Publications by authors named "Yueqin Huang"

99 Publications

Treatment for Major Depressive Disorder by Repetitive Transcranial Magnetic Stimulation in Different Parameters: A Randomized Double-Blinded Controlled Trial.

Front Psychiatry 2021 6;12:623765. Epub 2021 Apr 6.

National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China.

Repetitive transcranial magnetic stimulation (rTMS) has been proven to be safe and effective in treating major depressive disorder (MDD). However, the treatment parameters of rTMS are still divergent and need to be optimized further. The aim of this study was to compare the efficacy of rTMS in treating MDD with different parameters of stimulating frequency and location, and course of treatment. A total of 221 patients with MDD were recruited in the randomized, double-blind, controlled trial. All eligible patients were randomly assigned into four treatment groups: (1) 10 Hz in left dorsolateral pre-frontal cortex (DLPFC) ( = 55), (2) 5 Hz in left DLPFC ( = 53), (3) 10 Hz in bilateral DLPFC ( = 57), and (4) 5 Hz in bilateral DLPFC ( = 56). The patients received treatment for 6 weeks and an additional 6-week optional treatment. The efficacies were evaluated by Hamilton Depression Rating Scale-24 items (HDRS) and Clinical Global Impressions Scale (CGI). The trial is registered at the Chinese Clinical Trial Registry as ChiCTR-TRC-12002248. The ANOVAs of HDRS scores up to 6 weeks and 12 weeks with repeated measure of time showed a significant effect of duration without statistical difference among four treatment groups and no significance when time was interacted with inter-group as well. The response rates up until the 5th week were significantly different with the previous week. It concludes that there were no statistical differences in the efficacy of rTMS between unilateral left and bilateral DLPFC, and between 5 and 10 Hz for treating MDD.
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http://dx.doi.org/10.3389/fpsyt.2021.623765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055955PMC
April 2021

Incidence and Risk Factors of Depressive Symptoms in Chinese College Students.

Neuropsychiatr Dis Treat 2020 23;16:2449-2457. Epub 2020 Oct 23.

Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, People's Republic of China.

Purpose: Previous surveys have shown an increase in the prevalence of depression among college students. However, knowledge on the incidence and risk factors of depressive symptoms in Chinese college students is limited. The aim of the present study was to determine the two-year cumulative incidence of depressive symptoms in Chinese college freshmen and identified related psychosocial risk factors.

Patients And Methods: A prospective survey was used to examine the cumulative incidence and risk factors of depressive symptoms (as assessed by the Centre for Epidemiological Study-Depression Scale, CES-D) among undergraduate freshmen. Five times (baseline, 5, 12, 17, and 24 months later) of self-reported data were collected from the students.

Results: Of the initial 758 non-depressed respondents at baseline, 235 developed depressive symptoms (CES-D ≥ 16) during the follow-up period. The two-year cumulative incidence was estimated to be 42% and not significantly different between males and females (χ2=3.138, =1, p=0.077). Logistic regression model showed that female gender (OR=0.43, 95% CI (0.28-0.64)), high level of self-esteem (OR=0.67, 95% CI (0.52-0.86)), and moderate exercise (OR=0.71, 95% CI (0.55-0.92)) reduced the onset of depressive symptoms; while high levels of baseline anxiety (OR=1.48, 95% CI (1.12-1.94)), Eysenck Personality Questionnaire-Neuroticism (OR=1.40, 95% CI (1.09-1.79)), concern over mistakes (OR=1.35,95% CI (1.07-1.71)), daytime sleepiness (OR=1.28, 95% CI (1.02-1.60)), mild exercise (OR=1.25, 95% CI (1.01-1.55)) increased the new onset of depressive symptoms.

Conclusion: The high two-year cumulative incidence indicates that depressive symptoms are an important mental problem in Chinese college students. The present findings on the risk factors of depressive symptoms in Chinese college students may be useful for the design of student health screening and intervention programs.
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http://dx.doi.org/10.2147/NDT.S264775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591009PMC
October 2020

Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies.

BMC Public Health 2020 Sep 1;20(1):1330. Epub 2020 Sep 1.

Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.

Background: A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.

Methods: This study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants' residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health.

Results: Living far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).

Conclusions: The different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.
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http://dx.doi.org/10.1186/s12889-020-09435-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465327PMC
September 2020

The association between frailty and incidence of dementia in Beijing: findings from 10/66 dementia research group population-based cohort study.

BMC Geriatr 2020 04 15;20(1):138. Epub 2020 Apr 15.

Global Health Institute, King's College London, London, UK.

Background: The relationship between frailty and dementia is unclear and there are very few population-based studies regarding this issue in China. The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence.

Methods: A five-year prospective cohort study was carried out in 2022 participants aged 65 years and over in urban and rural sites in Beijing, China. The participants were interviewed by trained community primary health care workers from 2004 to 2009. Frailty was defined using modified Fried frailty phenotype, physical frailty definition, and multidimensional frailty definition. Dementia was diagnosed using the 10/66 dementia criterion for calculating cumulative incidence. Both competing risk regression models and Cox proportional hazards models were applied to examine the associations between frailty at baseline and five-year cumulative incidence of dementia.

Results: At the end of follow-up the five-year cumulative incidence rates of dementia with frailty and without frailty defined by the modified Fried frailty were 21.0% and 9.6%, those defined by the physical frailty were 19.9% and 9.0%, and those defined by the multidimensional frailty were 22.8% and 8.9%, respectively. Compared with non-frail participants, frail people had a higher risk of incident dementia using multidimensional frailty definition after adjusting covariates based on competing risk regression model (HR = 1.47, 95% CI 1.01~2.17) and Cox proportional hazards model (HR = 1.56, 95% CI 1.07~2.26). The association between frailty and incident dementia was statistically significant in participants in the upper three quartiles of age (aged 68 years and over) using the multidimensional frailty definition based on the competing risk regression model (HR = 1.61, 95% CI 1.06~2.43) and Cox proportional hazard model (HR = 1.76, 95% CI 1.19~2.61).

Conclusions: Multidimensional frailty may play an inherent role in incident dementia, especially in the people aged over 68, which is significant for distinguishing high risk people and determining secondary prevention strategies for dementia patients.
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http://dx.doi.org/10.1186/s12877-020-01539-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158148PMC
April 2020

The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study.

Int J Geriatr Psychiatry 2020 01 24;35(1):29-36. Epub 2019 Oct 24.

King's College London, Social Epidemiology Research Group, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

Objectives: Depression and anxiety are common mental disorders in later life. Few population-based studies have investigated their potential impacts on mortality in low- and middle-income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity, and mortality in later life using a population-based cohort study across eight LMICs.

Methods: This analysis was based on the 10/66 cohort study including 15 991 people aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China, and India, with an average follow-up time of 3.9 years. Subthreshold and clinical levels of depression were determined using EURO-D and ICD-10 criteria, and anxiety was based on Geriatric Mental State (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard modelling was used to estimate how having depression, anxiety, or both was associated with mortality adjusting for sociodemographic and health factors.

Results: Participants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24-1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15-1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Comorbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I  = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21-3.27).

Conclusions: Depression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.
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http://dx.doi.org/10.1002/gps.5211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916169PMC
January 2020

The comorbidity of mental and physical disorders with self-reported chronic back or neck pain: Results from the China Mental Health Survey.

J Affect Disord 2020 01 29;260:334-341. Epub 2019 Aug 29.

Department of Biostatistics, School of Public Health, School of Government, and Institute of Social Science Survey, Peking University, Beijing, China.

Background: To investigate mental and physical health comorbidity with chronic back or neck pain in the Chinese population, and assess the level of disability associated with chronic back or neck pain.

Methods: Data were derived from a large-scale and nationally representative community survey of adult respondents on mental health disorders in China (n = 28,140). Chronic back or neck pain, other chronic pain conditions and chronic physical conditions were assessed by self-report. Mental disorders were assessed by the Composite International Diagnostic Interview (CIDI). Role disability during the past 30 days was assessed with the World Health Organization Disability Assessment Schedule (WHO-DAS-II).

Results: The 12-month prevalence of chronic back or neck pain was 10.8%. Most of respondents with chronic back or neck pain (71.2%) reported at least one other comorbid condition, including other chronic pain conditions (53.4%), chronic physical conditions (37.9%), and mental disorders (23.9%). It was found by logistic regression that mood disorders (OR = 3.7, 95%CI:2.8-4.8) showed stronger association with chronic back or neck pain than anxiety disorders and substance disorders. Most common chronic pains and physical conditions were significantly associated with chronic back or neck pain. Chronic back or neck pain was associated with role disability after controlling for demographics and for comorbidities. Physical and mental comorbidities explained 0.7% of the association between chronic back or neck pain and role disability.

Conclusions: Chronic back or neck pain and physical-mental comorbidity is very common in China and chronic back or neck pain may increase the likelihood of other physical and mental diseases. This presents a great challenge for both clinical treatment and public health education. We believe that further study needs to be conducted to improve the diagnostic and management skills for comorbidity conditions.
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http://dx.doi.org/10.1016/j.jad.2019.08.089DOI Listing
January 2020

Prevalence of mental disorders in China - Author's reply.

Authors:
Yueqin Huang

Lancet Psychiatry 2019 06;6(6):468

Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China. Electronic address:

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http://dx.doi.org/10.1016/S2215-0366(19)30177-4DOI Listing
June 2019

Prevalence of mental disorders in China: a cross-sectional epidemiological study.

Lancet Psychiatry 2019 Mar 18;6(3):211-224. Epub 2019 Feb 18.

Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.

Background: The China Mental Health Survey was set up in 2012 to do a nationally representative survey with consistent methodology to investigate the prevalence of mental disorders and service use, and to analyse their social and psychological risk factors or correlates in China. This paper reports the prevalence findings.

Methods: We did a cross-sectional epidemiological survey of the prevalence of mental disorders (mood disorders, anxiety disorders, alcohol-use and drug-use disorders, schizophrenia and other psychotic disorders, eating disorder, impulse-control disorder, and dementia) in a multistage clustered-area probability sample of adults from 157 nationwide representative population-based disease surveillance points in 31 provinces across China. Face-to-face interviews were done with a two-stage design by trained lay interviewers and psychiatrists with the Composite International Diagnostic Interview, the Structured Clinical Interview for DSM-IV Axis I disorders, the Community Screening Instrument for Dementia from the 10/66 dementia diagnostic package, and the Geriatric Mental State Examination. Data-quality control procedures included logic check by computers, sequential recording check, and phone-call check by the quality controllers, and reinterview check by the psychiatrists. Data were weighted to adjust for differential probabilities of selection and differential response as well as to post-stratify the sample to match the population distribution.

Findings: 32 552 respondents completed the survey between July 22, 2013, and March 5, 2015. The weighted prevalence of any disorder (excluding dementia) was 9·3% (95% CI 5·4-13·3) during the 12 months before the interview and 16·6% (13·0-20·2) during the participants' entire lifetime before the interview. Anxiety disorders were the most common class of disorders both in the 12 months before the interview (weighted prevalence 5·0%, 4·2-5·8) and in lifetime (7·6%, 6·3-8·8). The weighted prevalence of dementia in people aged 65 years or older was 5·6% (3·5-7·6).

Interpretation: The prevalence of most mental disorders in China in 2013 is higher than in 1982 (point prevalence 1·1% and lifetime prevalence 1·3%), 1993 (point prevalence 1·1% and lifetime prevalence 1·4%), and 2002 (12-month prevalence 7·0% and lifetime prevalence 13·2%), but lower than in 2009 (1-month prevalence 17·5%). The evidence from this survey poses serious challenges related to the high burdens of disease identified, but also offers valuable opportunities for policy makers and health-care professionals to explore and address the factors that affect mental health in China.

Funding: National Health Commission of Health (Ministry of Health) and Ministry of Science and Technology of China.
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http://dx.doi.org/10.1016/S2215-0366(18)30511-XDOI Listing
March 2019

Dependence- and Disability-Free Life Expectancy Across Eight Low- and Middle-Income Countries: A 10/66 Study.

J Aging Health 2020 Jun/Jul;32(5-6):401-409. Epub 2019 Jan 30.

King's College London, UK.

The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence and disability from the 10/66 cohort study, which included 16,990 people aged 65 or above in China, Cuba, Dominican Republic, India, Mexico, Peru, Puerto Rico, and Venezuela, and country-specific life tables from the World Population Prospects 2017. DFLE and DepFLE declined with older age across all sites and were higher in women than men. Mexico reported the highest DFLE at age 65 for men (15.4, = 0.5) and women (16.5, = 0.4), whereas India had the lowest with (11.5, = 0.3) in men and women (11.7, = 0.4). Healthy life expectancy based on disability and dependency can be a critical indicator for aging research and policy planning in LMICs.
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http://dx.doi.org/10.1177/0898264319825767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322974PMC
December 2020

A descriptive epidemiological study of disability prevalence attributed to neurotic disorders in China.

Psychiatry Res 2019 02 21;272:398-403. Epub 2018 Dec 21.

Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China.

This study estimated the prevalence, correlates, severity and functional impairment of disabilities attributed to neurotic disorders in the Chinese population. Data from a representative national sample of 2,526,145 non-institutionalized residents were obtained from the Second China National Sample Survey on Disabilities (CNSSD) in 2006. The data were analyzed to estimate prevalence, correlates, severity and functional impairment of disability attributable to neurotic disorders by gender, age, region, and other key socio-demographic and economic factors. The disability prevalence attributed to neurotic disorders was 0.032% (805/2,526,145) in China. Women, rural residents, unemployed job status, low education level and those who were divorced or widowed showed higher prevalence rates than their counterparts. Proportions of mild, moderate, severe and extremely severe of neurotic attributed disability only accounted for 78.48%, 9.14%, 6.5% and 5.9%, respectively. Finally, these findings provide evidence that, prevalence rates of disability attributable to neurotic disorders vary greatly among different population groups and regions. Multiple disabilities including disability attributable to neurotic disorders can bring much more impairment to individuals than disability attributable to neurotic disorder only.
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http://dx.doi.org/10.1016/j.psychres.2018.12.113DOI Listing
February 2019

Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries.

Lancet Psychiatry 2019 02 15;6(2):174-186. Epub 2018 Nov 15.

Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Integrated care is defined as health services that are managed and delivered such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services, coordinated across the different levels and sites of care within and beyond the health sector and, according to their needs, throughout the life course. In this Review, we describe the most relevant concepts and models of integrated care for people with chronic (or recurring) mental illness and comorbid physical health conditions, provide a conceptual overview and a narrative review of the strength of the evidence base for these models in high-income countries and in low-income and middle-income countries, and identify opportunities to test the feasibility and effects of such integrated care models. We discuss the rationale for integrating care for people with mental disorders into chronic care; the models of integrated care; the evidence of the effects of integrating care in high-income countries and in low-income and middle-income countries; the key organisational challenges to implementing integrated chronic care in low-income and middle-income countries; and the practical steps to realising a vision of integrated care in the future.
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http://dx.doi.org/10.1016/S2215-0366(18)30298-0DOI Listing
February 2019

Prevalence, risk factors and multi-group latent class analysis of lifetime anxiety disorders comorbid depressive symptoms.

J Affect Disord 2019 01 18;243:360-365. Epub 2018 Sep 18.

Chifeng Anding Hospital, Chifeng, Inner Mongolia, 024000, China.

Background: Previous studies about comorbidity have primarily focused on disorders based on diagnostic criteria instead of symptoms. This study aimed to describe the prevalence and risk factors of anxiety comorbid depression based on a population-based sample in Chifeng City Inner Mongolia and explored the gender differences of depressive subtypes in anxiety patients.

Methods: This study was a cross-sectional study conducted among 6376 community residents. Logistics analysis and multiple-group latent class analysis was used in exploring the risk factors and subtypes of anxiety comorbid depressive symptoms.

Results: A total of 4528 respondents were interviewed in this study. The lifetime prevalence estimates for anxiety in the total sample was 5.70%. Among residents who had ever had anxiety, most of them reported having depressive symptoms while 15.79% of them met the criteria of MDD. Logistics analysis showed childhood adversities were associated with anxiety comorbid depressive symptoms. The results of multiple-group latent class analysis showed that the latent class probabilities were different between males and females.

Conclusion: The prevalence rates of comorbidity were similar to the reports of previous regional surveys in China with statistically significant differences of comorbidity occurring between males and females. Precision prevention should therefore be targeted towards different kinds of populations.
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http://dx.doi.org/10.1016/j.jad.2018.09.053DOI Listing
January 2019

Psychiatric Epidemiology and Mental Health Service in the Tibet Autonomous Region of the People's Republic of China.

Shanghai Arch Psychiatry 2018 Apr;30(2):127-130

Mental health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.

Little is known internationally about the psychiatric epidemiology and mental health services in Tibet. This article reviews the relevant research of psychiatric epidemiology and mental health services in the Tibet Autonomous Region (TAR), P. R. China. There is a substantive number of people suffering from mental disorders and psychological problems in an area with a general lack of modern mental health institutions and professionals.
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http://dx.doi.org/10.11919/j.issn.1002-0829.217148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936039PMC
April 2018

Psychiatric Epidemiology and Mental Health Service in the Tibet Autonomous Region of the People's Republic of China.

Shanghai Arch Psychiatry 2018 Apr;30(2):127-130

Mental health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.

Little is known internationally about the psychiatric epidemiology and mental health services in Tibet. This article reviews the relevant research of psychiatric epidemiology and mental health services in the Tibet Autonomous Region (TAR), P. R. China. There is a substantive number of people suffering from mental disorders and psychological problems in an area with a general lack of modern mental health institutions and professionals.
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http://dx.doi.org/10.11919/j.issn.1002-0829.217148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936039PMC
April 2018

A cohort study of the effects of older adult care dependence upon household economic functioning, in Peru, Mexico and China.

PLoS One 2018 13;13(4):e0195567. Epub 2018 Apr 13.

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, London, United Kingdom.

Background: While links between disability and poverty are well established, there have been few longitudinal studies to clarify direction of causality, particularly among older adults in low and middle income countries. We aimed to study the effect of care dependence among older adult residents on the economic functioning of their households, in catchment area survey sites in Peru, Mexico and China.

Methods: Households were classified from the evolution of the needs for care of older residents, over two previous community surveys, as 'incident care', 'chronic care' or 'no care', and followed up three years later to ascertain economic outcomes (household income, consumption, economic strain, satisfaction with economic circumstances, healthcare expenditure and residents giving up work or education to care).

Results: Household income did not differ between household groups. However, income from paid work (Pooled Count Ratio pCR 0.88, 95% CI 0.78-1.00) and government transfers (pCR 0.80, 95% CI 0.69-0.93) were lower in care households. Consumption was 12% lower in chronic care households (pCR 0.88, 95% CI 0.77-0.99). Household healthcare expenditure was higher (pCR 1.55, 95% CI 1.26-1.90), and catastrophic healthcare spending more common (pRR 1.64, 95% CI 1.64-2.22) in care households.

Conclusions: While endogeneity cannot be confidently excluded as an explanation for the findings, this study indicates that older people's needs for care have a discernable impact on household economics, controlling for baseline indicators of long-term economic status. Although living, typically, in multigenerational family units, older people have not featured prominently in global health and development agendas. Population ageing will rapidly increase the number of households where older people live, and their societal significance. Building sustainable long-term care systems for the future will require some combination of improved income security in old age; incentivisation of informal care through compensation for direct and opportunity costs; and development of community care services to support, and, where necessary, supplement or substitute the central role of informal caregivers.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195567PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898721PMC
July 2018

Leg length, skull circumference, and the incidence of dementia in Latin America and China: A 10/66 population-based cohort study.

PLoS One 2018 12;13(4):e0195133. Epub 2018 Apr 12.

Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

Background: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. Cross-sectional studies indicate inverse associations with dementia risk, but there have been few prospective studies.

Methods: Population-based cohort studies in urban sites in Cuba, Dominican Republic Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, and anthropometric measures taken, with ascertainment of incident dementia, and mortality, three to five years later.

Results: Of the original at risk cohort of 13,587 persons aged 65 years and over, 2,443 (18.0%) were lost to follow-up; 10,540 persons with skull circumference assessments were followed up for 40,466 person years, and 10,400 with leg length assessments were followed up for 39,954 person years. There were 1,009 cases of incident dementia, and 1,605 dementia free deaths. The fixed effect pooled meta-analysed adjusted subhazard ratio (ASHR) for leg length (highest vs. lowest quarter) was 0.80 (95% CI, 0.66-0.97) and for skull circumference was 1.02 (95% CI, 0.84-1.25), with no heterogeneity of effect between sites (I2 = 0%). Leg length measurements tended to be shorter at follow-up, particularly for those with baseline cognitive impairment and dementia. However, leg length change was not associated with dementia incidence (ASHR, per cm 1.006, 95% CI 0.992-1.020), and the effect of leg length was little altered after adjusting for baseline frailty (ASHR 0.82, 95% CI 0.67-0.99). A priori hypotheses regarding effect modification by gender or educational level were not supported. However, the effect of skull circumference was modified by gender (M vs F ASHR 0.86, 95% CI 0.75-0.98), but in the opposite direction to that hypothesized with a greater protective effect of larger skull dimensions in men.

Conclusions: Consistent findings across settings provide quite strong support for an association between adult leg length and dementia incidence in late-life. Leg length is a relatively stable marker of early life nutritional programming, which may confer brain reserve and protect against neurodegeneration in later life through mitigation of cardiometabolic risk. Further clarification of these associations could inform predictive models for future dementia incidence in the context of secular trends in adult height, and invigorate global efforts to improve childhood nutrition, growth and development.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195133PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896923PMC
July 2018

Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study.

PLoS One 2018 28;13(2):e0192889. Epub 2018 Feb 28.

Medical University of Matanzas, Matanzas, Cuba.

Background: Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence.

Methods: Population-based cohort studies of women aged 65 years and over in urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche, birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five years later.

Results: 9,428 women participated at baseline, with 72-98% responding by site. The 'at risk' cohort comprised 8,466 dementia-free women. Mean age varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in Latin America. Mean parity was 4.1 (2.4-7.2 by site), generally higher in rural than urban sites. 6,854 women with baseline reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895 dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio [ASHR] 1.001, 95% CI 0.988-1.015) did not support any association with dementia incidence, with no evidence for effect modification by APOE genotype. No association was observed between incident dementia and; ages at menarche, birth of first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002-1.059, I2 = 0.0%).

Conclusions: We found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences dementia incidence in late life.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192889PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831083PMC
April 2018

Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study.

PLoS One 2018 28;13(2):e0192889. Epub 2018 Feb 28.

Medical University of Matanzas, Matanzas, Cuba.

Background: Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence.

Methods: Population-based cohort studies of women aged 65 years and over in urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche, birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five years later.

Results: 9,428 women participated at baseline, with 72-98% responding by site. The 'at risk' cohort comprised 8,466 dementia-free women. Mean age varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in Latin America. Mean parity was 4.1 (2.4-7.2 by site), generally higher in rural than urban sites. 6,854 women with baseline reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895 dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio [ASHR] 1.001, 95% CI 0.988-1.015) did not support any association with dementia incidence, with no evidence for effect modification by APOE genotype. No association was observed between incident dementia and; ages at menarche, birth of first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002-1.059, I2 = 0.0%).

Conclusions: We found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences dementia incidence in late life.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192889PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831083PMC
April 2018

The Prevalence and Correlates of Frailty in Urban and Rural Populations in Latin America, China, and India: A 10/66 Population-Based Survey.

J Am Med Dir Assoc 2018 04 3;19(4):287-295.e4. Epub 2018 Jan 3.

Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. Electronic address:

Background: There have been few cross-national studies of the prevalence of the frailty phenotype conducted among low or middle income countries. We aimed to study the variation in prevalence and correlates of frailty in rural and urban sites in Latin America, India, and China.

Methods: Cross-sectional population-based catchment area surveys conducted in 8 urban and 4 rural catchment areas in 8 countries; Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico, China, and India. We assessed weight loss, exhaustion, slow walking speed, and low energy consumption, but not hand grip strength. Therefore, frailty phenotype was defined on 2 or more of 4 of the usual 5 criteria.

Results: We surveyed 17,031 adults aged 65 years and over. Overall frailty prevalence was 15.2% (95% confidence inteval 14.6%-15.7%). Prevalence was low in rural (5.4%) and urban China (9.1%) and varied between 12.6% and 21.5% in other sites. A similar pattern of variation was apparent after direct standardization for age and sex. Cross-site variation in prevalence of frailty indicators varied across the 4 indicators. Controlling for age, sex, and education, frailty was positively associated with older age, female sex, lower socioeconomic status, physical impairments, stroke, depression, dementia, disability and dependence, and high healthcare costs.

Discussion: There was substantial variation in the prevalence of frailty and its indicators across sites in Latin America, India, and China. Culture and other contextual factors may impact significantly on the assessment of frailty using questionnaire and physical performance-based measures, and achieving cross-cultural measurement invariance remains a challenge.

Conclusions: A consistent pattern of correlates was identified, suggesting that in all sites, the frailty screen could identify older adults with multiple physical, mental, and cognitive morbidities, disability and needs for care, compounded by socioeconomic disadvantage and catastrophic healthcare spending.
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http://dx.doi.org/10.1016/j.jamda.2017.09.026DOI Listing
April 2018

Trauma and PTSD in the WHO World Mental Health Surveys.

Eur J Psychotraumatol 2017 27;8(sup5):1353383. Epub 2017 Oct 27.

Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.

: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' : To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. : WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. : In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. : Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.
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http://dx.doi.org/10.1080/20008198.2017.1353383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632781PMC
October 2017

Neighbourhood characteristics and mental disorders in three Chinese cities: multilevel models from the World Mental Health Surveys.

BMJ Open 2017 Oct 11;7(10):e017679. Epub 2017 Oct 11.

Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.

Objectives: The rapid growth of urban areas in China in the past few decades has introduced profound changes in family structure and income distribution that could plausibly affect mental health. Although multilevel studies of the influence of area-level socioeconomic factors on mental health have become more common in other parts of the world, a study of this sort has not been carried out in Chinese cities. Our objectives were to examine the associations of two key neighbourhood-level variables-median income and percentage of married individuals living in the neighbourhood-with mental disorders net of individual-level income and marital status in three Chinese cities.

Setting: Household interviews in Beijing, Shanghai and Shenzhen, PRC, as part of the cross-sectional World Mental Health Surveys.

Participants: 4072 men and women aged 18-88 years.

Primary And Secondary Outcome Measures: Lifetime and past-year internalising and externalising mental disorders.

Results: Each one-point increase in neighbourhood-level percentage of married residents was associated with a 1% lower odds of lifetime (p=0.024) and 2% lower odds of past-year (p=0.008) individual-level externalising disorder, net of individual-level marital status. When split into tertiles, individuals living in neighbourhoods in the top tertile of percentage of married residents had 54% lower odds of a past-year externalising disorder (OR=0.46, 95% CI: 0.24 to 0.87) compared with those in the bottom tertile. Neighbourhood-level marital status was not statistically associated with either lifetime or past-year internalising disorders. Neighbourhood-level income was not statistically associated with odds of either internalising or externalising disorders.

Conclusions: The proportion of married residents in respondents' neighbourhoods was significantly inversely associated with having externalising mental disorders in this sample of Chinese cities. Possible mechanisms for this finding are discussed and related to social causation, social selection and social control theories. Future work should examine these relationships longitudinally.
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http://dx.doi.org/10.1136/bmjopen-2017-017679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652513PMC
October 2017

Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys.

World Psychiatry 2017 Oct;16(3):299-307

Colegio Mayor de Cundinamarca University, Bogota, Colombia.

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.
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http://dx.doi.org/10.1002/wps.20457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608813PMC
October 2017

A journey without maps-Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru.

PLoS One 2017 7;12(8):e0182360. Epub 2017 Aug 7.

Health Service and Population Research Department, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom.

Purpose Of The Study: Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability.

Design & Methods: We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person.

Results: Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a 'journey without maps'. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched.

Implications: Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182360PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546609PMC
October 2017

The role of religious advisors in mental health care in the World Mental Health surveys.

Soc Psychiatry Psychiatr Epidemiol 2017 03 2;52(3):353-367. Epub 2016 Nov 2.

Psychology Research Institute Londonderry, University of Ulster, Coleraine, UK.

Objectives: To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups.

Methods: Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity.

Results: 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors.

Conclusions: Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.
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http://dx.doi.org/10.1007/s00127-016-1290-8DOI Listing
March 2017

Knowledge, Attitudes, and Clinical Practices for Patients With Dementia Among Mental Health Providers in China: City and Town Differences.

Gerontol Geriatr Educ 2016 Oct-Dec;37(4):342-358. Epub 2015 Jan 27.

a School of Social Work , University of Southern California , Los Angeles , California , USA.

Mental health providers are the major resource families rely on when experiencing the effects of dementia. However, mental health resources and manpower are inadequate and unevenly distributed between cities and towns in China. This study was conducted to examine similarities and differences in knowledge, attitudes, and clinical practices concerning dementia and working with family caregivers from mental health providers' perspectives in city versus town settings. Data were collected during focus group discussions with 40 mental health providers in the Xicheng (city) and Daxing (town) districts in Beijing, China in 2011. Regional disparities between providers' knowledge of early diagnosis of dementia and related counseling skills were identified. Regional similarities included training needs, dementia-related stigma, and low awareness of dementia among family caregivers. Culturally sensitive education specific to dementia for mental health providers and a specialized dementia care model for people with dementia and their family caregivers are urgently needed. Implications for geriatric practitioners and educators are discussed.
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http://dx.doi.org/10.1080/02701960.2014.990152DOI Listing
January 2018

The China Mental Health Survey: II. Design and field procedures.

Soc Psychiatry Psychiatr Epidemiol 2016 11 1;51(11):1547-1557. Epub 2016 Nov 1.

Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.

China Mental Health Survey (CMHS), which was carried out from July 2013 to March 2015, was the first national representative community survey of mental disorders and mental health services in China using computer-assisted personal interview (CAPI). Face-to-face interviews were finished in the homes of respondents who were selected from a nationally representative multi-stage disproportionate stratified sampling procedure. Sample selection was integrated with the National Chronic Disease and Risk Factor Surveillance Survey administered by the National Centre for Chronic and Non-communicable Disease Control and Prevention in 2013, which made it possible to obtain both physical and mental health information of Chinese community population. One-stage design of data collection was used in the CMHS to obtain the information of mental disorders, including mood disorders, anxiety disorders, and substance use disorders, while two-stage design was applied for schizophrenia and other psychotic disorders, and dementia. A total of 28,140 respondents finished the survey with 72.9% of the overall response rate. This paper describes the survey mode, fieldwork organization, procedures, and the sample design and weighting of the CMHS. Detailed information is presented on the establishment of a new payment scheme for interviewers, results of the quality control in both stages, and evaluations to the weighting.
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http://dx.doi.org/10.1007/s00127-016-1269-5DOI Listing
November 2016

The China Mental Health Survey (CMHS): I. background, aims and measures.

Soc Psychiatry Psychiatr Epidemiol 2016 11 31;51(11):1559-1569. Epub 2016 Oct 31.

Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.

The China Mental Health Survey (CMHS) is the first nationally representative community survey on mental disorders and mental health services in China. One-step diagnoses for mood disorders, anxiety disorders and substance use disorders were obtained using the Composite International Diagnostic Interview-3.0 (CIDI-3.0), according to the criteria and definition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A two-step procedure was applied for schizophrenia and other psychotic disorders, using psychosis screening section in CIDI-3.0 as a screening instrument and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID) as a diagnostic tool. Dementia was diagnosed by the 10/66 dementia diagnosis package in a two-step design. The main aims of the CMHS were: (1) to investigate the prevalence of mood disorders, anxiety disorders, substance use disorders, schizophrenia and other psychotic disorders, and dementia; (2) to obtain data of service use of individuals with mental disorders in China; and (3) to analyse the social and psychological risk factors or correlates of mental disorders and mental health services. This paper presents a brief review of the background of the CMHS, its aims and measures.
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http://dx.doi.org/10.1007/s00127-016-1270-zDOI Listing
November 2016

Genome-wide DNA methylation analysis in obsessive-compulsive disorder patients.

Sci Rep 2016 08 16;6:31333. Epub 2016 Aug 16.

Peking University Sixth Hospital &Institute of Mental Health, Beijing 100191, China.

Literatures have suggested that not only genetic but also environmental factors, interactively accounted for susceptibility of obsessive-compulsive disorder (OCD). DNA methylation may regulate expression of genes as the heritable epigenetic modification. The examination for genome-wide DNA methylation was performed on blood samples from 65 patients with OCD, as well as 96 healthy control subjects. The DNA methylation was examined at over 485,000 CpG sites using the Illumina Infinium Human Methylation450 BeadChip. As a result, 8,417 probes corresponding to 2,190 unique genes were found to be differentially methylated between OCD and healthy control subjects. Of those genes, 4,013 loci were located in CpG islands and 2,478 were in promoter regions. These included BCYRN1, BCOR, FGF13, HLA-DRB1, ARX, etc., which have previously been reported to be associated with OCD. Pathway analyses indicated that regulation of actin cytoskeleton, cell adhesion molecules (CAMs), actin binding, transcription regulator activity, and other pathways might be further associated with risk of OCD. Unsupervised clustering analysis of the top 3,000 most variable probes revealed two distinct groups with significantly more people with OCD in cluster one compared with controls (67.74% of cases v.s. 27.13% of controls, Chi-square = 26.011, df = 1, P = 3.41E-07). These results strongly suggested that differential DNA methylation might play an important role in etiology of OCD.
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http://dx.doi.org/10.1038/srep31333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985637PMC
August 2016

Cohort Profile: The 10/66 study.

Int J Epidemiol 2017 04;46(2):406-406i

King's College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

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http://dx.doi.org/10.1093/ije/dyw056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837706PMC
April 2017