Semyon Gluzman

Cross-National Prevalence and Risk Factors for Suicidal Ideation, Plans, and Attempts

BACKGROUND Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not wellknown, especially in low- and middle-income countries. AIMS To report on the prevalence and risk factors for suicidal behaviours across 17 countries. METHOD A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors. RESULTS The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries. CONCLUSION There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.

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.

Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health survey.

BackgroundThis study presents the lifetime, 12-month, and 1-month prevalence estimates of nine psychiatric and alcohol disorders in Ukraine assessed as part of the World Health Organization (WHO) World Mental Health (WMH) research program. The Ukraine WMH survey is the first psychiatric epidemiologic study in a former Soviet Union country to administer a structured psychiatric interview to a nationally representative sample.MethodIn 2002, a national probability sample of 4,725 respondents ages 18 and older were interviewed with the WMH version of the Composite International Diagnostic Interview (WMH-CIDI). Prevalence estimates, age-of-onset curves, comorbidity, demographic and geographic risk factors, and treatment seeking were examined.ResultsClose to one third of the population experienced at least one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorder in their lifetime, 17.6% experienced an episode in the past year, and 10.6% had a current disorder. There was no gender difference in the overall prevalence rates. In men, the most common diagnoses were alcohol disorders (26.5% lifetime) and mood disorders (9.7% lifetime); in women, they were mood disorders (20.8% lifetime) and anxiety disorders (7.9% lifetime). The odds ratios for most pairs of disorders were highly significant. Age of onset was primarily in the teens and early 20s. Age, education, and living in the Eastern region of Ukraine were significant risk factors across disorders, with respondents older than 50 years having the highest prevalence of mood disorder and the lowest prevalence of alcoholism and intermittent explosive disorder. Only a minority of respondents talked to a professional about their symptoms.ConclusionPrevalence estimates of alcoholism among men and recent depression among women were higher in Ukraine than in comparable European surveys. The results argue for the need to develop and implement educational programs focused on the recognition and treatment of mental and alcohol disorders for the general population, psychiatrists, and general medical providers, who are the main source of mental health care.

Stress and well-being in mothers of young children 11 years after the Chornobyl nuclear power plant accident"

BACKGROUND This paper examines the association between exposure to the Chornobyl nuclear power plant explosion and the psychological and physical well-being of mothers with young children. The study also examines whether exposure to Chornobyl increased the vulnerability of mothers to subsequent economic and social stress, and thus represents a unique test of the stress-vulnerability model in a non-Western setting. METHOD The sample consisted of mothers evacuated from the contamination zone surrounding the plant (evacuees) and mothers who had never lived in a radiation-contaminated area (controls). In addition to exposure status, the interview obtained data on perceived economic stress, social stress and stress moderators. The dependent variables were measured by the SCL-90 global severity index (GSI), perceived physical health and number of days unable to work due to illness. RESULTS Overall, evacuees reported fewer stressors and greater personal and social resources than control mothers. Nevertheless, evacuees scored higher on the GSI, reported lower perceived physical health and took more sick days relative to control mothers, even after controlling for demographic factors, stressors and stress moderators. Tests of interaction effects were not statistically significant. CONCLUSIONS The findings confirmed that married women with young children evacuated to Kyiv following the Chornobyl nuclear power plant explosion reported significantly poorer psychological and perceived physical health than controls 11 years later. Although perceived social and economic adversities also affected these outcomes, there was no evidence that exposure to the Chornobyl accident increased the vulnerability of mothers to these stressors, giving support to the additive burden model of stress.

Ukrainian application of the Children's Somatization Inventory: psychometric properties and associations with internalizing symptoms.

This paper examines the psychometric properties of the Childrens Somatization Inventory (CSI) in 600 10–12-year old children in Kyiv, Ukraine, replicating and extending the original findings from a sample in Nashville, Tennessee (J. Garber et al. 1991). The Kyiv children had significantly lower CSI total scores and reported significantly fewer symptoms than the American children. The Kyiv mothers, however, reported significantly more somatization symptoms in their children than did the American mothers. A factor analysis of the childrens data yielded four similar factors encompassing pseudoneurologic, cardiovascular, gastrointestinal, and pain/weakness symptoms. Consistent with the findings from the Nashville study, the CSI was significantly related to the childrens self-reports of health and depressive and anxiety symptoms and to maternal reports of child depression and anxiety symptoms. In addition, although more children with the highest CSI scores (25+) reported various illness experiences than those with 0–1 symptoms, no differences were found in the school absentee records. Thus, the results were congruent with the findings of the Nashville study, indicating that the CSI reliably measured somatization in this Ukrainian sample.

Psychological well-being and risk perceptions of mothers in Kyiv, Ukraine, 19 years after the Chornobyl disaster

Background: The Chornobyl nuclear power plant explosion in April 1986 was one of the worst ecological disasters of the 20th century. As with most disasters, its long-term mental health consequences have not been examined. Aims: This study describes the psychological well-being and risk perceptions of exposed women 19–20 years later and the risk factors associated with mental health. Methods: We assessed Chornobyl-related post-traumatic stress disorder (PTSD), major depressive episode (MDE) and overall distress among three groups of women in Kyiv, Ukraine (N = 797): mothers of small children evacuated to Kyiv in 1986 from the contaminated area near the plant (evacuees); mothers of their children’s classmates (neighbourhood controls); and population-based controls from Kyiv. Risk perceptions and epidemiologic correlates were also obtained. Results: Evacuees reported poorer well-being and more negative risk perceptions than controls. Group differences in psychological well-being remained after adjustment for epidemiologic risk factors but became non-significant when Chornobyl risk perceptions were added to the models. Conclusions: The relatively poorer psychological well-being among evacuees is largely explained by their continued concerns about the physical health risks stemming from the accident. We suggest that this is due to the long-term, non-resolvable nature of health fears associated with exposure.

Suicide ideation, plans and attempts in Ukraine: findings from the Ukraine World Mental Health Survey.

BACKGROUND Because the suicide rates in Eastern Europe have increased, the epidemiology of suicide behaviors in this part of the world is in urgent need of study. Using data from the Ukraine site of the World Mental Health (WMH) Survey Initiative, we present the first population-based findings from a former Soviet country on the descriptive epidemiology of suicide ideation, plans and attempts, and their links to current functioning and service utilization. METHOD In 2002, a nationally representative sample of 4725 adults in Ukraine was interviewed with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Risk factors included demographic characteristics, trauma, smoking, and parental and personal psychiatric disorders. Current functional impairments and recent service utilization were assessed. RESULTS The lifetime prevalence of suicide ideation was 8.2%. The average age of onset was 31. The key risk factors were female sex, younger age, trauma, parental depression, and prior alcohol, depressive and intermittent explosive disorders, especially the presence of co-morbidity. Ideators had poorer functioning and greater use of health services. One-third of ideators had a plan, and one-fifth made an attempt. Among ideators, young age, smoking and prior psychiatric disorders were risk factors for these behaviors. CONCLUSIONS Together with the increasing suicide rate, these results suggest that suicide intervention programs in Ukraine should focus on the generation of young adults under 30. The associations with co-morbidity, impairments in current functioning and greater service use indicate that a physician education program on suicidality should be comprehensive in scope and a public health priority in Ukraine.

Psychological aftermath of the Lviv air show disaster : a prospective controlled study

Objective:  To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data.

School and Neuropsychological Performance of Evacuated Children in Kyiv 11 Years after the Chornobyl Disaster

This paper examines the cognitive and neuropsychological functioning of children who were in utero to age 15 months at the time of the Chornobyl disaster and were evacuated to Kyiv from the 30-kilometer zone surrounding the plant. Specifically, we compared 300 evacuee children at ages 10-12 with 300 non-evacuee Kyiv classmates on objective and subjective measures of attention, memory, and school performance. The evacuee children were not significantly different from their classmates on the objective measures (grades; Symbolic Relations subtest of the Detroit Test; forms 1 and 2 of the Visual Search and Attention Test; Benton Form A; Trails A; Underline the Words Test) or on most of the subjective measures (the attention subscale of the Child Behavior Checklist completed by mothers; the attention items of the Iowa Conners Teachers Rating Scale; mother and child perceptions of school performance). The one exception was that 31.3% of evacuee mothers compared to 7.4% of classmate mothers indicated that their child had a memory problem. However, this subjective measure of memory problems was not significantly related to neuropsychological or school performance. No significant differences were found in comparisons of evacuees and classmates who were in utero at the time of the explosion, children from Pripyat vs. other villages in the 30-kilometer zone, and children manifesting greater generalized anxiety. For both groups, children with greater Chornobyl-focused anxiety performed significantly worse than children with less Chornobyl-focused anxiety on measures of attention. The results thus fail to confirm two previous reports that relatively more children from areas contaminated by radiation had cognitive deficits compared to controls. Possible reasons for the differences in findings among the studies are discussed.

The Chornobyl accident and cognitive functioning: a follow-up study of infant evacuees at age 19 years.

BACKGROUND The cognitive and academic outcomes of infants exposed to radiation after the meltdown at Chornobyl have been intensely debated. Western-based investigations indicate that no adverse effects occurred, but local studies reported increased cognitive impairments in exposed compared with non-exposed children. Our initial study found that at age 11 years, school grades and neuropsychological performance were similar in 300 children evacuated to Kiev as infants or in utero compared with 300 classmate controls, yet more evacuee mothers believed that their children had memory problems. This study re-examined the childrens performance and academic achievement at age 19 years. METHOD In 2005-2006, we conducted an 8-year follow-up of the evacuees (n=265) and classmate controls (n=261) assessed in Kiev in 1997. Outcomes included university attendance, tests of intelligence, attention, and memory, and subjective appraisals of memory problems. Scores were standardized using a local population-based control group (n=327). Analyses were stratified by parental education. RESULTS Evacuees and classmates performed similarly and in the normal range on all tests, and no differential temporal changes were found. The results were comparable for the in utero subsample. The rates of university attendance and self-reported memory problems were also similar. Nevertheless, the evacuee mothers were almost three times as likely to report that their children had memory problems compared with controls. CONCLUSIONS Chornobyl did not influence the cognitive functioning of exposed infants although more evacuee mothers still believed that their offspring had memory problems. These lingering worries reflect a wider picture of persistent health concerns as a consequence of the accident.