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BMC Public Health

, 13:414

Health behavior, health promotion and society


BackgroundMental illness represents an important public health problem. Local-level data concerning mental illness in different populations e.g., socio-demographics and residence – metropolitan-urban-rural provides the evidence-base for public health authorities to plan, implement and evaluate control programs. This paper describes prevalence and covariates of psychiatric conditions in Georgia populations in three defined geographic areas.

MethodsData came from the Georgia population-based random-digit-dialing study investigating unwellness and chronic fatigue syndrome CFS in Georgia populations of three defined geographic areas metropolitan, urban, and rural. Respondents were screened for symptoms of fatigue, sleep, cognition, and pain at household screening interviews, and a randomly selected sample completed detailed individual phone interviews. Based on the detailed phone interviews, we conducted one-day clinical evaluations of 292 detailed interview participants classified as unwell with a probable CFS i.e. CFS-like; a functional somatic syndrome, 268 classified as other unwell, and 223 well matched to CFS-like. Clinical evaluation included psychiatric classification by means of the Structured Clinical Interview for DSM SCID. To derive prevalence estimates we used sample weighting to account for the complexity of the multistage sampling design. We used 2- and 3-way table analyses to examine socio-demographic and urbanicity specific associations and multiple logistic regression to calculate adjusted odds ratios.

ResultsAnxiety and mood disorders were the most common psychiatric conditions. Nineteen percent of participants suffered a current anxiety disorder, 18% a mood disorder and 10% had two or more conditions. There was a significant linear trend in occurrence of anxiety or mood disorders from well to CFS-like. The most common anxiety disorders were post-traumatic stress disorder PTSD 6.6% and generalized anxiety disorder GAD 5.8%. Logistic regression showed that lower education and female sex contributed significantly to risk for both PTSD and GAD. In addition, rural-urban residence and Hispanic ethnicity were associated with PTSD. We defined moderate to severe depression as Major Depressive Disorder or a Zung score >60 and logistic regression found lower education to be significantly associated but sex, age and urbanicity were not.

ConclusionsOverall occurrence of anxiety and mood disorders in Georgia mirrored national findings. However, PTSD and GAD occurred at twice the published national rates 3.6 and 2.7%, respectively. State and local prevalence and associations with education, sex and urbanicity comprise important considerations for developing control programs. The increased prevalence of anxiety and mood disorders in people with a functional somatic syndrome or CFS-like illness is important for primary care providers, who should consider additional psychiatric screening or referral of individuals presenting with somatoform symptoms.

AbbreviationsSCIDStructured Clinical Interview for DSM

PTSDPost-Traumatic Stress Disorder

GADGeneralized Anxiety Disorder

CDCCenters for Disease Control and Prevention

GMCGeneral Medical Condition

OCDObsessive Compulsive Disorder

NOSNot Otherwise Specified

AORAdjusted Odds Ratios

BRFSSBehavioral Risk Factor Surveillance System

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-13-414 contains supplementary material, which is available to authorized users.

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Autor: William C Reeves - Jin-Mann S Lin - Urs M Nater


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