Many people with mental health problems do not use mental health care, resulting in poorer clinical and social outcomes. Reasons for low service use rates are still incompletely understood. In this longitudinal, population-based study, we investigated the influence of mental health literacy, attitudes toward mental health services, and perceived need for treatment at baseline on actual service use during a 6-month follow-up period, controlling for sociodemographic variables, symptom level, and a history of lifetime mental health service use. Positive attitudes to mental health care, higher mental health literacy, and more perceived need at baseline significantly predicted use of psychotherapy during the follow-up period. Greater perceived need for treatment and better literacy at baseline were predictive of taking psychiatric medication during the following 6 months. Our findings suggest that mental health literacy, attitudes to treatment, and perceived need may be targets for interventions to increase mental health service use.

SUMMARY. Background -In order to minimise retrospective recall in developing estimates of the prevalence of mental disorders in the general population, we conducted a prospective study of a cohort of youth from Zurich, Switzerland. Method -A 20 year prospective study of a community-based cohort aged 19-20 from Zurich Switzerland. The sample was enriched by subjects scoring high on the Symptom Checklist 90 R (Derogatis, 1977). A semi-structured diagnostic interview was administered by clinically experienced psychologists and psychiatrists. The six interviews from 1979 to 1999 assessed diagnoses and sub-threshold manifestations of major diagnostic categories (with the exception of schizophrenia) for the past twelve months, depending on the current DSM versions (DSM-IH, DSM-HI R, DSM-IV). Additional information on symptoms and treatment were collected for the years between the interviews. The reported prevalence rates are weighted for stratified sampling and cumulate the one-year rates of the six interviews. Results -The cumulative weighted prevalence rates for any psychiatric disorder were 48.6% excluding, and 57.7% including tobacco dependence. In addition 29.2% and 21.8%, respectively manifested sub-diagnostic syndromes. Overall there were no significant gender differences. The corresponding treatment prevalence rates were 22.4% and 31.1%, respectively for the diagnostic subjects and 6.9% and 6.1 %, respectively for the sub-diagnostic groups. The total treatment prevalence rate was 37.2% of the population (males 30.0%, females 44.1%). Conclusions -Our findings reveal that psychiatric disorders are quite common in the general population. When the spectra of mental disorders are considered, nearly three quarters of the general population will have manifested at least one of the mental disorders across their lifetime. Limitations -The data are based on a relatively small sample; a single age cohort, and the study was conducted in Zurich, Switzerland. These study features may diminish the generalisability of the findings.

Recent research suggests that search volumes of the most popular search engine worldwide, Google, provided via Google Trends, could be associated with national suicide rates in the USA, UK, and some Asian countries. However, search volumes have mostly been studied in an ad hoc fashion, without controls for spurious associations. This study evaluated the validity and utility of Google Trends search volumes for behavioral forecasting of suicide rates in the USA, Germany, Austria, and Switzerland. Suicide-related search terms were systematically collected and respective Google Trends search volumes evaluated for availability. Time spans covered 2004 to 2010 (USA, Switzerland) and 2004 to 2012 (Germany, Austria). Temporal associations of search volumes and suicide rates were investigated with time-series analyses that rigorously controlled for spurious associations. The number and reliability of analyzable search volume data increased with country size. Search volumes showed various temporal associations with suicide rates. However, associations differed both across and within countries and mostly followed no discernable patterns. The total number of significant associations roughly matched the number of expected Type I errors. These results suggest that the validity of Google Trends search volumes for behavioral forecasting of national suicide rates is low. The utility and validity of search volumes for the forecasting of suicide rates depend on two key assumptions (“the population that conducts searches consists mostly of individuals with suicidal ideation”, “suicide-related search behavior is strongly linked with suicidal behavior”). We discuss strands of evidence that these two assumptions are likely not met. Implications for future research with Google Trends in the context of suicide research are also discussed.

Background:There are only a small number of prospective studies that have systematically evaluated standardised diagnostic criteria for mental disorder for more than a decade. The aim of this study is to present the approximated overall and sex-specific cumulative incidence of mental disorder in the Zurich cohort study, a prospective cohort study of 18–19 years olds from the canton of Zurich, Switzerland, who were followed through age 50.Method:A stratified sample of 591 participants were interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology, a semi-structured interview that uses a bottom-up approach to assess the past-year presence of 15 psychiatric syndromes. Seven interview waves took place between 1979 and 2008. Approximated cumulative incidence was estimated using Kaplan–Meier methods.Results:Rates of mental disorder were considerably higher than those generally reported in cross-sectional surveys. We found rates ranging from 32.5% for major depressive disorder to 1.2% for Bipolar I disorder. The cumulative probability of experiencing any of the mental disorders assessed by age 50 was 73.9%, the highest reported to date. We also found that rates differed by sex for most disorders, with females generally reporting higher rates of mood, anxiety and phobic disorder, and males reporting higher rates of substance- and alcohol-related disorders.Conclusions:These findings confirm those of other long-term prospective studies that indicate the nearly universal nature of disturbances of emotion and behaviour across the life span. Greater community awareness of the normative nature of these experiences is warranted. An important area of future research is study long-term course and stability to determine who among those with such disturbances suffer from chronic disabling mental disorders. Such longitudinal studies may aid in directing services and intervention efforts where they are most needed.

Personality relates consistently to poor socio-environmental resources, health-impairing behaviours and psychopathology. We also found some evidence for an association with metabolic and immune functions that are assumed to influence health. A short personality inventory could provide valuable information for preventive medicine when used as a means to screen entire populations for distinct risk exposure, in particular with respect to psychopathology.

We assessed normal personality traits and childhood trauma in approximately 1170 subjects from a general population-based community sample. In bivariate analyses emotional abuse was most pervasively related to personality, showing significant detrimental associations with neuroticism, extraversion, openness, conscientiousness, and agreeableness. Neuroticism was significantly related to emotional abuse and neglect, physical abuse and neglect, and sexual abuse. Emotional abuse was related to neuroticism in men more profoundly than in women (β = 0.095). Adjusting for the covariance between childhood maltreatment variables, neuroticism was mainly related to emotional abuse (β = 0.193), extraversion to emotional neglect (β = -0.259), openness to emotional abuse (β = 0.175), conscientiousness to emotional abuse (β = -0.110), and agreeableness to emotional neglect (β = -0.153). The proportion of variance explained was highest in neuroticism (5.6%) and lowest in openness (1.9%) and conscientiousness (1.8%). These findings help to understand the complex association between childhood maltreatment and both normal and pathological personality.

There is increasing evidence pointing toward a continuous distribution of psychotic symptoms and accompanying factors between subclinical and clinical populations. However, for the construction of continuum models, a more detailed knowledge of different types of psychotic-like experiences (PLE) and their associations with distress, functional impairment, and demographic variables is needed. We investigated PLE in a sample of healthy adults (N = 206) incorporating the recently developed revised Exceptional Experiences Questionnaire (PAGE-R). For the first time, the PAGE-R was cross validated with PLE, disorganized-, and negative-like symptoms [Schizotypal Personality Questionnaire (SPQ), Physical Anhedonia Scale (PAS)]. We subjected the PAGE-R to exploratory factor analyses and examined the resulting subtypes of EE for specific associations with contextual factors, valence ratings, socio-demographic variables, and general psychological burden (Revised Symptom-Checklist-90). Correlational cross-validation suggested that the PAGE-R measures facets of PLE. Importantly, we (1) identified three types of exceptional experiences (EE): Odd beliefs, dissociative anomalous perceptions, and hallucinatory anomalous perceptions. Further, the results suggested that even in healthy individuals (2) PLE and EE are indicative of reduced functioning, as reflected by increased psychological burden and lower educational achievement. Moreover, (3) similar sex-differences might exist as in psychotic patients with women reporting more positive-like symptoms and EE but less disorganized-like symptoms than men. Importantly, (4) EE might be differentially implicated in psychological functioning. We suggest that the PAGE-R holds the potential to complement the current assessment of sub-clinical psychosis. However, whereas our results might point toward a continuity of psychotic symptoms with EE and normal experiences, they require replication in larger samples as well as equivalence testing across the psychosis continuum. Future analyses incorporating the PAGE-R might shed more light onto mechanisms that are implicated in the progress or resilience toward clinical illness.

Objectives:Although clinical evidence suggests important differences between unipolar mania and bipolar-I disorder (BP-I), epidemiological data are limited. Combining data from nine population-based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP-I with both manic and depressive episodes with respect to demographic and clinical characteristics in order to highlight differences.Methods: Participants were compared for gender, age, age at onset of mania, psychiatric comorbidity, temperament, and family history of mental disorders. Generalized linear mixed models with adjustment for sex and age as well as for each study source were applied. Analyses were performed for the pooled adult and adolescent samples, separately. Results: Within the included cohorts, 109 adults and 195 adolescents were diagnosed with M/Md and 323 adults and 182 adolescents with BP-I. In both adult and adolescent samples, there was a male preponderance in M/Md, whereas lifetime generalized anxiety and/panic disorders and suicide attempts were less common in M/ Md than in BP-I. Furthermore, adults with mania revealed bulimia/binge eating and drug use disorders less frequently than those with BP-I. Conclusions: The significant differences found in gender and comorbidity between mania and BP-I suggest that unipolar mania, despite its low prevalence, should be established as a separate diagnosis both for clinical and research purposes. In clinical settings, the rarer occurrence of suicide attempts, anxiety, and drug use disorders among individuals with unipolar mania may facilitate successful treatment of the disorder and lead to a more favorable course than that of BP-I disorder. K E Y W O R D S bipolar-I disorder, comorbidity, epidemiology, family history, gender, mania How to cite this article: Angst J, Rössler W, Ajdacic-Gross V, et al. Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies. Bipolar Disord. 2019;21:437-448. https://doi.