Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

Background Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. Aims To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries. Method Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI). Results Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. Conclusions Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys

Background Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries. Aims To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys. Method The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated. Results Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (chi(2)(9)=5.5-8.1, P=0.5-0.79). These losses are equivalent to 0.3-0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations: Conclusions These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.

Childhood adversities as risk factors for onset and persistence of suicidal behaviour

Background Suicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood. Aims To examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide. Method Respondents from nationally representative samples (n = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour. Results Childhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2-5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents` lifetime mental disorder status. Conclusions Childhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.

Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative

Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a six-item scale developed to provide a brief valid screen for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined N = 41,770 respondents). Twelve-month prevalence of DSM-IV SMI was assessed with the fully-structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores, taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve, was generally substantial (median 0.83; range 0.76-0.89; inter-quartile range 0.81-0.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied. Copyright (c) 2010 John Wiley & Sons, Ltd.

AGE DIFFERENCES IN THE PREVALENCE AND CO-MORBIDITY OF DSM-IV MAJOR DEPRESSIVE EPISODES: RESULTS FROM THE WHO WORLD MENTAL HEALTH SURVEY INITIATIVE

Background: Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late we. Methods: We investigated this issue by studying age differences in co-morbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys of respondents in 10 developed countries (n = 52,485) and 8 developing countries (n = 37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical co-morbidity. Physical conditions were assessed with a standard chronic conditions checklist. Results: Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of co-morbid mental disorders generally either decreased or remained stable with age, while co-morbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while co-morbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. Conclusions: The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly. Depression and Anxiety 27:351-364, 2010. (C) 2009 Wiley-Liss, Inc.

SUBTYPING SOCIAL ANXIETY DISORDER IN DEVELOPED AND DEVELOPING COUNTRIES

SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears Versus number of interactional fears. Results: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. Conclusion: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears. Depression and Anxiety 27:390-403, 2010. (C) 2009 Wiley-Liss, Inc.

Treatment of suicidal people around the world

Background Suicide is a leading cause of death worldwide; however, little information is available about the treatment of suicidal people, or about barriers to treatment. Aims To examine the receipt of mental health treatment and barriers to care among suicidal people around the world. Method Twenty-one nationally representative samples worldwide (n=55 302; age 18 years and over) from the World Health Organization`s World Mental Health Surveys were interviewed regarding past-year suicidal behaviour and past-year healthcare use. Suicidal respondents who had not used services in the past year were asked why they had not sought care. Results Two-fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%) or non-psychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%) and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment. Conclusions Most people with suicide ideation, plans and attempts receive no treatment. This is a consistent and pervasive finding, especially in low-income countries. Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking.

The role of the intelligence service in preventing and combating transnational terrorism

Outrora dominado por ameaças provenientes de Estados-nação, o cenário global actual, dominado por uma rápida mudança de poderes que nos apresenta uma interacção complexa entre múltiplos actores, onde inimigos desconhecidos, anteriormente bem identificados, é actualmente controlado por grupos terroristas bem preparados e bem organizados. Hezbollah é reconhecido como um dos grupos terroristas mais capazes, com uma extensa rede fora do Líbano dedicada a tráfico de droga, armas e seres humanos, tal como o branqueamento de capitais para financiar o terrorismo, representando um grande foco de instabilidade à segurança. Como instrumento de Estado, os serviços de informações detêm a capacidade de estar na linha da frente na prevenção e combate ao terrorismo. Todavia, para compreender este fenómeno é necessário analisar os actores desta ameaça. À luz desta conjuntura, esta dissertação está dividida em três capítulos principais que visam responder às seguintes questões fundamentais: O que é o terrorismo? Como opera um grupo terrorista transnacional? Será que os serviços de informações têm as ferramentas necessárias para prevenir e combater estas ameaças?

Tritordeum, wheat and triticale yield components under multi-local mediterranean drought conditions

The species x location interaction was of great importance in explaining the behaviour of genetic material. The study presented here shows, for the first time, the performance, under field conditions of the new tritordeum species, compared to wheat and triticale in a wide range of Mediterranean countries (Spain, Lebanon and Tunisia). The results obtained revealed that despite the diversity of environmental conditions, the main differences in yield were due to genotypes, especially to differences between species. The multi-local study with different growth conditions revealed important information about the water availability effect on yield. In the lowest yielding environments (Tunisia rainfed), Tritordeum and triticale yields were equivalent. However under better growth conditions (Spain), tritordeum yield was shown to be lower than wheat and triticale. Interestingly, when water limitation was extended during the pre-anthesis period, differences in tritordeum versus wheat-triticale yield rate were larger than when water stress occurred during anthesis. These variations were explained by the fact that kernel weight has been found as the limiting factor for yield determination in tritordeum, and a delay in the anthesis date may have been the cause for the low kernel weight and low yield under Mediterranean drought conditions. Such differences in yield between tritordeum and wheat or triticale could be explained by the fact that tritordeum is a relatively new species and far fewer resources have been devoted to its improvement when compared to wheat and triticale. Our results suggest that breeding efforts should be directed to an earlier anthesis date and a longer grain filling period. tritordeum proved to have possibilities to be grown under drought environments as a new crop, since its performance was quite close to wheat and triticale. Besides, it has qualitative added values that may improve farmers' income per unit land.

Fossil psychodoid flies and their relation to parasitic diseases

Psychodid sand flies are blood-sucking fly vectors of several parasitic diseases. The oldest definitive record of this group is from the Lower Cretaceous amber of Lebanon (circa -135 to -125 My), but the high diversity within this group supports the idea that the psychodoids originated much earlier in history. The palaeontology demonstrates that the Lower Cretaceous representatives of the different subfamilies of Psychodidae had similar morphology and were blood-feeders, which supports Hennig's hypothesis on the ground plan structure of this family. Historical relationship between sand flies and diseases is unclear up to the present time, but this relationship could be as old as the origin of psychodoids because of the blood-feeding life mode.

New and revised maimetshid wasps from cretaceous ambers (Hymenoptera, Maimetshidae)

New material of the wasp family Maimetshidae (Apocrita) is presented from four Cretaceous amber de- posits- the Neocomian of Lebanon, the Early Albian of Spain, the latest Albian/earliest Cenomanian of France, and the Campanian of Canada. The new record from Canadian Cretaceous amber extends the temporal and paleogeographical range of the family. New material from France is assignable to Guyote- maimetsha enigmatica Perrichot et al. including the first females for the species, while a series of males and females from Spain are described and figured as Iberomaimetsha Ortega-Blanco, Perrichot & Engel, gen. n., with the two new species Iberomaimetsha rasnitsyni Ortega-Blanco, Perrichot & Engel, sp. n. and I. nihtmara Ortega-Blanco, Delclòs & Engel, sp. n.; a single female from Lebanon is described and figured as Ahiromaimetsha najlae Perrichot, Azar, Nel & Engel, gen. et sp. n., and a single male from Canada is described and figured as Ahstemiam cellula McKellar & Engel, gen. et sp. n. The taxa are compared with other maimetshids, a key to genera and species is given, and brief comments made on the family.

Hybrid warfare – just a twist of compound warfare? : views on warfare from the United States Armed Forces perspective

The wars the Western armies are involved with today are different from those that were fought in the end of 20th century. To explain this change, the Western military thinkers have come up with various different types of definitions of warfare over the last 30 years, each describing the tendencies involved in the conflicts of the time. The changing nature of conflicts surfaced a new term – hybrid warfare. The term was to describe and explain the multi-modality and complexity of modern day conflict. This thesis seeks the answer for the question: what is the development of thought behind hybrid warfare? In this thesis the Vietnam War (1965-1975) is used as an example of compound warfare focusing on the American involvement in the war. The Second Lebanon War (2006) serves as an example of hybrid warfare. Both case studies include an irregular opposing force, namely National Liberation Front in Vietnam War and Hezbollah in the Second Lebanon War. These two case studies are compared with the term full spectrum operations introduced in the current U.S. Department of Army Field Manual No. 3-0 Operations to see the differences and similarities of each term. The perspective of this thesis is the American point of view. This thesis concludes that hybrid warfare, compound warfare and full spectrum operations are very similar. The first two terms are included in the last one. Although hybrid warfare is not officially defined, it will most likely remain to be used in the discussion in the future, since hybrid wars and hybrid threats are officially accepted terms.

Libanon ja Syyrian kansannousu

Lebanon has been largely stable during the tumultuous Arab Spring, but the country remains vulnerable to internal and regional instability. In addition to Lebanon's volatile internal conflicts, Lebanon is particularly exposed to increased regional tensions. While renewed tension in South Lebanon is often considered the most likely cause for instability in Lebanon, the deepening conflict in Syria now poses the greatest threat to Lebanon. This publication examines how the uprising in Syria affects both the internal stability of Lebanon and the South Lebanon conflict, arguing that the uprising in Syria greatly complicates Lebanon's internal power balance, elevating internal tensions, while also changing the context within which the South Lebanon conflict takes place.

Hezbollah and Taliban - hybrid adversaries in contemporary conflicts? : views on an adversary from the United States Armed Forces perspective

The experiences of the United States Armed Forces of the wars in Iraq and Afghanistan and Israel Defense Forces in the Second Lebanon War resulted a new term to surface called “hybrid warfare”. It was to describe the complexity of today’s battlefield. The term “hy-brid warfare” was never officially defined nor is it today. The updated version of the US ARMY Field Manual 3-0: Operations (Change 1) from February 22, 2011, introduced and defined “hybrid threat” and thus opened the discussion for hybrid adversary. In this thesis a model is introduced according to which any organization, group or an ad-versary can be examined and evaluated to see whether it qualifies as a hybrid adversary. It is demonstrated by the example of Hezbollah, which is recognized as the best example of an organization utilizing “hybrid warfare” and subsequently categorizing as a hybrid adver-sary. The model will be tested with Afghan Taliban to see whether both the model works and Taliban qualifies as a hybrid adversary or not. According to the model used in this thesis, it is concluded that Taliban does not meet the standards of a hybrid adversary, but with acquisition of standoff weapons it would quickly qualify as one. The model proved to work, and it could be used as a tool by intelligence of-ficers for estimating the threat levels of any group or identifying those groups that are al-ready or are about to develop into a hybrid adversary.