Cultural neuroscience and global mental health: addressing grand challenges.

Mental, neurological and substance-use (MNS) disorders comprise approximately 13% of the global burden of disease. The Grand Challenges in Global Mental Health Initiative has recently identified research priorities for the next decade to address prevention and treatment of MNS disorders. One main research priority is to identify the root causes, risks and protective factors associated with global mental health. Recent advances in cultural neuroscience have identified theoretical, methodological, and empirical methods of identifying biomarkers associated with mental health disorders across nations. Here we review empirical research in cultural neuroscience that address meeting the grand challenges in global mental health.

Age of Parental Concern, Diagnosis, and Service Initiation Among Children With Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) require substantial support to address the core symptoms of ASD and co-occurring behavioral/developmental conditions. This study explores the early diagnostic experiences of school-aged children with ASD using survey data from a large probability-based national sample. Multivariate linear regressions were used to examine age when parent reported developmental concern to doctor, received ASD diagnosis, and first obtained services. Children whose parents had concerns about their child's verbal communication reported earlier ages for all outcomes when compared to children of parents who did not have verbal communication concerns. Children whose parents had concerns about their child's nonverbal communication or unusual gestures/movements received an earlier diagnosis than children whose parents did not have these specific concerns.

Diagnosis lost: Differences between children who had and who currently have an autism spectrum disorder diagnosis.

Autism spectrum disorder diagnoses sometimes change due to misdiagnosis, maturation, or treatment. This study uses a probability-based national survey-the Survey of Pathways to Diagnosis and Services-to compare currently diagnosed (n = 1420) and previously diagnosed (n = 187) children aged 6-17 years based on retrospective parental reports of early concerns about their children's development, responses to those concerns by doctors and other healthcare providers, the type of provider who made the first autism spectrum disorder diagnosis, and the autism spectrum disorder subtype diagnoses received (if any). Propensity score matching was used to control for differences between the groups on children's current level of functioning and other current characteristics that may have been related to diagnosis loss. Approximately 13% of the children ever diagnosed with autism spectrum disorder were estimated to have lost the diagnosis, and parents of 74% of them believed it was changed due to new information. Previously diagnosed children were less likely to have parents with early concerns about verbal skills, nonverbal communication, learning, and unusual gestures or movements. They were also less likely to have been referred to and diagnosed by a specialist. Previously diagnosed children were less likely to have ever received a diagnosis of Asperger's disorder or autistic disorder.

Service and treatment use among children diagnosed with autism spectrum disorders.

OBJECTIVE: Children diagnosed with autism spectrum disorder (ASD) require substantial support to address not only core ASD symptoms but also a range of co-occurring conditions. This study explores treatment and service use among children with ASD with and without intellectual disability (ID) and parents' perception of unmet needs from these treatments. METHODS: Data were retrieved from a probability-based national sample of 2077 children diagnosed with ASD, ID, or both (ASD and ID). Weighted multivariate logistic regressions examined differences between diagnostic groups for current medication and service utilization with a subanalysis exploring differences among those with co-occurring psychiatric conditions. Additional modeling examined parents' perception of unmet needs. RESULTS: Children diagnosed with ASD and ID were significantly more likely to be receiving current medication and services when compared with children with ID only or ASD only. Children with a co-occurring psychiatric diagnosis, from all 3 diagnostic groups, were more likely to be receiving a current medication, but not more likely to be receiving a current service when compared with children without a co-occurring psychiatric diagnosis. Children with ASD and a co-occurring psychiatric diagnosis were significantly more likely to have parents who reported unmet needs when compared with parents of children with ASD without a co-occurring psychiatric diagnosis. CONCLUSIONS: Children diagnosed with ASD and ID, especially those with a comorbid psychiatric condition, represent a vulnerable population with substantial rates of current service (98%) and medication (67%) usage, but despite these high rates, approximately 30% of parents report that their child's developmental needs are still not being met by their current treatment and services.

Data for building a national suicide prevention strategy: what we have and what we need.

Suicide is a leading cause of death in the U.S. As both the rate and number of suicides continue to climb, the country struggles with how to reverse this alarming trend. Using population-based data from publically available sources including the Web-based Injury Statistics Query and Reporting System, National Survey on Drug Use and Health, the authors identified patterns of suicide that can be used to steer a public health-based suicide prevention strategy. That most suicide deaths occur upon the first attempt, for example, suggests that a greater investment in primary prevention is needed. The fact that definable subgroups receiving care through identifiable service systems, such as individuals in specialty substance use treatment, exhibit greater concentrations of suicide risk than the general public suggests that integrating suicide prevention strategies into those service system platforms is an efficient way to deliver care to those with heightened need. The data sets that reveal these patterns have both strengths (e.g., population-level) and weaknesses (e.g., lack of longitudinal data linking changing health status, intervention encounters, suicidal behavior, and death records). Some of the data needed for crafting a comprehensive, public health-based approach for dramatically reducing suicide are currently available or may be available in the near term. Other resources will have to be built, perhaps by enhancing existing federal surveillance systems or constructing new ones. The article concludes with suggestions for immediate and longer-term actions that can strengthen public data resources in the service of reducing suicide in the U.S.