Direct and indirect effects of different types of microplastics on freshwater prey (Corbicula fluminea) and their predator (Acipenser transmontanus).

We examined whether environmentally relevant concentrations of different types of microplastics, with or without PCBs, directly affect freshwater prey and indirectly affect their predators. Asian clams (Corbicula fluminea) were exposed to environmentally relevant concentrations of polyethylene terephthalate (PET), polyethylene, polyvinylchloride (PVC) or polystyrene with and without polychlorinated biphenyls (PCBs) for 28 days. Their predators, white sturgeon (Acipenser transmontanus), were exposed to clams from each treatment for 28 days. In both species, we examined bioaccumulation of PCBs and effects (i.e., immunohistochemistry, histology, behavior, condition, mortality) across several levels of biological organization. PCBs were not detected in prey or predator, and thus differences in bioaccumulation of PCBs among polymers and biomagnification in predators could not be measured. One of the main objectives of this study was to test the hypothesis that bioaccumulation of PCBs would differ among polymer types. Because we could not answer this question experimentally, a bioaccumulation model was run and predicted that concentrations of PCBs in clams exposed to polyethylene and polystyrene would be greater than PET and PVC. Observed effects, although subtle, seemed to be due to microplastics rather than PCBs alone. For example, histopathology showed tubular dilation in clams exposed to microplastics with PCBs, with only mild effects in clams exposed to PCBs alone.

Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness.

OBJECTIVE: To use expert consensus to inform the development of policy and guidelines for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. METHOD: The Delphi method was used. A systematic search of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on a priori-defined levels of importance written into the expert consensus statement. RESULTS: The participation rate for the clinicians across all three rounds was 65%, with consumers and carers only completing one round due to high endorsement rates. Finally, 386 strategies were endorsed as essential or important by one or all panels. The endorsed strategies provided information on engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side effects; and the role of health professionals. CONCLUSION: The consensus statement is intended to be used by health professionals, people with an enduring psychotic illness and their families and carers. The next step needed is an implementation strategy by the Royal Australian and New Zealand College of Psychiatrists and other stakeholders.

Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys.

BACKGROUND: Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. METHODS: Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. RESULTS: 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. CONCLUSIONS: A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies.

Early-life mental disorders and adult household income in the World Mental Health Surveys.

BACKGROUND: Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income. METHODS: Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income. RESULTS: Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income. CONCLUSIONS: Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.

Ecologically informed engineering reduces loss of intertidal biodiversity on artificial shorelines.

Worldwide responses to urbanization, expanding populations and climatic change mean biodiverse habitats are replaced with expensive, but necessary infrastructure. Coastal cities support vast expanses of buildings and roads along the coast or on "reclaimed" land, leading to "armouring" of shorelines with walls, revetments and offshore structures to reduce erosion and flooding. Currently infrastructure is designed to meet engineering and financial criteria, without considering its value as habitat, despite artificial shorelines causing loss of intertidal species and altering ecological natural processes that sustain natural biodiversity. Most research on ameliorating these impacts focus on soft-sediment habitats and larger flora (e.g., restoring marshes, encouraging plants to grow on walls). In response to needs for greater collaboration between ecologists and engineers to create infrastructure to better support biodiversity, we show how such collaborations lead to small-scale and inexpensive ecologically informed engineering which reduces loss of species of algae and animals from rocky shores replaced by walls. Adding experimental novel habitats to walls mimicking rock-pools (e.g., cavities, attaching flowerpots) increased numbers of species by 110% within months, in particular mobile animals most affected by replacing natural shores with walls. These advances provide new insights about melding engineering and ecological knowledge to sustain biodiversity in cities.

The role of criterion A2 in the DSM-IV diagnosis of posttraumatic stress disorder.

BACKGROUND: Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror. METHODS: Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys. RESULTS: Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases. CONCLUSIONS: Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement.

Prevalence, impairment and severity of 12-month DSM-IV major depressive episodes in Te Rau Hinengaro: New Zealand Mental Health Survey 2003/4.

OBJECTIVE: To assess the prevalence, symptom severity, functional impairment and treatment of major depressive episodes in the New Zealand population, in light of recent criticism that depression is 'over-diagnosed', especially in community surveys. METHOD: Nationally representative cross-sectional household survey of 12 992 adults (aged 16+): The New Zealand Mental Health Survey 2003/4. 12-month major depressive episode measured in face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). RESULTS: The 12-month prevalence of major depressive episode (MDE) was 6.6% for the total population, with decreasing prevalence with increasing age, and higher prevalence in females (8.1% versus 4.9% in males). Fewer than 10% of 12-month episodes were classified on a symptom severity rating scale as mild, and 69% of all episodes were accompanied by severe impairment in at least one domain of functioning. Only a third of those with severe impairment received treatment in the mental health sector, and half saw a general medical practitioner. CONCLUSION: These results offer little support for the suggestion that depression is over-diagnosed and over-treated, and that current diagnostic thresholds allow the inclusion of too many mild episodes in community surveys.

Barriers and facilitators to the utilization of adult mental health services by Australia's Indigenous people: seeking a way forward.

Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people.

Spatial patterns of plastic debris along Estuarine shorelines.

The human population generates vast quantities of waste material. Macro (>1 mm) and microscopic (<1 mm) fragments of plastic debris represent a substantial contamination problem. Here, we test hypotheses about the influence of wind and depositional regime on spatial patterns of micro- and macro-plastic debris within the Tamar Estuary, UK. Debris was identified to the type of polymer using Fourier-transform infrared spectroscopy (FT-IR) and categorized according to density. In terms of abundance, microplastic accounted for 65% of debris recorded and mainly comprised polyvinylchloride, polyester, and polyamide. Generally, there were greater quantities of plastic at downwind sites. For macroplastic, there were clear patterns of distribution for less dense items, while for microplastic debris, clear patterns were for denser material. Small particles of sediment and plastic are both likely to settle slowly from the water-column and are likely to be transported by the flow of water and be deposited in areas where the movements of water are slower. There was, however, no relationship between the abundance of microplastic and the proportion of clay in sediments from the strandline. These results illustrate how FT-IR spectroscopy can be used to identify the different types of plastic and in this case was used to indicate spatial patterns, demonstrating habitats that are downwind acting as potential sinks for the accumulation of debris.

Bipolar disorder with frequent mood episodes in the New Zealand Mental Health Survey.

BACKGROUND: Rapid cycling bipolar disorder has been studied almost exclusively in clinical samples. METHODS: A national cross-sectional survey in 2003-2004 in New Zealand used the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis was by DSM-IV. Depression severity was assessed with the Quick Inventory of Depressive Symptoms (QIDS) and role impairment using Sheehan Scales. Complex survey analyses compared percentages and means, and used logistic regression and discrete-time survival analyses. Frequent mood episodes (FMEs) in the past 12 months (4+) were used as an indicator of rapid cycling. RESULTS: The lifetime prevalence of bipolar disorder (I + II) was 1.7%. Twelve-month prevalence was 1.0%: 0.3% with FME and 0.7% with No FME (1-3 episodes). Another 0.7% had no episodes in that period. Age of onset was earliest for FME (16.0 years versus 19.5 and 20.1, p<.05). In the past 12 months, weeks in episode, total days out of role and role impairment in the worst month were all worse for the FME group (p<.0001) but both the FME and No-FME groups experienced severe and impairing depression. Lifetime suicidal behaviours and comorbidity were high in all three bipolar groups but differed little between them. About three-quarters had ever received treatment but only half with twelve-month disorder made treatment contact. LIMITATIONS: Recall, not observation of episodes. CONCLUSIONS: Even in the community the burden of bipolar disorder is high. Frequent mood episodes in bipolar disorder are associated with still more disruption of life than less frequent episodes. Treatment is underutilized and could moderate the distress and impairment experienced.

The Kessler Psychological Distress Scale in Te Rau Hinengaro: the New Zealand Mental Health Survey.

OBJECTIVE: The aim of the present study was to compare two versions of the Kessler 10-item scale (K10), as measures of population mental health status in New Zealand. METHOD: A nationwide household survey of residents aged > or = 16 years was carried out between 2003 and 2004. The World Mental Health Composite International Diagnostic Interview (CIDI 3.0) was used to obtain DSM-IV diagnoses. Serious mental illness (SMI) was defined as for the World Mental Health Surveys Initiative and the USA National Comorbidity Survey Replication. Participants were randomly assigned to receive the 'past month' K10 or the 'worst month in the past 12 months' K10. There were 12 992 completed interviews; 7435 included the K10. The overall response rate was 73.3%. Receiver operator characteristic (ROC) curves were used to examine the ability of both K10 versions to discriminate between CIDI 3.0 cases and non-cases, and to predict SMI. RESULTS: Scores on both versions of the K10 were higher for female subjects, younger people, people with fewer educational qualifications, people with lower household income and people resident in more socioeconomically deprived areas. Both versions of the K10 were effective in discriminating between CIDI 3.0 cases and non-cases for anxiety disorder, mood disorders and any study disorder. The worst month in the past 12 months K10 is a more effective predictor than the past 1 month K10 of SMI (area under the curve: 0.89 vs 0.80). CONCLUSIONS: Either version of the K10 could be used in repeated health surveys to monitor the mental health status of the New Zealand population and to derive proxy prevalence estimates for SMI. The worst month in the past 12 months K10 may be the preferred version in such surveys, because it is a better predictor of SMI than the past month K10 and also has a more logical relationship to 12 month disorder and 12 month service use.

2007 National Survey of Mental Health and Wellbeing: methods and key findings.

OBJECTIVE: To provide a description of the methods and key findings of the 2007 Australian National Survey of Mental Health and Wellbeing. METHOD: A national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years was carried out using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Diagnoses were made according to ICD-10. Key findings include the prevalence of mental disorder, sex and age distributions of mental disorders, severity of mental disorders, comorbidity among mental disorders, and the extent of disability and health service use associated with mental disorders. RESULTS: The prevalence of any lifetime mental disorder was 45.5%. The prevalence of any 12 month mental disorder was 20.0%, with anxiety disorders (14.4%) the most common class of mental disorder followed by affective disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were disabling. One in four people (25.4%) with 12 month mental disorders had more than one class of mental disorder. One-third (34.9%) of people with a mental disorder used health services for mental health problems in the 12 months prior to the interview. CONCLUSIONS: Mental disorders are common in Australia. Many people have more than one class of mental disorder. Mental disorders are associated with substantial disability, yet many people with mental disorders do not seek help for their mental health problems.

Usefulness of the construct of social network to explain mental health service utilization by the maori population in new zealand.

This article briefly reviews the literature on the relationship between social network and mental health, and presents a theoretical framework outlining the role social networks may play in explaining the differential mental health service utilization rates between Maori and European people of New Zealand. By buffering individuals from the ill effects of stressful events, social networks may have a protective effect on people's mental health. In addition, social networks influence the way people with mental illnesses use mental health services. An inverse relationship between the size of an individual's social network and the rate of utilization of in-patient services has been reported. Despite having a larger and presumably more supportive social networks, Maori are over-represented in mental health service utilization statistics. Using the Maori example, we demonstrate that ethnic differences exist in the structure of social networks and the provision of social support to their members. Such differences may be based on the degree of emphasis placed on kinship or on individualism by cultures and on the receptivity or prejudice of the host community. We examine the sources of stress on Maori social networks that may adversely affect the network's ability to support its members experiencing mental illnesses. Caution must be exercised in using service utilization rates as measures of the mental health needs of different ethnic groups because of problems with help seeking and the detection of mental health issues in different ethnic groups.

Ingested microscopic plastic translocates to the circulatory system of the mussel, Mytilus edulis (L).

Plastics debris is accumulating in the environment and is fragmenting into smaller pieces; as it does, the potential for ingestion by animals increases. The consequences of macroplastic debris for wildlife are well documented, however the impacts of microplastic (< 1 mm) are poorly understood. The mussel, Mytilus edulis, was used to investigate ingestion, translocation, and accumulation of this debris. Initial experiments showed that upon ingestion, microplastic accumulated in the gut. Mussels were subsequently exposed to treatments containing seawater and microplastic (3.0 or 9.6 microm). After transfer to clean conditions, microplastic was tracked in the hemolymph. Particles translocated from the gut to the circulatory system within 3 days and persisted for over 48 days. Abundance of microplastic was greatest after 12 days and declined thereafter. Smaller particles were more abundant than larger particles and our data indicate as plastic fragments into smaller particles, the potential for accumulation in the tissues of an organism increases. The short-term pulse exposure used here did not result in significant biological effects. However, plastics are exceedingly durable and so further work using a wider range of organisms, polymers, and periods of exposure will be required to establish the biological consequences of this debris.

Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders.

UNLABELLED: Although there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249). Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions among females and older persons; and chronic pain was similarly associated with depression-anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries. PERSPECTIVE: Chronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries.

Obesity and mental disorders in the adult general population.

OBJECTIVE: The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education). METHODS: A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater. RESULTS: Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05). CONCLUSION: Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.

Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative.

Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in seventeen countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk, and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescents, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders.