Biomedical subjects

Glyn Lewis

Publications and source records attributed to Glyn Lewis.

At least 19 recordsLinked to original sources

PubMed2006

Violence and psychiatric morbidity in a national household population--a report from the British Household Survey.

This study measured the prevalence of self-reported violence and associations with psychiatric morbidity in a national household population, based on a cross-sectional survey in 2000 of 8,397 respondents in Great Britain. Diagnoses were derived from computer-assisted interviews, with self-reported violent behavior over the previous 5 years. The 5-year prevalence of nonlethal violence in Britain was 12% (95% confidence interval: 11, 13). The risk of violence was substantially increased by alcohol dependence (odds ratio=2.72, 95% confidence interval: 1.85, 3.98), drug dependence (odds ratio=2.63, 95% confidence interval: 1.45, 4.74), and antisocial personality disorder (odds ratio=6.12, 95% confidence interval: 3.87, 9.66). Low prevalences of these conditions (7%, 4%, and 4%, respectively) contrasted with their relatively high proportions of attributed risk of violence (23%, 15%, and 15%). Hazardous drinking was associated with 56% of all reported violent incidents. Screening positive for psychosis did not independently increase risk (odds ratio=3.20, 95% confidence interval: 0.35, 29.6). The study concluded that psychiatric morbidity makes a significant public health impact on violence exerted primarily by persons with any personality disorder, substance dependence, and hazardous drinking. Population interventions for violent behavior are appropriate for hazardous drinking as are targeted interventions for substance dependence and antisocial personality disorder. Despite public concern, the risks of violence from persons with severe mental illness were very low.

Adolescent↗

PubMed2006

Pain in veterans of the Gulf War of 1991: a systematic review.

BACKGROUND: Veterans of the Persian Gulf War of 1991 have reported a range of adverse health symptoms. This systematic review aims to identify all studies that have compared the prevalence of symptoms of pain in veterans of the Gulf War to that in a non-Gulf military comparison group, and to determine whether Gulf War veterans are at increased risk of reporting pain. METHODS: Studies published between January 1990 and May 2004 were identified by searching a large number of electronic databases. Reference lists and websites were also searched and key researchers were contacted. Studies were included if they reported the prevalence of any symptom or condition that included the word "pain" in Gulf War veterans and in a comparison group of non-Gulf veterans. 2401 abstracts were independently reviewed by two authors. RESULTS: Twenty studies fulfilled the inclusion criteria. Five main sites of pain were identified (muscle, joint, chest/heart, back and abdominal pain) and separate meta-analyses were performed to summarise the results related to each site. A greater proportion of Gulf veterans reported symptoms at each site of pain when compared to a non-Gulf military group. Gulf deployment was most strongly associated with abdominal pain, with Gulf veterans being more than three times more likely to report such pain than a comparison group (OR 3.23; 95% CI 2.31-4.51). Statistical heterogeneity between study estimates was significant, probably due to variation in measured periods of prevalence and symptom measurement methods. CONCLUSION: A higher proportion of veterans of the Persian Gulf War of 1991 reported symptoms of pain than military comparison groups. This is consistent with previously demonstrated increased reporting of more general symptoms (fatigue, multiple chemical sensitivity, post traumatic stress disorder) in these veterans compared with non-Gulf military groups. However, the primary studies were heterogeneous and varied greatly in quality.

Gulf War↗

PubMed2006

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000.

BACKGROUND: Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. METHODS: A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. RESULTS: The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. CONCLUSIONS: Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Adolescent↗

PubMed2006

Risk of schizophrenia and other non-affective psychosis among individuals exposed to head injury: case control study.

Studies of the risk of schizophrenia and related non-affective psychoses among individuals exposed to head injury have reported conflicting findings. The diagnostic specificity of reported associations remains unclear and the effects of sex, genetic vulnerability and timing of exposures are also uncertain. The authors used a comprehensive range of data derived from the linkage of several Swedish registers to investigate associations of head injury with schizophrenia and other non-affective psychoses. We carried out a nested case control study drawn from a cohort of 785,051 men and women born between 1973 and 1980. After head injury exposure, there was a small increase in the risk (OR 1.37 (CI 1.14-1.66)) of non-schizophrenic, non-affective psychoses but not schizophrenic disorder (OR 1.10 CI 0.82 to 1.47). There was no critical period effect for exposures in early childhood, the association with non-affective psychosis being observed only in those exposed to head injury after age 10. There was no evidence that associations differed in males and females or in those with, and those without, a family history of psychosis. We conclude that it is unlikely that head injury causes schizophrenia. There is a small but significant risk of non-schizophrenic psychotic disorders but this is not associated with early age of injury or family history of psychosis. Further research is needed to clarify the potential roles of social and biological intermediary factors.

Adult↗

PubMed2006

Multi-symptom illnesses, unexplained illness and Gulf War Syndrome.

Explanatory models for the increased prevalence of ill health in Gulf veterans compared to those not deployed to the Gulf War 1990-1991 remain elusive. This article addresses whether multi-symptom reporting in Gulf veterans are types of medically unexplained symptoms and whether the alleged Gulf War Syndrome is best understood as a medically unexplained syndrome. A review of the epidemiological studies, overwhelmingly cross-sectional, describing ill health was conducted including those that used factor analysis to search for underlying or latent clinical constructs. The overwhelming evidence was that symptoms in Gulf veterans were either in keeping with currently defined psychiatric disorders such as depression and anxiety or were medically unexplained. The application of factor analysis methods had varied widely with a risk of over interpretation in some studies and limiting the validity of their findings. We concluded that ill health in Gulf veterans and the alleged Gulf War Syndrome is best understood within the medically unexplained symptoms and syndromes constructs. The cause of increased reporting in Gulf veterans are still not clear and requires further inquiry into the interaction between sociological factors and symptomatic distress.

Fatigue Syndrome, Chronic↗

PubMed2006

Fetal growth and childhood behavioral problems: results from the ALSPAC cohort.

Using data on 4,813 children from the ALSPAC cohort in Bristol, United Kingdom, recontacted in 1998-1999, the authors investigated whether intrauterine growth restriction (indexed by birth weight and length) was associated with behavioral problems at age 7 years. Childhood behavioral problems were measured by using a brief behavioral screening questionnaire (the Strengths and Difficulties Questionnaire (parental completion)). For term singleton infants, a one standard deviation increase in birth weight was associated with an 11% reduction in the odds of behavioral problems at age 81 months. After adjustment for confounders and birth length, this association was no longer seen. The association with birth length remained after adjustment for confounders. A one standard deviation increase in birth length was associated with a 14% decrease in the odds of being in the top tertile of total behavioral difficulties at age 81 months (odds ratio = 0.86, 95% confidence interval: 0.79, 0.95) and was similarly associated with hyperactivity and conduct problems. Evidence was weak for an association between birth length and behavioral problems earlier in childhood. In summary, there was a weak association between intrauterine growth restriction, indexed by birth length (rather than weight), and childhood behavioral problems. Future work should focus on elucidating the biologic mechanisms that lead to variations in birth length and underlie this association.

Birth Weight↗

PubMed2006

Systematic review of multi-symptom conditions in Gulf War veterans.

BACKGROUND: Gulf War veterans have a number of health complaints. We therefore decided to carry out a systematic review to identify and summarize the findings from studies that have assessed multi-symptom conditions in Gulf War veterans and in an unexposed comparison group. METHOD: Studies published between January 1990 and May 2004 were identified by searching a large number of electronic databases. Reference lists and websites were also searched and key researchers were contacted. Studies were included if they compared the prevalence of chronic fatigue syndrome, multiple chemical sensitivity, CDC-defined chronic multi-symptom illness, fibromyalgia, or symptoms of either fatigue or numbness and tingling in Gulf War veterans and non-Gulf veterans. A total of 2401 abstracts were independently reviewed by two authors. RESULTS: Twenty-three publications fulfilled the inclusion criteria. Gulf deployment was most strongly associated with chronic fatigue syndrome (OR 3.8, 95% CI 2.2-6.7). Gulf War veterans were also approximately three and a half times more likely than non-Gulf veterans to report multiple chemical sensitivity or chronic multi-symptom illness as defined by CDC. The methodological quality of the studies varied but the later and larger studies were of a high methodological standard with robust sampling strategies, adequate response rates and good adjustment for confounders. CONCLUSIONS: The results support the hypothesis that deployment to the Gulf War is associated with greater reporting of multi-symptom conditions.

Anxiety Disorders↗

PubMed2006

Perceptions of social capital and the built environment and mental health.

There has been much speculation about a possible association between the social and built environment and health, but the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation, social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the individual level (households and postcodes) in order to assess if these constructs reflect some contextual effect; and (3) to study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these derived factors. A cross-sectional household survey was undertaken during May-August 2001 in a district of South Wales with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and 10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus suggesting that some of our compositional measures capture contextual characteristics of the built and social environment. After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors to show statistically significant associations with GHQ-12 scores. However, these factors also showed little variation at postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the contextual nature of social capital.

Adult↗

PubMed2006

Disability pension for psychiatric disorders: regional differences in Norway 1988-2000.

The aim of this study was to describe regional differences in the incidence of disability pensions (DPs) with psychiatric diagnoses, and to determine whether these differences were related to age and/or gender. We compared the incidence rates of new DPs including all diagnoses, with DP with psychiatric diagnoses in Norwegian regions from 1988 to 2000. The population at risk was all individuals aged 16-67 in each year. Individuals already on DP were excluded. Cases were collected from the Norwegian National Insurance Administration. The results showed that the incidence rate ratio (IRR; Norway reference) for DP with psychiatric diagnoses was most elevated for men 1.41 (95% CI 1.27-1.58) and women 1.48 (95% CI 1.34-1.64) living in the most rural region. Men in the urban area had a higher IRR, 1.33 (95% CI 1.26-1.40), than urban women, 1.02 (95% CI 0.96-1.07). The incidence more than doubled in the youngest age group (16-29 years) and decreased in the oldest age group (60-67 years) between 1988 and 2000. The findings conclude that individuals living in semi-rural regions of Norway are more likely to receive a DP with a psychiatric diagnosis than those living in urban areas. Large gender differences were found in the urban area. Further research is needed to investigate the impact of the psychiatric healthcare system and access to rehabilitation on psychiatric disability.

Adolescent↗

PubMed2006

Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000.

OBJECTIVE: There is little information about obsessive-compulsive disorder in large representative community samples. The authors aimed to establish obsessive-compulsive disorder prevalence and its clinical typology among adults in private households in Great Britain and to obtain generalizable estimates of impairment and help-seeking. METHOD: Data from the British National Psychiatric Morbidity Survey of 2000, comprising 8,580 individuals, were analyzed using appropriate measurements. The study compared individuals with obsessive-compulsive disorder, individuals with other neurotic disorders, and a non-neurotic comparison group. ICD-10 diagnoses were derived from the Clinical Interview Schedule-Revised. RESULTS: The authors identified 114 individuals (74 women, 40 men) with obsessive-compulsive disorder, with a weighted 1-month prevalence of 1.1%. Most individuals (55%) in the obsessive-compulsive group had obsessions only. Comorbidity occurred in 62% of these individuals, which was significantly greater than the group with other neuroses (10%). Co-occurring neuroses were depressive episode (37%), generalized anxiety disorder (31%), agoraphobia or panic disorder (22%), social phobia (17%), and specific phobia (15%). Alcohol dependence was present in 20% of participants, mainly men, and drug dependence was present in 13%. Obsessive-compulsive disorder, compared with other neurotic disorders, was associated with more marked social and occupational impairment. One-quarter of obsessive-compulsive disorder participants had previously attempted suicide. Individuals with pure and comorbid obsessive-compulsive disorder did not differ according to most indices of impairment, including suicidal behavior, but pure individuals were significantly less likely to have sought help (14% versus 56%). CONCLUSIONS: A rare yet severe mental disorder, obsessive-compulsive disorder is an atypical neurosis, of which the public health significance has been underestimated. Unmet need among individuals with pure obsessive-compulsive disorder is a cause for concern, requiring further investigation of barriers to care and interventions to encourage help-seeking.

Comorbidity↗

PubMed2006

Violence and psychiatric morbidity in the national household population of Britain: public health implications.

BACKGROUND: It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence. AIMS: To measure associations between psychiatric morbidity and severity, chronicity and types of victims of violence in the national household population of Britain. METHOD: Cross-sectional survey of persons in households (n = 8397).Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews. RESULTS: Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%. CONCLUSIONS: The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.

Adolescent↗

PubMed2006

Rural/non-rural differences in rates of common mental disorders in Britain: prospective multilevel cohort study.

BACKGROUND: Some UK studies have reported an urban excess in the prevalence of the most common mental disorders of anxiety and depression. AIMS: To investigate rural/non-rural differences in the onset and maintenance of episodes of common mental disorders, after adjusting for the characteristics of respondents and their households. METHOD: A12-month cohort study of 7659 adults aged 16-74 years living in 4338 private households, nested within 626 electoral wards in England, Wales and Scotland. Common mental disorders were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised by Office for National Statistics classification and by population density. Data were analysed using multilevel statistical modelling. RESULTS: Rural residents had slightly better mental health than non-rural counterparts. The effects of geographical location on the mental health of participants were neither significantly confounded nor modified by socio-economic status, employment status or household income. CONCLUSIONS: There are small but statistically significant differences in rates of common mental disorders between urban and rural residents. Quantifying between-place differences using population density alone risks missing important contextual effects on mental health.

Adolescent↗

PubMed2006

Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey.

BACKGROUND: Scarce longitudinal data exist on the occurrence of psychotic symptoms in the general population. AIMS: To estimate the incidence of, and risk factors for, self-reported psychotic symptoms in Great Britain. METHOD: Data from the 18-month follow-up of a national survey were used. Incident cases were those who endorsed one or more items on the Psychosis Screening Questionnaire at follow-up, but not at baseline. The association between factors recorded at baseline and incident self-reported symptoms was examined. RESULTS: At follow-up, 4.4% of the general population reported incident psychotic symptoms. Six factors were independently associated with incident symptoms: living in a rural area; having a small primary support group; more adverse life events; smoking tobacco; neurotic symptoms; and engaging in a harmful pattern of drinking. CONCLUSIONS: A small but not insignificant percentage of the population of Great Britain reported incident psychotic symptoms over 18 months. The risk factors for psychotic symptoms showed some similarities with risk factors for schizophrenia, but there were also some striking differences. The relationship between such risk factors and the factors that perpetuate psychotic symptoms remains to be ascertained.

Adolescent↗

PubMed2006

Socio-economic position and common mental disorders. Longitudinal study in the general population in the UK.

BACKGROUND: Individuals in lower socio-economic groups have an increased prevalence of common mental disorders. AIMS: To investigate the longitudinal association between socio-economic position and common mental disorders in a general population sample in the UK. METHOD: Participants (n=2406) were assessed at two time points 18 months apart with the Revised Clinical Interview Schedule. The sample was stratified into two cohorts according to mental health status at baseline. RESULTS: None of the socio-economic indicators studied was significantly associated with an episode of common mental disorder at follow-up after adjusting for baseline psychiatric morbidity. The analysis of separate diagnostic categories showed that subjective financial difficulties at baseline were independently associated with depression at follow-up in both cohorts. CONCLUSIONS: These findings support the view that apart from objective measures of socio-economic position, more subjective measures might be equally important from an aetiological or clinical perspective.

Adolescent↗

PubMed2006

Gender differences in reoffending after discharge from medium-secure units. National cohort study in England and Wales.

BACKGROUND: Previous research has shown that there are gender differences in reoffending after discharge from medium-secure units, but these have not been adequately explained. AIMS: To investigate gender differences in reoffending after discharge from medium-secure psychiatric units. METHOD: All people discharged from medium-secure units in England and Wales between April 1997 and March 1998 were followed up for 1 year (n=959; 12% women). Reoffending was estimated by collecting reconviction data from the Home Office's Offenders' Index or from files at the mental health unit up to 2 years after discharge. RESULTS: Women were less likely than men to be reconvicted within 2 years of discharge (9% v. 16%, OR=0.49, 95% CI 0.25-0.98). Adjustments for history of self-harm, drug or alcohol problems and previous offending substantially reduced the gender difference. In the full model the OR was 0.97 (95% CI 0.45-2.12). CONCLUSIONS: Some or all of the gender differences in reoffending between men and women are explained by self-harm, alcohol and drug problems and previous criminal history.

Adolescent↗

PubMed2005

Inequities in mental health care after health care system reform in Chile.

OBJECTIVES: We compared differences in mental health needs and provision of mental health services among residents of Santiago, Chile, with private and public health insurance coverage. METHODS: We conducted a cross-sectional survey of a random sample of adults. Presence of mental disorders and use of health care services were assessed via structured interviews. Individuals were classified as having public, private, or no health insurance coverage. RESULTS: Among individuals with mental disorders, only 20% (95% confidence interval [CI]=16%, 24%) had consulted a professional about these problems. A clear mismatch was found between need and provision of services. Participants with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation; participants with private coverage exhibited exactly the opposite pattern. After adjustment for age, income, and severity of symptoms, private insurance coverage (odds ratio [OR]=2.72; 95% CI=1.6, 4.6) and higher disability level (OR=1.27, 95% CI=1.1, 1.5) were the only factors associated with increased frequency of mental health consultation. CONCLUSIONS: The health reforms that have encouraged the growth of the private health sector in Chile also have increased risk segmentation within the health system, accentuating inequalities in health care provision.

Adolescent↗

PubMed2005

Is there a gender difference on the association between informal work and common mental disorders?

Economic activity in Brazilian women has been increasing in recent years, particularly in the form of under- and self-employment, which allows more flexibility in the work schedule and facilitates part-time work, a crucial issue for women reconciling family duties and the need for a remunerated occupation. This paper investigates the gender difference in the association between employment status and common mental disorders (CMD). A cross-sectional survey of a random sample of private households included 683 adults aged 15 years and over living in Olinda, Brazil. The self-reporting questionnaire (SRQ-20) was used to estimate the prevalence of CMD. The association between unemployment and CMD for men (OR=1.77, 95% CI 0.8-3.9) was in the same direction as that found for women (OR=2.66, 95% CI 1.1-6.3), but not significant. In contrast to this, while women working in the informal sector were more likely to be a case of CMD than formal workers (OR=3.02, 95% CI 1.3-7.2), no difference was found for informally working men (OR=1.08, 95% CI 0.5-2.4). The estimated OR for female informal workers was out of the 95% confidence intervals of the corresponding OR estimated for males, and the test for interaction was statistically significant (p=0.04). From a policy perspective, the value of encouraging people to take informal work depends both on how quickly individuals can be moved out of unemployment into informal work compared to other destinations, and how well individuals fare once in informal work. The results of the present study suggest that working outside the protection of employment legislation and with limited opportunity for skill use may be a risk for women's mental health.

Adolescent↗

PubMed2005

Patients' views on outcome following head injury: a qualitative study.

BACKGROUND: Head injuries are a common occurrence, with continuing care in the years following injury being provided by primary care teams and a variety of speciality services. The literature on outcome currently reflects areas considered important by health-care professionals, though these may differ in some respects from the views of head injured individuals themselves. Our study aimed to identify aspects of outcome considered important by survivors of traumatic head injury. METHODS: Thirty-two individuals were interviewed, each of whom had suffered head injury between one and ten years previously from which they still had residual difficulties. Purposive sampling was used in order to ensure that views were represented from individuals of differing age, gender and level of disability. These interviews were fully transcribed and analysed qualitatively by a psychologist, a sociologist and a psychiatrist with regular meetings to discuss the coding. RESULTS: Aspects of outcome mentioned by head injury survivors which have received less attention previously included: specific difficulties with group conversations; changes in physical appearance due to scarring or weight change; a sense of loss for the life and sense of self that they had before the injury; and negative reactions of others, often due to lack of understanding of the consequences of injury amongst both family and general public. CONCLUSION: Some aspects of outcome viewed as important by survivors of head injury may be overlooked by health professionals. Consideration of these areas of outcome and the development of suitable interventions should help to improve functional outcome for patients.

Adolescent↗