Makoto Watanabe

Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders

UNLABELLEDnAlthough there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249). Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions among females and older persons; and chronic pain was similarly associated with depression-anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries.nnnPERSPECTIVEnChronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries.

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

Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys

BACKGROUNDnThe relationship between mental and physical disorders is well established, but there is less consensus as to the nature of their joint association with disability, in part because additive and interactive models of co-morbidity have not always been clearly differentiated in prior research.nnnMETHODnEighteen general population surveys were carried out among adults as part of the World Mental Health (WMH) Survey Initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions (arthritis, heart disease, respiratory disease, chronic back/neck pain, chronic headache, and diabetes) were ascertained using a standard checklist. Severe disability was defined as on or above the 90th percentile of the WMH version of the World Health Organization Disability Assessment Schedule (WHODAS-II).nnnRESULTSnThe odds of severe disability among those with both mental disorder and each of the physical conditions (with the exception of heart disease) were significantly greater than the sum of the odds of the single conditions. The evidence for synergy was model dependent: it was observed in the additive interaction models but not in models assessing multiplicative interactions. Mental disorders were more likely to be associated with severe disability than were the chronic physical conditions.nnnCONCLUSIONSnThis first cross-national study of the joint effect of mental and physical conditions on the probability of severe disability finds that co-morbidity exerts modest synergistic effects. Clinicians need to accord both mental and physical conditions equal priority, in order for co-morbidity to be adequately managed and disability reduced.

Epidemiologic Features of Kawasaki Disease in Japan: Results from the Nationwide Survey in 2005-2006

Background The most recent epidemiologic features of Kawasaki disease are unknown. Methods The 19th nationwide survey of the disease was conducted in 2007, targeting patients who were affected by this disease in 2005 and 2006. All pediatric departments in hospitals with 100 or more beds and pediatric hospitals were asked to report all Kawasaki disease patients during the 2 survey years. Results From 1543 departments and hospitals, a total of 20475 patients (10041 in 2005 and 10434 in 2006) were reported. There were 11892 male patients and 8583 female patients. The average annual incidence rate was 184.6 per 100000 children aged 0-4 years. The number of patients and the incidence rate have increased significantly during the past 12 years. The age-specific incidence rate was distributed monomodally with a peak at 6-8 months of age. The prevalence of cardiac lesions in the acute phase of the disease and of cardiac sequelae were higher among infants and old patients. Conclusion The number of patients with Kawasaki disease and its incidence rate in Japan are continuously increasing.

The epidemiological study of autism in Fukushima-ken.

Abstract: A survey of children aged under 18 years in Fukushima‐ken (prefecture) in Japan showed that 2.33 per 10,000 children suffered from early infantile autism. The average of prevalence rates of autistic children born between 1968 and 1974 was 4.96 per 10,000 children. Based on a comparison between cities and rural districts, the prevalence rates of the former were significantly higher than those of the latter. Autistic boys outnumbered autistic girls with a sex ratio of 9: 1. Psychiatric illnesses; were very rare among the relatives of autistic children. The rate of prenatal and perinatal complications was higher than the national norm among autistic children. Parents of autistic children had a significantly higher education than the national norm. There were more nuclear families in the autistic group than in the national norm.

Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey

OBJECTIVEnTo clarify the prevalence and clinical characteristics of myasthenia gravis (MG) in Japan.nnnMETHODSnWe performed a nationwide epidemiological survey of MG in Japan. The clinical features were compared among five groups of patients, divided according to onset age. A generalized additive model (GAM) was used to assess the linearity of these relationships.nnnRESULTSnA total of 8542 patients were reported, and detailed data were analyzed for 3141 patients. The estimated number of MG patients in Japan was 15,100, giving a prevalence of 11.8 per 100,000. Elderly-onset MG (≥ 65 years) accounted for 7.3% in 1987 (adjusted for population in 2005), but this had increased to 16.8% in 2006. Infantile-onset MG (0-4 years) accounted for 10.1% in 1987, and was still as high as 7.0% in 2006. The rate of ocular MG was highest (80.6%) in infantile-onset and lowest (26.4%) in early-onset disease, but the rate rose again in the late-onset group. GAM analysis of the ocular form showed a U-shaped curve, with a dip in the 20s. Anti-acetylcholine receptor antibodies were positive in only 50% of infantile-onset, but nearly 90% of elderly-onset patients. GAM analyses assessing the concurrence of thymoma and hyperplasia both showed reversed U-shapes, with peaks in the 50s and 20s-40s, respectively.nnnCONCLUSIONSnPersistent high incidence of infantile-onset disease and clinical heterogeneity according to onset age are characteristic features of MG in Japan.

Blood Serotonin and Free Tryptophan Concentration in Autistic Children

In 37 autistic children and 67 normal control subjects, determinations of plasma free and total tryptophan and blood serotonin levels were made simultaneously in order to establish a relationship between these parameters and the clinical rating scales: Childrens Psychiatric Rating Scale (CPRS-1), Werry-Weiss-Peters Activity Scale (WWPAS), and Developmental Quotient (DQ). The plasma free tryptophan level was significantly higher in autistic children than in normal control subjects. There tended to be a significant positive correlation between the plasma free tryptophan level and CPRS-1 or WWPAS score and a negative correlation between the plasma free tryptophan level and DQ. The blood serotonin level was significantly higher in autistic children than in normal control subjects. No correlation was established, however, between the blood serotonin level and CPRS-1, WWPAS score or DQ, and hence the clinical symptoms. Nor was there a correlation between blood serotonin and free tryptophan levels in these children. These results suggest that autistic children have some defect in tryptophan-serotonin metabolism in the brain, which is responsible for the clinical manifestations and behavioral abnormalities of infantile autism.

Hypothalamic-pituitary-adrenal axis function in chronic schizophrenia: association with clinical features.

The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.

The Diurnal Variation and Response to Dexamethasone Suppression Test of Saliva Cortisol Level in Autistic Children

Abstract: In order to examine the function of hypothalamic‐pituitary‐adrenal axis (HPA‐axis) in autistic children, the diurnal rhythm of saliva Cortisol and the response of Cortisol to the DST was investigated using saliva samples.

Social Class Inequalities in Self-rated Health and Their Gender and Age Group Differences in Japan

BACKGROUND Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive. METHODS The data derived from interviews with 2987 randomly selected Japanese adults in four prefectures in Japan who completed the cross-national World Mental Health survey from 2002 through 2005. We calculated odds ratios (ORs) of having poor self-rated physical and mental health by two social class indicators independently with multivariate logistic regression models, adjusted for age, gender, marital status, and area. Stratified analyses by gender and age group were also conducted. RESULTS The adjusted ORs of the lowest educational attainment category having poor self-rated physical and mental health were 1.42 (95% confidence interval [CI]: 1.15-1.76) and 1.37 (95% CI: 1.10-1.70), respectively. Among females, educational attainment had significant linear associations with self-rated physical and mental health. Adjusted household income was also significantly associated with self-rated physical health among female respondents. No associations were found among males. While educational attainment was associated with self-rated health among the young age group, adjusted household income was associated with self-rated physical health in the middle and old age group. CONCLUSION These results indicated social inequalities in self-rated health and prominent social inequalities in self-rated health among females in Japan. Social inequalities in self-rated health seemed to exist across age groups. However, the mechanism of social inequalities in self-rated health could be different depending on the age group.