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A policy brief for heads of government, updating ADI's prevalence figures published in the World Alzheimer Report 2009. The new estimates are an increase of 17% on the figures published in 2009, with data showing that the number of people with dementia will increase from 115 to 135 million by 2050. The report also predicts a shift in the distribution of the global burden of dementia. By 2050, 71% of all people with dementia will live in low or middle income countries. The briefing has been released ahead of the first G8 Dementia Summit, which will take place in London, UK, on 11 December 2013. The update focused on the new evidence emerging from China and the sub-Saharan African region, applying the new prevalence rates to the latest (2012) UN population projections. This report has been a joint effort of the Global Observatory for Ageing and Dementia Care at King's College London (Prof Martin Prince, Dr Maëlenn Guerchet and Dr Matthew Prina) and Alzheimer's Disease International.

Background: The ethnic density effect describes a phenomenon whereby adverse mental health outcomes among individuals from ethnic minorities are greater in neighbourhoods where they comprise a smaller proportion of the population. Most previous studies of the ethnic density effect have been quantitative in design, and thus have only been able to speculate on some of the underlying mechanisms explaining this phenomenon. Aims: This paper attempts to remedy this deficit, using in-depth qualitative methodology to explore mechanisms underlying the ethnic density effect. Methods: We chose an inner-London electoral ward, Gospel Oak, with a relatively low proportion of ethnic minorities, as a case study. Thirty-two residents, eight of whom were from minority ethnic groups, participated in either focus groups or in-depth interviews. We also conducted participant observation and collected relevant quantitative data. Results: We found four principal overlapping mechanisms that may help to explain why minorities living in predominantly white electoral wards may have greater risk of adverse mental health outcomes. These were perceived exclusion from local networks, a need to rely on geographically dispersed culturally specific services and facilities, perceived risk of physical and psychological intimidation and damaging effects of everyday racism. Conclusions: These mechanisms are presented as a framework, grounded in a qualitative case study, which can be applied in future study. They may help to explain the causes behind the ethnic density effect on mental health although further research in other settings is necessary in order to test the framework's external validity.

Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global mental health is the application of these principles to the domain of mental ill-health. The most striking inequity is that concerning the disparities in provision of care and respect for human rights of people living with mental health problems (MHP) between rich and poor countries

Abstract Background In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages; less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity Methods A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ). Results Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women's own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin. Conclusions The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal.

Looking to the future of the ever-evolving field of psychiatric epidemiology, this new edition covers the many advances in the field since the release of the first. With new content on key topics from bioethics to life course epidemiology, this new edition will continue to be an invaluable reference for clinicians in practice and in training.

Background: Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC).Methods: A one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0.Results: 17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. the most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.Conclusions: There is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies. ; Wellcome Trust (UK) ; WHO ; US Alzheimer's Association ; FONACIT-Venezuela ; Puerto Rico State Legislature ; Inst Memory Depress & Dis Risk, Lima 12, Peru ; Kings Coll London, Ctr Global Mental Hlth, Hlth Serv & Populat Res Dept, Inst Psychiat Psychol & Neurosci, London WC2R 2LS, England ; Peruvian Univ, Lima, Peru ; Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil ; Med Univ Havana, Havana, Cuba ; Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil ; Wellcome Trust (UK): GR066133 ; US Alzheimer's Association: IIRG-04-1286 ; Web of Science

Natural disasters cause immense suffering among affected communities. Most occur in developing countries, which have fewer resources to respond to the resulting traumas and difficulties. As a consequence, most survivors have to rely on their own coping resources and draw from what support remains within family, social networks and the wider community to manage and deal with their losses and consequent emotional distress. Taking the 2004 Asian tsunami as an example, this article reports findings from a qualitative study designed to investigate how survivors responded in Sri Lanka, and the range of coping strategies adopted and resources mobilized. In-depth interviews were conducted with 38 survivors purposively sampled from the Matara district of southern Sri Lanka. Survivors' accounts emphasized the importance of extended supportive networks, religious faith and practices, and cultural traditions in facilitating recovery and sustaining emotional well-being. Government and external aid responses that promoted these, through contributing to the re-establishment of social, cultural, and economic life, were particularly valued by participants. Recourse to professional mental health care and Western psychological interventions was limited and survivors preferred to seek help from traditional and religious healers. Our findings tentatively suggest that long-term mental health following disaster may, in the first instance, be promoted by supporting the re-establishment of those naturally occurring resources through which communities traditionally respond to suffering.

Latin American and the Caribbean countries exhibit high life expectancy and projections show that they will experience the fastest growth of older people in the following years. As people live longer, it is important to maximise the opportunity to age healthily. We aimed to examine the associations of lifestyle behaviours with healthy ageing in Cuba, Dominican Republic, Peru, Mexico and Puerto Rico, part of the 10/66 study. Residents 65 years old and over (n = 10,900) were interviewed between 2003 and 2010. In the baseline survey, we measured four healthy behaviours: Physical activity, non-smoking, moderate drinking and fruits or vegetables consumption. Healthy ageing was conceptualised within the functional ability framework over a median of 4 years follow-up. Logistic models were calculated per country and then pooled together with fixed-effects meta-analysis. People engaging in physical activity and consuming fruits or vegetables had increased odds of healthy ageing in the follow-up (OR: 2.59, 95% CI: 2.20⁻3.03; OR: 1.24, 95% CI: 1.06⁻1.44, respectively). Compared with participants engaging in none or one healthy behaviour, the ORs of participants engaging in two, three or four healthy behaviours increased in a linear way (OR: 1.60, 95% CI: 1.40⁻1.84; OR: 2.29, 95% CI: 1.94⁻2.69; OR: 2.46, 95% CI: 1.54⁻3.92, respectively). Our findings highlight the importance of awareness of a healthy lifestyle behaviour among older people. ; The authors would like to thank the ATHLOS (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) project, funded by the European Union's Horizon 2020 Research and Innovation Programme under grant agreement number 635316

Background: Our population is ageing and in 2050 more than one out of five people will be 60 years or older; 80% of whom will be living in a low-and-middle income country. Living longer does not entail living healthier; however, there is not a widely accepted measure of healthy ageing hampering policy and research. The World Health Organization defines healthy ageing as the process of developing and maintaining functional ability that will enable well-being in older age. We aimed to create a healthy ageing index (HAI) in a subset of six low-and-middle income countries, part of the 10/ 66 study, by using items of functional ability and intrinsic capacity. Methods: The study sample included residents 65-years old and over (n = 12,865) from catchment area sites in Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico. Items were collected by interviewing participants or key informants between 2003 and 2010. Two-stage factor analysis was employed and we compared one-factor, second-order and bifactor models. The psychometric properties of the index, including reliability, replicability, unidimensionality and concurrent convergent validity as well as measurement invariance per ethnic group and gender were further examined in the best fit model. Results: The bifactor model displayed superior model fit statistics supporting that a general factor underlies the various items but other subdomain factors are also needed. The HAI indicated excellent reliability (ω = 0.96, ωΗ = 0.84), replicability (H = 0.96), some support for unidimensionality (Explained Common Variance = 0.65) and some concurrent convergent validity with self-rated health. Scalar measurement invariance per ethnic group and gender was supported. Conclusions: A HAI with excellent psychometric properties was created by using items of functional ability and intrinsic capacity in a subset of six low-and-middle income countries. Further research is needed to explore sub-population differences and to validate this index to other cultural settings. ; This work is also supported by the ATHLOS (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) project, funded by the European Union's Horizon 2020 Research and Innovation Programme under grant agreement number 635316. A. M. P. was supported by the MRC MR/K021907/1