The Fix-it face-to-face intervention increases multihazard household preparedness cross-culturally.

Vulnerability to natural disasters is increasing globally1-3. In parallel, the responsibility for natural hazard preparedness has shifted to communities and individuals4. It is therefore crucial that households increase their preparedness, yet adoption of household preparedness measures continues to be low, even in high-risk regions5-8. In addition, few hazard-preparedness interventions have been evaluated longitudinally using observational measures. Therefore, we conducted a controlled intervention with a 12-month follow-up on adults in communities in the United States and Turkey that focused on improving household earthquake and fire preparedness. We show that this Fix-it intervention, involving evidence-based, face-to-face workshops, increased multihazard preparedness in both cultures longitudinally. Compared to baseline, the primary outcome-overall preparedness-increased significantly in the intervention groups, with more improvement in earthquake preparedness in the Turkish participants and more improvements in fire preparedness in the US participants. High baseline outcome expectancy and home ownership predicted overall preparedness change in both intervention groups longitudinally, implying that a sense of agency influences preparedness. An unintended consequence of observation is that it may increase preparedness, as even the control groups changed their behaviour. Therefore, observation of home preparatory behaviours by an external source may be a way to extend multihazard preparedness across a population.

Efficacy of the Social Cognition Training Program in a Sample of Outpatients with Schizophrenia.

OBJECTIVE: Social cognition is recognized to be a deficit in individuals suffering from schizophrenia. Numerous studies have explored the relationship between social cognition and social functioning in outpatients with schizophrenia through the use of different social cognition training programs. This study examines the efficacy of the Social Cognition Training Program (PECS in Spanish) in adults with a diagnosis of schizophrenia. METHODS: Data were derived from a sample of 44 non-hospitalized adult patients who presented with a DSM-IV-TR Axis I diagnosis of schizophrenia and 39 healthy controls. The 44 patients were divided into an experimental group (n=20) and a control task group (n=24) that received cognitive training. Healthy controls did not receive any treatment. Sociodemographic and clinical variables correlates were computed. The 2-way ANOVA was conducted to examine differences between groups in pre- and post-treatment measures. Intragroup differences were explored using the paired-samples t-test. RESULTS: At the end of the training, patients in the experimental group showed a higher performance compared to patients in the control task group in the Hinting Task Test and in the emotion recognition of sadness, anger, fear, and disgust. CONCLUSIONS: The PECS proved to be effective in the improvement of some areas of theory of mind and emotion recognition in outpatients with schizophrenia. The PECS is one of the first programs developed in Spanish to train social cognition, and the data obtained support the importance of expanding the social cognition programs to non-English language samples.

Effect of first episode axis I disorders on quality of life.

Cross-sectional studies indicate that mental disorders are inversely associated with quality of life (QoL) and that the magnitude of the negative correlation varies across disorders. The aims of this study were to examine whether QoL decreases after new onset of psychiatric disorders and to characterize variations across disorders. Data were drawn from a longitudinal study representative of the adult US population. Changes were examined in QoL, as measured by the Short Form-12 version 2, after incidence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), disorders at wave 2 in individuals without the given disorder at wave 1. A subanalysis examined change of QoL after incidence of mental disorders in individuals without a history of any mental disorder. With the exception of alcohol abuse, new incidence of each examined DSM-IV disorder was associated with a decrement in QoL, being the largest for major depressive disorder and generalized anxiety disorder. Incidence of these disorders was associated with a decrease in QoL even in individuals without history or presence of any other mental disorder. Although the incidence of most DSM-IV disorders is associated with a decrement in QoL, mood and anxiety disorders have the largest impact.

Efficacy of the Social Cognition Training Program in a sample of schizophrenic outpatients.

Objective: Social cognition is recognized to be a deficit in individuals suffering from schizophrenia. Numerous studies have explored the relationship between social cognition and social functioning in outpatients with schizophrenia through the use of different social cognition training programs. This study examines the efficacy of the Social Cognition Training Program (PECS in Spanish) in adults with a diagnosis of schizophrenia. Methods: Data were derived from a sample of 44 non-hospitalized adult patients, who presented with a DSM-IV-R Axis I diagnosis of schizophrenia, and 39 healthy controls. Patients were divided into an experimental group and a control task group, that received cognitive training. Healthy controls did not receive any treatment. Sociodemographic and clinic variables correlates were computed. 2-way ANOVA was conducted to examine differences between groups in pre and post-treatment measures. Intragroup differences were explores using the paired-samples t-test. Results: At the end of the training, patients in the experimental group showed a higher performance compared to patients in the control task group, in the Hinting Task Test and in the emotion recognition of sadness, anger, fear, and disgust. Conclusions: The PECS proved to be effective in the improvement of some areas of theory of mind and emotion recognition, in outpatients with schizophrenia. The PECS is one of the first programs developed in Spanish to train social cognition, and the data obtained support the importance of expand the social cognition programs to non-English language samples.

Quality of life following remission of mental disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: Although psychiatric disorders are associated with decreased health-related quality of life, it is unknown whether symptom remission is associated with its improvement or normalization. METHOD: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a large national sample of the United States population. A total of 34,653 adults 18 years and older residing in households completed 2 waves (2001-2002 and 2004-2005) of face-to-face surveys. DSM-IV psychiatric diagnoses of mood, anxiety, and substance use disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Health-related quality of life was assessed with the Short Form-12 Health Survey, Version 2 (SF-12). RESULTS: Remission from alcohol dependence, major depressive disorder, bipolar disorder, dysthymia, social anxiety disorder, and generalized anxiety disorder was associated with significant improvement in SF-12 scores compared to nonremission (ranging from ß = 7.28 in dysthymia to ß = 3.16 in social anxiety disorder, all P < .05). However, with the exception of alcohol abuse, individuals who had remitted from all other disorders had lower SF-12 scores than individuals without lifetime history of the disorder. Furthermore, remission of alcohol abuse, cannabis use disorder, nicotine dependence, panic disorder, and specific phobia was not associated with significant improvement in SF-12 scores. CONCLUSIONS: The relationship between psychiatric disorders and health-related quality of life is complex and differs across disorders. Although remission of several psychiatric disorders was associated with significant improvements, remission was generally not associated with full restoration of health-related quality of life, even among those without comorbid disorders.

Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: results from National Epidemiological Survey on Alcohol and Related Conditions.

BACKGROUND: Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population. METHODS: The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed. RESULTS: In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only. CONCLUSION: PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD.

Trends in the prevalence of tobacco use in the United States, 1991-1992 to 2004-2005.

OBJECTIVE This study examined changes in the prevalence of daily tobacco use in the United States between 1991-1992 and 2004-2005 by sociodemographic characteristics and psychiatric disorders. METHODS Secondary analyses were performed using data from the National Longitudinal Alcohol Epidemiologic Survey, conducted in 1991-1992 (N=41,612), and wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, conducted in 2004-2005 (N=34,653). RESULTS Although the overall prevalence of past-year daily tobacco use decreased significantly, the reduction was not uniform across all segments of the population. In both surveys, past-year daily tobacco use was higher among respondents with a drug use disorder, an alcohol use disorder, and major depressive disorder and among individuals from socioeconomically disadvantaged groups. Declines in use were slower among individuals with a lifetime alcohol use disorder or major depressive disorder. The prevalence of past-year daily tobacco use did not decrease among Native Americans. CONCLUSIONS Individuals with substance use disorders or major depressive disorder and Native Americans reported higher rates of past-year daily tobacco use than the general population. These findings suggest the need to emphasize specific interventions for these groups.

Prevalence and correlates of child sexual abuse: a national study.

BACKGROUND: This study examines the prevalence, correlates, and psychiatric disorders of adults with history of child sexual abuse (CSA). METHODS: Data were derived from a large national sample of the US population. More than 34000 adults 18 years and older residing in households were interviewed face-to-face in a survey conducted during the 2004-2005 period. Diagnoses were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between CSA and psychiatric disorders, adjusted for sociodemographic characteristics, risk factors, and other Axis I psychiatric disorders. RESULTS: The prevalence of CSA was 10.14% (24.8% in men and 75.2% in women). Child physical abuse, maltreatment, and neglect were more prevalent among individuals with CSA than among those without it. Adults with CSA history had significantly higher rates of any Axis I disorder and suicide attempts. The frequency, type, and number of CSA were significantly correlated with psychopathology. CONCLUSIONS: The high correlation rates of CSA with psychopathology and increased risk for suicide attempts in adulthood suggest the need for a systematic assessment of psychiatric disorders and suicide risk in these individuals. The risk factors for CSA emphasize the need for health care initiatives geared toward increasing recognition and development of treatment approaches for the emotional sequelae CSA as well as early preventive approaches.

Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions.

BACKGROUND: To examine gender differences among individuals diagnosed with DSM-IV lifetime cannabis use disorder (CUD). METHODS: A nationally representative sample of U.S. adults aged 18 years or older that were diagnosed with lifetime CUD (n=3297): Men (n=2080), Women (n=1217). Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). The survey response rate was 81%. RESULTS: Nearly all individuals with CUD had a psychiatric comorbidity (95.6% of men, 94.1% of women). Men with lifetime CUD were more likely than women to be diagnosed with any psychiatric disorder, any substance use disorder and antisocial personality disorder, whereas women with CUD had more mood and anxiety disorders. After adjusting for gender differences in sociodemographic correlates and the prevalence of psychiatric disorders in the general population, women with CUD were at greater risk for externalizing disorders. Men with CUD met more criteria for cannabis abuse, had longer episodes of CUD, smoked more joints, and were older at remission when compared to women with CUD. Women experienced telescoping to CUD. Treatment-seeking rates were very low for both genders, and there were no gender differences in types of services used or reasons for not seeking treatment. CONCLUSIONS: There are important gender differences in the clinical characteristics and psychiatric comorbidities among individuals with CUD.

Epidemiology of chronic and nonchronic major depressive disorder: results from the national epidemiologic survey on alcohol and related conditions.

BACKGROUND: Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. METHODS: Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). RESULTS: The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. CONCLUSION: Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment.

Substance-abusing physicians: monitoring and twelve-step-based treatment.

This study was designed to provide an independent evaluation of the oversight and rehabilitation of substance-impaired physicians. Records of 104 physicians who had completed their monitoring period by the New York State Committee on Physicians' Health were selected at random from CPH files. They had been followed for an average of 41.3 months. Practice characteristics and substance use before admission, as well as workplace monitoring, twelve-step attendance, urine toxicologies, and relapse incidence after admission are reported. Significant intercorrelations among these variables were ascertained by logistic regression. The utility of twelve-step-based rehabilitation as part of a treatment plan for sustaining abstinence and averting relapse is discussed.