Prevalence of dementia and mild cognitive impairment in indigenous Bolivian forager-horticulturalists.

INTRODUCTION: We evaluated the prevalence of dementia and mild cognitive impairment (MCI) in indigenous Tsimane and Moseten, who lead a subsistence lifestyle. METHODS: Participants from population-based samples ≥ 60 years of age (n = 623) were assessed using adapted versions of the Modified Mini-Mental State Examination, informant interview, longitudinal cognitive testing and brain computed tomography (CT) scans. RESULTS: Tsimane exhibited five cases of dementia (among n = 435; crude prevalence = 1.2%, 95% confidence interval [CI]: 0.4, 2.7); Moseten exhibited one case (among n = 169; crude prevalence = 0.6%, 95% CI: 0.0, 3.2), all age ≥ 80 years. Age-standardized MCI prevalence was 7.7% (95% CI: 5.2, 10.3) in Tsimane and 9.8% (95% CI: 4.9, 14.6) in Moseten. Cognitive impairment was associated with visuospatial impairments, parkinsonian symptoms, and vascular calcification in the basal ganglia. DISCUSSION: The prevalence of dementia in this cohort is among the lowest in the world. Widespread intracranial medial arterial calcifications suggest a previously unrecognized, non-Alzheimer's disease (AD) dementia phenotype.

Treatment and adequacy of treatment of mental disorders among respondents to the Mexico National Comorbidity Survey.

OBJECTIVE: This study described the rate and adequacy of mental health service use among participants in the Mexico National Comorbidity Survey and the correlates of any 12-month treatment and of adequate treatment. METHOD: The authors conducted face-to-face household surveys of a probability sample of individuals ages 18 to 65 years in the noninstitutionalized population living in urban areas of Mexico from 2001 to 2002. The use of mental health services and 12-month DSM-IV disorders was assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview. The rates and correlates of any service use and the adequacy of treatment were identified in logistic regression analyses, taking into account the complex sample design and weighting process. RESULTS: The data reported here were based on 2,362 interviews. Fewer than one in five respondents with any psychiatric disorder during the last 12 months used any service during the prior year. The rates of service use by those with mood disorders were somewhat higher. About one in every two respondents who used services received minimally adequate care. CONCLUSIONS: The authors found large unmet needs for mental health services among those with psychiatric disorders. Those with mental illness and those who deliver or seek to improve mental health care in Mexico face enormous challenges.

A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R).

BACKGROUND: Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators. METHOD: The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders. RESULTS: Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.6, 0.7 and 0.4% respectively. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0.88]. The distribution (conditional probability of attempt) of the risk index is: 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high-risk category. CONCLUSIONS: A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.

Suicidal behavior in the Mexican National Comorbidity Survey (M-NCS): Lifetime and 12- month prevalence, psychiatric factors and service utilization

Abstract: Background: Nationally representative data from México are presented on the lifetime and 12-month prevalence of the onset of suicide ideation, suicide plans and suicide attempt, as well as associated DSM-IV psychiatric disorders and service utilization. Methods: Data are from the Mexican National Comorbidity Survey (M-NCS). This population survey was carried out in 2001-2003 in a sample of 5,782 respondents of 18 years and older. Onset of ideation, a plan, and suicide attempt, as well as psychiatric and service use correlates were estimated using survival analysis. Results: Of the respondents, 8.3% reported lifetime ideation, 3.2% reported a lifetime plan and 2.8% reported lifetime suicide attempt(s). The prevalence for 12-month suicidal behaviors was 2.3%, 1.0% and 0.6%, respectively. Suicidal behaviors were more prevalent in early adolescence and early adulthood and became less common after the mid-thirties, with the exception of suicidal ideation that continues into older ages. Having met criteria for one or more of the DSM-IV disorders assessed in the survey was common among suicide ideators (60.9%), planners (75.6%) and attempters (74.6%), and was a strong risk factor for suicidal behaviors, with odds ratios of 4.8 for ideation, 10.2 for plan and 9.6 for attempt. Approximately one of every four lifetime attempters reported to have ever seen a psychiatrist. Conclusions: As in many other countries, mental disorders have an important impact on suicidal behaviors in Mexico. Intervention efforts aimed at identifying and treating persons at or before the onset of suicidal ideation is strongly recommended.

Resumen: Antecedentes: Se documentan datos representativos a nivel nacional en México sobre las prevalencias para inicio de ideación, plan e intento suicidas, así como trastornos psiquiátricos (de acuerdo con el DSM-IV) y uso de servicios asociados a estos comportamientos suicidas. Métodos: Los datos fueron tomados de la Encuesta Nacional de Epidemiología Psiquiátrica de México (ENEP). La población fue tomada de una muestra de 5,782 entrevistados de 18 o más años de edad, durante el periodo 2001-2003. Se estimaron inicios para ideación, plan e intento suicida, así como factores psiquiátricos y de uso de servicios mediante el análisis de supervivencia. Resultados: De los entrevistados, el comportamiento suicida alguna vez en la vida fue como sigue: el 8.3% reportó haber tenido ideación, el 3.2% reportó haber tenido un plan y el 2.8% reportó haber tenido intento(s) suicida(s). La prevalencia para los comportamientos suicidas los 12 meses previos a la entrevista fue de 2.3%, 1.0% y 0.6%, respectivamente. Dichos comportamientos prevalecieron en la adolescencia y adultez temprana y fueron menos comunes después de los 35 años de edad, con excepción de la ideación suicida que se mantuvo presente en edades más avanzadas. El presentar uno o más trastornos, evaluados en la encuesta de acuerdo con el DSM-IV, fue común entre las personas con ideación (60.9%), plan (75.6%) e intento (74.6%) suicidas y se encontró que este hecho es un factor de riesgo fuerte para el comportamiento suicida, incrementando en 4.8 veces el riesgo para ideación, 10.2 para plan y 9.6 para intento. Aproximadamente una de cada cuatro personas con intento suicida reportó haber consultado alguna vez un psiquiatra. Conclusiones: Como en muchos otros países, en México los trastornos mentales tienen un impacto importante en los comportamientos suicidas. Se recomiendan ampliamente los esfuerzos de intervención enfocados a la identificación y al tratamiento de personas antes o durante el inicio de la ideación suicida.

The prevalence of treated and untreated mental disorders in five countries.

We analyzed survey data from Canada, Chile, Germany, The Netherlands, and the United States to study the prevalence and treatment of mental and substance abuse disorders. Total past-year prevalence estimates range between 17.0 percent (Chile) and 29.1 percent (U.S.). Many cases are mild. Although disorder severity is strongly related to treatment, one- to two-thirds of serious cases receive no treatment each year. Most treatment goes to minor and mild cases. Undertreatment of serious cases is most pronounced among young poorly educated males. Outreach is needed to reduce barriers to care among serious cases and young people at risk of serious disorders.

Prevalence of ICD-10 mental disorders in a catchment area in the city of São Paulo, Brazil.

BACKGROUND: The prevalence (lifetime, 12-month, 1-month) of mental disorders, their relationship with sociodemographic features, and the use of services were investigated in the population aged 18 years or older living in the catchment area of a large hospital complex in the city of São Paulo, Brazil. METHODS: A community survey was conducted in two boroughs of São Paulo, on 1,464 residents aged 18 years or older. The assessment of psychopathology was made by CIDI 1.1, yielding diagnoses according to ICD-10 for mood disorders, anxiety disorders, non-affective psychosis, substance use disorders, dissociative and somatoform disorders, and cognitive impairment. RESULTS: Of the total sample, 45.9 % had at least one lifetime diagnosis of mental disorder, 26.8 % in the year, and 22.2 % in the month prior to interview. The most prevalent disorders (lifetime, 12-month, and 1-month, respectively) were: nicotine dependence (25 %, 11.4 %, 9.3 %), any mood disorder (18.5 %, 7.6 %, 5 %) with depressive episode the most prevalent mood disorder (16.8 %, 7.1 %, 4.5 %), any anxiety disorder (12.5 %, 7.7 %, 6 %), somatoform disorder (6 %, 4.2 %, 3.2 %), and alcohol abuse/dependence (5.5 %, 4.5 %, 4 %). No gender differences were found in overall morbidity. Excluding substance use disorders, women had a higher risk for non-psychotic disorders. The presence of psychiatric diagnosis increased the use of services, with a low proportion of subjects seeking specialty mental care. CONCLUSION: Our results confirm the high prevalence of mental disorders in the community, similar to findings in other countries. A comparison with findings from other studies with similar methodology is made.