Biomedical subjects

V Kovess

Publications and source records attributed to V Kovess.

At least 19 recordsLinked to original sources

PubMed2006

Risk factors for suicidality in Europe: results from the ESEMED study.

BACKGROUND: Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. METHODS: The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. RESULTS: Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. LIMITATIONS: Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. CONCLUSIONS: In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Adolescent↗

PubMed2005

Differing mental health practice among general practitioners, private psychiatrists and public psychiatrists.

BACKGROUND: Providing care for mental health problems concerns General Practitioners (GPs), Private Psychiatrists (PrPs) and Public Psychiatrists (PuPs). As patient distribution and patterns of practice among these professionals are not well known, a survey was planned prior to a re-organisation of mental health services in an area close to Paris METHODS: All GPs (n = 492), PrPs (n = 82) and PuPs (n = 78) in the South-Yvelines area in France were informed of the implementation of a local mental health program. Practitioners interested in taking part were invited to include prospectively all patients with mental health problem they saw over an 8-day period and to complete a 6-month retrospective questionnaire on their mental health practice. 180 GPs (36.6%), 45 PrPs (54.9%) and 63 PuPs (84.0%) responded. RESULTS: GPs and PrPs were very similar but very different from PuPs for the proportion of patients with anxious or depressive disorders (70% v. 65% v. 38%, p < .001), psychotic disorders (5% v. 7% v. 30%, p < .001), previous psychiatric hospitalization (22% v. 26 v. 61%, p < .001) and receiving disability allowance (16% v. 18% v. 52%, p < .001). GPs had fewer patients with long-standing psychiatric disorders than PrPs and PuPs (52%, 64% v. 63%, p < .001). Time-lapse between consultations was longest for GPs, intermediate for PuPs and shortest for PrPs (36 days v. 26 v. 18, p < .001). Access to care had been delayed longer for Psychiatrists (PrPs, PuPs) than for GPs (61% v. 53% v. 25%, p < .001). GPs and PuPs frequently felt a need for collaboration for their patients, PrPs rarely (42% v. 61%. v. 10%, p < .001). Satisfaction with mental health practice was low for all categories of physicians (42.6% encountered difficulties hospitalizing patients and 61.4% had patients they would prefer not to cater for). GPs more often reported unsatisfactory relationships with mental health professionals than did PrPs and PuPs (54% v. 15% v. 8%, p < .001). CONCLUSION: GP patients with mental health problems are very similar to patients of private psychiatrists; there is a lack of the collaboration felt to be necessary, because of psychiatrists' workload, and because GPs have specific needs in this respect. The "Yvelines-Sud Mental Health Network" has been created to enhance collaboration.

Adult↗

PubMed2005

[Factors associated with cervical cancer screening in women covered by national health insurance].

BACKGROUND: The aims of our study were to examine the factors associated with cervical screening in women whose tests are supported by a national health insurance scheme, the Mutuelle Générale de l'Education Nationale. METHODS: A self-administered postal questionnaire was sent to a random sample of 10,000 adults aged 20 to 60 years old living in France and insured with the Mutuelle Générale de l'Education Nationale. Response rate was 66.5% (N=6,518). RESULTS: Of the 3,741 women aged 20 to 60 years old, 88.5% have had at least one cervical smear. Mean age for the first cervical smear was 29.3 years (95% CI: 29.0-29.6). Preventive practices (mammogram, cervical smear and fecal occult-blood testing) were strongly related. The predictive factors for cervical smear during the past three years included: age between 30 and 49 years, marital status (married, separated or divorced), the socioeconomic status (unskilled workers reported cervical smears less often than women from other socioeconomic status). Consulting a gynaecologist in the past twelve months increased 9-fold the probability of having a cervical smear and 2-fold when consulting a general practitioner compared to women who consulted neither a gynecologist nor a general practitioner. CONCLUSIONS: In a population whose tests were supported by a national health scheme, the socioeconomic status was one of the determinants of Pap smear.

Adult↗

PubMed2004

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Adolescent↗

PubMed2004

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Adolescent↗

PubMed2004

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Adolescent↗

PubMed2004

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. METHOD: The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. RESULTS: In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. CONCLUSION: The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.

Adult↗

PubMed2004

Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Adult↗

PubMed2004

Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. RESULTS: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). CONCLUSION: These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.

Adolescent↗

PubMed2003

Could health care costs for depression be decreased if the disorder were correctly diagnosed and treated?

BACKGROUND: The aim of the present study was to assess the general population from two Sardinian areas to ascertain the direct health care costs involved in a diagnosis of major depression, and to verify the hypothesis of an increased expenditure for untreated depressed subjects. DESIGN: A case-control study was carried out using the database of an epidemiological community survey. Cases were subjects with a diagnosis of Major Depressive Episode (ICD-10, WHO 1992) in the last year, and controls comprised two groups matched to cases for sex and age, made up of healthy subjects and subjects affected by chronic somatic disorders, respectively. RESULTS: Depressed subjects use more health care resources than those affected by chronic somatic disorders or healthy subjects. An increase in health care costs is observed for drugs and hospitalisations in depressed subjects for whom no adequate antidepressive treatment has been prescribed. CONCLUSIONS: In spite of the limitations of the small sample size, the results seem to confirm an increase of direct health care costs in untreated depressed subjects. In view of the availability of efficient forms of treatment for depression, the findings obtained indicate that depression should be considered a priority question for public health and assigning of resources. Further confirmation should be sought in larger population-based studies representing the entire national context.

Adult↗

PubMed2003

[Cultural adaptation and validation of questionnaires measuring satisfaction with the French health system].

Two questionnaires measuring satisfaction of the population with regard to health care offer were constructed from measures validated in the USA (the Consumer Satisfaction Survey Questionnaire or CSS, and the Visit-Specific Satisfaction questionnaire, the VSQ). This work was comprised two stages: i) translation and cultural adaptation of the American instrument to the French health care context, implicating 6 translators, users and experts; and ii) a telephone survey in the general population (n = 706) to test the psychometric qualities of the French instrument (content and internal validity). The French version, the CSS-VF comprises 9 scales: access to primary care, access to secondary care, scope for choice, health cover, communication with and competence of GPs, communication with specialists, competence of specialists, human qualities of practitioners and overall satisfaction. The VSQ-VF, which measures satisfaction with the last medical consultation is unidimensional. The results of the psychometric analyses are good overall, and endorse the use of these scales in assessment studies.

Consumer Behavior↗

PubMed2002

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) project: rationale and methods.

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) is a new cross-sectional study investigating the prevalence and the associated factors of mental disorders, as well as their effect on health-related quality of life and the use of services in six European countries. This paper describes the rationale, methods and the plan for the analysis of the project. A total of 22,000 individuals representative of the non-institutionalized population aged 18 and over from Belgium, France, Germany, Italy, the Netherlands and Spain are being interviewed in their homes. Trained interviewers use a computer-assisted personal interview (CAPI) including the most recent version of the Composite International Diagnostic Interview (CIDI, 2000), a well-established epidemiological survey for assessing mental disorders. This is the first international study using the standardized up-to-date methodology for epidemiological assessment. Sizeable differences in prevalence, impact and level of need that is met by the health services are expected. The analysis of these differences should facilitate the monitoring of ongoing mental health reform initiatives in Europe and provide new research hypotheses.

Adolescent↗

PubMed2002

A French study of the Dominic Interactive.

INTRODUCTION: The Dominic Interactive was developed in North America to assess a child's perception of her/his own symptoms, which is critical to balance parents' and school professionals' perception. It is a computerized, DSM-IV-based pictorial questionnaire akin to a video game, for children aged 6-11. A strengths and competencies scale displays positive situations. Most children complete the Dominic Interactive 90 situations within 10-15 min. OBJECTIVE: Because of the cultural differences between North American and French children, a study of the appropriateness of the instrument to assess French children was required. METHODS: The CD-ROM-based Dominic Interactive was completed by 253 community children, and by 150 children from outpatient clinics in four French cities. The latter also received clinical diagnoses. Prevalence estimates yielded by the Dominic Interactive in the general population and referred children, relationships between prevalence estimates based on the Dominic Interactive and clinical judgments, and differences between Dominic Interactive scores in sub-samples of children with and without a clinical diagnosis were studied. RESULTS: Significant differences between clinically referred and non-referred children were found for every diagnosis, and between Dominic Interactive scores of referred children with and without a clinical diagnosis with the exception of oppositional disorder. Parental acceptability of the instrument was never a problem, children like it, and clinicians' comments were positive. DISCUSSION: Reference and clinical judgment both indicate that the Dominic Interactive is appropriate to assess child mental health in France. Clinical judgment discrepancies between sites and small numbers are the limitations of this study. CONCLUSION: The instrument performed well in the French context. The potential advantages of using the Dominic Interactive (children enjoy the activity, parents approve of it, it is relatively cost-effective, etc.) suggest its applicability in other settings.

Child↗

PubMed2002

Psychiatric disorders in Sardinian immigrants to Paris: a comparison with Parisians and Sardinians resident in Sardinia.

BACKGROUND: The aim of the present study was to compare the prevalence of ICD-10 psychiatric disorders in a community sample of subjects of Sardinian origin resident in Paris (here "immigrants"), of the general Parisian population ("Parisians") and of Sardinians resident in Sardinia ("Sardinians"). METHODS: The sample of immigrants was obtained by contacting a fifth of all households with a Sardinian surname in Paris telephone directories. The other samples have already been partially described in previous studies. All subjects were interviewed using the CIDIS, a shortened version of the structured WHO interview CIDI. RESULTS: High or very high response rates were achieved in all studies. The final sample sizes were: 153 immigrants, 2,260 Parisians and 1,040 Sardinians. Immigrants showed high rates of depressive disorders, as did Parisians, and high rates of anxiety disorders, as did Sardinians. The immigrants' offspring (second-generation immigrants) seemed to be particularly at risk for depression, drug-abuse and bulimia. Elderly Sardinians who had returned to Sardinia after a long period of emigration showed an increased risk of dysthymia. The presence of a confidential relationship had a protective effect. CONCLUSIONS: The results are consistent with previous findings which suggest a greater risk of anxiety disorders in Southern Europe and of depression in Northern European countries. Immigrants in this study seem to present a particularly unfavourable pattern of mental disorders compared to both origin and host populations. The role of social support, use of mental health services and social conditions of second-generation immigrants should be analysed in greater depth.

Adult↗

PubMed2002

[Assessment of quality of life for home ventilated patients with Duchenne muscular dystrophy].

A social and psychological survey was conducted for patients with DMD submitted to home mechanical ventilation for more than one year. Thirty six were tracheostomized and 16 were using non invasive ventilation. Fifty two patients were recruited: 36 were tracheostomized and 16 were using non invasive ventilation. Mean age was 25 +/- 5 years. In the two groups: 1- the main disagreement was air leaking and cutaneous erosions. 2- when present, headache, dyspnea, sleep troubles and general fatigue were improved by mechanical ventilation. 3- ventilation was considered as improving health but with an increasing of dependencies. 4- Majors disappointment are sexual life (70 percent) and physical status (40 percent) but patients spent more than half time with positive feeling (92 percent). There was no difference between satisfaction evaluation and type of ventilation. Home ventilated patients with DMD have positive assessment of satisfaction. Despite technical disagreement as air leaking, patients feel an improvement of their life and advise other DMD to use early home ventilation.

Adult↗

PubMed2000

Assessing the impact of a consensus conference on long-term therapy for schizophrenia.

OBJECTIVE: Our aim was to assess the impact of six recommendations regarding drug prescription on the clinical practices of French psychiatrists. The recommendations were part of the conclusions of a consensus conference entitled "Long-term therapy of schizophrenia" (Paris, January 1994). METHODS: The impact of the conference was assessed on the basis of awareness of the existence of the conference, knowledge of its conclusions, and actual changes in clinical practice. We performed: a) a survey of a representative sample of 396 psychiatrists 2 years after the conference; and b) an analysis of changes in drug prescriptions in a cohort of 2,407 patients with schizophrenia under treatment at the time of the conference. RESULTS: Overall, 78% of interviewed psychiatrists were aware of the existence of the conference and 70% of its conclusions. Declared prescription practices conformed with conference conclusions about 60% (10%-95%) of the time. No difference in practices was noted between psychiatrists who were aware of the recommendations and those who were not. Single neuroleptic prescriptions increased in the cohort study in line with the main conference recommendation. The increase was small, but significant from 51.1% to 56.4%, and mainly concerned patients recently put on treatment. Contrary to recommendations, prescriptions of anticholinergics plus neuroleptics inexplicably rose from 48.2% to 54.3%. CONCLUSION: Small changes in prescription habits occurred in the wake of the consensus conference, but we cannot really ascribe them to a direct impact of the conference. Despite the great pains we took in disseminating the conclusions of the conference as widely as possible, it is clear that a more forceful action plan (e.g., including continuous medical education) is required.

Adolescent↗

PubMed1999

The prevalence of psychiatric disorders and use of care by homeless people in Paris.

BACKGROUND: Homelessness is a growing problem in the cities of the western world, and homeless people have a plethora of mental health and social difficulties. These are, nevertheless, difficult to evaluate epidemiologically. METHOD: In this paper we present a population survey using the Composite International Diagnostic Interview (CIDI) conducted in the city of Paris in winter 1996 on a representative sample of 838 homeless people. Night shelters as well as food kitchens were randomly sampled, and the mean response rate was around 65%. RESULTS: The sample was relatively young and predominantly male (85%). Forty percent were born outside France, 96% had worked at some time, and one-third reported no resources at all. The lifetime prevalence of psychiatric disorders was 57.9%, while the 1-year prevalence was 29.1%. For definite psychotic disorders, prevalence was 16% (lifetime) and 6% (1 year). Generally, this Parisian homeless population had some access to care: in the preceding 6 months 57.7% of them had been medically attended and 14.2% of these had been hospitalised. The survey was cross-sectional, and did not evaluate regular access to care or the quality of care. CONCLUSIONS: The implications for health and social systems are discussed in the light of comparisons with European and North American data.

Adult↗

PubMed1999

Mental health and use of care in people receiving a French social benefit.

BACKGROUND: This paper presents and epidemiological survey of 300 adults randomly sampled among the Parisian population and 207 randomly sampled recipients of a social benefit. The RMI (Revenu Minimal d'Insertion) provides a regular minimal income to any person with resources below a certain level. It is not targeted at people with mental health problems. METHODS: The subjects were evaluated by trained interviewers using collateral information provided by an informant, together with CIDIS, a simplified version of the CIDI, covering: somatisation, panic attack, phobias, generalised anxiety, major depression and alcohol and illegal drug abuse (DSM-III-R and ICD-10 classifications). RESULTS: The response rate was 79% for the Parisian sample and 75% for the RMI recipients. As expected, the sociodemographic composition of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral information showed that psychoses of all types were more frequent among RMI recipients (4.2% vs 1.2%, P < 0.02). There were large differences in rates for substance abuse and dependence, antisocial personality and lifetime depressive disorders, but no difference for mental deficiency. This corresponded partly with the direct CIDIS measure: male RMI recipients suffered significantly more from severe depression than male Parisian controls: 16.7% compared to 3.4% (P < 0.01 lifetime) and from drug and alcohol abuse or dependency disorders. Depressed RMI recipients made less use of available medical care for their depression than Parisians controls, mainly because RMI recipients did not consult psychiatrists, whereas controls did (21%, P < 0.0001). On average, the duration of depressive episodes is longer in RMI recipients, especially in women. CONCLUSION: The high rate of psychiatric disorders and poor access to resources in RMI recipients have implications for the health system. Care would be improved if social workers administering the benefit were better trained to recognise psychiatric problems, and able to link their clients with (particularly) primary care services.

Adult↗