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Purpose: The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US.Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted.Results: Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast.Conclusions: Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities. [ABSTRACT FROM AUTHOR]

Purpose: The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.Method: NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.Result: The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.Conclusions: Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify posttraumatic stress disorder (PTSD) symptom groups and assess their longitudinal progression during their first year of reintegration among United States (US) National Guard (NG) service members.Methods: A cohort of NG service members (n = 886) completed surveys at 6 and 12 months following their return from deployment to Iraq or Afghanistan. Latent class analysis (LCA) and latent transition analysis (LTA) were used to empirically derive groups based on their PTSD symptoms and examine their longitudinal course, respectively.Results: The best fitting model at both assessments was the four-class model, comprising an asymptomatic class (6 months = 54%; 12 months = 55%), a mild symptom class with elevated hyperarousal symptoms (6 months = 22%; 12 months = 17%), a moderate symptom class (6 months = 15%; 12 months = 15%), and a severe symptom class (6 months = 10%; 12 months = 13%). Based on LTA, stability of class membership at the two assessments was 0.797 for the asymptomatic class, 0.453 for the mild class, 0.560 for the moderate class, and 0.580 for the severe class. Estimated transition probabilities were greater with respect to transitioning to less severe, rather than more severe, classes over time.Conclusions: The four latent PTSD classes were distinguished primarily by severity; however, the mild symptom class was characterized by higher levels of hyperarousal than other symptoms. Although the absolute number of individuals within classes remained fairly constant between 6 and 12 months, there was movement between severity classes. Most NG service members without symptoms continued to do well during the first year, with only an estimated 7% moving to the moderate or severe class. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiological research has consistently shown an association between mental disorders and marital dissolution. However, this research mostly examined the association of divorce as a risk factor for mental illness. This study prospectively examined the associations of mood, anxiety, and substance use disorders with future marital dissolution and new marriages in a representative population sample.Methods: The study used data from the National Comorbidity Survey panel study-a two-wave community epidemiological survey of 5001 participants interviewed in 1990-1992 and re-interviewed in 2001-2003. Mental disorders were ascertained with the Composite International Diagnostic Interview, a fully structured instrument. Associations of baseline lifetime disorders and disorders with onset after the baseline with subsequent divorce and marriage/remarriage were examined using discrete-time survival analysis models.Results: Mental disorders at baseline or with onset after baseline were associated with significantly greater odds of subsequent divorce among respondents who either were married at baseline or got married after baseline. Mental disorders with onset after baseline were associated with smaller odds of marriage or remarriage. Projections assuming causal effects of mental illness on marital outcomes suggest that preventing the effects of common mood, anxiety, and substance use disorders would be associated with 6.7 million fewer divorces and 3.5 million more marriages in the US population over an 11-year period.Conclusions: Individuals with common mental disorders are at greater risk of marital dissolution and are less likely to enter new marriages. These factors contribute to the diminished social engagement and social support for individuals with these disorders. Interventions aimed at improving marital and family relationships could potentially ameliorate the effect of mental disorders on these vital social ties. [ABSTRACT FROM AUTHOR]

Purpose: Vulnerability to post-traumatic disorder (PTSD) following a traumatic event can be influenced by individual-level as well as contextual factors. Characteristics of the social and economic environment might increase the odds for PTSD after traumatic events occur. One example that has been identified as a potential environmental determinant is income inequality. The purpose of this study is to investigate the association between State-level income inequality and PTSD among adults who have been exposed to trauma.Methods: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653). Structured diagnostic interviews were administered at baseline (2001-2002) and follow-up (2004-2005). Weighted multi-level logistic regression was used to determine if US State-level income inequality, as measured by the Gini coefficient, was associated with incident episodes of PTSD during the study's 3-year follow-up period adjusting for individual and state-level covariates.Results: The mean Gini coefficient across states in the NESARC was 0.44 (SD = 0.02) and ranged from 0.39 to 0.53. Of the respondents, 27,638 reported exposure to a traumatic event. Of this sample, 6.9 and 2.3% experienced persistent or recurrent and incident PTSD, respectively. State-level inequality was not associated with increased odds for persistent or recurrent PTSD (OR = 1.02; 95% CI 0.85, 1.22), but was associated with incident PTSD (OR = 1.30, 95% CI 1.04, 1.63).Conclusion: The degree of income inequality in one's state of residence is associated with vulnerability to PTSD among individuals exposed to traumatic events. Additional work is needed to determine if this association is causal (or alternatively, is explained by other socio-contextual factors associated with income inequality), and if so, what anxiogenic mechanisms explain it. [ABSTRACT FROM AUTHOR]

Purpose: To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample.Methods: Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment.Results: Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, -5.8% (95% CI -6.5, -5.2%), and largest among Hispanics interviewed in Spanish, -11.2% (95% CI -12.4, -10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, -23.3% (95% CI -34.9, -11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI -48.0, -17.2%).Conclusions: This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities. [ABSTRACT FROM AUTHOR]

Purpose: A conspiracy world view may be a form of mistrust that is typically corrosive to individual and societal well-being. Our aim was to establish the correlates of conspiracy thinking in an epidemiologically representative sample.Methods: US National Comorbidity Survey-Replication (NCS-R) data were analysed from 5645 people who had completed the item "I am convinced there is a conspiracy behind many things in the world." Results were weighted to be representative of the US adult English speaking household population.Results: 1618 people (weighted 26.7%) endorsed the conspiracy belief item. These individuals were more likely to be: male; currently unmarried; less educated; in a lower income household; outside the labour force; from an ethnic minority group; not attending religious services; taking a weapon outside; and perceiving themselves as of lower social standing compared to others. Individuals endorsing the conspiracy belief item had lower levels of physical and psychological well-being, higher levels of suicidal ideation, weaker social networks, less secure attachment style, difficult childhood family experiences, and were more likely to meet criteria for a psychiatric disorder. There were no differences between those who endorsed conspiracy beliefs and those who did not in age, importance of religious beliefs in daily life, body mass index, or in having a gun at home.Conclusions: Viewing conspiracies in the world is associated with a raised risk of a wide range of adverse circumstances. It is a type of cognitive style that requires systematic empirical study, including monitoring of prevalence, tests of causation, and modelling of propagation. [ABSTRACT FROM AUTHOR]

We examine whether intersectionality theory-which formalizes the notion that adverse health outcomes owing to having a marginalized social status, identity, or characteristic, may be magnified for individuals with an additional marginalized social status, identity, or characteristic-can be applied using quantitative methods to describe the differential effects of poverty on alcohol consumption across sex and race/ethnicity. Using the National Epidemiologic Survey on Alcohol and Related Conditions, we analyze longitudinal data from Black, Hispanic, and White drinkers (n = 21,140) to assess multiplicative interactions between poverty, as defined by the US Census Bureau, sex, and race/ethnicity, on adverse alcohol outcomes. Findings indicated that the effect of poverty on the past-year incidence of heavy episodic drinking was stronger among Black men and Black women in comparison to men and women of other racial/ethnic groups. Poverty reduction programs that are culturally informed may help reduce racial/ethnic disparities in the adverse outcomes of alcohol consumption. [ABSTRACT FROM AUTHOR]

Purpose: The course of conduct disorder (CD) is heterogeneous. Moffitt proposed the heuristic of life course persistent (LCP) and adolescence limited (AL) to differentiate etiologically distinct forms of antisocial behavior (AB), each with distinct predictors and consequences, although a few studies have assessed this demarcation within the context of CD. The objective of this study was to apply Moffitt's taxonomy in a nationally representative US sample to investigate the prevalence, predictors, and outcomes of LCP and AL CD.Methods: Data come from the Collaborative Psychiatric Epidemiology Studies, a set of population-based nationally representative cross-sectional surveys (N = 20,130). Predictors included harsh discipline, maternal and paternal closeness, poverty in childhood, history of learning disability, parental deviance, and nativity. Outcomes included substance use, employment status, education attainment, marital status, income level, and self-rated mental and physical health.Results: The prevalence of LCP and AL CD was 0.5 and 4.6%, respectively, for females, and 1.9 and 5.1%, respectively, for males. Low childhood SES [Odds Ratio (OR) = 3.49], lack of maternal closeness (OR = 2.50), and history of harsh discipline (OR = 2.17) increased odds of LCP group membership. The LCP group had higher odds of developing substance use disorders (OR = 2.00) relative to AL.Conclusions: LCP CD is more strongly influenced by childhood environment and confers increased odds for substance use problems in adulthood relative to AL CD. [ABSTRACT FROM AUTHOR]

Purpose: While gender inequality has been a topic of concern for decades, little is known about the relationship between gender discrimination and illicit drug use. Further, whether this association varies by education level is unknown.Methods: Among 19,209 women participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005), we used logistic regression to test the association between gender discrimination (measured with four items from the Experiences of Discrimination instrument) and three outcomes: past-year illicit drug use, frequent drug use, and drug use disorders. We then tested whether associations differed by education level.Results: Gender discrimination was reported by 9% of women and was associated with past-year drug use [adjusted odds ratio (aOR) = 2.67; 95% confidence interval (CI) 2.17-3.29], frequent drug use (aOR = 2.82; CI 1.99-4.00), and past-year drug use disorders (aOR = 3.15; CI 2.16-4.61). All specific domains of gender discrimination (on the job, in public, with institutions, being called a sexist name) were associated with all drug use outcomes. The association between gender discrimination and past-year drug use was stronger among women with less than a high school education (aOR = 6.33; CI 3.38-11.85) compared to those with more education (aOR = 2.45; CI 1.97-3.04; p interaction < 0.01).Conclusions: Gender discrimination is consistently and strongly associated with illicit drug use and drug use disorders among U.S. women, with significantly higher odds for drug use among women with less than a high school education. Future research should examine whether explicitly addressing distress from discrimination could benefit women in drug treatment, especially among clients with lower educational attainment. [ABSTRACT FROM AUTHOR]

Objectives: To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD).Methods: Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5.Results: Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with Conclusions: DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prevalence of common psychiatric disorders and associated treatment-seeking, stratified by gender, among American Indians/Alaska Natives and non-Hispanic whites in the United States. Lifetime and 12-month rates are estimated, both unadjusted and adjusted for sociodemographic correlates.Method: Analyses were conducted with the American Indians/Alaska Native (n = 701) and Non-Hispanic white (n = 24,507) samples in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions [(NESARC) n = 43,093].Results: Overall, 70 % of the American Indian/Alaska Native men and 63 % of the women met criteria for at least one Diagnostic and Statistical Manual-IV lifetime disorder, compared to 62 and 53 % of Non-Hispanic white men and women, respectively. Adjusting for sociodemographic correlates attenuated the differences found. Nearly half of American Indians/Alaska Natives had a psychiatric disorder in the previous year; again, sociodemographic adjustments explained some of the differences found. Overall, the comparisons to non-Hispanic whites showed differences were more common among American Indian/Alaska Native women than men. Among those with a disorder, American Indian/Alaska Native women had greater odds of treatment-seeking for 12-month anxiety disorders.Conclusion: As the first study to provide national estimates, by gender, of the prevalence and treatment of a broad range of psychiatric disorders among American Indians/Alaska Natives, a pattern of higher prevalence of psychiatric disorder was found relative to Non-Hispanic whites. Such differences were more common among women than men. Prevalence may be overestimated due to cultural limitations in measurement. Unmeasured risk factors, some specific to American Indians/Alaska Natives, may also partially explain these results. [ABSTRACT FROM AUTHOR]

Purpose: This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories.Methods: Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms.Results: Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview.Conclusions: Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the relationship of self-reported racial discrimination with illicit drug use among US Blacks, and whether this differed by socioeconomic position (SEP).Methods: Among 6587 Black participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005), we used multiple logistic regression models to test the association between racial discrimination (measured on the 6-item Experiences of Discrimination scale) and past-year illicit drug use, and whether this differed by SEP.Results: Racial discrimination was associated with past-year drug use [adjusted odds ratio (aOR) 2.32; 95 % confidence interval (CI) 1.70, 3.16] and with frequent drug use (aOR 1.91; 95 % CI 1.22, 2.99). For frequent illicit drug use, this relationship was stronger among higher SEP participants (aOR 3.55; 95 % CI 2.09, 6.02; p interaction < 0.01).Conclusions: The stronger association between racial discrimination and frequent illicit drug use among higher SEP Blacks suggests a complex interplay between disadvantaged and privileged statuses that merits further investigation. The finding of a significant difference by SEP highlights the importance of considering differences within heterogeneous race/ethnic groups when investigating health disparities. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to examine the relationship between adult-onset posttraumatic stress disorder (PTSD) and subsequent alcohol use outcomes (frequent heavy drinking, alcohol abuse, and alcohol dependence) in non-Hispanic white, non-Hispanic black, and Hispanic US women, and whether this relationship was moderated by ethnic minority stressors (discrimination and acculturation).Methods: The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression.Results: Women with PTSD were over 50 % more likely than those without PTSD to develop alcohol dependence [adjusted hazards ratio (aHR) 1.55; 95 % confidence interval (CI) 1.15, 2.08]. Hispanic and black women were at lower risk of most alcohol outcomes than white women. In race-/ethnic-specific analyses, however, PTSD only predicted alcohol abuse among Hispanic women (aHR 3.02; CI 1.33, 6.84). Higher acculturation was positively associated with all alcohol outcomes among Hispanic women and discrimination was associated with AUD among Hispanic and black women. Acculturation and discrimination modified the effect of PTSD on AUD among Hispanic women: PTSD predicted alcohol dependence among those with low acculturation (aHR 10.2; CI 1.27, 81.80) and alcohol abuse among those without reported discrimination (aHR 6.39; CI 2.76, 16.49).Conclusions: PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent, however, when ethnic minority stressors are not present. [ABSTRACT FROM AUTHOR]

Purpose: Recent decades have witnessed a rise in the number of immigrant children in the United States (US) and concomitant concerns regarding externalizing behaviors such as crime, violence, and drug misuse by immigrant adolescents. The objective of the present study was to systematically compare the prevalence of externalizing behaviors and migration-related factors among immigrant and US-born adolescents in the US.Method: Data on 12 to 17 year olds (Weighted N in thousands = 25,057) from the National Survey on Drug Use and Health (NSDUH) R-DAS between 2002 and 2009 were used. The R-DAS online analytic software was employed. Prevalence estimates and 95 % confidence intervals were calculated adjusting for the complex survey sampling design.Results: Compared to their US-born counterparts, immigrant adolescents-particularly those between the ages of 15 and 17 years-are significantly less likely to be involved in externalizing behaviors. In addition, later age of arrival and fewer years spent in the US were associated with reduced odds of externalizing behavior. Supplementary analyses indicate that the link between nativity and externalizing behavior may be primarily driven by differences between US-born and immigrant youth who self-identify as non-Hispanic black or Hispanic. Immigrant adolescents are also more likely to report cohesive parental relationships, positive school engagement, and disapproving views with respect to adolescent substance use.Conclusions: This study extends prior research on the "immigrant paradox" to externalizing behavior among adolescents using a nationally representative data source. Findings highlight the importance of examining age, age of arrival, duration, and race/ethnicity in the study of nativity and externalizing. [ABSTRACT FROM AUTHOR]

Purpose: There is a trend of decreasing response rates in population surveys, and selective nonresponse represents a major source of potential bias in population-based survey estimates of drug use behaviors, especially estimates based on longitudinal designs.Methods: This study compared baseline substance use behaviors among initial respondents who did respond (n = 34,653) and did not respond (n = 8440) to a 3-year follow-up interview in a prospective study of the general U.S. adult population. Differences in nonresponse rates were assessed as a function of past-year drug use behaviors both before and after adjustment for socio-demographic differences potentially associated with these behaviors, and the effects of interactions of the socio-demographic characteristics with the drug use behaviors were assessed in multivariate logistic regression models for response at the 3-year follow-up.Results: Weighted and unweighted nonresponse rates varied between alcohol users and users of other drugs such as cocaine and marijuana, with rates of nonresponse being higher in the latter drug categories. There were also significant differences in nonresponse rates as a function of frequency of use and demographics. More specifically, being married tends to reduce the probability of non-response, while older age, being male, being Asian or Hispanic, and having lower education all substantially increase the probability of nonresponse at Wave 2, even after controlling for relevant covariates.Conclusions: This study provides the substance abuse field with a methodology that users of longitudinal data can apply to test the sensitivity of their inferences to assumptions about attrition patterns. [ABSTRACT FROM AUTHOR]

Purpose: Although significant negative associations of mental disorders with employment have been documented in epidemiological research, much of this research was based on cross-sectional samples and focused only on severe and persistent mental disorders. The present study examined the longitudinal associations of more common mental disorders with employment.Methods: Data on the associations of common mental disorders with employment are presented here from 4501 respondents in the National Comorbidity Survey panel study, a two-wave community epidemiological survey of respondents aged 15-54 at baseline (1990-1992) who were re-interviewed in 2001-2003 and were employed, unemployed in the labor force or student at baseline. Lifetime mental disorders at baseline and disorders with onset after baseline were assessed with the Composite International Diagnostic Interview, a fully structured interview that assessed lifetime prevalence of internalizing fear disorders (panic, phobias), anxiety/misery disorders (major depression, generalized anxiety disorder, post-traumatic stress disorder), externalizing disorders (conduct disorder, alcohol and illicit drug abuse-dependence), and bipolar disorder.Results: Both baseline lifetime disorders and disorders with onsets after baseline were associated with significantly reduced odds of subsequent employment among respondents who were either employed or students at baseline. Population projections based on the assumption that these associations represented causal effects suggest that the mental disorders considered here were associated with 1.7-3.2 million adults being unemployed in the US population at follow-up.Conclusions: Expanded access to treatment among current employees and students with mental disorders might lead to improved employment outcomes in these segments of the population. [ABSTRACT FROM AUTHOR]

Purpose: The study sought to examine the association of mental disorders with educational attainment in a community sample.Methods: Data were from 5001 respondents aged 15-54 in the 1990-1992 National Comorbidity Survey (NCS), re-interviewed in the 2001-2003 NCS follow-up (NCS-2). Discrete-time survival analysis was used to examine the association of disorders present at baseline (NCS) or having first onset after the baseline (assessed in NCS-2) with educational outcomes among 3954 eligible respondents. Mental disorders were categorized into internalizing fear disorders (simple phobia, social phobia, panic disorder with/without agoraphobia and agoraphobia without panic disorder), internalizing anxiety-misery disorders (major depressive disorder, generalized anxiety disorder and post-traumatic stress disorder), externalizing disorders (alcohol and drug use disorders, conduct disorder) and bipolar disorder. Analyses were conducted separately in students and non-students at baseline.Results: Among students, baseline bipolar and externalizing disorders, as well as fear, anxiety-misery and externalizing disorders with onset after baseline were associated with lower odds of high school graduation; baseline anxiety-misery disorders with lower odds of going to college; and baseline externalizing disorders and bipolar disorder with onset after baseline with lower odds of college graduation. Among non-students, baseline fear disorders were associated with lower odds of high school graduation and bipolar disorder with lower odds of going to college. Assuming that the regression coefficients represent causal effects, mental disorders accounted for 5.8-11.0% of high school and 3.2-11.4% of college non-completion.Conclusions: Expanding access to mental health services for youth might have a net positive societal value by helping to prevent some of these adverse educational outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Poor mental health is associated with teen dating violence (TDV), but whether there are specific types of psychiatric disorders that could be targeted with intervention to reduce TDV remains unknown.Methods: Multivariable logistic regression models were used to assess the associations of psychiatric disorders that emerged prior to dating initiation with subsequent physical dating violence in a nationally representative sample from the National Comorbidity Survey Replication, adjusting statistically for adverse childhood experiences.Results: In adjusted models, internalizing disorders (AOR 1.14, 95 % CI 1.04,1.25; no sex differences noted) and externalizing disorders (males: AOR 1.28, 95 % CI 1.10, 1.49; females: AOR 1.85, 95 % CI 1.55, 2.21) were associated with subsequent involvement in any physical dating violence victimization or perpetration before the age of 21. Those at greatest risk included girls with ADHD and a substance use disorder, in particular.Conclusions: The range of psychiatric disorders associated with TDV is broader than has generally been recognized for both boys and girls. Clinical and public health prevention programs should incorporate strategies for addressing multiple pathways through which poor mental health may put adolescents at risk for TDV. [ABSTRACT FROM AUTHOR]

Background: We determined whether patients with serious mental illness were more likely to report low social support than those without serious mental illness.Method: We conducted a national, cross-sectional study of VA patients in Fiscal Year 1999 who were diagnosed with a serious mental illness, as well as a random sample of VA patients without a diagnosis of serious mental illness (N = 8,547) from the National Psychosis Registry who also completed the VA's Large Health Survey of Veteran Enrollees (LHSV) 9-item questionnaire on social support. Using generalized estimating equations; we assessed patient's likelihood of reporting low social support, while controlling for patient socio-economic and clinical factors.Results: In multivariable models adjusting for patient factors, patients with serious mental illness were more likely to report low instrumental support, e.g., having no one to help with chores (OR = 1.41, p < 0.001) and low emotional support, e.g., having no one to relax with (OR = 2.05, p < 0.001).Conclusions: Patients diagnosed with serious mental illness reported low social support across different dimensions. Recovery-oriented services for persons with serious mental illness should focus on improving and sustaining emotional and instrumental supports for this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Studying pathways to care, or contacts made during the period of time from the onset of illness until the first initiation of treatment, is critical for understanding how to improve the early recognition and treatment of mental disorders. However, little is known about pathways to care among patients with first-episode psychosis in the United States. The objectives of this study were to examine the pathways to care and number of help contacts prior to hospitalization in first-episode patients, and to ascertain the frequency of contact with primary care providers and police.Method: Pathways to care, including all contacts for help from the onset of prodromal symptoms until first hospital admission, were assessed in 25 urban African American patients. Other measures were obtained as part of an ongoing study of predictors of the duration of untreated psychosis.Results: The median durations from the onset of illness to hospital admission and from the emergence of positive psychotic symptoms to hospital admission were 128.0 weeks (range 0.6-476.9) and 32.9 weeks (range 0.4-337.7), respectively. Of the 83 total contacts, 17 were with police, whereas only four were with primary care providers. While the number of contacts per patient ranged from one to eight, 16 of the 25 patients were admitted within 1 week of their first contact for help.Conclusions: The findings indicate that pathways to care in this population are highly variable, and there is a need for additional research to better understand the nature and determinants of these pathways. Such investigations may provide insights into service enhancements that can promote early detection and intervention, thus improving illness outcomes. [ABSTRACT FROM AUTHOR]

Background: To obtain prevalence estimates and identify factors associated with psychological problems and receipt of help by a geographically proximate population in which some persons had direct exposure but the overall prevalence of direct exposure was low, 5-15 months after the September 11th, 2001 terrorist incidents.Method: Telephone survey data from the Behavioral Risk Factor Surveillance System (BRFSS) (Connecticut Module) with a randomly selected cohort of 2741 women and 1899 men aged 18 and older were examined using bivariate Chi Square and multivariate logistic regression analyses of weighted data.Results: One in three respondents reported 9/11-related psychological problems, 26% of whom reported receiving formal services or peer support. Risk factors for reporting psychological problems included being surveyed earlier, female gender, age 64 or younger, Hispanic ethnicity, disability, recent depression, and reporting one day or more in the past 30 of poor mental health, sleep problems or worry. Poor mental health was associated with receipt of formal services, and increased alcohol use was associated with receipt of peer support.Conclusion: In the post-impact recovery period following mass trauma, psychological problems by persons with ongoing mental health conditions or increased alcohol use warrant continuing public and professional attention. Women, Hispanics, and disabled adults also may be under-served. [ABSTRACT FROM AUTHOR]

Background: The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended "natural experiment" allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied.Methods: Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined.Results: In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher's exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms.Conclusions: Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods. [ABSTRACT FROM AUTHOR]

Objective: The phenomenon of somatization was explored in relation to the experiences of acculturation, stress, support, and distress.Methods: A representative community sample of 1,747 Chinese Americans (aged 18-65 years), selected by a multi-stage household sampling design, in the Los Angeles County was interviewed to tap their psychiatric diagnoses, symptomatology, level of acculturation, stress, and support.Results: Across all indices, Chinese Americans' level of somatic symptoms, impairment related to somatization, and percentage of meeting the Somatic Symptom Index 5/5 (SSI 5/5) criterion were comparable to those found in other populations. Length of residence in the U. S. and acculturation were not related to somatization. Regression analyses showed that anxiety, depression, gender, age, education, stressors, and support were significantly related to somatization, ps < 0.05. Somatizers tended to perceive themselves with poor health and utilized both Western and indigenous Chinese medicine.Conclusion: The importance of demographics, psychological distress, and stress was emphasized in the explanation of somatization tendencies among immigrant Chinese Americans. Somatization might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS).Method: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734). Depressive symptoms were assessed with the CES-D. Symptom coverage and response categories varied across study wave. The first wave (1992) used a four-category response, whereas subsequent waves (1994 and 1996) used a two-category response. A structural equations model (SEM) based in Item Response Theory (IRT) was used to calibrate symptoms and generate linked depressive symptom burden scores.Results: Linked depressive symptom burden scores, derived from calibrated symptoms, were distributed similarly across HRS wave.Conclusion: Our results demonstrate the applicability of an IRT-based SEM to address a common challenge in prospective studies: changes in the content and context of symptom assessment. Future investigations may make use of our linked syndrome scores to further explore other aspects of depression from a longitudinal perspective. [ABSTRACT FROM AUTHOR]