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Biomedical subjects

Rachel Jenkins

Publications and source records attributed to Rachel Jenkins.

At least 19 recordsLinked to original sources
PubMed2007

Income-related inequality in mental health in Britain: the concentration index approach.

BACKGROUND: Reduction of health inequalities is a major policy goal in the UK. While there is general recognition of the disadvantaged position of people with mental health problems, the extent of inequality, particularly the association with socio-economic characteristics, has not been widely studied. We aimed to measure income-related inequality in the distribution of psychiatric disorders and to compare with inequality in other health domains. METHOD: The concentration index (CI) approach was used to examine income-related inequality in mental health using data from the Psychiatric Morbidity Survey 2000 for Britain. RESULTS: There is marked inequality unfavourable to lower income groups with respect to mental health disorders. The extent of inequality increases with the severity of problems, with the greatest inequality observed for psychosis. Income-related inequality for psychiatric disorders is higher than for general health in the UK. Standardized CIs suggest that these inequalities are not due to the demographic composition of the income quintiles. CONCLUSIONS: Income-related inequalities exist in mental health in Britain. As much of the observed inequality is probably due to factors associated with income and not due to the demographic composition of the income quintiles, it may be that these inequalities are potentially 'avoidable'.

Adolescent↗
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

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

Relationship between parental psychopathology, parenting strategies and child mental health--findings from the GB national study.

BACKGROUND: Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population. METHODS: The sample included 10,438 children of 5-15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child. FINDINGS: Parental psychopathology scores (OR 3.99, 95% CI 3.13-5.09) and non-physical punishment (OR 1.50, 95% CI 1.27-1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28-4.30) and non-physical punishment (OR 3.19, 95% CI 2.55-3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies. CONCLUSIONS: Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy.

Adolescent↗
PubMed2006

Primary mental health care in rural Punjab, Pakistan: providers, and user perspectives of the effectiveness of treatments.

Neuro-psychiatric disorders are associated with a considerable burden of disease, not only globally, but also in low- and middle-income countries. Epidemiological information about treatment of these disorders is required to help formulate treatment and prevention strategies. The aim of this study was to describe different types of mental health care providers, and examine patients' knowledge of the treatments and their views about its effectiveness in rural Punjab, Pakistan. We conducted a cross-sectional survey of attenders at a 1-day psychiatric consultation clinic in rural Punjab, Pakistan. Patients sought help from five different types of providers and were treated with physical, psychotherapeutic and spiritual treatments. Most recognised psychiatric problems as treatable. There was a discrepancy between belief and knowledge of the treatment of mental disorders; most had a very basic understanding of treatment. They reported general practitioner (GP) treatments as more effective (56%) compared to other practitioners (20%). We argue that treatments given by primary mental health care providers need to be standardised. A systematic appraisal of the theoretical rationale of the mental health treatments prescribed in primary care settings is required in low-income countries like Pakistan. This will help ensure standardisation of care especially regarding spiritual/psychological therapies so that in future valid inferences can be made about their effectiveness in populations. Further work should include improving mental health literacy with special reference to treatments available for mental health problems.

Adult↗
PubMed2006

Health system factors impacting on delivery of mental health services in Russia: multi-methods study.

OBJECTIVE: To evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation. METHODS: A multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports. RESULTS: Mental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing. CONCLUSION: In Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors.

Delivery of Health Care↗
PubMed2006

Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years.

STUDY OBJECTIVES: To compare age-group differences in somatic/psychiatric comorbidity, impact, and pharmacotherapy associated with sleep disturbance across a broad adult age range. DESIGN: Cross-sectional national mental health survey. SETTING: Adults living in private households in England, Scotland, and Wales. PARTICIPANTS: 8,580 people aged 16 to 74 years. MEASUREMENTS AND RESULTS: Insomnia (4 symptom/syndrome definitions), depression, generalized anxiety disorder, and daytime fatigue were defined from the revised Clinical Interview Schedule. Any insomnia was reported by 37% of the sample, moderate insomnia by 12%, insomnia with fatigue by 13%, and symptoms fulfilling diagnostic criteria for primary/secondary insomnia by 5%. All categories of insomnia were associated with mental disorders, worse physical health, and fatigue to a similar degree in all decade age groups. The associations between insomnia categories and separated, divorced, or widowed marital status were strongest in younger participants. Insomnia categories were of longer reported duration and more strongly associated with worse physical health-related quality of life (SF-12) in older age groups. For participants with any definition of insomnia, benzodiazepine hypnotics were more commonly reported in older age groups. CONCLUSIONS: The association between insomnia and impaired quality of life is most pronounced in older age groups. Associations with physical and mental health status and those with daytime fatigue do not vary in strength between age groups. Older people with insomnia in this population were more likely to be taking benzodiazepine hypnotics.

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

Knowledge and practice of help-seeking for treatment of mental disorders in Pemba Island, Zanzibar.

The objective of this study was to describe how people explain mental disorders and its treatment in Pemba Island, Zanzibar. Eight hundred and twenty-one participants (users, carers, health professionals, traditional healers, community members and leaders) were interviewed as part of a cross-sectional survey. Most people viewed mental disorder as arising within their internal or supernatural world. Although they thought that they could be helped both by primary health care and alternative healing, the majority described going to the traditional healers when things went wrong. This provides evidence that there is considerable reliance on traditional care for the treatment of mental disorders. It is therefore important for the health services to be in dialogue with the traditional healers.

Cross-Sectional Studies↗
PubMed2006

Eliciting explanatory models of common mental disorders using the Short Explanatory Model Interview (SEMI) Urdu adaptation--a pilot study.

The purpose of this pilot study was to describe the presenting symptoms and its explanation from the patients' perspective of GHQ (General Health Questionnaire) positive cases attending primary care facility/a general practice in semiurban Lahore. Fifteen consecutive attenders were screened with GHQ and 11 GHQ positive cases went on to complete an adapted questionnaire derived from SEMI (Short Explanatory Model Interview). Though there was no consistency in the presenting symptoms of GHQ positive cases on presentation to a general practitioner, all described their problems as intense, less than 2 years on onset and on reflection located its origins in their social worlds. These findings have implications in terms of providing preliminary data for a larger study, perhaps looking at development of psychosocial interventions for treatment of mental distress in our local context as it seems to have its origins in their social worlds.

Adult↗
PubMed2005

The distribution of the common mental disorders: social inequalities in Europe.

BACKGROUND: The social class distribution of the common mental disorders (mostly anxiety and/or depression) has been in doubt until recently. This paper reviews the evidence of associations between the prevalence of the common mental disorders in adults of working age and markers of socio-economic disadvantage. METHODS: Work is reviewed which brings together major population surveys from the last 25 years, together with work trawling for all European population studies. Data from more recent studies is examined, analysed and discussed. Because of differences in methods, instruments and analyses, little can be compared precisely, but internal associations can be examined. FINDINGS: People of lower socio-economic status, however measured, are disadvantaged, and this includes higher frequencies of the conditions now called the 'common mental disorders' (mostly non-psychotic depression and anxiety, either separately or together). In European and similar developed populations, relatively high frequencies are associated with poor education, material disadvantage and unemployment. CONCLUSION: The large contribution of the common mental disorders to morbidity and disability, and the social consequences in working age adults would justify substantial priority being given to addressing mental health inequalities, and deprivation in general, within national and European social and economic policy.

Journal Article↗
PubMed2005

Psychiatric and social aspects of suicidal behaviour in prisons.

BACKGROUND: Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM: To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD: This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS: Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS: The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Adolescent↗
PubMed2005

Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain.

BACKGROUND: Structural characteristics of social networks such as primary group size have received less attention than measures of perceived social support. Previous research suggests that associations between social network size and later common mental disorder status may differ according to sex and initial mental state. METHOD: Adults participating in the 2000 British National Household Survey of psychiatric morbidity were randomly selected for follow-up 18 months later. The revised Clinical Interview Schedule (CIS-R) and the Interview Measure of Social Relations (IMSR) were administered at baseline and follow-up. Primary group size was defined as the total number of close relatives and friends. A four-level scale of common mental disorder was modelled with ordinal logistic regression, based on weighted data (n=2413). FINDINGS: After adjusting for confounders, a primary group size of three or less at time 1 predicted worse mental health at time 2. This effect was greatest in men who were initially non-cases at baseline (averaged odds 4.5) and in women who were initially cases at baseline (average odds 2.9). Primary group size at time 2 was significantly predicted by level of common mental disorder at time 1 in women but not in men. Thus, confounding by baseline disorder does not explain risk of developing poor mental health in socially isolated men. CONCLUSION: This study replicates the strong effects of primary group size on future mental health that emerge when men and women are studied separately and when subjects are categorized according to baseline mental health status.

Adolescent↗
PubMed2005

Psychosis in the community and in prisons: a report from the British National Survey of psychiatric morbidity.

OBJECTIVE: Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. METHOD: A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. RESULTS: The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. CONCLUSIONS: This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.

Adolescent↗