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.

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.

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.

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.

To calculate the 1-year prevalence of schizophrenia and related disorders in a catchment area of Malaga (Spain) and determine the prevalence by gender, dwelling (rural or urban) and socioeconomic area (deprived or non-deprived area).

This cross-sectional study comprised the mental health area covered by Carlos Haya Hospital. We used multiple large clinical databases and key informants to identify cases.

The mean 1-year prevalence of schizophrenia and related disorders was 6.27 per 1000. It was nearly double in men (8.45 per 1000) than in women (4.26 per 1000) (p < 0.001), with a male-to-female ratio of 1.98. The rate was higher in urban (6.64 per 1000) than rural areas (3.95 per 1000) (p < 0.0001) and in socioeconomic deprived areas (7.56 per 1000) than non-deprived areas (6.12 per 1000) (p = 0.005). For the subgroup of schizophrenia, the rates were: men, 5.88 per 1000 and women, 2.2 per 1000 (p < 0.0001), with a male-to-female ratio of 2.67. The rate was also higher in urban (4.2 per 1000) than rural areas (2.49 per 1000) (p < 0.0001) and in socioeconomic deprived areas (4.49 per 1000) than non-deprived areas (3.9 per 1000) (p = 0.149).

The use of multiple clinical sources of information not only from mental health services, but also from emergency departments, primary care and private settings revealed high prevalence rates of schizophrenia and related disorders. This diagnosis is more common in men and in cities. Such precise estimates of the prevalence of schizophrenia have important repercussions for resource allocation and policy planning.

The first aim of this study is to compare involuntary admissions across the Veneto Region in Italy. The second aim is to explore the relation between mental health services provision, characteristics of population, individual factors and involuntary admissions.

For 21 Mental Health Departments (MHDs) in the Veneto Region (Italy), the average population prevalence rate of involuntary admissions between 2000 and 2007 and the percentage of involuntary admissions were calculated. Chi-square tests for equality of proportions were used to test hypotheses. Variables at the individual, contextual and organisational levels were used in multiple regressions, with the involuntary admission data as dependent variables.

The average prevalence rate of involuntary commitment was 12.75 ranging from 1.96 to 27.59 across MHDs . About 75% of the involuntary admissions referred to psychotic patients, and almost half of patients were aged 25–44. Significant differences among MHDs emerged; higher percentages of involuntary admissions were generally found in densely populated areas. Higher ageing indices and rates of social workers were found as predictors of the prevalence rate. In the multilevel regression, being males and psychotic significantly increased involuntary admissions, while the percentage of singles in population decreased it.

This study contributes to define the specific contribution of each factor predicting the use of involuntary admission, even within areas under the same legislation. It shows how the inclusion of both individual and contextual factors may lead to better predictions and provides precious data for the services improvement.

Little is known about whether particular suicide methods have contributed differently to the recent unfavourable suicide mortality trends in Japan. Analysing such trends may shed light on the effect of potentially preventable factors, such as the impact of restricting access to certain popular suicide methods, on overall rates. Therefore, we assessed recent trends in method-specific suicide by gender and age in Japan.

Suicide mortality and population data between 1990 and 2011 were obtained from the Vital Statistics of Japan and used to calculate method-specific mortality rates. Suicide methods were divided into seven groups: overdose, gases, hanging, drowning, cutting, jumping and other means. Age was divided into four groups: 15–24, 25–44, 45–64 and 65+ years. We applied joinpoint regression to the data and quantified the observed changes.

The results of the joinpoint regression analyses showed a sharp increase in overall suicide rates for males and females of all ages until the late 1990s. Suicide from hanging and jumping, in particular, contributed to this increase. After 2000, an increasing trend in overall suicide rates in both males and females aged 15–24 and 25–44 years was observed, with overdose, gases and hanging contributing to this increasing trend.

Our findings revealed that different suicide methods varied in their contribution to the recent overall suicide transition in Japan. Regarding factors associated with the recent increase in suicides by overdose, gases, hanging and jumping, further research is needed in order to promote and implement effective means restriction strategies.

Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.

“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.

Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.

Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.

To examine changes in service utilisation before, during and after the 2006 Lebanon War – a 34-day military conflict in northern Israel and Lebanon – among three groups: general population, people ‘at risk’ for depression or anxiety and severely mentally ill individuals. Given that exposure to traumatic events is a pathogenic factor known to cause and exacerbate psychiatric distress and disorder, we hypothesised that healthcare service utilisation would increase in populations exposed to war, especially among more vulnerable populations such as those with mental illness.

A nested case–control design was used to examine changes in health care utilisation and use of psychiatric medication as recorded by the databases of Maccabi Healthcare Services (MHS), one of Israel's largest health maintenance organisations (HMOs). Purchases of benzodiazepines, antidepressants and antipsychotic medications were identified from all the medications purchased in pharmacies by MHS members during 2006. Drug consumption data were expressed as defined daily doses (DDDs), summing all DDDs per person per month. Similarly, number of visits to general practitioners (GPs), psychiatrists and Emergency Rooms (ERs) were summed per person per month. Three-way repeated measures ANOVA was used, including the variables time (12 months), region (north/other) and study group.

During the war there was a decline in GP visits among people from the general population and people ‘at risk’ for depression/anxiety who resided in northern Israel that was not paralleled among controls. Similarly, in all three study groups, there was a decline in the number of psychiatrist visits during the war among people from northern Israel which did not occur to the same extent in the control group. There were no changes in ER visits or use of psychiatric medication that could be attributed to the war.

There is less utilisation of community services at times of war among exposed populations, and there is neither evident compensation in use of emergency services, nor any compensation after the war. This may suggest that if there is an efficient medical and mental health infrastructure, people with or without psychiatric risk factors can tolerate a few weeks of a mass stress event, with no need to expand medical service utilisation. However, service utilisation at times of war may be confounded by other variables and may not serve as a direct measure of increased stress.