Tuesday, March 29, 2016

Stigma is perceived as often by people with depression as by people with schizophrenia

A 2012 mental health survey conducted in Canada (called the Canadian Community Health Survey-Mental Health or CCHS-MH) included a brief interview module designed to assess perceived stigma among those accessing mental health services. The module was called the Mental Health Experiences Scale, developed by Dr. Heather Stuart, at Queens University. The CCHS was a large survey, with a sample size of > 25,000 respondents. It employed a sophisticated sampling design to ensure representation of the national household population. However, the stigma scale was only administered to a subset (an estimated 8% of the population) who reported accessing mental health services in the preceding year. However, the questions in the scale asked about perceived stigma from any source, not just health professionals. About one in four of these respondents reported encountering stigma. The survey also included measures of mental health status, such as perceived mental health, a distress scale, self-reported diagnosis and a structured diagnostic interview. People with diagnoses were more likely to report stigmatization (irrespective of whether the diagnoses were from the diagnostic interview or from a health professional). Surprisingly, the frequency of perceived stigma was almost as high in people with mood and anxiety disorders as among people with Schizophrenia. Similar to previous studies, the perception of stigma was found to be lower in older respondents, over the age of 55. It is often assumed that stigma results from labelling, or that labelling is an essential component of the process of stigmatization. In this regard, an interesting finding was that people who reported receiving no diagnosis still often reported stigmatization, especially if they had symptoms suggestive of a diagnosable disorder (e.g. high distress, pronounced depressive symptoms). This suggests that stigma can occur directly as a result of manifestations of mental health difficulties, without the need for a diagnostic label. The paper is available here

Sunday, March 6, 2016

Adverse Childhood Events and Subsequent Health Outcomes

In this study, information gleaned from a sample assessed during childhood and then subsequently followed in an adult health survey was used to assess adverse health outcomes associated with adverse childhood events (ACEs). Some studies have suggested that many adult health outcomes are associated with ACEs. For example, cardiovascular disease may have a higher risk in people exposed to ACEs as children. However, such associations are not fully confirmed. Most such studies are based on retrospective reports of ACEs, and retrospective recall is not very reliable. It is possible, for example, that people with more adverse health outcomes during adulthood are more likely to report or remember childhood adversities. Many of these studies have used clinical samples - and ACEs may affect health care use, which could distort the associations. If such associations exist (e.g. cardiovascular disease) it is likely that they occur through complex pathways, e.g. if ACEs increase the risk of depression, this may lead to higher rates of other behaviours (e.g. dietary and lifestyle factors) that may in turn increase the risk of cardiovascular disease. For these reasons, we recently sought to link survey that collected data from the same people during childhood and adulthood in representative community samples and to look at proximate changes that occur in relation to ACEs (i.e. changes that are evident in young adulthood). We found the most convincing evidence of associations for three inter-related outcomes and ACEs:  Major depression, psychotropic medication use and smoking. The abstract is available here. This study provides some insights into the early life impact of ACEs and suggests and smoking, especially, may be a link connecting ACEs to later health difficulties.