RESUMEN
BACKGROUND: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.
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Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Canadá/epidemiología , Comparación Transcultural , Femenino , Estudios de Seguimiento , Francia/epidemiología , Alemania/epidemiología , Humanos , Corea (Geográfico)/epidemiología , Líbano/epidemiología , Masculino , Estado Civil , Trastornos Mentales/psicología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Puerto Rico/epidemiología , Distribución por Sexo , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures. METHOD: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries. RESULTS: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries. CONCLUSIONS: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.
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Comparación Transcultural , Trastorno de Pánico/epidemiología , Adolescente , Adulto , Edad de Inicio , Anciano , Agorafobia/epidemiología , Canadá/epidemiología , Comorbilidad , Trastorno Depresivo/epidemiología , Femenino , Alemania/epidemiología , Humanos , Italia/epidemiología , Corea (Geográfico)/epidemiología , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Puerto Rico/epidemiología , Factores Sexuales , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
With the advent of improved vectors for DNA delivery, somatic gene therapeutic approaches have expanded rapidly in the last few years. The vast majority of applications include ex vivo and in vivo protocols in patients postnatally. Nonetheless there is increasing interest and compelling reasons to consider prenatal application of somatic gene therapy (1,2. In the current chapter, we will review theoretical, ethical, and experimental support for in utero gene therapy and then outline the methodology and large animal model we are currently using to consider retrovirus-mediated gene transfer to fetal lung. In this latter regard, the candidate inherited disorder is cystic fibrosis and the reader is referred to Chapters 1 and 12 in this volume.
RESUMEN
OBJECTIVE: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys. DESIGN AND SETTING: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand. PARTICIPANTS: Approximately 38000 community subjects. OUTCOME MEASURES: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression. RESULTS: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries. CONCLUSIONS: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.
Asunto(s)
Trastorno Bipolar/epidemiología , Trastorno Depresivo/epidemiología , Adolescente , Adulto , Edad de Inicio , Anciano , Canadá/epidemiología , Comorbilidad , Comparación Transcultural , Femenino , Francia/epidemiología , Alemania Occidental/epidemiología , Humanos , Italia/epidemiología , Corea (Geográfico)/epidemiología , Líbano/epidemiología , Modelos Logísticos , Masculino , Estado Civil , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Vigilancia de la Población , Puerto Rico/epidemiología , Factores de Riesgo , Distribución por Sexo , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
We present a preliminary report on cross-national rates, age at onset, comorbidity, suicide attempts and symptom profiles of social phobia. These data are based on epidemiologic community surveys using similar methods from the United States, Canada, Puerto Rico and Korea. The lifetime rate of social phobia (cases per 100 persons) varies by country, from 2.6 in the United States to 0.5 in Korea. Rates are higher in females than in males in all countries. The age of onset for any phobia is mid-teens to early twenties, and social phobia usually has its first onset before other psychiatric disorders. Only a third or fewer cases of social phobia are uncomplicated by another psychiatric disorder. The presence of social phobia increases the risk of suicide attempts in persons with any other psychiatric disorder. Symptom profiles vary by country. Our data indicate consistent patterns but different cultural expressions of social phobia in the countries studied. The early age of onset of social phobia followed subsequently by another psychiatric disorder raises the possibility that early treatment of social phobia could prevent the onset of other psychiatric disorders.
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Trastornos Fóbicos/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Canadá/epidemiología , Femenino , Humanos , Corea (Geográfico)/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Puerto Rico/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.
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Trastorno Obsesivo Compulsivo/epidemiología , Adolescente , Adulto , Distribución por Edad , Edad de Inicio , Anciano , Canadá/epidemiología , Comorbilidad , Comparación Transcultural , Femenino , Alemania/epidemiología , Humanos , Cooperación Internacional , Corea (Geográfico)/epidemiología , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Puerto Rico/epidemiología , Distribución por Sexo , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
The Diagnostic Interview Schedule (DIS) is a highly structured instrument that enables lay examiners to gather the clinical information necessary to generate psychiatric disorders according to the DSM-III, Feighner, and Research Diagnostic Criteria. It was developed originally as the diagnostic interview for the Epidemiologic Catchment Area (ECA) survey. Because it adheres to DSM-III and can be used by lay interviewers, thus making it practical for studies involving large samples, it has been used for other population surveys in North and South America, Europe, and Asia. This investigation compares the epidemiology of DSM-III-defined alcohol abuse and addiction in DIS-based population surveys cross-nationally (in St Louis, Mo; Edmonton, Canada; Puerto Rico; Taipei City, Taiwan; and South Korea). We found considerable variation in the lifetime prevalence of alcoholism but a similarity in the age of onset, the symptomatic expression, and the associated risk factors. We also found an inverse correlation between the prevalence of alcoholism and the strength of the association of the risk factors we examined. The work described herein demonstrates the utility of consistent definition and method in cross-cultural psychiatric research. The substantive findings have implications for the definition of alcoholism and for a better understanding of genetic and environmental interactions in its etiology.