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Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders

  • Martínez-Leal R
  • Vilella E
  • Haro JM
  • Orejuela C
  • Rovira L
  • Muñoz S
  • Irazábal M
  • Vicens P
  • Salvador-Carulla L
  • Cortés MJ
  • Folch A
© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd Background: Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. Method: This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. Results: Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People
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Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study.

  • Martín-María N
  • Caballero FF
  • Lara E
  • Joan Domènech Abella
  • Haro JM
  • Olaya B
  • Ayuso-Mateos JL
  • Maria Miret
OBJECTIVES: The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time. METHODS: A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression. RESULTS: Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one. CONCLUSIONS: Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.
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Temporal trends in leisure-time sedentary behavior among adolescents aged 12-15 years from 26 countries in Asia, Africa, and the Americas.

  • Felez-Nobrega M
  • Raine LB
  • Haro JM
  • Wijndaele K
  • Koyanagi A
BACKGROUND: Multi-country studies examining trends in sedentary behaviors among adolescents have mainly focused on high-income or Western countries, and almost no data exists for the rest of the world. Thus, this study aims to examine temporal trends in adolescents' leisure time sedentary behavior (LTSB) employing nationally representative datasets from 26 countries from five WHO-defined geographical regions. METHODS: Data from the Global School-based Student Health Survey 2003-2017 were analyzed in 17,734 adolescents [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. LTSB was self-reported and included all types of sedentary behaviors, excluding time spent at school or doing homework. The prevalence and 95%CI of high LTSB (i.e., =3 h/day) was calculated for the overall sample and by sex for each survey. Crude linear trends in high LTSB were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls. RESULTS: Temporal variations in LTSB substantially diverged across countries, with results showing increasing (6/26 countries), decreasing (4/26) and stable trends. The sharpest increases in LTSB occurred in United Arab Emirates, Kuwait, and Thailand. Some countries did not show an increase in LTSB prevalence over time but had very high levels of LTSB (i.e., > 40%) across multiple years. Most countries showed no differences in LTSB trends between boys and girls. CONCLUSIONS: Data from our study may serve as an important platform for policymakers, as well as local and national stakeholders, to establish country-specific and tailored strategies for reducing LTSB.
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Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries.

  • McGrath JJ
  • Lim CCW
  • Plana-Ripoll O
  • Holtz Y
  • Agerbo E
  • Momen NC
  • Mortensen PB
  • Pedersen CB
  • Abdulmalik J
  • Aguilar-Gaxiola S
  • Al-Hamzawi A
  • Alonso J
  • Bromet EJ
  • Bruffaerts R
  • Bunting B
  • de Almeida JMC
  • de Girolamo G
  • De Vries YA
  • Florescu S
  • Gureje O
  • Haro JM
  • Harris MG
  • Hu C
  • Karam EG
  • Kawakami N
  • Kiejna A
  • Kovess-Masfety V
  • Lee S
  • Mneimneh Z
  • Navarro-Mateu F
  • Orozco R
  • Posada-Villa J
  • Roest AM
  • Saha S
  • Scott KM
  • Stagnaro JC
  • Stein DJ
  • Torres Y
  • Viana MC
  • Ziv Y
  • Kessler RC
  • de Jonge P
AIMS: Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. METHODS: The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. RESULTS: Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2-110.8, interquartile range = 6.0-19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1-2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs. CONCLUSIONS: Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
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Cognitive function associated with different diagnoses of anxiety disorders over the lifespan: Results from a Spanish representative sample.

  • Gayete S
  • Giné A
  • Maria Miret
  • Ayuso-Mateos JL
  • Haro JM
  • Olaya B
BACKGROUND: Previous research suggests an association between anxiety disorders and worse cognitive function. However, this association may vary depending on the type of disorder and age. We analysed the association of panic attack, 12-month and lifetime panic disorder (PD), and generalized anxiety disorder (GAD), with cognitive function in a representative sample of Spanish adults, and compared three age groups (18-49, 50-64, and 65+). METHODS: Some 4,582 participants were interviewed with an adapted CIDI interview. Unadjusted and adjusted linear regression models were calculated by age group, using T scores of verbal fluency and episodic memory as the outcomes. RESULTS: In young adults, 12-month GAD was associated with significantly lower scores of memory performance and verbal fluency, and 12-month PD with worse verbal fluency. In middle-aged participants, lifetime panic attack was related to better performance in verbal fluency, whereas having a diagnosis of lifetime PD was associated with lower scores. However, only participants aged 18-49 with 12-month GAD showed lower memory and verbal fluency, at almost one standard deviation below participants without 12-month GAD. LIMITATIONS: Low prevalence rates of anxiety disorder could have led to biased results. CONCLUSIONS: In young adults, a concurrent GAD might be particularly associated with memory and verbal fluency deficits, whereas only verbal fluency is affected in middle-aged adults with a history of PD, although this association is small. In older adults, anxiety disorders are not clearly associated with worse cognition, probably because in this age group other confounder variables might be attenuating this link. Overall, our findings suggest that cognitive interventions for anxiety disorders may be relevant, especially for young and middle-aged adults.
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Using smartphones and wearable devices to monitor behavioural changes during COVID-19.

  • Sun S
  • Folarin AA
  • Ranjan Y
  • Rashid Z
  • Conde P
  • Stewart C
  • Cummins N
  • Matcham F
  • Dalla Costa G
  • Simblett S
  • Leocani L
  • Sørensen PS
  • Buron M
  • Guerrero Pérez AI
  • Zabalza A
  • Penninx BW
  • Lamers F
  • Sara Siddi
  • Haro JM
  • Myin-Germeys I
  • Rintala A
  • Wykes T
  • Narayan VA
  • Comi G
  • Hotopf M
  • Dobson RJ
BACKGROUND: In the absence of a vaccine or highly effective treatment for COVID-19, countries have adopted Non-Pharmaceutical Interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is urgently required. OBJECTIVE: We aimed to explore the utility of the recently developed open-source mobile health platform RADAR-base as a toolbox to rapidly test the effect and response to NPIs aimed at limiting the spread of COVID-19. METHODS: We analysed data extracted from smartphone and wearable devices and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the UK, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post-hoc Dunn's tests to assess differences in these features among baseline, pre-, and during-lockdown periods. We also studied behavioural differences by age, gender, body mass index (BMI), and educational background. RESULTS: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between pre- and during-lockdown periods (P < .001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone usage. People were more active on their phones (P < .001 for Italy, Spain, and the UK), spending more time using social media apps (P < .001 for Italy, Spain, the UK, and the Netherlands), particularly around major news events. Furthermore, participants had lower heart rate (P < .001 for Italy, Spain; P = .02 for Denmark), went to bed later (P < .001 for Italy, Spain, the UK, and the Netherlands), and slept more (P < .001 for Italy, Spain, and the UK). We also found that young people had longer homestay than older people during lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. CONCLUSIONS: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioural changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epi/pandemics and could be particularly vital in helping ease out of lockdown.
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Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder.

  • Vigo D
  • Haro JM
  • Hwang I
  • Aguilar-Gaxiola S
  • Alonso J
  • Borges G
  • Bruffaerts R
  • Caldas-de-Almeida JM
  • de Girolamo G
  • Florescu S
  • Gureje O
  • Karam E
  • Karam G
  • Kovess-Masfety V
  • Lee S
  • Navarro-Mateu F
  • Ojagbemi A
  • Posada-Villa J
  • Sampson NA
  • Scott K
  • Stagnaro JC
  • Ten Have M
  • Viana MC
  • Wu CS
  • Chatterji S
  • Cuijpers P
  • Thornicroft G
  • Kessler RC
BACKGROUND: Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. METHODS: Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. RESULTS: MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. CONCLUSIONS: Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
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Transdiagnostic development of internalizing psychopathology throughout the life course up to age 45: a World Mental Health Surveys report.

  • de Vries YA
  • Al-Hamzawi A
  • Alonso J
  • Andrade LH
  • Benjet C
  • Bruffaerts R
  • Bunting B
  • de Girolamo G
  • Florescu S
  • Gureje O
  • Haro JM
  • Karam A
  • Karam EG
  • Kawakami N
  • Kovess-Masfety V
  • Lee S
  • Mneimneh Z
  • Navarro-Mateu F
  • Ojagbemi A
  • Posada-Villa J
  • Scott K
  • Stagnaro JC
  • Torres Y
  • Xavier M
  • Zarkov ZN
  • Kessler RC
  • de Jonge P
  • WHO World Mental Health Survey collaborators
BACKGROUND: Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45. METHODS: We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression. RESULTS: The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1-2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001). CONCLUSIONS: We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
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Metabolic dysregulation in older adults with depression and loneliness: The ATHLOS study.

  • de la Torre-Luque A
  • Lara E
  • de la Fuente J
  • Rico-Uribe LA
  • Caballero FF
  • Lopez-Garcia P
  • Sánchez-Niubó A
  • Bobak M
  • Koskinen S
  • Haro JM
  • Ayuso-Mateos JL
This study aimed to examine how loneliness contributes to metabolic dysregulation among older adults with depression and determine the relative contribution of loneliness to the development of chronic diseases in late adulthood. Harmonised data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project were used. Concretely, the sample comprised 6195 participants (53.95% women; M = 61.30 years, SD = 7.11) from three European cohorts. Three groups were considered: control group (CG); depressive symptom episode group (DEP); and a group with depression and loneliness (DEP + LONE). A metabolic score was estimated using anthropometric and blood indicators, by means of multi-indicator multi-causes (MIMIC) modelling and after controlling for sociodemographic and health-related covariates. Group-comparison was based on measurement-invariance procedures. Multimorbidity development was predicted at follow-up considering the study group and relevant covariates. All the analyses were sex-specific. As a result, measurement invariance revealed the influence of group ( CFI = -0.017 for male participants and CFI = -0.009 for female ones) on metabolic scores in both sexes. Metabolic scores were significantly lower (i.e., they had more metabolic risk) in DEP + LONE women in comparison to women from the other groups. DEP men showed the lowest metabolic scores but those from the DEP + LONE group showed meaningfully lower scores than CG men (d = 1.35). In terms of multimorbidity prediction, DEP + LONE group membership significantly predicted the outcome in both sexes; DEP group membership significantly predicted multimorbidity at follow-up in women. In summary, these results highlight the relevant contribution of loneliness in depression-related metabolic dysregulation in the short- (concurrent metabolic risk) and long-term (chronic condition development). Moreover, sex-specific mechanisms seem to be involved in metabolic alterations of depressed people showing loneliness feelings. This study calls for action to reduce the impact of loneliness in old age and to promote healthy ageing.
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Photoplethysmographic Waveform Analysis for Autonomic Reactivity Assessment in Depression.

  • Kontaxis S
  • Gil E
  • Marozas V
  • Lazaro J
  • Garcia E
  • Posadas-de Miguel M
  • Sara Siddi
  • Bernal ML
  • Aguilo J
  • Haro JM
  • De La Camara C
  • Laguna P
  • Bailon R
OBJECTIVE: In the present study, a photoplethysmographic (PPG) waveform analysis for assessing differences in autonomic reactivity to mental stress between patients with Major Depressive Disorder (MDD) and healthy control (HC) subjects is presented. METHODS: PPG recordings of 40 MDD and 40 HC subjects were acquired at basal conditions, during the execution of cognitive tasks, and at the post-task relaxation period. PPG pulses are decomposed into three waves (a main wave and two reflected waves) using a pulse decomposition analysis. Pulse waveform characteristics such as the time delay between the position of the main wave and reflected waves, the percentage of amplitude loss in the reflected waves, and the heart rate (HR) are calculated among others. The intra-subject difference of a feature value between two conditions is used as an index of autonomic reactivity. RESULTS: Statistically significant individual differences from stress to recovery were found for HR and the percentage of amplitude loss in the second reflected wave ( A(13)) in both HC and MDD group. However, autonomic reactivity indices related to A(13) reached higher values in HC than in MDD subjects (Cohen's d =0.81, AUC = 0.74), implying that the stress response in depressed patients is reduced. A statistically significant (p < 0.001) negative correlation (r = 0.5) between depression severity scores and A(13) was found. CONCLUSION: A decreased autonomic reactivity is associated with higher degree of depression. SIGNIFICANCE: Stress response quantification by dynamic changes in PPG waveform morphology can be an aid for the diagnosis and monitoring of depression.
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