During the past year, we have continued to investigate the spectrum of mood disorders and mental-physical comorbidity in this national survey of U.S. adults, and to expand our network of collaborators. We oversaw a successful completion of a paper on the prevalence and correlates of bipolar spectrum disorder in an international population-based study using data from the common methodology WHO World Mental Health survey (WMH) initiative. We examined the prevalence of bipolar spectrum disorder (BPS includes bipolar I, II and subthreshold) in 11 high, medium, and low income countries, and found that despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior and comorbidity across each diagnostic category provide evidence for the validity of the concept of a bipolar spectrum. BPS treatment needs are often unmet, particularly in low-income countries (Merikangas, 2011). We have investigated the structure of depression observed in adults (NCS-R) and adolescents (NCS-A) and found highly similar classes and probabilities across adults and youth, with greater complexity in structure among adults than in adolescents. This finding suggested the need for early treatment and prevention of depression in adolescents (Lamers et al., manuscript under review). We have also examined the associations between both maternal and paternal psychopathology and subtypes of neglect, assessed the associations between subtypes of neglect subtypes and lifetime DSM-IV disorders in adults, and evaluated the independent associations between neglect and psychopathology after adjustment for parental psychopathology, other adverse experiences, recall bias, and social and demographic correlates. We found that childhood supervisory neglect is associated with negative mental health outcomes among exposed youth, independent of other demographic and familial risk factors. Furthermore, both paternal and maternal psychopathology demonstrated significant associations with neglect subtypes. These findings highlight the importance of neglect in characterizing childhood adversity, and demonstrate the importance of a broader conceptualization of childhood risk factors for adult psychopathology. (Heaton et al., manuscript in preparation) Public Health Impact: These findings have broadened our knowledge on the prevalence and correlates of the full spectrum of bipolar in a global view with common methods. Bipolar is an impairing disorder constituting economic and social challenge, but many cases go unrecognized and untreated. Our findings underscore the urgent need for increased recognition and treatment facilitation. The strong links between neglect and long standing psychiatric disorders have provided insights on importance of early intervention. Expansion of empirical inquiry into the associations between paternal, as well as maternal, risk factors and neglect in population based samples may provide advancements in both etiology and prevention. Future Plans: Now that we have completed the analyses of most relevant topics to our research program, our efforts on the NCS-A as an independent project will be reduced. The only planned analyses will be comparative analyses of symptom patterns, correlates and consequences of disorders shown in our parallel adolescent sample.
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