IMPORTANCE The inverse social gradient in mental disorders is a well-established research finding with important implications for causal models and policy. This research has used traditional objective social status (OSS) measures, such as educational level, income, and occupation. Recently, subjective social status (SSS) measurement has been advocated to capture the perception of relative social status, but to our knowledge, there have been no studies of associations between SSS and mental disorders.OBJECTIVES To estimate associations of SSS with DSM-IV mental disorders in multiple countries and to investigate whether the associations persist after comprehensive adjustment of OSS. DESIGN, SETTING, AND PARTICIPANTS Face-to-face cross-sectional household surveys of community-dwelling adults in 18 countries in Asia, South Pacific, the Americas, Europe, and the Middle East (N = 56 085). Subjective social status was assessed with a self-anchoring scale reflecting respondent evaluations of their place in the social hierarchies of their countries in terms of income, educational level, and occupation. Scores on the 1 to 10 SSS scale were categorized into 4 categories: low (scores 1-3), low-mid (scores 4-5), high-mid (scores 6-7), and high (scores 8-10). Objective social status was assessed with a wide range of fine-grained objective indicators of income, educational level, and occupation. MAIN OUTCOMES AND MEASURESThe Composite International Diagnostic Interview assessed the 12-month prevalence of 16 DSM-IV mood, anxiety, and impulse control disorders. RESULTSThe weighted mean survey response rate was 75.2% (range, 55.1%-97.2%). Graded inverse associations were found between SSS and all 16 mental disorders. Gross odds ratios (lowest vs highest SSS categories) in the range of 1.8 to 9.0 were attenuated but remained significant for all 16 disorders (odds ratio, 1.4-4.9) after adjusting for OSS indicators. This pattern of inverse association between SSS and mental disorders was significant in 14 of 18 individual countries, and in low-, middle-, and high-income country groups but was significantly stronger in high-vs lower-income countries.CONCLUSIONS AND RELEVANCE Significant inverse associations between SSS and numerous DSM-IV mental disorders exist across a wide range of countries even after comprehensive adjustment for OSS. Although it is unclear whether these associations are the result of social selection, social causation, or both, these results document clearly that research relying exclusively on standard OSS measures underestimates the steepness of the social gradient in mental disorders.

Objective The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Results Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th–75th percentiles]=1.4%–6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%–1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Conclusions Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

Sr. Editor. Las enfermedades psiquiátricas explican el 16% de los años de vida saludable perdidos por discapacidad o muerte prematura en el Perú, lo que coloca a este grupo de enfermedades como la causa más importante de carga de enfermedad en el país. De estas, la depresión unipolar es una de las más importantes, junto con los problemas relacionados al consumo de alcohol (1) . El problema de las enfermedades mentales se ve agudizado debido al reducido número de psiquiatras, y su distribución muy desigual en las regiones, con una concentración mayor en Lima, ciudad capital.Ha quedado establecido que el 90% de los problemas psiquiátricos pueden ser manejados en la atención primaria de salud (2) , por ello la detección y manejo por parte de los médicos no psiquiatras constituye un gran apoyo para enfrentar la depresión unipolar en las poblaciones. Sin embargo, se ha evidenciado que los médi-cos no psiquiatras no reconocen los síntomas ni establecen el tratamiento adecuado (3) .Para lograr que más personas puedan acceder a tratamientos de calidad para depresión, es importante contar con instrumentos diagnósticos validados localmente. El PHQ-9 (Patient Health Questionnarie-9) es una prueba de tamizaje de depresión que ha sido validado en muchos países, incluyendo Chile (4,5) . La principal ventaja del PHQ-9 sobre otros instrumentos de tamizaje para depresión es su rapidez; puede ser autoaplicado y, además de ser una herramienta diagnóstica, también indica la gravedad del cuadro, por lo que serviría para hacer un seguimiento del manejo y evolución de cada paciente.Aunque los creadores del instrumento presentaron una versión oficial para el Perú (disponible en Patient Health Questionnaire (PHQ) Screeners), este instrumento aún no ha sido validado; es por ello que la Dirección de Salud Mental del Ministerio de Salud del Perú (MINSA), en coordinación con el Instituto Nacional de Salud (INS), dentro del marco del desarrollo de "Algoritmos de Diagnóstico y Tratamiento de Depresión" ha realizado la validación por juicio de expertos del PHQ-9, como primer paso para su validación en el contexto peruano. Esta validación se realizó en una reunión técnica con la presencia de especialistas en salud mental, incluyendo 23 psiquiatras, 3 psicólogos y una enfermera.En general, la percepción entre los especialistas fue que el PHQ-9 es un buen instrumento para el diagnóstico de depresión, y que puede ser de fácil uso en el contexto del sistema de atención primaria en el Perú. Algunos comentarios en el sentido de perfeccionar el instrumento incluyeron los siguientes: i) especificar el número de días para la clasificación de ¨para nada", "varios días", "más de la mitad de los días" y "casi todo los días¨; con el fin de que sea más entendible para la mayoría de pacientes; ii) en el ítem 2, añadir la palabra "triste" para reforzar el concepto de "deprimido"; iii) en el ítem 7, se recomendó no especificar la palabra "periódico", y dejar el ítem fraseado de la siguiente manera: "Dificultad para poner atención o concentrarse en las cosas, ...

Objective:  To analyze the status of mental health research in 30 Latin American and Caribbean countries (LAC). Method:  Medline and PsycInfo databases were searched to identify the LAC authors. Their publications were classified according to the topic, type of research and target population studied. Scientific indicators of these countries were assessed in other two different databases: Essential Scientific Information and Atlas of Science Project, both from Institute for Scientific Information. Results:  Indexed‐publications were concentrated in six countries: Argentina, Brazil, Chile, Colombia, Mexico and Venezuela. Most studies dealt with the burdensome mental disorders but neglected important topics such as violence and other mental health priorities. Conclusion:  Mental health research is mostly concentrated in a few LAC countries, but these countries would contribute to reduce the research gap, if they provide research training to their neighbors and engage in bi‐ or multi‐lateral research collaboration on common region priorities.

Background and objectives Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. Methods During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician’s diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. Results 1,860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR=1.8; 95%CI 1.3–2.4), panic (OR=1.4; 95%CI 1.0–2.0), generalized anxiety (OR=1.3; 95%CI 1.1–1.7), specific phobia (OR=1.4; 95%CI 1.2–1.6); post-traumatic stress (OR=1.5; 95%CI 1.1–2.0); binge eating (OR=1.9; 95%CI 1.2–2.9) and alcohol abuse (OR=1.5; 95%CI 1.2–2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). Conclusions A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.