Online ISSN: 2451-4950

Author : Lecic-Tosevski, Dusica

Longitudinal study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk

Bojana Pejuskovic; Dusica Lecic-Tosevski; Oliver Toskovic

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 1, Pages 64-71

Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.

Subjects and methods
The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.

In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.

PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.


The Main Gaps for Randomized-controlled Trials in Psychiatry: A Bibliometric Study

João Mauricio Castaldelli-Maia; Michelle B. Riba; Dusica Lecic-Tosevski; Prabha S. Chandra; Alfredo Cia; Peter J. Tyrer; Reinhard Heun; Christopher Paul Szabo

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 1, Pages 51-63

There is evidence of a progressive increase in the number of Randomized Controlled Trials (RCTs) in the area of psychiatry. However, some areas of psychiatry receive more attention from researchers potentially to the detriment of others.

Aiming to investigate main gaps for RCTs in psychiatry, the present bibliometric study analysed the bi-annual and five-year rates of RCTs in the main database of medical studies (Pubmed) over the 1999–2018 period (n = 3,449). This analysis was carried out using the ICD-10 mental and behavioural chapter. ICD-10, was the edition of the manual used throughout the above period.

Overall, after 16 years of considerable increase in the bi-annual absolute number of RCTs, there has been a slowdown in the last 4 years, similar to other medical areas. Affective, organic and psychotic disorders, and depression, schizophrenia and dementia were the top studied groups and disorders respectively – ahead of other groups/diagnoses. For substance use disorders, there has been a decrease of RCT in the last 5 years, in line with the fall of alcohol use disorder in the ranking of most studied disorders. Delirium and mild cognitive disorder are both ascending in this ranking. Personality disorders and mental retardation stand out as the least studied groups over the whole assessment period.

Novel treatments, ease of access to patient populations, and ‘clinical vogue’, seem to be more important in guiding the undertaking of RCTs than the actual need as indicated by prevalence and/or burden of disorders and public health impact. Regarding specific disorders, acute/transient psychosis; mixed anxiety and depression; adjustment disorder; dissociative and conversion disorders; somatization; hypochondria; and neurasthenia, would deserve future RCTs. Clinical researchers and editors of scientific journals should give special attention to the less studied areas and disorders, when considering conducting and publishing RCT studies, respectively.


Scientific publishing: a developmental role for the World Psychiatric Association

Christopher Paul Szabo; Joao Mauricio Castaldelli- Maia; Prabha Chandra; Alfredo Cia; Reinhard Heun; Dusica Lecic-Tosevski; Michelle Riba; Peter Tyrer

GLOBAL PSYCHIATRY, 2018, Volume 1, Issue 1, Pages 1-2

Scientifi c publishing is a cornerstone of clinical practice. Credible content is critical, and sources of such content
equally so. A major challenge confronting researchers is publishing their data. Whilst publications are available in
abudance, the process of seeing completed research appear in print is more likely the exception and not the rule. Some might argue that the possibility of bad science in print needs to be contained given this attitude. A valid point, assuming all that is published is good science. We have no way of knowing how much good data does not fi nd its way into the scientifi c literature, but we certainly know that not all data that does is indeed good.
Th ere are numerous reasons why research does not get published, not least of which is that notwithstanding
the plethora of available titles in which to publish – it is competitive. Each journal has a specifi c focus, target market and requirements. Th ere is seemingly a fi nite capacity, and one cannot, of course, ignore cost. Th en come the publishing costs. Th e publishing industry is for profi t, and if not profi table at the very least costs must be covered by the publication if they are not owned by one of any number of publishing houses (where cross subsidization may be possible). Costs and budget have implications for frequency of issues, number of pages per issue, publication format, distribution and so on. Someone has to pay, not only to cover costs of publication
but also access to the publication where costs are not covered up front by authors. Certainly the publishing landscape has evolved and will no doubt continue to do so. Th e issue of access is germane as it speaks to many factors that impact on researchers, both in the so called developed world and most certainly in the developing world (whose countries fi nd themselves known as Low and Middle Income Countries, i.e. LAMIC). With an emphasis on LAMIC, the World Psychiatric Association (WPA) has had an important role to play in recent times. Various operational committees and task teams under the guidance of various secretaries for scientifi c
publications have engaged in activities to address some of the experienced diffi culties encountered by LAMIC member societies. Th ese include access to skills, access to credible publishing platforms, and accessing content, to name a few. To this end, various WPA–facilitated developmental agendas have been implemented. Th ese have included WPA hosted workshops aimed at improving quality of local publications (Szabo et al. 2010). Th e aim has been indexation in credible scientifi c databases (Mari et al. 2011). Local policy should ideally be informed
by local content. Local content should be available in credible publications that serve not only a local audience. Sharing of credible data cannot simply be a one–way stream from developed to developing world countries as if the developing world has little to off er by way of science. Developed world researchers certainly frequent developing world countries to access clinical material, which invariably is published in journals not necessarily accessible to the population of psychiatrists whose patients comprise the sample. Th e WPA, through World Psychiatry, might consider having special issues for cross–cultural studies and those that have been conducted in LAMIC.
For local data to be available in credible local publications that serve an international audience, these publications need to be indexed in certain databases. Inclusion in these databases is generally problematic for local publications insofar asthey struggle to meet the minimum standards required for inclusion. Hence the aforementioned WPA workshops are conducted. To this end, the WPA has through their website – in the past triennium - initiated the development of a database that seeks to include all member society open access publications, i.e. the provision of a platform for dissemination that in effect by passes existing databases to which access can be limited.
Finally, LAMIC researchers struggle to publish in the major publications that inform the discipline. Scientific writing and how to get published is certainly an area where the WPA, in the interests of world psychiatry, has played a role through hosting of targeted workshops with interactive sessions at WPA congresses over the past triennium for junior researchers and so called early career psychiatrists. The aim has been to provide both helpful information as well mentorship, where local mentorship in their home countries is lacking. This could be developed further, e.g. through inclusion of recorded clips on the WPA website by established and previous editors of major journals with tips on choosing the right journal, pitching an article to the right source, giving examples of well written and
not so well written articles and how editors think. If the WPA is to serve the world, it needs to pursue a
developmental agenda that is truly global in scope, recognizing the need to close the gap between developed and developing.
Specific initiatives have demonstrated a commitment to such an agenda (Szabo et al. 2012). The next triennium of office bearers recently elected at the WPA Congress in Berlin (October 2017) will hopefully continue with such work.