Anxiety Disorders: Levav I

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.

Kohn R, Saxena S, Levav I, Saraceno B. · Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. · Bull World Health Organ. · Pubmed #15640922 links to  free full text

Abstract: 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.

Shemesh AA, Kohn R, Radomislensky I, Brodsky J, Levav I. · Health Economics, Ministry of Health, Jerusalem, Israel. · Isr J Psychiatry Relat Sci. · Pubmed #19439828 links to  free full text

Abstract: BACKGROUND: In prior community studies survivors of the Shoa (Hebrew for Holocaust) scored higher on emotional distress (ED) than Europe-born Jews who were not in Nazi-occupied countries during World War II (WWII). OBJECTIVE: Are elderly Shoa survivors, who by definition have survived the difficulties of a long life, equally distressed? ED was assessed among a population of elderly survivors living in the community, about 55 years after the end of WWII. ED was also examined by the severity of exposure to adverse life conditions during the war. In addition, other health-related dimensions, e.g., sleep disturbances and social activities, were measured. METHODS: A national survey of 5,055 respondents, of whom 4,231 were Jewish-Israelis, was conducted among community residents aged 60 years and over. The research population included former residents of Nazi-occupied countries (N=896). This group was compared with Europe- and America-born individuals who resided elsewhere during WWII (N=331). All respondents were administered, among many other items, the 12-GHQ to measure ED and a questionnaire that included socio-demographic and other health-related variables. Bivariate and multivariate methods of analysis were used to compare distributions and to identify relevant factors. RESULTS: The group of elderly survivors was significantly more distressed than the comparison group. Individuals who had been in ghettos, hiding, or labor or extermination camps had higher mean scores than survivors who were in Nazi-occupied countries, but were spared those experiences. Multivariate analysis showed that the direct effect of the Shoa experience was no longer evident when two other Shoa-dependent variables, years of education and number of chronic health conditions, were entered into the model. Sleep disturbances were more often present in the survivors than among their counterparts, including after controlling for other variables. Social activities that contribute to well-being were more limited among survivors. CONCLUSION: Fifty years after WWII there was partial evidence of increased emotional distress among our group of elderly survivors, and clear evidence for the presence of adverse effects on other health-related dimensions and pleasurable activities.

Mirsky J, Kohn R, Levav I, Grinshpoon A, Ponizovsky AM. · Ben-Gurion University, Beer-Sheva, Israel. · J Clin Psychiatry. · Pubmed #19026255 No free full text.

Abstract: BACKGROUND: The Israel National Health Survey (INHS), the local component of the World Mental Health Survey, was designed to estimate the prevalence rates of common mental disorders and psychological distress in the total adult population. This report focuses on the immigrant population and explores 2 alternative hypotheses about the association between migration and psychiatric morbidity-the migration-morbidity hypothesis and the healthy-immigrant hypothesis. METHOD: The INHS included face-to-face interviews, conducted from May 2003 to April 2004, with 2114 Israeli-born Jewish respondents and 844 post-1990 immigrants from the former Soviet Union (FSU). Psychological distress was measured with the 12-item General Health Questionnaire, and psychiatric disorders were diagnosed with the World Mental Health version of the Composite International Diagnostic Interview. RESULTS: Psychological distress among FSU immigrants was significantly higher than among their Israeli-born counterparts for both genders. Twelve-month prevalence rates of common mental disorders were generally higher in the FSU group of immigrants than in the comparison group (any disorder: men, 9.5% vs. 8.7%, OR = 1.57 [95% CI = 1.44 to 1.71]; women, 12.5% vs. 9.5%, OR = 1.42 [95% CI = 1.33 to 1.53] and mood disorders: men, 5.6% vs. 4.4%, OR = 1.37 [95% CI = 1.27 to 1.54]; women, 8.6% vs. 7.3%, OR = 1.17 [95% CI = 1.07 to 1.28]). CONCLUSION: The findings, which generally support the migration-morbidity hypothesis, are discussed in light of the nonselective migration policy implemented in Israel. Additional factors such as length of residence in the host country, immigration circumstances, and ethnicity are associated with immigrants' mental health and need further investigation.

Gal G, Kaplan G, Gross R, Levav I. · Mental Health Epidemiology and Psychosocial Aspects of Illness, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #18587675 No free full text.

Abstract: OBJECTIVE: Research on status inconsistency (SI) and its impact on mental health has been dormant for many years. This study tested the association between SI and emotional distress, anxiety and mood disorders. METHODS: Data were gathered from the Israel-based component of the World Mental Health Survey (n = 4,859). SI was defined by the combination of high education (13+ years) with low income (1st decile). Mood and anxiety disorders were diagnosed with the composite international diagnostic instrument (CIDI), and emotional distress was measured with the 12-item general health questionnaire (GHQ-12). RESULTS: Multivariate analysis showed increased risk for mood or anxiety disorders among SI subjects (n = 231), odds ratio (OR) = 1.75, 95% confidence interval (95% CI) 1.13-2.63. The estimate was slightly attenuated when marital status was added to the model (OR = 1.55, 95% CI 1.0-2.39). SI subjects showed higher GHQ-12 scores. CONCLUSION: SI, which can disrupt an individual's sense of coherence, is associated, although not causally, with increased 12 month prevalence rates for mood or anxiety disorders and with higher psychological distress.

Levinson D, Lerner Y, Zilber N, Grinshpoon A, Levav I. · Mental Health Services, Ministry of Health, Rivka 29, Jerusalem, Israel. · Isr J Psychiatry Relat Sci. · Pubmed #18080648 links to  free full text

Abstract: OBJECTIVE: To measure the 12-month utilization rates for mental health reasons in all types of services. METHOD: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older were interviewed at their homes between May 2003 and April 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: About 10% of the adult population receives some type of treatment for emotional or mental health problems within a single year. More than half of service consumers were not classified as suffering from mood or anxiety disorders. Of those diagnosed with mood or anxiety disorders in the past 12 months only about 50% used any type of service for mental health problems. CONCLUSION: There is only a partial overlap between those who utilize the services and those who meet the criteria for a clinical diagnosis of mental disorder.

Levav I, Al-Krenawi A, Ifrah A, Geraisy N, Grinshpoon A, Khwaled R, Levinson D. · Mental Health Services, Ministry of Health, Jerusalem, Israel. · Isr J Psychiatry Relat Sci. · Pubmed #18080647 links to  free full text

Abstract: OBJECTIVES: Psychiatric epidemiological data on Arab populations are generally scanty. This community-based survey, a component of the World Health Organization's 27-country study, explored the prevalence rates of anxiety and mood disorders, emotional distress and help-seeking practices among Arab-Israelis, and compared them with those found among Jewish-Israelis. METHODS: Close to 5,000 non-institutionalized individuals were interviewed with the WHO/Composite International Diagnostic Interview (CIDI) to determine the prevalence rates of selected psychiatric diagnoses, and with the 12-item General Health Questionnaire (GHQ) to measure emotional distress. The schedule included other items, e.g., socio-demographic variables and help-seeking practices. RESULTS: Arab-Israelis, in contrast to Jewish-Israelis, had higher mean GHQ-12 scores and lower self-appraisal of mental health. Twelve-month prevalence rates for any anxiety or affective disorder were not significantly higher among Arab-Israelis. Among respondents with diagnosed disorders, rates of help-seeking from specialized health services were lower among Arab-Israelis than among Jewish-Israelis. Intention to consult was elicited from both groups when the disorders were accompanied by higher distress scores. CONCLUSIONS: Despite major health gains, the social stresses impacting the Arab-Israeli minority may explain both the higher emotional distress and lower self-appraisal of mental health. However, no impact was observed of social causation factors on the rates of common mental disorders in the Arab-Israeli group. Cultural factors, including the definition of disorders and stigma and a lesser availability of culturally-tailored services, could account for the marked treatment gap.

Levinson D, Zilber N, Lerner Y, Grinshpoon A, Levav I. · Mental Health Services, Ministry of Health, Jerusalem, Israel. · Isr J Psychiatry Relat Sci. · Pubmed #18080646 links to  free full text

Abstract: OBJECTIVE: To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. METHOD: A representative sample of respondents extracted from the National Population Register of non-institutionalized residents, aged 21 or older, were interviewed at home between May, 2003, and April, 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview. RESULTS: Seventeen percent of the sampled adult population reported a lifetime occurrence of a mood or anxiety disorder, while nearly one in 10 (9.7%) reported a mood or anxiety disorder occurring during the previous 12 months. Mood disorders were twice as common as anxiety disorders. CONCLUSION: Contrary to expectations born out of Israel's unique life circumstances, the prevalence of mood or anxiety disorders fall within the range of other western countries. However, given the current age structure and the age of onset of these disorders, their total burden in the near future is likely to increase.

Kohn R, Levav I, Donaire I, Machuca M, Tamashiro R. · Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island 02906, USA. · Rev Panam Salud Publica. · Pubmed #16354426 No free full text.

Abstract: BACKGROUND: Posttraumatic stress disorder (PTSD) and other psychopathological outcomes have not been sufficiently studied in community-based samples in Latin America. This study explored various psychopathological reactions and their respective risk factors two months after Hurricane Mitch struck Honduras in October 1998. METHODS: In the Honduran capital of Tegucigalpa, 800 respondents age 15 and older were selected from residential areas of high, middle, or low socioeconomic status that had suffered either high or low impact from the devastating effects of the hurricane. The Composite International Diagnostic Interview was used to diagnose PTSD. Depression, alcohol misuse, and grief reaction were examined using screening instruments, and the Self-Reporting Questionnaire was used to measure demoralization. The Impact of Event Scale was administered to ascertain the severity of the posttraumatic reaction. RESULTS: PTSD was present in 10.6% of the sample. Respondents from the high-impact residential areas were more distressed, had higher scores on the grief inventory, and showed greater severity in PTSD symptoms. The respondents from the high-impact residential areas also had higher prevalence rates of major depression, alcoholism, and prior emotional problems. The best explanatory model for the risk of developing PTSD included the degree of exposure based on reported traumatic events, and associated increased demoralization. Among the persons with PTSD, its severity was predicted by being female and by the degree of exposure to hurricane-related traumatic events. CONCLUSIONS: Out of a total population of 3.3 million adults (age 15 and older) in Honduras, it is estimated that over 492,000 of them may have developed PTSD due to Hurricane Mitch. Adequate health disaster preparedness and response requires full acknowledgement of the multiple psychological effects that victims experience.

Kohn R, Levav I, Garcia ID, Machuca ME, Tamashiro R. · Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA. · Int J Geriatr Psychiatry. · Pubmed #16116578 No free full text.

Abstract: OBJECTIVES: This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. RESULTS: PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. CONCLUSION: No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.

Selten JP, Cantor-Graae E, Nahon D, Levav I, Aleman A, Kahn RS. · Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, Ref. Nr A00.241, The Netherlands. · Schizophr Res. · Pubmed #12892867 No free full text.

Abstract: AIM: Maternal stress during pregnancy is a possible risk factor for schizophrenia in the offspring. Using data from the Israel Psychiatric Registry we examined the impact of wars in Israel. METHOD: Retrospective birth cohort study. RESULTS: Relative risks for cohorts exposed to Six-Day War and Yom Kippur War were 0.98 (95% CI: 0.85-1.13) and 1.00 (0.86-1.16). CONCLUSION: The evidence for maternal stress as a risk factor for schizophrenia remains insufficient.