Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative

Data are presented on patterns of failure and delay in making initial treatment contact after first onset of a mental disorder in 15 countries in the World Health Organization (WHO)''s World Mental Health (WMH) Surveys. Representative face-to-face household surveys were conducted among 76,012 respondents aged 18 and older in Belgium, Colombia, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, People''s Republic of China (Beijing and Shanghai), Spain, and the United States. The WHO Composite International Diagnostic Interview (CIDI) was used to assess lifetime DSM-IV anxiety, mood, and substance use disorders. Ages of onset for individual disorders and ages of first treatment contact for each disorder were used to calculate the extent of failure and delay in initial help seeking. The proportion of lifetime cases making treatment contact in the year of disorder onset ranged from 0.8 to 36.4% for anxiety disorders, from 6.0 to 52.1% for mood disorders, and from 0.9 to 18.6% for substance use disorders. By 50 years, the proportion of lifetime cases making treatment contact ranged from 15.2 to 95.0% for anxiety disorders, from 7.9 to 98.6% for mood disorders, and from 19.8 to 86.1% for substance use disorders. Median delays among cases eventually making contact ranged from 3.0 to 30.0 years for anxiety disorders, from 1.0 to 14.0 years for mood disorders, and from 6.0 to 18.0 years for substance use disorders. Failure and delays in treatment seeking were generally greater in developing countries, older cohorts, men, and cases with earlier ages of onset. These results show that failure and delays in initial help seeking are pervasive problems worldwide. Interventions to ensure prompt initial treatment contacts are needed to reduce the global burdens and hazards of untreated mental disorders.     

Experimental evidence for the attenuating effect of SOM protection on temperature sensitivity of SOM decomposition

The ability to predict C cycle responses to temperature changes depends on the accurate representation of temperature sensitivity (Q₁₀) of soil organic matter (SOM) decomposition in C models for different C pools and soil depths. Theoretically, Q₁₀ of SOM decomposition is determined by SOM quality and availability (referred to here as SOM protection). Here, we focus on the role of SOM protection in attenuating the intrinsic, SOM quality dependent Q₁₀. To assess the separate effects of SOM quality and protection, we incubated topsoil and subsoil samples characterized by differences in SOM protection under optimum moisture conditions at 25 °C and 35 °C. Although lower SOM quality in the subsoil should lead to a higher Q₁₀ according to kinetic theory, we observed a much lower overall temperature response in subsoil compared with the topsoil. Q₁₀ values determined for respired SOM fractions of decreasing lability within the topsoil increased from 1.9 for the most labile to 3.8 for the least labile respired SOM, whereas corresponding Q₁₀ values for the subsoil did not show this trend (Q₁₀ between 1.4 and 0.9). These results indicate the existence of a limiting factor that attenuates the intrinsic effect of SOM quality on Q₁₀ in the subsoil. A parallel incubation experiment of ¹³C‐labeled plant material added to top‐ and subsoil showed that decomposition of an unprotected C substrate of equal quality responds similarly to temperature changes in top‐ and subsoil. This further confirms that the attenuating effect on Q₁₀ in the subsoil originates from SOM protection rather than from microbial properties or other nutrient limitations. In conclusion, we found experimental evidence that SOM protection can attenuate the intrinsic Q₁₀ of SOM decomposition.     

Climate change leads to decreasing bird migration distances

Global climate change has led to warmer winters in NW Europe, shortening the distance between suitable overwintering areas and the breeding areas of many bird species. Here we show that winter recovery distances have decreased over the past seven decades, for birds ringed during the breeding season in the Netherlands between 1932 and 2004. Of the 24 species included in the analysis, we found in 12 a significant decrease of the distance to the wintering site. Species from dry, open areas shortened their distance the most, species from wet, open areas the least, while woodland species fall in between the other two habitats. The decline in migration distance is likely due to climate change, as migration distances are negatively correlated with the Dutch temperatures in the winter of recovery. With a shorter migration distance, species should be better able to predict the onset of spring at their breeding sites and this could explain the stronger advancement of arrival date found in several short distance species relative to long-distance migrants.     

Coordinated approaches to quantify long‐term ecosystem dynamics in response to global change

Many serious ecosystem consequences of climate change will take decades or even centuries to emerge. Long‐term ecological responses to global change are strongly regulated by slow processes, such as changes in species composition, carbon dynamics in soil and by long‐lived plants, and accumulation of nutrient capitals. Understanding and predicting these processes require experiments on decadal time scales. But decadal experiments by themselves may not be adequate because many of the slow processes have characteristic time scales much longer than experiments can be maintained. This article promotes a coordinated approach that combines long‐term, large‐scale global change experiments with process studies and modeling. Long‐term global change manipulative experiments, especially in high‐priority ecosystems such as tropical forests and high‐latitude regions, are essential to maximize information gain concerning future states of the earth system. The long‐term experiments should be conducted in tandem with complementary process studies, such as those using model ecosystems, species replacements, laboratory incubations, isotope tracers, and greenhouse facilities. Models are essential to assimilate data from long‐term experiments and process studies together with information from long‐term observations, surveys, and space‐for‐time studies along environmental and biological gradients. Future research programs with coordinated long‐term experiments, process studies, and modeling have the potential to be the most effective strategy to gain the best information on long‐term ecosystem dynamics in response to global change.     

Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI.