Stephani L. Hatch

Psychosis and Place

One important line of epidemiologic inquiry implicating social context in the etiology of psychosis is the examination of spatial variation in the distribution of psychotic illness. The authors conducted a systematic review of evidence from urbanicity and neighborhood studies regarding spatial variation in the incidence of psychosis in developed countries since 1950. A total of 44 studies (20 of urbanicity and 24 of neighborhood) were culled from three databases with similar time frames: Medline (1950-2007), PsychInfo (1950-2007), and Sociological Abstracts (1952-2007). With a special emphasis on social factors potentially relevant to etiology, the authors elucidated contributions, limitations, and issues related to study design, measurement, and theory. Evidence from both arenas supports a possible etiologic role for social context. Studies of urbanicity indicate that early-life exposure may be important; dose-response relations, spatial patterning of schizophrenia, and interactions with other factors may exist. Neighborhood studies indicate heterogeneity in rates, hint at spatial patterning of schizophrenia, and offer intriguing evidence implying more proximal social (as opposed to physical) exposures. The authors encourage the exploration of social pathways engaging theory, methodological advances, and the life-course perspective. They also propose a conceptual shift from studies of spatial variation in outcomes to research addressing the etiologic effect of exposures shaped by place as a reservoir of risk or resilience.

Conceptualizing and Identifying Cumulative Adversity and Protective Resources: Implications for Understanding Health Inequalities

This article focuses on cumulative adversity and protective resources, both social and biological, that interrupt or deflect individuals from optimal life-course trajectories and contribute to widening gaps in health. Under the guiding framework of cumulative adversity and/or advantage, this narrative discusses the theoretical framework of cumulative adversity. presents identified sources of cumulative adversity and protective resources, and highlights the utilization of the life-course approach. Numerous social and biological adverse conditions are identified across multiple domains. Utilizing the life-course perspective in identifying early life determinants and the paucity of information regarding identified protective factors are discussed. Understanding health inequalities requires attention paid to heterogeneity in the impact of social statuses as well as sources of cumulative adversity and protective resources within diverging trajectories across the life course. Intervention implications are discussed, and suggestions for future research are made.

Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London Community Health (SELCoH) study

BackgroundResponses to public health need require information on the distribution of mental and physical ill health by demographic and socioeconomic factors at the local community level.MethodsThe South East London Community Health (SELCoH) study is a community psychiatric and physical morbidity survey. Trained interviewers conducted face-to-face computer assisted interviews with 1698 adults aged 16 years and over, from 1076 randomly selected private households in two south London boroughs. We compared the prevalence of common mental disorders, hazardous alcohol use, long standing illness and general physical health by demographic and socioeconomic indicators. Unadjusted and models adjusted for demographic and socioeconomic indicators are presented for all logistic regression models.ResultsOf those in the sample, 24.2% reported common mental disorder and 44.9% reported having a long standing illness, with 15.7% reporting hazardous alcohol consumption and 19.2% rating their health as fair or poor. The pattern of indicators identifying health inequalities for common mental disorder, poor general health and having a long term illness is similar; individuals who are socioeconomically disadvantaged have poorer health and physical health worsens as age increases for all groups. The prevalence of poor health outcomes by ethnic group suggests that there are important differences between groups, particularly for common mental disorder and poor general health. Higher socioeconomic status was protective for common mental disorder, fair or poor health and long standing illness, but those with higher socioeconomic status reported higher levels of hazardous alcohol use. The proportion of participants who met the criteria for common mental disorder with co-occurring functional limitations was similar or greater to those with poor physical health.ConclusionsHealth service providers and policy makers should prioritise high risk, socially defined groups in combating inequalities in individual and co-occurring poor mental and physical problems. In population terms, poor mental health has a similar or greater burden on functional impairment than long term conditions and perceived health.

Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health.

BackgroundMany people with mental illness do not seek or delay seeking care. This study aimed to develop, and provide an initial validation of, a comprehensive measure for assessing barriers to access to mental health care including a ‘treatment stigma’ subscale, and to present preliminary evidence about the prevalence of barriers experienced by adults currently or recently using secondary mental health services in the UK.MethodsThe Barriers to Access to Care Evaluation scale (BACE) was developed from items in existing scales, systematic item reduction, and feedback from an expert group. It was completed in an online survey by 117 individuals aged 18 and over who had received care from secondary mental health services in the past 12 months. Internal consistency, test-retest reliability, convergent validity (correlation of treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalised Stigma of Mental Illness Scale (ISMI)), respondent opinion and readability were assessed.ResultsThe BACE items were found to have acceptable test-retest reliability as all but one of the items exceeded the criterion for moderate agreement. The treatment stigma subscale had acceptable test-retest-reliability and good internal consistency. As hypothesised the subscale was significantly positively correlated with the SSRPH and the ISMI demonstrating convergent validity. The developmental process ensured content validity. Respondents gave the BACE a median rating of 8 on the 10-point quality scale. Readability scores indicated the measure can be understood by the average 11 to 12 year-old. The most highly endorsed barrier was ‘concern that it might harm my chances when applying for jobs’. The scale was finalised into a 30-item measure with a 12-item treatment stigma subscale.ConclusionsThere is preliminary evidence demonstrating the reliability, validity and acceptability of the BACE. It can be used to ascertain key barriers to access to mental health care which may help to identify potential interventions to increase care seeking and service use. Further research is needed to establish its factor analytic structure and population norms.

Epidemiology of hoarding disorder

BACKGROUND Hoarding disorder is typified by persistent difficulties discarding possessions, resulting in significant clutter that obstructs the individuals living environment and produces considerable functional impairment. The prevalence of hoarding disorder, as defined in DSM-5, is currently unknown. AIMS To provide a prevalence estimate specific to DSM-5 hoarding disorder and to delineate the demographic, behavioural and health features that characterise individuals with the disorder. METHOD We conducted a two-wave epidemiological study of 1698 adult individuals, originally recruited via the South East London Community Health (SELCoH) study. Participants screening positively for hoarding difficulties in wave 1, and who agreed to be re-contacted for wave 2 (n = 99), underwent in-home psychiatric interviews and completed a battery of self-report questionnaires. Current DSM-5 diagnoses were made via consensus diagnostic procedure. RESULTS In total, 19 individuals met DSM-5 criteria for hoarding disorder at the time of interview, corresponding to a weighted prevalence of 1.5% (95% CI 0.7-2.2). Those with hoarding disorder were older and more often unmarried (67%). Members of this group were also more likely to be impaired by a current physical health condition (52.6%) or comorbid mental disorder (58%), and to claim benefits as a result of these issues (47.4%). Individuals with hoarding disorder were also more likely to report lifetime use of mental health services, although access in the past year was less frequent. CONCLUSIONS With a lower-bound prevalence of approximately 1.5%, hoarding disorder presents as a condition that affects people of both genders and is associated with substantial adversity.

Adversity, cannabis use and psychotic experiences: evidence of cumulative and synergistic effects

Background There is robust evidence that childhood adversity is associated with an increased risk of psychosis. There is, however, little research on intervening factors that might increase or decrease risk following childhood adversity. Aims To investigate main effects of, and synergy between, childhood abuse and life events and cannabis use on odds of psychotic experiences. Method Data on psychotic experiences and childhood abuse, life events and cannabis use were collected from 1680 individuals as part of the South East London Community Health Study (SELCoH), a population-based household survey. Results There was strong evidence that childhood abuse and number of life events combined synergistically to increase odds of psychotic experiences beyond the effects of each individually. There was similar, but weaker, evidence for cannabis use (past year). Conclusions Our findings are consistent with the hypothesis that childhood abuse creates an enduring vulnerability to psychosis that is realised in the event of exposure to further stressors and risk factors.

Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis

Objectives To identify public perceptions of the risk to health after the poisoning of Alexander Litvinenko with polonium-210 (210Po) in London and to assess the impact of public health communications. Design Cross sectional telephone survey and qualitative interviews. Setting London, United Kingdom. Participants 1000 people completed the cross sectional survey and 86 potentially exposed people completed the qualitative interviews. Main outcome measures Perception of risk to personal health after the 210Po incident. Qualitative interviews were analysed with an emphasis on information needs. Results 11.7% of the survey sample (n=117) perceived their health to be at risk. Aside from personal variables the main predictors of perceived risk to health were believing that the incident was related to terrorism (odds ratio 2.7, 95% confidence interval 1.5 to 4.6) rather than to espionage, that it was targeted at the wider public rather than one person (5.9, 3.2 to 10.9), and that it could affect people who had not been in the contaminated area (3.2, 2.1 to 5.1). Participants in the qualitative interviews were generally satisfied with the information they had received, although they would have preferred more information about their individual risk of exposure, the results of their urine tests, and the health implications of the incident. Conclusions Perceptions of the public that the 210Po incident in London in 2006 was related to espionage helped to reassure them that the risks to personal health were low. In the event of future incidents it is important to ensure that detailed, comprehensible information about the risks of any exposure is available.

Coming Home: Social Functioning and the Mental Health of UK Reservists on Return From Deployment to Iraq or Afghanistan

PURPOSE There is speculation that high rates of mental illness among Reservists returning from deployment to Iraq and Afghanistan may be due to the challenge of reintegrating into civilian life. We aimed to examine the postdeployment social functioning of Reservists and to explore the relationship between adverse postdeployment experiences and subsequent mental ill health. METHODS A sample of 4,991 UK military personnel who had deployed to either Iraq or Afghanistan were asked about their postdeployment experiences with a particular focus on their levels of social integration, perceived support from the military, and civilian employment. All participants were asked to complete a series of validated measures of mental health. RESULTS Compared with Regular personnel, Reservists were more likely to feel unsupported by the military and to have difficulties with social functioning in the postdeployment period. Perceived lack of support from the military was associated with increased reporting of probable posttraumatic stress disorder (PTSD) and alcohol misuse. Low levels of non-military postdeployment social support and participation were associated with increased reporting of common mental disorder, probable PTSD, and alcohol misuse. CONCLUSIONS Many Reservists find the transition from military deployment to civilian life difficult. Differences in postdeployment experiences may explain some of the increased rates of mental ill health among Reservists.

A Life Course Approach to the Development of Mental Skills

A wide variety of factors across the life course jointly influence cognitive and emotional development. Indeed, research from a variety of disciplines strongly suggests that cognition and mental health are intertwined across the life course, by their common antecedents and underlying physiology in development and in their interplay across adult and later life. We suggest that cognitive and socioemotional function fuse to form skills for life supporting self-regulation, competence, and quality of life that persist into later life through linked reciprocal processes of genetic influence, nurturing, schooling, work, and lifestyle.

Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study

Objective To explore the views of sick doctors on the obstacles preventing them returning to work. Design Qualitative study. Setting Single participating centre recruiting doctors from all over the UK. Participants Doctors who had been away from work for at least 6 months with physical or mental health problems, drug or alcohol problems, General Medical Council involvement or any combination of these, were eligible. Eligible doctors were recruited in conjunction with the Royal Medical Benevolent Fund, the General Medical Council and the Practitioner Health Programme. These organisations approached 77 doctors; 19 participated. Each doctor completed an in-depth semistructured interview. We used a constant comparison method to identify and agree on the coding of the data and the identification of a number of central themes. Results The doctors described that being away from work left them isolated and sad. Many experienced negative reactions from their family and some deliberately concealed their problems. Doctors described a lack of support from colleagues and feared a negative response when returning to work. Self-stigmatisation was central to the participants’ accounts; several described themselves as failures and appeared to have internalised the negative views of others. Conclusions Self-stigmatising views, which possibly emerge from the belief that ‘doctors are invincible’, represent a major obstacle to doctors returning to work. From medical school onwards cultural change is necessary to allow doctors to recognise their vulnerabilities so they can more easily generate strategies to manage if they become unwell.