating characteristic curves (AUCs), was excellent, with values as high as 0.94 (95% confidence interval = 0.88 to 0.99) for K6 and 0.94 (0.88 to 0.995) for K10. Stratum‐specific likelihood ratios (SSLRs), which express screening test characteristics and can be used to produce individual‐level predicted probabilities of being a case from screening scale scores and pretest probabilities in other samples, were strikingly similar between the Japanese and the original versions. The Japanese versions of the K6 and K10 thus demonstrated screening performances essentially equivalent to those of the original English versions. Copyright

Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys

BACKGROUND Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. METHODS Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. RESULTS Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. CONCLUSION These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries.

Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys

Objective:  We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study.

Age patterns in the prevalence of DSM-IV depressive/anxiety disorders with and without physical co-morbidity.

BACKGROUND Physical morbidity is a potent risk factor for depression onset and clearly increases with age, yet prior research has often found depressive disorders to decrease with age. This study tests the possibility that the relationship between age and mental disorders differs as a function of physical co-morbidity. METHOD Eighteen general population surveys were carried out among household-residing adults as part of the World Mental Health (WMH) surveys initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). The effect of age was estimated for 12-month depressive and/or anxiety disorders with and without physical or pain co-morbidity, and for physical and/or pain conditions without mental co-morbidity. RESULTS Depressive and anxiety disorders decreased with age, a result that cannot be explained by organic exclusion criteria. No significant difference was found in the relationship between mental disorders and age as a function of physical/pain co-morbidity. The majority of older persons have chronic physical or pain conditions without co-morbid mental disorders; by contrast, the majority of those with mental disorders have physical/pain co-morbidity, particularly among the older age groups. CONCLUSIONS CIDI-diagnosed depressive and anxiety disorders in the general population decrease with age, despite greatly increasing physical morbidity with age. Physical morbidity among persons with mental disorder is the norm, particularly in older populations. Health professionals, including mental health professionals, need to address barriers to the management of physical co-morbidity among those with mental disorders.

Cognitive and symptom profiles in Asperger's syndrome and high-functioning autism.

Abstract  Asperger syndrome (AS) and autistic disorder are two subtypes of pervasive developmental disorders (PDD), but there has been considerable debate over whether AS and autistic disorder without mental retardation (IQ ≥ 70), called high‐functioning autism (HFA), are distinct conditions or not. The aim of the present paper was to clarify this issue through a comparison of cognitive function and autistic symptom profiles. Based on the DSM‐IV and ICD‐10 definitions of language acquisition, 36 age‐ and IQ‐balanced subjects with AS (mean age, 12.8 years; mean full‐scale IQ, 98.3) were compared with 37 subjects with HFA (mean age, 12.6 years; mean full‐scale IQ, 94.6) on the Japanese version of the Wechsler Intelligence Scales and the Childhood Autism Rating Scale‐Tokyo Version (CARS‐TV). Compared with the HFA subjects, the AS subjects scored significantly higher on Verbal IQ, Vocabulary, and Comprehension, but scored significantly lower on Coding. Although the total CARS‐TV score did not differ significantly between the two groups, AS subjects scored significantly lower (i.e. less abnormal) on Verbal communication and Non‐verbal communication than did the HFA subjects. A history of normal language acquisition in early childhood could predict his/her better verbal ability in mid‐childhood or later. Autistic cognitive characteristics shared by both AS and HFA subjects appear to support the validity of the current diagnostic classification of PDD.

Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell?

Telling people that they have cancer has a great impact on their lives, so many doctors are concerned about how they should inform patients about a cancer diagnosis and its prognosis. We conducted a general population survey in Japan to investigate people’s preferences on receiving this information. There were no significant differences in respondents’ preferences according to the seriousness of the cancer. Full disclosure of the diagnosis was preferred by 86.1% of the respondents, while 2.7% wanted non-disclosure. As for the initial provision of information, the majority preferred partial disclosure concerning the prospects of complete recovery (64.5%) and the expected length of survival (64.1%). Those who responded negatively to the statement, “If I am close to the end of my life, I want to be informed of the fact so I can choose my own way of life”, were more likely to want non-disclosure on diagnosis. The results suggest that, at the first opportunity of providing information, a disclosure policy of giving patients full details of their diagnosis and some information on prognosis can satisfy the preferences of most patients. Contrary to popular belief, the seriousness of the cancer and people’s demographic characteristics displayed little impact in this study.

Early cannabis use and estimated risk of later onset of depression spells: Epidemiologic evidence from the population-based world health organization world mental health survey initiative

Early-onset cannabis use is widespread in many countries and might cause later onset of depression. Sound epidemiologic data across countries are missing. The authors estimated the suspected causal association that links early-onset (age <17 years) cannabis use with later-onset (age > or =17 years) risk of a depression spell, using data on 85,088 subjects from 17 countries participating in the population-based World Health Organization World Mental Health Survey Initiative (2001-2005). In all surveys, multistage household probability samples were evaluated with a fully structured diagnostic interview for assessment of psychiatric conditions. The association between early-onset cannabis use and later risk of a depression spell was studied using conditional logistic regression with local area matching of cases and controls, controlling for sex, age, tobacco use, and other mental health problems. The overall association was modest (controlled for sex and age, risk ratio = 1.5, 95% confidence interval: 1.4, 1.7), was statistically robust in 5 countries, and showed no sex difference. The association did not change appreciably with statistical adjustment for mental health problems, except for childhood conduct problems, which reduced the association to nonsignificance. This study did not allow differentiation of levels of cannabis use; this issue deserves consideration in future research.

Childhood Autism Rating Scale − Tokyo Version for screening pervasive developmental disorders

Abstract To assess the utility of the Childhood Autism Rating Scale − Tokyo Version (CARS‐TV), its total score was compared among 430 children with DSM‐IV per subgroup (i.e. autistic disorder (AD), childhood disintegrative disorder (CDD), Aspergers disorder, and pervasive developmental disorders (PDD) not otherwise specified (PDDNOS)). Values of Cronbachs alpha were 0.91 for the PDD group and 0.89 for the non‐PDD mental retardation (MR) group, and 0.93 for both groups combined. The total score was significantly higher in PDD (mean = 30.1, SD = 4.5) than in non‐PDD MR (mean = 22.9, SD = 3.3), t(503) = 13.7, P< 0.0001. The cut‐off to distinguish PDD from non‐PDD MR was 25.5/26, with sensitivity, specificity, positive predictive value and negative predictive value of 0.86, 0.83, 0.97 and 0.50, respectively. The total score differed significantly among the four groups, with CDD and AD being significantly higher than both PDDNOS and Aspergers disorder, PDDNOS being significantly higher than Aspergers disorder and no significant difference between CDD and AD. The cut‐off to distinguish AD from PDDNOS was 30/30.5, with sensitivity, specificity, positive predictive value and negative predictive value of 0.71, 0.75, 0.77 and 0.69, respectively. CARS‐TV seems to be a useful instrument for differentiating between PDD and non‐PDD MR and between AD and PDDNOS, although further replication is needed.

Behavioral and Emotional Problems in Chinese Children : Teacher Reports for Ages 6 to 11

This study examined the applicability of the Chinese Version of Teachers Report Form (TRF-CV) and estimated the prevalence of behavioral problems in a general population sample of 2,936 children aged 6 through 11 years in the Shandong Province of China. Teachers completed the TRF-CV and the Conners Hyperkinesis Index (CHI). The TRF-CV total scale showed satisfactory 2-week test-retest reliability (r = .83) and internal consistency (Cronbachs alpha = .94). The TRF-CV Total Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior had acceptable concurrent validity with the CHI (mean r = .62). With the TRF-CV Total Problems score of 26 as a cutoff, an overall correct classification rate of 90% for clinical sample and nonreferral required children was obtained. Exploratory factor analysis yielded six syndromes: Aggressive/Delinquent Behavior, Withdrawn/Depressed, Somatic Complaints, Attention Problems, Social Problems, and Thought Problems, with significant correlations with corresponding American cross-informant syndromes (mean r = .84). The overall prevalence rate of behavioral problems was 15.5% (95% CI = 14.2-16.8%), with a boy-to-girl ratio of 2.0:1 (chi2 = 59.70, p < .001). Younger boys exhibited more externalizing problems. These findings indicate that the TRF-CV is applicable for Chinese children, and the prevalence of behavioral problems shown by it among Chinese children seems comparable to that found in other countries. Although most of the American syndromes were well replicated, the differences in the present subjects, when submitted to principal components analysis, from American samples from whom the original syndromes were derived, could have prevented the study from replicating distinctions between aggressive vs. delinquent and depressed vs. withdrawn syndromes.

Mental disorders and suicide in Japan: a nation-wide psychological autopsy case-control study.

BACKGROUND The purpose of the present nationwide psychological autopsy case-control study is to identify the association between mental disorders and suicide in Japan, adjusting for physical conditions. METHODS A semi-structured interview was conducted of the closest family members of 49 suicide completers and 145 gender-, age-, and municipality-matched living controls. The interview included sections of socio-demographic characteristics, physical conditions, and a psychiatric interview producing DSM-IV diagnoses of mental disorders prior to suicide (or at survey). We compared prevalences of mental disorders between the two groups, using conditional logistic regression. RESULTS A significantly higher proportion with any mental disorder was found in the suicide group (65.3%) compared to the control group (4.8%) (p=0.003, odds ratio [OR]=7.5). The population attributable risk proportion associated with mental disorder was 0.24. Mood disorder, particularly major depressive disorder, was the most strongly associated with suicide (p<0.001). Anxiety disorder, alcohol-related disorder, and brief psychotic disorder were also significantly associated with suicide (p<0.05). These patterns were unchanged after adjusting for serious chronic physical conditions. LIMITATIONS The present study had some limitations, such as small sample size, sampling bias and information bias. CONCLUSIONS Most mental disorders, particularly mood disorder, were significantly associated with a greater risk of suicide in Japan, independent of physical conditions. Mental disorders are a major target of suicide prevention programs in Japan.