Natacha Carragher

Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function.

CONTEXT Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. OBJECTIVES To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. MAIN OUTCOME MEASURES The Composite International Diagnostic Interview version 3.0 of the World Health Organizations World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. RESULTS A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75). CONCLUSION Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

Transdiagnostic factors of psychopathology and substance use disorders: a review

PurposeResearch on the structure of mental disorders and comorbidity indicates that many forms of psychopathology and substance use disorders are manifestations of relatively few transdiagnostic latent factors. These factors have important consequences for mental disorder research and applied practice.MethodsWe provide an overview of the transdiagnostic factor literature, with particular focus on recent advances.ResultsInternalizing and externalizing transdiagnostic factors have been well characterized in terms of their structures, links with disorders, stability, and statistical properties (e.g., invariance and distributions). Research on additional transdiagnostic factors, such as thought disorder, is quickly advancing latent structural models, as are integrations of transdiagnostic constructs with personality traits. Genetically informed analyses continue to clarify the origins of transdiagnostic factor levels, and links between these factors and important environmental exposures provide promising new avenues of inquiry.ConclusionsTransdiagnostic factors account for the development and continuity of disorders and comorbidity over time, function as the primary links between disorders and important outcomes such as suicide, mediate associations between environmental exposures and disorders, provide an empirically supported classification system, and serve as foci for efficient, broadband intervention approaches. Overall, transdiagnostic factor research indicates the paramount importance of understanding these constructs and, thereby, broadening our understanding of mental disorder in general.

Disorders without borders: current and future directions in the meta-structure of mental disorders

PurposeClassification is the cornerstone of clinical diagnostic practice and research. However, the extant psychiatric classification systems are not well supported by research evidence. In particular, extensive comorbidity among putatively distinct disorders flags an urgent need for fundamental changes in how we conceptualize psychopathology. Over the past decade, research has coalesced on an empirically based model that suggests many common mental disorders are structured according to two correlated latent dimensions: internalizing and externalizing.MethodsWe review and discuss the development of a dimensional-spectrum model which organizes mental disorders in an empirically based manner. We also touch upon changes in the DSM-5 and put forward recommendations for future research endeavors.ResultsOur review highlights substantial empirical support for the empirically based internalizing–externalizing model of psychopathology, which provides a parsimonious means of addressing comorbidity.ConclusionsAs future research goals, we suggest that the field would benefit from: expanding the meta-structure of psychopathology to include additional disorders, development of empirically based thresholds, inclusion of a developmental perspective, and intertwining genomic and neuroscience dimensions with the empirical structure of psychopathology.

Assessing the fit of the Dysphoric Arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC

Since the initial inclusion of PTSD in the DSM nomenclature, PTSD symptomatology has been distributed across three symptom clusters. However, a wealth of empirical research has concluded that PTSDs latent structure is best represented by one of two four-factor models: Numbing or Dysphoria. Recently, a newly proposed five-factor Dysphoric Arousal model, which separates the DSM-IVs Arousal cluster into two factors of Anxious Arousal and Dysphoric Arousal, has gathered support across a variety of trauma samples. To date, the Dysphoric Arousal model has not been assessed using nationally representative epidemiological data. We employed confirmatory factor analysis to examine PTSDs latent structure in two independent population based surveys from American (NESARC) and Australia (NSWHWB). We specified and estimated the Numbing model, the Dysphoria model, and the Dysphoric Arousal model in both samples. Results revealed that the Dysphoric Arousal model provided superior fit to the data compared to the alternative models. In conclusion, these findings suggest that items D1-D3 (sleeping difficulties; irritability; concentration difficulties) represent a separate, fifth factor within PTSDs latent structure using nationally representative epidemiological data in addition to single trauma specific samples.

Factor structure of posttraumatic stress disorder symptoms in the Australian general population

The tripartite model of posttraumatic stress disorder (PTSD) articulated in DSM-IV has received limited empirical support. Over the past decade, a burgeoning literature on PTSD symptom structure has accumulated suggesting several alternative models. Elucidating the latent structure of PTSD has important clinical and theoretical implications. This paper presents the first confirmatory factor analytic investigation of PTSD symptoms in an epidemiologically based trauma-exposed sample from Australia. Data from a subsample of respondents from the 2007 National Survey of Mental Health and Wellbeing (NSMHWB; n=2677) were submitted to confirmatory factor analysis and several alternative conceptual models were tested. Empirical support was found for an intercorrelated four-factor model reflecting re-experiencing, avoidance, dysphoria, and hyperarousal symptoms. Given that the DSM is currently under revision, research addressing structural validity concerns is especially timely. The present findings renew calls in the structural literature suggesting that the structure of PTSD should be revised in DSM-V.

A latent class analysis of DSM-IV criteria for pathological gambling: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

With rapid increases in gambling opportunities over the past decade, gambling has emerged as an important social and public health concern. The pending revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has prompted a flurry of empirical research evaluating the extant diagnostic classification scheme; however few studies have evaluated the pathological gambling criteria. This paper utilized latent class analysis (LCA) to empirically derive and validate a typology of gamblers. LCA was applied to the 10 DSM-IV pathological gambling criteria utilizing data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=11,104). LCA identified three latent classes which largely differed according to severity. The majority of respondents were assigned to the no gambling problems class (93.3%). Gamblers in the moderate gambling problems class (6.1%) primarily endorsed the preoccupation, tolerance, and chasing criteria. The pervasive gambling problems class (0.6%) endorsed the majority of the criteria. A number of significant differences between the classes emerged as a function of demographic, psychiatric and substance use disorders. The findings offer a heuristic and clinically useful typology of gamblers. Support for a continuum of gambling-related problems reiterate the need for assessment, prevention, and treatment strategies that reflect this more nuanced understanding of gambling.

Treatment-seeking behaviours for depression in the general population: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND In light of the public health and clinical significance of major depression, treatment utilisation is an important issue. Epidemiological data is particularly useful for yielding accurate estimates of national trends; assessing unmet need in the population; and, informing mental health policy and focused planning of public health prevention and intervention programs. METHODS Based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), latent class analysis (LCA) was used to empirically identify and validate a typology of treatment-seeking behaviours for depression. Analyses were based on a subsample of individuals with a lifetime diagnosis of major depressive disorder (MDD). RESULTS A three-class solution emerged as the best-fitting model. The classes were labelled highly active treatment-seeking, partially active treatment-seeking, and inactive treatment-seeking. The classes were validated by reference to predisposing, enabling, and need factors associated with treatment utilisation. LIMITATIONS Since information was retrieved by retrospective self-report it was not possible to corroborate information on treatment utilisation or medical conditions with independent clinical or administrative records. Reporting bias and recall error therefore cannot be ruled out. Also, given that the NESARC utilised lay interviewer-administered structured interviews to determine mental health diagnoses, one should be mindful that diagnoses are epidemiological research diagnoses rather than clinician diagnoses. CONCLUSIONS This study demonstrated the utility of LCA for identifying clinically meaningful subgroups of treatment-seeking behaviour.

The structure of adolescent psychopathology: a symptom-level analysis

BACKGROUND Most empirical studies into the covariance structure of psychopathology have been confined to adults. This work is not developmentally informed as the meaning, age-of-onset, persistence and expression of disorders differ across the lifespan. This study investigates the underlying structure of adolescent psychopathology and associations between the psychopathological dimensions and sex and personality risk profiles for substance misuse and mental health problems. METHOD This study analyzed data from 2175 adolescents aged 13.3 years. Five dimensional models were tested using confirmatory factor analysis and the external validity was examined using a multiple-indicators multiple-causes model. RESULTS A modified bifactor model, with three correlated specific factors (internalizing, externalizing, thought disorder) and one general psychopathology factor, provided the best fit to the data. Females reported higher mean levels of internalizing, and males reported higher mean levels of externalizing. No significant sex differences emerged in liability to thought disorder or general psychopathology. Liability to internalizing, externalizing, thought disorder and general psychopathology was characterized by a number of differences in personality profiles. CONCLUSIONS This study is the first to identify a bifactor model including a specific thought disorder factor. The findings highlight the utility of transdiagnostic treatment approaches and the importance of restructuring psychopathology in an empirically based manner.

A network approach to the comorbidity between posttraumatic stress disorder and major depressive disorder: The role of overlapping symptoms

BACKGROUND The role of symptom overlap between major depressive disorder and posttraumatic stress disorder in comorbidity between two disorders is unclear. The current study applied network analysis to map the structure of symptom associations between these disorders. METHODS Data comes from a sample of 909 Australian adults with a lifetime history of trauma and depressive symptoms. Data analysis consisted of the construction of two comorbidity networks of PTSD/MDD with and without overlapping symptoms, identification of the bridging symptoms, and computation of the centrality measures. RESULTS The prominent bridging role of four overlapping symptoms (i.e., sleep problems, irritability, concentration problems, and loss of interest) and five non-overlapping symptoms (i.e., feeling sad, feelings of guilt, psychomotor retardation, foreshortened future, and experiencing flashbacks) is highlighted. LIMITATIONS The current study uses DSM-IV criteria for PTSD and does not take into consideration significant changes made to PTSD criteria in DSM-5. Moreover, due to cross-sectional nature of the data, network estimates do not provide information on whether a symptom actively triggers other symptoms or whether a symptom mostly is triggered by other symptoms. CONCLUSION The results support the role of dysphoria-related symptoms in PTSD/MDD comorbidity. Moreover, Identification of central symptoms and bridge symptoms will provide useful targets for interventions that seek to intervene early in the development of comorbidity.

Real or perceived impediments to minimum pricing of alcohol in Australia: Public opinion, the industry and the law

A burgeoning body of empirical evidence demonstrates that increases in the price of alcohol can reduce per capita alcohol consumption and harmful drinking. Taxes on alcohol can be raised to increase prices, but this strategy can be undermined if the industry absorbs the tax increase and cross-subsidises the price of one alcoholic beverage with other products. Such loss-leading strategies are not possible with minimum pricing. We argue that a minimum (or floor) price for alcohol should be used as a complement to alcohol taxation. Several jurisdictions have already introduced minimum pricing (e.g., Canada, Ukraine) and others are currently investigating pathways to introduce a floor price (e.g., Scotland). Tasked by the Australian government to examine the public interest case for a minimum price, Australias peak preventative health agency recommended against setting one at the present time. The agency was concerned that there was insufficient Australian specific modelling evidence to make robust estimates of the net benefits. Nonetheless, its initial judgement was that it would be difficult for a minimum price to produce benefits for Australia at the national level. Whilst modelling evidence is certainly warranted to support the introduction of the policy, the development and uptake of policy is influenced by more than just empirical evidence. This article considers three potential impediments to minimum pricing: public opinion and misunderstandings or misgivings about the operation of a minimum price; the strength of alcohol industry objections and measures to undercut the minimum price through discounts and promotions; and legal obstacles including competition and trade law. The analysis of these factors is situated in an Australian context, but has salience internationally.