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Psychosis prevalence and physical, metabolic and cognitive comorbidity. Data from the second Australian national survey of psychosis
VA Morgan, JJ McGrath, A Jablensky, JC Badcock, A Waterreus, R Bush, V Carr, D Castle, M Cohen, C Galletly, C Harvey, B Hocking,
P McGorry, AL. Neil, S Saw, S Shah, HJ. Stain, A Mackinnon
CONTENTS
TOC \o "1-3" \h \z \u HYPERLINK \l "_Toc364258000"Supplementary Methods PAGEREF _Toc364258000 \h 2
HYPERLINK \l "_Toc364258001"Estimation of one-month treated prevalence PAGEREF _Toc364258001 \h 2
HYPERLINK \l "_Toc364258002"Lifetime morbid risk PAGEREF _Toc364258002 \h 2
HYPERLINK \l "_Toc364258003"Sample weights PAGEREF _Toc364258003 \h 2
HYPERLINK \l "_Toc364258004"Participant response rates PAGEREF _Toc364258004 \h 2
HYPERLINK \l "_Toc364258005"Inter-rater reliability PAGEREF _Toc364258005 \h 2
HYPERLINK \l "_Toc364258006"Physical health assessments PAGEREF _Toc364258006 \h 3
HYPERLINK \l "_Toc364258007"Physical health calculations PAGEREF _Toc364258007 \h 4
HYPERLINK \l "_Toc364258008"Supplementary Tables PAGEREF _Toc364258008 \h 5
HYPERLINK \l "_Toc364258009"Table S1. Sociodemographic profile PAGEREF _Toc364258009 \h 5
HYPERLINK \l "_Toc364258010"Table S2. Marital and parenting status PAGEREF _Toc364258010 \h 6
HYPERLINK \l "_Toc364258011"Table S3. Mental health profile PAGEREF _Toc364258011 \h 7
HYPERLINK \l "_Toc364258012"Table S4. Physical health profile PAGEREF _Toc364258012 \h 8
HYPERLINK \l "_Toc364258013"Table S5. Cognitive profile PAGEREF _Toc364258013 \h 9
HYPERLINK \l "_Toc364258014"Table S6. Smoking PAGEREF _Toc364258014 \h 10
HYPERLINK \l "_Toc364258015"Table S7. Alcohol use PAGEREF _Toc364258015 \h 11
HYPERLINK \l "_Toc364258016"TableS 8. Substance use PAGEREF _Toc364258016 \h 12
HYPERLINK \l "_Toc364258017"Table S9. Functioning, quality of life and social relationships PAGEREF _Toc364258017 \h 13
HYPERLINK \l "_Toc364258018"Table S10. Victimisation and offending PAGEREF _Toc364258018 \h 14
HYPERLINK \l "_Toc364258019"Table S11. Medication and medication side effects PAGEREF _Toc364258019 \h 15
HYPERLINK \l "_Toc364258020"Table S12. Service utilisation PAGEREF _Toc364258020 \h 16
HYPERLINK \l "_Toc364258021"Table S13. Visits to general practitioner PAGEREF _Toc364258021 \h 17
HYPERLINK \l "_Toc364258022"Table S14. Physical examinations PAGEREF _Toc364258022 \h 18
HYPERLINK \l "_Toc364258023"References PAGEREF _Toc364258023 \h 19
Supplementary Methods
Estimation of one-month treated prevalence
Population one-month treated prevalence was estimated using sampling weights derived from phase 1 to phase 2 ADDIN EN.CITE Alonzo20034990(Alonzo, 2003)4990499017Alonzo, T. A.Pepe, M. S.Lumley, T.Estimating disease prevalence in two-phase studiesBiostatistics Biostatistics313-32642003(HYPERLINK \l "_ENREF_2" \o "Alonzo, 2003 #4990"Alonzo et al., 2003) and by expressing estimated numbers of persons in the screened population meeting diagnostic criteria as a proportion of the corresponding at-risk resident population of the catchment areas. Confidence intervals for these values were calculated by considering the resident population estimates to be fixed and expressing the upper and lower bounds of estimated numbers meeting diagnostic criteria. Diagnostic status was ascertained at interview and the proportion of screened people meeting criteria for an ICD-10 diagnosis of psychosis was estimated using appropriately weighted screen-positive and screen-negative subsamples. From this proportion, the number of people meeting diagnostic criteria in the census month was estimated for each site. Aggregate estimates in each age and sex stratum were obtained by combining the fraction of the estimated resident population of each catchment meeting diagnostic criteria. For estimates combining strata, adjustments were made to reflect the age and sex distributions of the Australian population aged 18-64 years. The statistical package Stata/IC version 12.1 was used for prevalence estimation.
Lifetime morbid risk
Lifetime morbid risk (LMR) is the probability of a person developing a disorder during a specified period of their life or up to a specified age. It attempts to cover the entire lifetime of a birth cohort, both past and future, and includes those deceased at the time of the survey ADDIN EN.CITE Kessler20075214(Kessler, 2007)5214521417Kessler, Ronald C.Angermeyer, MatthiasAnthony, James C.De Graaf, RonDemyttenaere, KoenGasquet, IsabelleDe Girolamo, GiovanniSemyon Gluzman,Gureje, OyeHaro, Josep MariaKawakami, NoritoKaram, AimeeLevinson, DaphnaMora, Maria Elena MedinaOakley Browne, Mark A.Posada-Villa, JosStein, Dan J.Tsang, Cheuk Him AdleyAguilar-Gaxiola, SergioAlonso, JordiLee, SingHeeringa, StevenPennell, Beth-EllenBerglund, PatriciaGruber, Michael J.Petukhova, MariaChatterji, Somnathstn, T. Bedirhanon behalf of the WHO World Mental Health Survey Consortium,Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey InitiativeWorld PsychiatryWorld Psychiatry168176632007(HYPERLINK \l "_ENREF_10" \o "Kessler, 2007 #5214"Kessler et al., 2007). We estimated LMR of psychotic disorder using Weinberg's abridged method ADDIN EN.CITE Jablensky20115230(Jablensky, 2011)523052305Jablensky, A. J.Kirkbride, J. B.Jones, P. B.Weinberger, D.R.Harrison, P. J.The epidemiological horizon.Schizophrenia185-2253rd2011OxfordWiley-Blackwell0SZ(HYPERLINK \l "_ENREF_8" \o "Jablensky, 2011 #5230"Jablensky et al., 2011). This involves adjusting the denominator of ratio of persons affected to population numbers according to the formula:
EMBED Equation.3
where A is the number of prevalent cases; B is the total catchment population or subpopulation; B0 is the number of persons who have not yet entered the risk period; and Bm is the number of persons within the risk period. Reflecting the spectrum of psychotic disorders, the period of risk was defined as 18 to 45 years. Catchment resident population estimates for persons outside the survey age range, which was 18-64 years, were not available so estimation was based on prorating those of the whole Australian population.
Sample weights
Phase 2 estimates were calculated using sampling weights reflecting the number of screen-positive and screen-negative participants interviewed by site, sex and within each of two age strata (18-34 and 35-64 years). The estimates therefore reflect the census population as screened.
Participant response rates
The response rate among 4,189 people selected and contacted for interview from those screen-positive for psychosis and randomised was 44%. A further 2,107 people had been randomly sampled for interview but were not asked to participate because (i) they could not be traced or had died (57%), (ii) case managers had assessed them as too unwell mentally or had not contact them about the survey (21%), or (iii) interviewers judged them to be too unwell to provide consent (22%). A flow chart of case enumeration has been published ADDIN EN.CITE Morgan20125108(Morgan, 2012)5108510817Morgan, Vera AWaterreus, AnnaJablensky, AssenMackinnon, AndrewMcGrath, John JCarr, VaughanBush, RobertCastle, DavidCohen, MartinHarvey, CarolGalletly, CherrieStain, Helen JNeil, Amanda LMcGorry, PatrickHocking, BarbaraShah, SonalSaw, SuzyPeople living with psychotic illness in 2010: The second Australian national survey of psychosisAustralian and New Zealand Journal of PsychiatryAustralian and New Zealand Journal of PsychiatryAust. N. Z. J. PsychiatryAust N Z J PsychiatryAustralian & New Zealand Journal of Psychiatry735-7524682012http://anp.sagepub.com/cgi/content/abstract/46/8/735SHIP paperv10.1177/0004867412449877(HYPERLINK \l "_ENREF_11" \o "Morgan, 2012 #5108"Morgan et al., 2012).
Inter-rater reliability
Interviewers were predominantly mental health professionals trained to use the survey instruments and to take standardised physical measures. They received specialised training in administering and scoring the Diagnostic Interview for Psychosis (AJ) and cognitive tasks (JCB). Procedures were implemented to ensure quality and reliability. Inter-rater reliability was assessed in the course of field interviews (AJ, HS), with good agreement among interviewers (averaged pairwise agreement of 0.94 for ICD-10 diagnoses and intra-class correlation of 0.98 for the NART-R).
Physical health assessments
Blood Sampling
For analysis of total cholesterol, high density lipoprotein, triglyceride and plasma glucose levels.
One authorised pathology service at each site collected, analysed and reported results.
Participants were asked to fast from midnight the night before testing.
Participants unable to fast undertook the test with the non fasting time recorded.
5.5mls blood were collected.
Results were recorded in mmol/L to two decimal points
Waist circumference
Perfect waist tape measures were provided to all interviewers.
It is made of fiberglass fabric which is flexible and won't stretch like cotton fabric does.
The tape was wrapped around the waist; the peg at the end was secured into the case, and cinched until snug.
Waist circumference was measured as recommended in the NIH guidelines ADDIN EN.CITE National Institutes of Health20005391(National Institutes of Health, 2000)5391539127National Institutes of Health,The Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults2000BethesdaNational Institutes of Health(HYPERLINK \l "_ENREF_12" \o "National Institutes of Health, 2000 #5391"National Institutes of Health, 2000) by locating the top of the hip bone (iliac crest). The tape measure was placed evenly around the abdomen at the level of this bone. The tape measure was snug without compressing the skin. The participant was asked to breathe out gently and the measurement was taken at end of a normal expiration.
Measurements were recorded to the nearest centimetre.
Height
Interviewers used wall mounted height measuring devices or standard tape measures attached to the wall for readings.
Participants were asked to remove shoes. Each participant was positioned to be standing fully erect with heels, buttocks and shoulders resting lightly against the wall, in front of, the measurement device. Readings were taken to the nearest centimetre.
Weight
All interviewers used scales provided: Propert maxi weigh glass electronic scales capacity 200kg model 3202
Scales placed on a firm and even surface
Scales turned on by pressing the centre of the glass platform with foot. The display showed 0.0.
Participants shoes were removed.
The participant was asked to stand on the scales making sure feet were placed evenly and standing still.
Weight was recorded from digital display on scales and was recorded to the nearest kilogram.
Blood pressure
All interviewers used blood pressure monitors provided: AND digital blood pressure monitor model UA-767 plus
Ideally, the participant should not have consumed caffeine or smoked for at least 2 hours before BP was measured.
Participants were seated and had been for at least 5-10 minutes before measurement.
The appropriate cuff size was selected (medium or large). The selected arm (preferably left) was freed of constricting clothing so that the cuff could be wrapped around the upper arm without impediment.
The cuff was wrapped around the upper arm about 2-3cms above the elbow with the airhose extended towards the hand and in the middle of the arm.
The START button was pressed.
If an appropriate pressure was not obtained the machine automatically inflated again.
When completed the readings were displayed and recorded.
Physical health calculations
Body Mass Index (BMI)
Body mass index was calculated from measured height and weight, using the following formula: weight in kilograms divided by height in meters squared. BMI values are grouped according to the list below which allows categories to be reported against the World Health Organization (WHO) guidelines ADDIN EN.CITE World Health Organization20005327(World Health Organization, 2000)5327532727World Health Organization,Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894 2000GenevaWorld Health Organization