Bidirectional Association between First-Episode Panic Disorder and Major Depressive Disorder in a Nationwide General Population Survey in Korea

BACKGROUND: Panic disorder (PD) and major depressive disorder (MDD) can occur concurrently, despite different clinical manifestations. Because MDD and PD patients tend to have more complicated conditions, understanding the co-occurrence and pattern of these conditions is important. Here, we investigated the influence of PD and MDD on each other, with respect to time interval. METHODS: Data from three national representative surveys were pooled (total 18,807 respondents), and the age of onset (AOO) of PD and MDD was analyzed. We performed Kaplan-Meier analysis to estimate separate survival functions, using the AOO of MDD and PD as the outcome. To understand the temporal effect of other disorders, we used a Cox proportional hazard model to estimate the hazard ratios for the onset of MDD/PD with other comorbidities as time-dependent covariates. RESULTS: PD elevated the risk of subsequent MDD by 1.5-fold, whereas MDD elevated the risk of subsequent PD by 3.8-fold. The effect of such an elevation risk was significant for up to 2 years. CONCLUSION: The results revealed a bidirectional relationship between MDD and PD. Each disease represents a risk of a subsequent occurrence of the other, which lasts for a considerable duration.

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.

A cross-sectional study of 4 mental disorders in Chifeng City of Inner Mongolia Autonomous Region / 中国心理卫生杂志

Objective:To describe the epidemiological characteristics of mental disorders in community resi-dents aged 18 years and over in the Chifeng City of Inner Mongolia Autonomous Region.Methods:Six thousand three hundred and seventy six individuals aged 18 years and over were sampled using stratified Probability-Propor-tional-to-Size Sampling in Chifeng City in 2010.All respondents were investigated by face-to-face interview.The Composite International Diagnostic Interview-3.0 Computer Assisted Personal Interview (CIDI-3.0-CAPI)was used to make diagnoses based on the definition and criteria of the Diagnostic and Statistical Manual of Mental Dis-orders,Fourth Edition (DMS-IV).Results:A total of 4528 subjects completed the CIDI-3.0-CAPI.Regarding anxi-ety disorder,mood disorder,substance use disorder,and impulse control disorder,the 30-day adjusted prevalence rates (95%CI)were 2.5%(2.08% -2.99%,0.9%(0.67% -1.23%),0.5%(0.34% -0.76%),and 0.6%(0.41% -0.86%)respectively,and the 12 -month prevalence rates were 4.5% (3.93% -5.15%),2.4%(2.0% -2.90%),1.1% (0.84% -1.45%),and 1.0% (0.74% -1.32%)respectively.The lifetime adjusted prevalence rates were 6.6% (5.92% -7.36%),6.5% (5.81% -7.24%),2.7% (2.26% -3.21%),and 1.4%(1.23% -1.95%)respectively.Conclusion:According to morbidity,anxiety disorders,mood disorder,substance use disorders and impulse control disorders are common in Chifeng City of Inner Mongolia Autonomous Region se-quencely,being a prominent public health problem.

Community-based evaluation of the reliability and validity of Chinese version of Composite International Diagnostic Interview-3.0 / 中国心理卫生杂志

Objective:To evaluate the test-retest reliability and validity of Chinese version of World Health Organization Composite International Diagnostic Interview version 3.0(CIDI-3.0)by community-based study.Methods:Among 202 subjects from Dalian city,with the clinician-administered Structured Clinical Interview for DSM-IV(SCID),102 patents were diagnostic as mood disorder,anxiety disorder,schizophrenia or psychotic disorder and so on.All of the patients and the other 100 subjects without mental disorders as the control group were interviewed blindly by CIDI-3.0 to test the validity of CIDI-3.0.Ten patients among them were interviewed twice independently in a 7-day interval to evaluate the reliability of CIDI-3.0.Results:(1)For the screen section,the sensitivity values of different mental disorders ranged from 60.4% to 93.1%,while the specificity values from 33.6% to 92.7%.The positive predictive values were from 60.1% to 95.1%,and the negative predictive values were from 68.1% to 93.7%.(2)For different mental disorders,the specificity values ranged from 97.1% to 98.9%,while the sensitivity values were from 33.3% to 70.3%.Positive predict values were from 66.7% to 95.7%,and negative predictive values were from 87.7% to 95.4%.(3)The consistency was 0.78 in any mental disorder.(4)For test-retest reliability,kappa values ranged from 0.737 to 1.0.Conclusion:By clinical reappraisal,the Chinese version of CIDI-3.0 has satisfied validity and reliability.The screen section has high sensitivity,while the diagnostic sections have high specificities.That indicates that CIDI-3.0 is acceptable as a validated instrument for community survey on mental disorders.

Validación de una escala clinimétrica para el diagnóstico de depresión en pacientes con diabetes mellitus tipo 2, en unidades de atención primaria / Validation of a clinimetric scale for the diagnosis of depression in patients with diabetes mellitus type 2, in primary healt care

Background. The prevalence of depression in patients with type 2 diabetes mellitus (DM2) is of up to 49.3% in primary care clinics. Nevertheless, medical doctors only recognize only 30% of these cases. Depression is associated with poor glycemic control, increase of diabetes complications, deterioration in patient's quality of life, and increase in demand and resources to provide care. The objective was to design and validate a clinimetric scale for the diagnosis of depression (CSDD in patients with DM2, in primary care units. Patients and methods. The study was conducted on 528 DM2 patients in Family Medicine Unit No. 10 of the Instituto Mexicano del Seguro Social (Mexican Social Security Institute), during 2003. A diagnostic test design was employed, with the golden standard consisting of the composite international diagnostic interview. Samples were constructed around consecutive cases. Depression and its degrees were the dependent variables. Absolute and relative frequencies were calculated, along with the Kappa index, sensibility, specificity, positive predictive values (PPV) and negative predictive values (NPV) and ROC curves. Results. The CSDD presented a concordance between observers of 0.7739. The best cut-off point in the ROC curves for diagnosis of depression was 6, which obtained a sensibility of 95.3%, a specificity of 96.8%, a PPV of 92.2%, and a NPV of 98.1%. Conclusions. The CSDD is a consistent and valid instrument and easy to use for the diagnosis of depression in patients with DM2 in primary care clinic.

Antecedentes. La prevalencia de depresión en pacientes con diabetes mellitus tipo 2 (DM2) es hasta de 49.3% en unidades de atención primaria. El médico reconoce únicamente 30% de los casos, lo que lleva al paciente a un pobre control glucémico, aumento en las complicaciones propias de la diabetes, deterioro de la calidad de vida, mayor número de consultas e importante consumo de recursos institucionales. El objetivo del estudio fue diseñar y validar una escala clinimétrica para el diagnóstico de depresión (ECDD) en pacientes con DM2, en unidades de atención primaria. Pacientes y métodos. El estudio se llevó a cabo en 528 pacientes con DM2, en la Unidad de Medicina Familiar No. 10, del Instituto Mexicano del Seguro Social, durante 2003. Se utilizó un diseño de prueba diagnóstica, el estándar de oro fue la Cédula Diagnóstica Internacional Compuesta. El muestreo fue por casos consecutivos. La variable dependiente fue depresión y sus grados. Se calcularon frecuencias absolutas y relativas, índice Kappa, sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y curvas ROC. Resultados. La ECDD presentó una concordancia interobservador de 0.7739. El mejor punto de corte en las curvas ROC para diagnosticar depresión fue 6, con el cual se obtuvo una sensibilidad de 95.3%, especificidad 96.8%, VPP 92.2% y VPN 98.1%. Conclusiones. La ECDD aplicada en pacientes con DM2 es un instrumento consistente, válido y de fácil aplicación para diagnosticar depresión durante el acto de la consulta en atención primaria.