Informing Evidence-Based Assessment of ADHD in Veterans and Service Members

Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in approximately 2.5% to 5% of the population, and though epidemiological studies of ADHD in veterans and service members are lacking, available evidence suggests that there may be a higher prevalence of ADHD in service members than in the general population. Assessment of ADHD in military populations is complicated by the higher prevalence rates of many other disorders with symptoms that overlap those of ADHD (e.g., posttraumatic stress disorder), making differential diagnosis an important aspect of the evaluation of ADHD. Although the diagnostic interview remains the gold standard for the evaluation and diagnosis of ADHD with adults, several different types of psychological measures have been developed and validated that can aid the evaluation. Future epidemiological research focused on prevalence and comorbidity rates in military samples is warranted to better understand the scope and complexity of the diagnosis. In addition, continued study of diagnostic assessment techniques, including validity testing and neurocognitive performance of veterans and service members with ADHD, particularly postdeployed veterans pursuing higher education, is warranted. This article reviews relevant findings and identifies initial recommendations for clinicians and researchers.     

Proportion of US Congregations that have People Living with HIV

Surveillance studies monitor the prevalence and incidence of HIV, and this information is used by policy makers to design prevention programs and facilitate care for people living with HIV (PLWHIV). Although most of these studies monitor the presence of PLWHIV in the general population or specific communities, some assess the presence of PLWHIV in organizations. One type of organization that has not been examined, yet could potentially play a large role in caring for PLWHIV, is the religious congregation. In this study, we estimate the proportion of US religious congregations that have PLWHIV and examine whether congregations that are in contact with populations with high HIV prevalence and incidence rates are more likely to have PLWHIV using data from a nationally representative sample of congregations and the 2000 Census. Over 10,000 congregations have PLWHIV, and congregations containing, open to, or located in areas with populations with high HIV prevalence and incidence rates are more likely to have them. This study offers new insight into the presence of HIV in the United States and provides information about which congregations may be amenable to serving as sites of HIV programs.     

Are we going to close social gaps in HIV? Likely effects of behavioral HIV-prevention interventions on health disparities

Although experimental behavioral interventions to prevent HIV are generally designed to correct undesirable epidemiological trends, it is presently unknown whether the resulting body of behavioral interventions is adequate to correct the social disparities in HIV-prevalence and incidence present in the United States. Two large, diverse-population meta-analytic databases were reanalyzed to estimate potential perpetuation and change in demographic and behavioral gaps as a result of introducing the available behavioral interventions advocating condom use. This review suggested that, if uniformly applied across populations, the analyzed set of experimental (i.e. under testing) interventions is well poised to correct the higher prevalence and incidence among males (vs. females) and African-Americans and Latinos (vs. other groups), but ill poised to correct the higher prevalence and incidence among younger (vs. older) people, as well as men who have sex with men, injection-drug users, and multiple partner heterosexuals (vs. other behavioral groups). Importantly, when the characteristics of the interventions most efficacious for each population were included in the analyses of behavior change, results replicated with three exceptions. Specifically, after accounting for interactions of intervention and facilitator features with characteristics of the recipient population (e.g. gender), there was no behavior change bias for men who have sex with men, younger individuals changed their behavior more than older individuals, and African-Americans changed their behavior less than other groups.     

Exploration of Environmental and Genetic Risk Factors for Alzheimer’s Disease: The Value of Cross-Cultural Studies

Advances in molecular genetics have revolutionized epidemiological research. It is now possible to combine the techniques of population genetics with research on risk factors to construct genetic-environmental interactive models that explain geographic-ethnic variations in disease rates. Cross-cultural studies involving populations from developing and developed countries offer a unique opportunity for constructing these models by providing a wide diversity of environmental exposures. Results from a comparative Indianapolis-Ibadan study suggest that Alzheimer’s disease incidence rates are lower in Yoruba than in African Americans and that these lower rates may be due to a combination of genetic and environmental, primarily dietary, influences.     

The epidemiology of autistic spectrum disorders: is the prevalence rising?

For decades after Kanner's original paper on the subject was published in 1943, autism was generally considered to be a rare condition with a prevalence of around 2-4 per 10,000 children. Then, studies carried out in the late 1990s and the present century reported annual rises in incidence of autism in pre-school children, based on age of diagnosis, and increases in the age-specific prevalence rates in children. Prevalence rates of up to 60 per 10,000 for autism and even more for the whole autistic spectrum were reported. Reasons for these increases are discussed. They include changes in diagnostic criteria, development of the concept of the wide autistic spectrum, different methods used in studies, growing awareness and knowledge among parents and professional workers and the development of specialist services, as well as the possibility of a true increase in numbers. Various environmental causes for a genuine rise in incidence have been suggested, including the triple vaccine for measles, mumps and rubella (MMR]. Not one of the possible environmental causes, including MMR, has been confirmed by independent scientific investigation, whereas there is strong evidence that complex genetic factors play a major role in etiology. The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders. Whether there is also a genuine rise in incidence remains an open question.     

Sexual attitudes and behavior of Guatemalan teenagers: considerations for prevention of adolescent pregnancy

Two studies were conducted to explore the prevalence of adolescent pregnancy in Guatemala, and to identify the level of contraception. The first study assessed sexual attitudes and behavior of 850 adolescents. In this group, 89% of the males and 38% of the females said they had experienced coitus. Youngsters of upper-middle and lower-middle socioeconomic status had higher rates of coital activity than did those of the middle class. Only 10% of the sexually active couples were using some type of contraception. Boys indicated greater inclination toward "recreational" sex, while girls tended to be more affectively involved with their lovers. Ninety-six percent of sexually active girls planned to marry their current sexual partner, while 5.5% of the boys planned to do so. The second study assessed the prevalence of pregnancy in minors (17 years or younger) attending the gynecology department at a local general hospital. Over a period of two years, 551 cases were identified. Although rates of pregnancy increased with age, the rate of annual increase was dramatically highest from ages 13 to 14, after which it decreased progressively with age. Based on these results, it is recommended that, at least in the Guatemalan population, sex education be implemented at an early age in order to prevent adolescent pregnancy.     

Suicidal behavior in Italy: data, trends and guidelines for a suicide intervention/prevention policy.

Even though in Italy, as in the majority of Mediterranean countries, the increase in suicide rates is not among the highest in Europe, between 1969 and 1989 it showed a sharp upswing (+43% among males and +31% among females). In terms of geographical differences, the regions with the highest suicide rate are the northern ones (up to twice the national average). The age groups with the highest suicide risk are those over 74 years (in 1989 the rate among males over 65 was the highest of all: 31.3 per 100,000). The differences in the between-sexes distribution show that among females over 65 years old the suicide rate rose by 70% between 1974 and 1989, versus 77% for males of the same age. The preliminary epidemiological results of one of two Italian centers are presented. These centers are collaborating with the WHO/EURO Multicenter Study on Parasuicide; parasuicide rates are higher for females than for males (55.9 per 100,000, as against 38.1 for males), while the age group at highest risk is seen to be young women (15-24 years), with a specific rate of 115.6.     

Psychological distress in university students: A comparison with general population data

Objective: While the mental health of university students is recognised internationally as an important public health issue, more epidemiological data are needed that allows benchmarking with general population data. Methods: All enrolled students from two large Australian universities were invited to complete a web‐based survey. Anxiety‐mood disorders were assessed using the Kessler 10. A total of 6,479 students participated in the study with sociodemographics generally consistent with the university population. Results: The estimated prevalence for mental health problems was 19.2% with 67.4% reporting subsyndromal symptoms. These rates were significantly higher than the general population. Psychological distress was associated with disability and lower academic achievement. Predictors of distress included: full‐time status, financial stress, being aged between and 18 and 34 years, being female, and in a subsequent undergraduate year of their degree. Conclusions: The extremely high prevalence of mental health problems in university students provides evidence for this being an at‐risk population. Implications: The results highlight the need for universal early interventions to prevent the development of severe mental illness in university students.     

Cognitive Assessment of Individuals with Multiple Sclerosis in the Arab World: a Systematic Review

Neuropsychology Review - The prevalence of multiple sclerosis (MS) is on the rise globally, and recent epidemiological studies have observed increased rates in the Arab world (i.e., countries of...     

The Relationship between General Population Suicide Rates and the Internet: A Cross‐National Study

Internet Web sites and chat rooms have been reported both to promote suicides and have a positive beneficial effect on suicidal individuals. There is a paucity of studies examining the role of the Internet in general population suicide rates. The relationship between general population suicide rates and the prevalence of Internet users was examined in a cross‐national study using data from the World Health Organization and the United Nations Web sites. The prevalence of Internet users was significantly and positively correlated with general population suicide rates in both sexes. On multiple regression analysis the prevalence of Internet users was independently associated with general population suicide rates in males, and this independent relationship in females approached statistical significance. Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross‐sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.     

The integration of research and practice in the prevention of youth problem behaviors

The prevention of youth problem behaviors is increasingly guided by science. Sound epidemiological research is coming to guide preventive efforts. Valid methods of monitoring the incidence and prevalence of youth problems increasingly shape preventive practice. The identification of empirically supported prevention interventions is becoming more sophisticated, and numerous scientific organizations have begun to engage in dissemination activities. These trends will be accelerated by increased media advocacy for the use of scientific methods and findings, the development of a registry of preventive trials, achievement of consensus about the standards for identifying disseminable interventions, and increased research on the factors that influence the effective implementation of science-based practices.     

The epidemiology of mental retardation: challenges and opportunities in the new millennium

There are a number of problems and challenges in relating the science of epidemiology to mental retardation (MR). These relate to how MR is defined and classified and how these definitions may change over time. These as well as other differences in ascertainment sources and methods need to be considered when comparing MR prevalence over time and place. On the other hand, advances in technology also provide new and efficient methods of data collection both by data linkage and by use of web-based methods to study rare diseases. While prevalence studies have not been individually reviewed, we have examined the range of data including recent studies relating to how prevalence differs according to age, gender, social class and ethnicity. Some problems with available etiological classification systems have been identified. Recent etiological studies, most of which use different classification systems, have been reviewed and explanations have been postulated to account for differences in results. Individual risk factors for MR are considered whilst the option of considering a population as opposed to a high risk strategy to MR prevention is raised. This might well involve improving the social milieu surrounding the occurrence of individual risk factors. The impact of biotechnological advances such as antenatal and neonatal screening and assisted reproduction on MR are discussed. The issue of how inequalities in access to technology may impact on case identification and even have the potential to further widen inequalities is raised. The importance of extending the use of epidemiological tools to study the social, health and economic burden of MR is also emphasized. However, in order to apply to MR the "prevention-intervention-research" cycle, which surely underpins all epidemiology, it is vital to ensure that the methodological challenges we raise are adequately addressed.     

Prevalence of Smoking in Anxiety Disorders Uncomplicated by Comorbid Alcohol or Substance Abuse

This study examined the point prevalence of smoking in patients with anxiety disorders who do not have comorbid alcohol or substance abuse or dependence (ASAD). In a retrospective chart review, the smoking status of 581 patients with anxiety disorders was assessed. Patients, ages 18–65, were seeking treatment for anxiety disorders at an outpatient clinic that specialized in anxiety and related disorders. All participants were interviewed using the Anxiety Disorders Interview Schedule—IV, during which their smoking status was assessed. The prevalence of smoking across all anxiety disorders was 14.8%, which is much lower than found in the general population (23.3%; CDC, 2002) and even lower than previous estimates in individuals with comorbid anxiety and ASAD. Individuals with panic disorder and generalized anxiety disorder had the highest prevalence of smoking, although these rates were still considerably lower than those found in previous studies of smokers with anxiety disorders. Reasons for lower prevalence estimates are discussed.     

The epidemiology of the epilepsies in children

The epilepsies are a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. There are several types of epileptic seizures and syndromes that are unique to children, including infantile spasms, Lennox-Gastaut syndrome and absence seizures. Febrile seizures and neonatal seizures, while not epilepsy, are relatively common types of seizures in infants and children and are likely markers of risk of later epilepsy. Thus, it is important to consider the epidemiological features of the epilepsies as they occur specifically in infants and children. The purpose of this review is to summarize what is currently known about the epidemiology of the childhood epilepsies and to identify promising areas for further population-based studies. The epilepsies are an important cause of neurological morbidity in children. The average annual rate of new cases (incidence) of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 children will have epilepsy. There is evidence that the incidence of the epilepsies in some populations of children may be decreasing over time, and this possibility merits further investigation. Factors that are known to increase risk of the epilepsies in children include congenital malformations of the central nervous system (CNS), moderate or severe head trauma, CNS infections, certain inherited metabolic conditions, and genetic factors. However, these account for only 25% to 45% of cases, and thus, the etiology of most cases of the epilepsies remains obscure. The paucity of well-controlled etiological studies is due largely to formidable methodological problems in conducting epidemiological studies of the epilepsies. The prognosis for seizure control is generally good, although children with remote symptomatic seizures and those with additional neurological disabilities do less well.     

The Role of Parenting Programmes in the Prevention of Child Maltreatment

Child maltreatment is a major worldwide concern and continuing high rates of abuse demand action. This article examines the role of parenting programmes as a strategy to prevent child maltreatment in the population as a whole and also as a targeted intervention for parents who have abused, or are at risk of abusing, their children. We argue that a blend of universal and targeted interventions is needed to reduce the prevalence of child maltreatment. Parenting interventions that concurrently target positive parenting and effective child management skills, dysfunctional parental attributions, and increasing parents' capacity to regulate their emotions are particularly useful. A variant of the Triple P—Positive Parenting Program, known as Pathways Triple P, is discussed to illustrate the value of this approach. Contextual factors that need to be addressed in working with child protection cases are also discussed. The role of training and supervision is discussed in the context of disseminating evidence‐based parenting programmes, and future directions for research are presented.     

Ancestry, genes, and suicide: a test of the Finno-Ugrian Suicide Hypothesis in the United States

There is now convergent evidence from classic quantitative genetics (family, twin, and adoption studies) and molecular genetic studies for specific genetic risk factors for suicidal behavior. This emerging research field has recently been supplemented by geographical studies concerned with the Finno-Ugrian Suicide Hypothesis (FUSH), which states that population differences in genetic risk factors may partially account for conspicuous geographical patterns seen in suicide prevalence. In particular, the European high-suicide-rate nations constitute a contiguous, J-shaped belt, spanning from Finland to Austria. This area maps onto the second principal component identified for European gene distribution, most likely reflecting a major migration event of the past (i.e., the ancestral adaptation to cold climates and the Uralic language dispersion) still detectable in modern European populations. The present research tested the hypothesis in the United States. Consistent with the hypothesis, available historical (1913-1924 and 1928-1932) U.S. state suicide rates were uniformly positively associated with available state proportions of reported American ancestries from European high-suicide-rate countries (Hungary, Lithuania, Poland, Russia, Slovakia, and the Ukraine). However, contrary to the hypothesis, available contemporary (1990-1994) suicide rates were uniformly negatively associated with these ancestry proportions. The findings of this first test outside Europe are therefore conflicting. A proposal based on the geographical study approach is offered to further the progress of investigations into the genetics of suicide.     

A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “body image,” “binge eating,” “restrained eating,” “weight and shape concern,” and “dieting” as keywords. These were combined with the Boolean operator “AND” with “Mexico” and “Latin America.” Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population.     

Understanding Gender and Intimate Partner Violence from an International Perspective

This paper reviews the international literature on intimate partner violence with a focus on gender differences in perpetration and victimization rates. A total of 35 studies from 21 countries are discussed that report prevalence or incidence rates of men’s and women’s involvement in physical and/or sexual aggression against an intimate partner. In addition, evidence on risk factors as well as consequences of intimate partner violence for men and women is presented. Conceptual and methodological differences between the studies and the lack of comparable databases within countries are discussed as limitations of the evidence, and perspectives for future research are outlined in the framework of cross-cultural psychology.     

Prevalence of anxiety symptoms and disorders in the transgender population: A systematic review of the literature

Introduction: Anxiety disorders are the most common mental illness in the general population, affecting 18% of the population in the United States (12 months prevalence) and 13.6% in Europe (life time prevalence). Several studies have also described high rates of anxiety disorders and symptoms of anxiety among the transgender population. There is, however, a great variation of results (particularly related to gender prevalence), and few studies have described the type of anxiety disorders specific to the transgender population.

Aim: To collect and critically appraise the information from the available studies describing prevalence rates of anxiety disorders and symptoms.

Results: A total of 25 cross-sectional (n = 17) and longitudinal (n = 8) studies were found. Cross-sectional studies described higher prevalence rates of anxiety symptoms in the transgender group than in the cis population. The prevalence of anxiety disorders range from 17% to 68%. The most common anxiety disorders found were specific phobias, social phobias, panic disorders, and obsessive-compulsive disorders. Most of the large studies suggest higher levels of anxiety symptoms and disorders in transgender men compared with transgender women; however, considerable variation in results was found.

Conclusions: The findings identified that there is considerable variation in anxiety disorders and symptoms among transgender people attending transgender health services. These findings are likely to be the result of the tools used, the lack of matching controls, and the lack of homogeneity of the group studied. Overall this review indicates high levels of anxiety symptoms and disorders among transgender people attending gender services, primarily (but not exclusively) before commencement of cross-sex hormone treatment. Anxiety disorders related to social interaction (such as social anxiety) and panic attack appear to be particularly common, however more rigorous studies to confirm those findings are needed.