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Jewish-Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish-European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60-1.19; women: 0.95, 95% CI 0.55-1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer. (Contains 2 tables.)

The association between childhood and adolescent abuse and suicidal behavior, and the possible contribution of abuse to sex differences in non lethal suicidal behavior, was investigated. Data were extracted from the Israel-based component of the WHO World Mental Health Survey (Kessler & Utsun, 2008a). Increased risk for ideation, plan, and suicidal attempt were associated with childhood abuse, and increased risk for attempt was associated also with abuse at adolescence. No associations with sex or sex by abuse interactions were observed. The higher frequency of childhood abuse among women could account in part for their higher rates of suicidal attempts as compared to men. (Contains 3 tables.)

Background: The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence-based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004-2005 in a representative sample of 957 adolescents aged 14-17 and their mothers. Methods: The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio-demographic and health correlates. Disorders were ascertained with the Development and Well-Being Assessment inventory and verified by child psychiatrists. Results: The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. Conclusions: The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society.

Reviews findings of study on mortality effects of parental bereavement. Describes negative findings of study in which mortality risk of parents who lost son in war or accident was compared with mortality pattern of control group, calling findings surprising in view of evidence produced by studies on conjugal bereavement. Sees need for additional highly focused research. (Author/NB)

Objective To outline mental health service accessibility, estimate the treatment gap and describe service utilization for people with schizophrenic disorders in 50 low- and middle-income countries. Methods The World Health Organization Assessment Instrument for Mental Health Systems was used to assess the accessibility of mental health services for schizophrenic disorders and their utilization. The treatment gap measurement was based on the number of cases treated per 100 000 persons with schizophrenic disorders, and it was compared with subregional estimates based on the Global burden Of disease 2004 update report. Multivariate analysis using backward step-wise regression was performed to assess predictors of accessibility, treatment gap and service utilization. Findings The median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100 000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap. Conclusion The treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries. [TEXT NOT REPRODUCIBLE IN ASCII.] Disponibilidad y utilizacion de los servicios y desigualdad en el tratamiento de trastornos esquizofrenicos: encuesta realizada en 50 paises de ingresos bajos y medios Objetivo Esbozar la accesibilidad a los servicios de salud mental, evaluar la desigualdad en el tratamiento y describir la utilizacion de servicios para personas con trastornos esquizofrenicos en 50 paises de ingresos bajos y medios. Metodos Se empleo el Instrumento de Evaluacion para Sistemas de Salud Mental de la Organizacion Mundial de la Salud con el fin de valorar la accesibilidad a los servicios de salud mental para trastornos esquizofrenicos y su utilizacion. La medicion de la desigualdad en el tratamiento se baso en el numero de casos tratados por cada 100 000 personas con trastornos esquizofrenicos y se comparo con las estimaciones subregionales basadas en el informe de actualizacion Global burden of disease 2004. Se realizo un analisis multivariable empleando la eliminacion regresiva para evaluar los predictores de accesibilidad, la desigualdad en el tratamiento y la utilizacion de servicios. Resultados La tasa media anual de tratamiento de trastornos esquizofrenicos en los servicios de salud mental fue de 128 casos por cada 100 000 habitantes. La desigualdad media en el tratamiento fue del 69% y resulto superior en los paises participantes de ingresos bajos (89%) que en los paises de ingresos medios-bajos y en los paises de ingresos medios-altos (69% y 63%, respectivamente). El 80% de las personas con trastornos esquizofrenicos recibieron tratamiento en instalaciones ambulatorias. La disponibilidad de psiquiatras y enfermeros en las instalaciones de salud mental se determino como un predictor significativo de la accesibilidad a los servicios y de la desigualdad en el tratamiento. Conclusion La desigualdad en el tratamiento para trastornos esquizofrenicos en los 50 paises de ingresos bajos y medios incluidos en este estudio es desconcertantemente elevada y las instalaciones ambulatorias asumen la principal carga del cuidado. Los predictores significativos hallados sugieren una posibilidad de mejora del cuidado en estos paises. Disponibilite et utilisation du service et ecart de traitement des troubles schizophreniques: une etude dans 50 pays a revenu faible et moven Objectif Passer en revue l'accessibilite aux services de sante mentale, estimer l'ecart de traitement et decrire l'utilisation du service des personnes souffrant de troubles schizophreniques dans 50 pays a revenu faibleet moyen. Methodes L'instrument d'evaluation des systemes de sante mentale de l'Organisation mondiale de la Sante a ete utilise pour etudier l'accessibilite et l'utilisation des services de sante mentale pour les troubles schizophreniques. La mesure de l'ecart de traitement reposait sur le nombre de cas traites pour 100 000 personnes presentant des troubles schizophreniques, et elle a ete comparee aux estimations sous-regionales selon le rapport mis a jour Global burden of disease 2004 (Etude sur la charge mondiale de morbidite 2004). Une analyse multivariee utilisant la regression pas a pas descendante a ete effectuee afin d'evaluer les predicteurs d'accessibilite, l'ecart de traitement et l'utilisation du service. Resultats Le taux annuel median de traitement des troubles schizophreniques dans les services de sante mentale etait de 128 cas pour 100 000 habitants. L'ecart de traitement median etait de 69%. Il etait plus eleve dans les pays a revenu faible participant a l'etude (89%) que dans les pays a revenu moyen de la tranche inferieure et dans les pays a revenu moyen de la tranche superieure (69% et 63%, respectivement). 80% des personnes souffrant de troubles schizophreniques ont ete traitees dans des services de consultation externe. La disponibilite de psychiatres et d'infirmieres dans les etablissements de sante mentale etait un predicteur de l'accessibilite du service et de l'ecart de traitement. Conclusion Dans cette etude, l'ecart de traitement des troubles schizophreniques dans les pays a revenu faible et moyen est etonnamment important, et les services de consultation externe assurent la plus grande partie des soins. Les predicteurs significatifs identifies suggerent une direction a suivre pour ameliorer les soins dans ces pays., Introduction Schizophrenic disorders are chronic and severe mental conditions that affect 26 million people worldwide and result in moderate or severe disability in 60% of cases. (1) Due to their [...]

Religious observance has a protective effect on the mental health of individuals facing adverse events. Its role under terrorista has been less investigated. Gaza and West Bank settlers, both secular and those keeping different degrees of observance, have faced terrorism in recent years. We investigated their PERI-Demoralization mean scores following terrorist attacks controlling for confounding variables. The results showed that the higher the religiosity the lower the demoralization mean score. This protective effect lessened when there was dissonance between the degree of religiosity of the respondent and the religious observance of the settlement of residence.

Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States. Keywords Mental health services/utilization; Health services accessibility; Schizophrenia/therapy; Anxiety disorders/therapy; Mood disorders/therapy; Compulsive personality disorder/therapy; Alcoholism/therapy; Epidemiologic studies; Cost of illness; Americas; Europe (source: MESH, NLM). Mots cles Service sante mentale/utilisation; Accessibilite service sante; Schizophrenie/therapeutique; Etat anxiete/therapeutique; Troubles humeur/therapeutique; Personnalite compulsive/therapeutique;Alcoolisme/therapeutique; Etude analytique (Epidemiologie); Cout maladies Amerique; Europe (source: MeSH, INSERM). Palabras clave Servicios de salud mental/utilizacion; Accesibilidad a los servicios de salud; Esquizofrenia/terapia; Trastornos de ansiedad/terapia; Trastornos del humor/terapia; Trastorno de personalidad compulsiva/terapia; Alcoholismo/terapia; Estudios epidemiotogicos; Costo de la enfermedad; Americas; Europa (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII], Resume Le defaut de traitement en sante mentale Les troubles mentaux ont une prevalence elevee et representent une charge considerable en termes de souffrance et de maladie. De plus, de [...]