Common Mental Disorders

Objectives Common mental disorders (CMDs) are a
major cause of rising disability benefit expenditures. We
urgently need evidence on programmes that can increase
work participation in CMDs. The aim of this study was
to evaluate the effectiveness of work-focused cognitive–
behavioural therapy (CBT) and individual job support for
people struggling with work participation due to CMDs.
Methods A randomised controlled multicentre trial
(RCT) including 1193 participants was conducted.
Participants were on sick leave, at risk of going on sick
leave or on long-term benefits. The intervention
integrated work-focused CBT with individual job support.
The control group received usual care. The main
outcome was objectively ascertained work participation
at 12 months follow-up, with changes in mental health
and health-related quality of life as secondary outcomes.
Results A larger proportion of participants in the
intervention group had increased or maintained their
work participation at follow-up compared to the control
group (44.2% vs 37.2%, p=0.015). The difference
remained significant after 18 months (difference 7.8%,
p=0.018), and was even stronger for those on long-term
benefits (difference 12.2%, p=0.007). The intervention
also reduced depression (t=3.23, p≤0.001) and anxiety
symptoms (t=2.52, p=0.012) and increased healthrelated
quality of life (t=2.24, p=0.026) more than usual
care.
Conclusions A work-focused CBT and individual job
support was more effective than usual care in increasing
or maintaining work participation for people with CMDs.
The effects were profound for people on long-term
benefits. This is the first large-scale RCT to demonstrate
an effect of a behavioural intervention on work
participation for the large group of workers with CMDs.
Trial registration number ClinicalTrials.gov,
registration number: NCT01146730.

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders

The PHASE research programme is an NHS-Executive funded, randomized controlled trial of assisted self-help for common mental disorders, delivered by practice nurses in primary care. The self-help guide - Managing anxiety and depression: a self-help guide published by the Mental Health Foundation - is conceptualized as a ' health technology' where the nurse' s role is to educate patients how

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such ...

Depression and anxiety disorders commonly coexist with drug and alcohol use. Several general population surveys suggest non-linear associations between alcohol and depression symptoms. It is unclear whether such association patterns occur in clinical samples and in the context of poly-substance use. The aim of the study was to investigate the association patterns between substance use and common mental disorder (CMD) severity. Patients accessing a UK outpatient addictions service were recruited sequentially via routine treatment contacts. Psychiatric diagnosis and severity of symptoms were established using the revised clinical interview schedule (CIS-R) structured diagnostic interview; yielding WHO ICD-10 diagnoses for CMD. Data on substance use patterns in the last month and severity of dependence were collected using standardised measures. ANOVA and multivariate regression models were employed to investigate associations between CMD symptom severity and substance use patterns. The results of the multivariate regression analyses indicated a linear association between weekly alcohol use and CIS-R severity; this was statistically significant when adjusting for severity of dependence, poly-substance use, gender and age. Other drug use patterns were not directly associated with overall psychiatric symptom scores, but some evidence was found that specific patterns of drug use correlate with specific psychological symptoms. In conclusion, only alcohol use was significantly associated with psychiatric symptom severity in the context of poly-substance use. Contrary to epidemiological surveys in the general population, no evidence was found for non-linear associations between CMD and substance use in this clinical sample; nor did we find evidence that recent abstinence increases symptom severity.

Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMDs. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually evolving and reconfiguring to ensure that it continues to meet the demands of its clients.

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. 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. 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 responden...

Common mental disorders (CMDs) are highly prevalent in the working population, and are associated with long-term sickness absence and disability. Workers on sick leave with CMDs would benefit from interventions that enable them to successfully return to work (RTW). However, the effectiveness of RTW interventions for workers with a CMD is not well studied. The objective of this review is to assess the effectiveness of existing workplace and clinical interventions that were aimed at enhancing RTW. A systematic review of studies of interventions for improving RTW in workers with a CMD was conducted. The main outcomes were proportion of RTW and sick-leave duration until RTW. Randomized controlled trials (RCTs) were identified from Medline/PubMed, PsycINFO, EMBASE, SocINDEX, and Human resource and management databases from January 1995 to 2016. Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently homogeneous in different comparison groups and assessed the overall quality of the evidence. We reviewed 2347 abstracts from which 136 full-text articles were reviewed and 16 RCTs were included in the analysis. Combined results from these studies suggested that the available interventions did not lead to improved RTW rates over the control group [pooled risk ratio 1.05, 95% confidence interval (CI) 0.97–1.12], but reduced the number of sick-leave days in the intervention group compared to the control group, with a mean difference of −13.38 days (95% CI −24.07 to −2.69).

Objectives The aims of this study were to examine the prevalence of child abuse exposure among Thai people in a suburban community and to describe the association of abuse experiences with common mental disorders (CMD), alcohol use disorders and substance use. Methods A population-based cross-sectional survey was conducted in Northern Bangkok on a representative sample of 202 young residents, aged 16–25 years. Results Thirty eight percent of the respondents reported experiencing some form of abuse during childhood, with 5.8% having been subjected to sexual penetration, 11.7% having been physically abused and 31.8% emotionally abused. A graded relationship was found between the extent of exposure to abuse during childhood and mental problems. After controlling for potential confounders, CMD remained significantly associated with emotional abuse, and alcohol use disorders remained associated with sexual abuse. Strong but non-significant trends were present for associations between CMD and sexual abuse and all forms of abuse with substance use. Conclusion Child abuse experiences were common among the respondents. Childhood abuse, particularly sexual abuse, has a potentially devastating impact on adult mental health.

Background Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. Method Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n=199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness. Results The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation. Conclusions A quarter of cases of CMD were likely t...

Background. This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psych-osis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory.