Sociocultural Roots of Mental Illness: An Epidemiologic Survey


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The NCS-R offers several advantages over previous community surveys used to examine associations between psychiatric disorders and obesity. First, the sample was designed to be an accurate representation of the noninstitutionalized population of the 48 contiguous United States.


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Results can be generalized to this population. Second, the survey assessed a full range of psychiatric and substance use disorders, allowing us to examine associations with anxiety disorders, bipolar disorder, and substance use disorders. Third, mental disorders were assessed using a well-validated structured diagnostic interview, which allowed the association of obesity with these disorders to be assessed with accuracy.

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Fourth, the assessment considered lifetime diagnoses and current state. The associations between obesity and psychiatric disorders in this sample did not vary between men and women.

This contrasts with findings in other US national surveys 17 - 20 that indicate that positive associations between obesity and depression exist among women, whereas negative or absent associations exist among men. We are unable to identify any consistent differences in methods between our study and previous studies that would explain why earlier studies found no association between obesity and depression in men, whereas such an association was observed in the NCS-R sample.

In one earlier study, 20 the magnitude of the OR between obesity and depression in men was similar to that in women, but the lower prevalence of depression in men led to a wider CI and a statistically insignificant result. A similar phenomenon is seen in this sample for both mood and anxiety disorders. Because we observe no statistically significant interaction with sex, we conclude that this discrepancy significant association in women but not in men probably reflects differences in statistical power rather than differences in magnitude of the association.

Most previous research has focused on the association between obesity and depression, and various mechanisms have been proposed to explain this relationship. Increased appetite and weight gain are common symptoms of depression, 43 , 44 and tendency to gain weight remains stable across depressive episodes.

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Mental Disorder (Illness)

Depression may increase risk of weight gain through its effect on binge eating, 46 , 47 especially among women. The stigma attached to obesity especially for women may contribute to depression. We observed an interesting variation in the relationship between obesity and mood disorder across sociodemographic groups. Only the interaction with educational attainment, however, was significant at the. Approximately 40 years ago, The Midtown Manhattan Study 21 also observed that, among women, the association between obesity and depression was confined to those with higher socioeconomic status.

In the NCS-R sample, the groups that showed the strongest association between obesity and mood disorder were also the groups with the lowest overall rates of obesity. A similar phenomenon has been observed regarding the association between depression and tobacco use; as rates of tobacco use decline, the association between tobacco use and depression grows stronger.

Our findings are consistent with either direction of causal relationship between obesity and mood or anxiety disorders. If stigmatization of overweight and obesity causes or contributes to mood and anxiety disorders, the effects of stigma might be more powerful in sociodemographic groups with lower obesity rates. Some previous research suggests that self-perception of overweight 54 , 55 and the perceived stigma associated with obesity 56 - 59 may both be greater in white populations and those with higher income or educational attainment.

Alternatively, if mood or anxiety disorders contribute to obesity through an effect on health behaviors reduced physical activity, increased caloric intake , then this effect could be more easily expressed in sociodemographic groups with lower obesity rates. This cross-sectional study does not allow us to distinguish between causal mechanisms or examine how they might differ across sociodemographic groups.

Our findings also do not indicate a specific mechanism or causal direction for the observed negative association between obesity and substance use disorders.

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Although alcohol or other substances may have a direct effect on appetite or caloric intake, a negative association was also observed in those with histories of substance abuse ie, lifetime substance use disorder not active in the last 12 months. We conclude that obesity is meaningfully associated with a range of common mood and anxiety disorders in the general US population.

Obesity is associated with a moderately lower risk of substance use disorder. Clarifying the direction of causal relationships will require alternative research designs, including longitudinal and experimental studies. Correspondence: Gregory E. Submitted for Publication: August 15, ; final revision received December 9, ; accepted December 13, Disclaimer: The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or of the US government.

Alden Trust. These activities were supported by the John D. All Rights Reserved.


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    Original Article. Gregory E. Miglioretti, PhD ; Paul K. Kessler, PhD. Sign in to access your subscriptions Sign in to your personal account.

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    Sociocultural Roots of Mental Illness

    Create a free personal account to access your subscriptions, sign up for alerts, and more. Purchase access Subscribe now. More information is in the Data Collection Notes. National Comorbidity Survey Replication NCS-R was in with a new national probability sample of 10, English-speaking household residents aged 18 years and older in the coterminous United States. The NCS-R was an in-person survey. The goals of the NCS-R were to study trends in a wide range of variables assessed in NCS-1 and to obtain more information about a number of topics either not covered in NCS-1 or covered in less depth.

    The NCS-R data are available as both public-use and restricted-use files. It was designed to estimate the lifetime-to-date and current prevalence, age-of-onset distributions, course, and comorbidity of DSM-IV disorders in the child and adolescent years of life among adolescents in the United States; to identify risk and protective factors for the onset and persistence of these disorders; to describe patterns and correlates of service use for these disorders; and to lay the groundwork for subsequent follow-up studies that can be used to identify early expressions of adult mental disorders.

    Information was also collected from a parent or a parent surrogate that focused on five adolescent disorders for which parental reports are important for making diagnoses. NCS-A is only available as a restricted-use file. Collaborative Psychiatric Epidemiology Surveys CPES were initiated in recognition of the need for contemporary, comprehensive epidemiological data regarding the distributions, correlates and risk factors of mental disorders among the general population with special emphasis on minority groups. The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the United States.

    Secondary goals were to obtain information about language use and ethnic disparities, support systems, discrimination and assimilation, in order to examine whether and how closely various mental health disorders are linked to social and cultural issues. Please enable JavaScript in your browser.

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    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
    Sociocultural Roots of Mental Illness: An Epidemiologic Survey Sociocultural Roots of Mental Illness: An Epidemiologic Survey
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