Anxiety Disorders: Caraveo-Anduaga JJ

Kohn R, Levav I, de Almeida JM, Vicente B, Andrade L, Caraveo-Anduaga JJ, Saxena S, Saraceno B. · Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island 02906, USA. · Rev Panam Salud Publica. · Pubmed #16354419 No free full text.

Abstract: OBJECTIVE: The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevalence of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. METHODS: Data were extracted from community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalence rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. RESULTS: Nonaffective psychosis (including schizophrenia) had an estimated mean one-year prevalence rate of 1.0%; major depression, 4.9%; and alcohol use abuse or dependence, 5.7%. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. CONCLUSIONS: The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulated or updated and programs and services are expanded.

Caraveo-Anduaga JJ, Nicolini-Sánchez H, Villa-Romero A, Wagner FA. · Instituto Nacional de Psiquiatría Ramón de la Fuente, Departamento de investigaciones en servicios de salud, México, DF, México. · Salud Publica Mex. · Pubmed #15759910 No free full text.

Abstract: OBJECTIVE: To estimate the risk of psychiatric disorders across three family generations. MATERIAL AND METHODS: The research design corresponds to a "family history study" and is based upon a household survey conducted in 1995, on a representative sample of Mexico City's adult population aged 18 - 65 years (n=1932). Briefly, a standardized assessment of adults' lifetime prevalence of psychiatric disorders was obtained using an amended version of the Composite International Diagnostic Interview, CIDI. In addition, all respondents provided information on their parents' psychiatric history of anxiety, affective disorders, and substance-use disorders.Also, respondents who had 4-16 year old children living in the same household were interviewed using a standardized questionnaire that included specific questions on their children's psychiatric symptoms (n=925 parents, corresponding to 1686 children and adolescents). Familial psychopathology across generations was defined as follows: a) history of psychiatric disorders only in grandparents; b) history of psychiatric disorders in one parent only (mother or father); and, c) history of psychiatric disorders history in grandparents and in parent.The risk of psychiatric morbidity was estimated via odds ratios obtained from logistic regression models with and without random-effects and using Generalized Estimation Equations with robust variance estimation. RESULTS: The risk for psychopathology in the offspring across generations was estimated to be two to three times higher when psychiatric disorders occurred among the parents. The risk of psychiatric disorders was estimated to be higher when comorbidity among different types of disorders was present. Conclusions.The results suggest that the risk for developing psychopathology across generations is at least moderate and relatively stable. Familial transmission of psychopathology across three generations seems to resemble a genetic mixed model.

Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC, Kawakami N, Kiliç C, Offord D, Ustun TB, Wittchen HU. · Institute and Department of Psychiatry, School of Medicine, University of São Paulo, Brazil. · Int J Methods Psychiatr Res. · Pubmed #12830306 No free full text.

Abstract: Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.