Katherine A. McMillan

Relationship Between Household Income and Mental Disorders: Findings From a Population-Based Longitudinal Study

CONTEXT There has been increasing concern about the impact of the global economic recession on mental health. To date, findings on the relationship between income and mental illness have been mixed. Some studies have found that lower income is associated with mental illness, while other studies have not found this relationship. OBJECTIVE To examine the relationship between income, mental disorders, and suicide attempts. DESIGN Prospective, longitudinal, nationally representative survey. SETTING United States general population. PARTICIPANTS A total of 34,653 noninstitutionalized adults (aged ≥20 years) interviewed at 2 time points 3 years apart. MAIN OUTCOMES Lifetime DSM-IV Axis I and Axis II mental disorders and lifetime suicide attempts, as well as incident mental disorders and change in income during the follow-up period. RESULTS After adjusting for potential confounders, the presence of most of the lifetime Axis I and Axis II mental disorders was associated with lower levels of income. Participants with household income of less than

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

20,000 per year were at increased risk of incident mood disorders during the 3-year follow-up period in comparison with those with income of

Chronic pain and cigarette smoking and nicotine dependence among a representative sample of adults

70,000 or more per year. A decrease in household income during the 2 time points was also associated with an increased risk of incident mood, anxiety, or substance use disorders (adjusted odds ratio, 1.30; 99% confidence interval, 1.06-1.60) in comparison with respondents with no change in income. Baseline presence of mental disorders did not increase the risk of change in personal or household income in the follow-up period. CONCLUSIONS Low levels of household income are associated with several lifetime mental disorders and suicide attempts, and a reduction in household income is associated with increased risk for incident mental disorders. Policymakers need to consider optimal methods of intervention for mental disorders and suicidal behavior among low-income individuals.

The association between income and distress, mental disorders, and suicidal ideation and attempts: findings from the collaborative psychiatric epidemiology surveys

Background: Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma‐related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol‐use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events. The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD. Methods: The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnoses. Results: Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs. Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs. Conclusions: Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed. Depression and Anxiety, 2011.

Chronic Musculoskeletal Pain and Cigarette Smoking among a Representative Sample of Canadian Adolescents and Adults

INTRODUCTION Individuals with chronic pain problems are at an increased risk for certain types of substance abuse and dependence. Recent work suggests that there is a significant association between chronic pain and cigarette smoking; however, it is unclear as to whether pain-smoking effects are evident above and beyond sociodemographic factors and cooccurring substance use disorders. The present investigation examined the relation between lifetime and current (past year) chronic pain and cigarette smoking status and nicotine dependence. METHODS This investigation comprised a large representative sample of English-speaking adults (n = 9,282) residing in the United States. Data were collected primarily through face-to-face interviews conducted between February 2001 and April 2003. RESULTS After adjusting for sociodemographic variables and the presence of a lifetime substance use disorder, individuals with a lifetime history of chronic neck or back pain were significantly more likely to be current smokers and to be diagnosed with lifetime as well as current nicotine dependence. Although there was no significant incremental relation between current chronic neck and back pain and being a current smoker, there was a significant association with lifetime and current nicotine dependence. Similar relations were evident among those with and without medically unexplained chronic pain in regard to smoking status and lifetime and current nicotine dependence. DISCUSSION Findings are discussed in terms of better understanding the chronic pain-smoking association.

Types and number of traumas associated with suicidal ideation and suicide attempts in PTSD: findings from a U.S. nationally representative sample

OBJECTIVE To examine the relationship between household income and psychological distress, suicidal ideation and attempts, and mood, anxiety, and substance use disorders. METHOD Data came from the Collaborative Psychiatric Epidemiology Surveys, a collection of 3 nationally representative surveys of American adults conducted between 2001 and 2003. Psychological distress, suicidal ideation, suicide attempts, and mood, anxiety, and substance use disorders were examined in relation to household income after adjusting for sex, marital status, race, age, and employment status. RESULTS Analyses revealed an inverse association between income and psychological distress as measured by the Kessler Psychological Distress Scale, with those in the lowest income quartile demonstrating significantly more distress than any of the remaining 3 income quartiles (P < .05). Subsequent analysis of DSM-IV-diagnosed psychological disorders revealed a similar pattern of results, which were particularly strong for substance use disorders (adjusted odds ratio [AOR] = 1.74; 95% CI, 1.39-2.18), suicidal ideation (AOR = 1.77; 95% CI, 1.46-2.13), and suicide attempts (AOR = 2.15; 95% CI, 1.55-2.98). The association between income and mood and anxiety disorders was less consistent, and the relationship between income and suicidal ideation differed among the 5 race categories (non-Hispanic white, Hispanic, Asian American, black, and other). Non-Hispanic white persons showed a strong, negative relationship between income and suicidal ideation (AOR = 2.15; 95% CI, 1.66-2.80), while the association was considerably weaker or nonexistent for the other races. CONCLUSIONS Although conclusions cannot be drawn concerning causation, the strength of associations between income, suicidal ideation, suicide attempts, and substance abuse points to the need for secondary prevention strategies among low-income, high-risk populations.

Adverse childhood experiences and health anxiety in adulthood

The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechanisms underlying the association between chronic pain and smoking.

Startle response and anxiety sensitivity: subcortical indices of physiologic arousal and fear responding.

Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempt; however, research has largely focused on specific samples and a limited range of traumas. We examined suicidal ideation and suicide attempt relating to 27 traumas within a nationally representative U.S. sample of individuals with PTSD. Data were from the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653). Participants were assessed for lifetime PTSD and trauma history, suicidal ideation, and suicide attempt. We calculated the proportion of individuals reporting suicidal ideation or suicide attempt for each trauma and for the number of unique traumas experienced. Most traumas were associated with greater suicidal ideation and suicide attempt in individuals with PTSD compared to individuals with no lifetime trauma or with lifetime trauma but no PTSD. Childhood maltreatment, assaultive violence, and peacekeeping traumas had the highest rates of suicidal ideation (49.1% to 51.9%) and suicide attempt (22.8% to 36.9%). There was substantial variation in rates of suicidal ideation and suicide attempt for war and terrorism-related traumas. Multiple traumas increased suicidality, such that each additional trauma was associated with an increase of 20.1% in rate of suicidal ideation and 38.9% in rate of suicide attempts. Rates of suicidal ideation and suicide attempts varied markedly by trauma type and number of traumas, and these factors may be important in assessing and managing suicidality in individuals with PTSD.

Similarities in specific physical health disorder prevalence among formerly deployed Canadian forces veterans with full and subsyndromal PTSD.

Childhood experiences are thought to predispose a person to the development of health anxiety later in life. However, there is a lack of research investigating the influence of specific adverse experiences (e.g., childhood abuse, household dysfunction) on this condition. The current study examined the cumulative influence of multiple types of childhood adversities on health anxiety in adulthood. Adults 18-59 years of age (N=264) completed a battery of measures to assess adverse childhood experiences, health anxiety, and associated constructs (i.e., negative affect and trait anxiety). Significant associations were observed between adverse childhood experiences, health anxiety, and associated constructs. Hierarchical multiple regression analysis indicted that adverse childhood experiences were predictive of health anxiety in adulthood; however, the unique contribution of these experience were no longer significant following the inclusion of the other variables of interest. Subsequently, mediation analyses indicated that both negative affect and trait anxiety independently mediated the relationship between adverse childhood experiences and health anxiety in adulthood. Increased exposure to adverse childhood experiences is associated with higher levels of health anxiety in adulthood; this relationship is mediated through negative affect and trait anxiety. Findings support the long-term negative impact of cumulative adverse childhood experiences and emphasize the importance of addressing negative affect and trait anxiety in efforts to prevent and treat health anxiety.

Social Anxiety Disorder Is Associated With PTSD Symptom Presentation: An Exploratory Study Within A Nationally Representative Sample

There is a well-established and clinically meaningful relation between the cognitive-affective-based construct of anxiety sensitivity (AS) and risk for the development and maintenance of anxiety psychopathology (B. J. Cox, Fuentes, Borger, & Taylor, 2001). Research findings within this area have revealed mixed results; however, there is evidence to suggest that some individuals with anxiety disorder diagnoses may demonstrate enhanced subcortical arousal (e.g., exaggerated startle response to unexpected, aversive stimuli [A. M. Waters et al., 2008], and deficient prepulse inhibition [PPI; S. Ludewig, Ludewig, Geyer, Hell, & Vollenweider, 2002]), it is presently unclear whether these differences are found within the general population. To address this gap in the extant literature, the current investigation examined the impact of AS on acoustic startle response magnitude and PPI. Results indicated that individuals high and low in AS differ with regard to subcortical measures of arousal, with individuals expressing high levels of AS demonstrating enhanced startle response and deficient PPI. Results are discussed in terms of the role of the cognitive-affective-based factor of AS in the context of physiologic markers for vulnerability for anxiety psychopathology.