Mental disorders more common in people who live alone

by Public Library of Science

Prevalence of common mental disorders by living arrangement. Credit: Jacob et al., 2019

Living alone is positively associated with common mental disorders, regardless of age and sex, according to a study published May 1, 2019 in the open-access journal PLOS ONE by Louis Jacob from University of Versailles Saint-Quentin-en-Yvelines, France, and colleagues.

06 may 2019--The proportion of people living alone has increased in recent years due to population aging, decreasing marriage rates and lowering fertility. Previous studies have investigated the link between living alone and mental disorders but have generally been conducted in elderly populations and are not generalizable to younger adults.

In the new study, researchers used data on 20,500 individuals aged 16-64 living in England who participated in the 1993, 2000, or 2007 National Psychiatric Morbidity Surveys. Whether a person had a common mental disorder (CMD) was assessed using the Clinical Interview Schedule-Revised (CIS-R), a questionnaire focusing on neurotic symptoms during the previous week. In addition to the number of people living in a household, data was available on factors including weight and height, alcohol dependence, drug use, social support, and loneliness.

The prevalence of people living alone in 1993, 2000, and 2007 was 8.8%, 9.8%, and 10.7%. In those years, the rates of CMD was 14.1%, 16.3%, and 16.4%. In all years, all ages, and both men and women, there was a positive association between living alone and CMD (1993 odds ratio 1.69; 2000 OR 1.63; 2007 OR 1.88). In different subgroups of people, living alone increased a person's risk for CMD by 1.39 to 2.43 times. Overall, loneliness explained 84% of the living alone-CMD association. The authors suggest that interventions which tackle loneliness might also aid the mental wellbeing of individuals living alone.

Jacob summarizes: "Living alone is positively associated with common mental disorders in the general population in England."

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More information: Jacob L, Haro JM, Koyanagi A (2019) Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. PLoS ONE 14(5): e0215182. doi.org/10.1371/journal.pone.0215182

Journal information: PLoS ONE 

Provided by Public Library of Science 

Study links unexpected death of a loved one with onset of psychiatric disorders

The sudden loss of a loved one can trigger a variety of psychiatric disorders in people with no history of mental illness, according to researchers at Columbia University's Mailman School of Public Health and colleagues at Columbia's School of Social Work and Harvard Medical School. While previous studies have suggested there is a link between sudden bereavement and an onset of common psychiatric disorders, this is the first study to show the association of acute bereavement and mania in a large population sample. Findings are published online in the American Journal of Psychiatry.

30 may 2014--In people aged 30 years or older, the unexpected death of a loved one roughly doubled the risk for new-onset mania after controlling for prior psychiatric diagnoses, other traumatic experiences, and certain demographic variables like sex, race, income, education, and marital status.

The researchers analyzed data from 27,534 participants in the National Epidemiologic Survey on Alcohol and Related Conditions. Between about 20% and 30% of these participants identified the unexpected death of a loved one as the most traumatic event in their lives. This was still the case among those reporting 11 or more lifetime traumatic events, where losing a loved one unexpectedly was most traumatic for 22%.

"Our findings should alert clinicians to the possible onset of a wide range of psychiatric disorders, including disorders such as mania, after an unexpected death in otherwise healthy individuals," says Katherine Keyes, PhD, assistant professor of Epidemiology at the Mailman School of Public Health, and principal investigator. "However, it is also notable that the majority of individuals in the present study did not develop mental health issues in the wake of an unexpected death of a loved one."

Losing a loved one suddenly also raised the risk of major depression, excessive use of alcohol, and anxiety disorders, including panic disorder, post-traumatic stress disorder, and phobias. The largest risk increases were for post-traumatic stress disorder, which was seen across age groups with an increased risk as high as 30-fold. Most other disorders were concentrated in the older age groups.

While developing a psychiatric disorder for the first time in old age is relatively rare, these data indicate that psychiatric disorder onset in older age is commonly associated with the death of a loved one, according to the authors.

"Clinically, our results highlight the importance of considering a possible role for loss of close personal relationships through death in assessment of psychiatric disorders. When someone loses a close personal relationship, even late in life, there is a profound effect on sense of self and self reflection. These data indicate that, even in adults with no history of psychiatric disorders, it is also a vulnerable risk period for the onset of a potentially disabling psychiatric disorder," says Dr. Keyes.

Provided by Columbia University's Mailman School of Public Health

Medical conditions add to premature mortality risk of people with mental illness

Dr Ruth Cunningham

24 may 2014—People using mental health services in New Zealand are dying prematurely from both natural and external causes, a new University of Otago Wellington study has revealed.

While suicide and accidents are contributors to these high death rates, chronic medical conditions such as heart disease and cancer are a significant cause, the study has found.

Published today in the New Zealand Medical Journal, the study of 266,093 people who had contact with mental health services between 2002 and 2010 shows that the death rate for people who experience mental health problems severe enough to lead to contact with psychiatric services is twice that of the total population.

People with the most severe mental illnesses such as schizophrenia and bipolar disorder have three times the overall death rate of the total population, the study shows.

Lead author Dr Ruth Cunningham says the findings highlight the need to understand and meet the physical health needs of people with mental illness.

More than 7000 adults who had used mental health services died before the age of 65 during the study period. The main cause of death for both women and men were natural (71% and 58% respectively), due mainly to cancer and heart disease. Suicide accounted for 15% of deaths in women and 22% of deaths in men, and accidents were also common, Dr Cunningham says.

High smoking rates and antipsychotic medications are recognised health risks for people with mental illness that lead to medical conditions such as cancer and heart disease, but there are other less obvious risks, such as lack of appropriate treatment for medical conditions, that need to be acknowledged and addressed, she says.

Discrimination and social deprivation will also be contributing to the mortality gap, she adds.

"For example, both here and overseas, people using mental health services are saying they experience discrimination by health service providers. This can lead to a lack of adequate preventative care and treatment."

Discrimination can occur against anyone with mental illness, especially those with severe mental illness, and can make it extremely difficult to secure a job and decent housing, which further impacts on health, Dr Cunningham says.

"We found that those using mental health services were more likely to be living in socially deprived areas, which also drives up the risk of premature death."

This critical health issue has been well researched internationally, but this is the first time it has been documented in New Zealand, Dr Cunningham says.

The next step must be coordinated action to address these health inequalities, through initiatives such as the "Equally Well" project, which was initiated in September 2013 by Te Pou and Platform Trust, she says.

"Equally Well" is a New Zealand initiative which has been gathering evidence on the extent of physical health problems for people with a severe mental illness and/or addiction, including the results of this study. Its next phase will focus on coordinating action across key organisations, including medical colleges, and government and non-government agencies, to improve the physical health outcomes of people with a severe mental illness and/or addiction.

Ongoing monitoring of the physical health and mortality of people with mental illness is essential, in order to evaluate the effectiveness of any interventions and to ensure that the health of this group is no longer neglected, Dr Cunningham says.

Provided by University of Otago

Mental illness the largest contributor to disability worldwide

Mental illness is the largest contributor to disability, according to a report card on the world's health, The Global Burden of Disease 2010 (GBD 2010). The seven papers and two commentaries that make up the report  published in The Lancet   this week. 

16 dec 2012--GBD 2010 is a collaborative project led by the Institute for Health Metrics and Evaluation at the University of Washington (UW) in the US and involves 302 institutions across 50 countries. This is the first report since the inaugural study was published in the early 1990s.

Close to a quarter of the world's disability burden is attributed to mental and behavioural disorders combined (22.7 per cent). These include major depressive disorder, anxiety, Alzheimer's, schizophrenia and bipolar disease.

Major depressive disorder alone accounts for 8.1 per cent of the disability burden and is second only to low back pain. This compares with cardiovascular and circulatory diseases, which account for 2.8 per cent of the disability burden.

"This report looks at the total impact of disease over a person's life. So serious conditions like heart disease and cancer contribute relatively small amounts to the disability burden because they usually occur in later life," says UNSW Professor Philip Mitchell, who assisted in assessing the impact of bipolar disease around the world for the report.

"The mental illnesses present very commonly when people are in their 20s and 30s and they often reoccur, so the lifetime disability is greater," says Professor Mitchell, Head of Psychiatry at UNSW, who is based at the Black Dog Institute.

Other key findings relating to mental health: 

• The burden of major depression and anxiety have each increased by 37 per cent in 20 years
• Alzheimer's disease has increased by 80 per cent
• Major depressive disorders account for 63 million years spent living with a disability (YLD)

Other contributions from UNSW experts include: 

• UNSW Conjoint Professor Guy Marks contributed to the work on respiratory diseases. Pneumonia, tuberculosis, chronic obstructive pulmonary disease (or COPD, the occurrence of chronic bronchitis or emphysema) and lung cancer are major contributors to the global burden of disease and premature death. One of the key findings is that the disability-adjusted life years (DALYs) due to pneumonia and other lower respiratory infections has decreased by 44 per cent over the past 20 years. However, the burden of lung cancer has increased while COPD, asthma and tuberculosis have remained relatively unchanged.
• Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre at UNSW co-chaired the Expert Group on Mental Disorders and Illicit Drug Use. The results will be published in detail next year, but illicit drugs have become a bigger contributor to the global burden of disease over the past 20 years (from 1990 to 2010).

More information: www.thelancet.com/… n-of-disease

Time on the Farm Helps Psychiatric Patients

April 11, 2008-- Contact with farm animals may be therapeutic for patients with mental illness, much the way interaction with cats and dogs is, researchers found.
Working with cows, sheep, and other animals on small farms in Norway for 12 weeks modestly improved patients' sense of self-efficacy and coping ability, reported Bente Berget, of the Norwegian University of Life Sciences here, and colleagues online in Clinical Practice and Epidemiology in Mental Health.
Farm animals, plants, and gardens have been used as part of recreational and work-related interventions under the banner of "Green Care" for psychiatric patients, which has been gaining popularity in Europe as well as the United States, the researchers said.
These interventions were typically done at farms associated with hospitals or other healthcare institutions but now more commonly include community gardens, city farms, allotment gardens, and private farms, the researchers said.
Previous studies have shown that animal-assisted therapy involving cats and dogs can decreased stress and improve self-confidence, social competence, and quality of life.
To see if farm animals could provide the same benefits, the researchers randomized 90 adult psychiatric patients to a 12-week intervention with farm animals along with their normal medication or to standard treatment alone.
The participants were predominantly outpatients (84.5%). Their most common diagnoses were schizophrenia (37.7%), affective disorders (24.4%), and anxiety and stress-related disorders (11.1%).
The intervention involved 15 farmers who were mostly inexperienced in working with psychiatric patients. Ten of the farms had dairy cows, two had sheep, one had horses, and two had cattle for specialized meat production. All the farms also had small animals like rabbits, poultry, pigs, cats, or dogs.
One or two patients at a time visited the farms to work with the animals for three hours twice a week. The farmers were always close by to ensure that there were no risks from contact with the animals.
The researchers found no benefits during the relatively brief intervention for patients compared with controls. But "a rapid and great improvement" was unlikely, they said, because 72% of the patients had been under psychiatric care for more than three years.
However, six months later, patients in the farm intervention group were more likely to report that they were better able to respond to new or difficult situations than those in the control group.
Self-efficacy scores increased significantly by six months in the treatment group compared with preintervention scores (25.7 versus 23.1, P=0.05) and postintervention scores (25.7 versus 23.5, P=0.02). There was no improvement in the control group (25.4 versus 25.3 and 25.6).
Coping ability, measured using the Coping Strategies Scale of the Pressure Management Indicator, also improved at six months for those working with the farm animals compared with before the intervention (P=0.03), whereas no increases were seen in the control group.
None of the differences between or within groups overall were significant for quality of life, although controlled studies with pets had shown improvements in quality of life, the researchers noted.
Patients with affective disorders appeared to gain the most from contact with farm animals.
Their self-efficacy scores improved compared with the control group both during the intervention (P=0.03) and six months after (P=0.01). Their quality of life increased as well (P=0.01).
The delayed effects in the overall cohort may suggest that the intervention or the study was too short, the investigators said. It's also possible that the frequency of farm visits was too low for significant benefits to accrue, they said.
They noted that the study was limited by the moderate number of patients with each psychiatric condition and the lack of blinding to active treatment.
"Even if the results on self-efficacy and coping are rather moderate," Berget and colleagues concluded, "they are positive based on the limited sample size and the rather unspecific intervention."
The study was funded by a grant from the Research Council of Norway.
The researchers reported no conflicts of interest.
Additional source: Clinical Practice and Epidemiology in Mental HealthSource reference: Berget B, et al "Animal-assisted therapy with farm animals for persons with psychiatric disorders: effects on self-efficacy, coping ability and quality of life, a randomized controlled trial" Clin Pract Epidemol Ment Health 2008; 4: 9.

Significant Associations Between Mental Illness and Chronic Disease

Lexa W. Lee

October 24, 2007 (New Orleans) — A new study from the Centers for Disease Control and Prevention (CDC) shows a strong association between mental illness and chronic diseases and with their related risk factors.
Researchers led by Tara Strine, an epidemiologist at the CDC, in Atlanta, Georgia, report significant relationships between depression and anxiety and chronic diseases such as asthma, cardiovascular disease, and diabetes, as well as the adverse health behaviors such as smoking or inactivity that are risk factors for these diseases.
"It is time to examine mental and physical health as a combined entity in our public health efforts," the authors conclude.
Their findings were reported here at the 2007 American Psychiatric Association 59th Institute on Psychiatric Services.
Major Causes of Morbidity and Mortality
Depression and anxiety are 2 major causes of morbidity leading to mortality, the authors write. They are associated with impaired health, excess disability, and chronic disease.
The current study used data from the 2006 Behavior Risk Factor Surveillance System (BRFSS) Anxiety and Depression Module and was designed to examine the association of depression and anxiety and certain chronic disease and adverse health behaviors among adults living in the community.
The investigators believe this to be the first state-based study examining the relationship between current depression, using the Patient Health Questionnaire, PHQ-8 (a random-digit, state-based telephone survey of participants at least 18 years old), a lifetime diagnosis of anxiety or depression, chronic illness, obesity, and adverse health behaviors (smoking, lack of exercise, heavy drinking).
Data collected in 38 states, the District of Columbia, Puerto Rico, and the US Virgin Islands were available for 217,379 participants. The prevalence of current depression was 8.7%; a lifetime diagnosis of depression was present in 15.7%, and a lifetime diagnosis of anxiety was seen in 11.3%.
West Virginia had the highest rate of current depression, at 13.7%, and Arkansas had the highest rate of lifetime diagnosis of depression, at 21.3%. Chronic diseases like cardiovascular disease, diabetes, and asthma and risk factors such as obesity, smoking, physical inactivity, and heavy drinking were all significantly associated with current depression and a lifetime diagnosis of anxiety or depression.
The investigators concluded that there is a strong association of mental illness with chronic diseases and related adverse behaviors. This suggests a need to employ an integrated, multidimensional approach to healthcare, they conclude.
"The strengths of the study include the large sample size and the ability to combine it with data about chronic diseases and adverse health behaviors," Ms. Strine told Medscape Psychiatry. "However, we weren't able to include people in institutions, those without telephones, and those unable to complete the survey due to their diseases or mental illness."American Psychiatric Association 59th Institute on Psychiatric Services: Poster 166. Presented October 13, 2007.