bluuebunny/crossref_metadata_2025 huggingface dataset:
The Contribution of Sleep Medicine to the Assessment of the Tired Patient
Authors: Moldofsky Harvey
Published: January 2017

Tiredness is one of the most common complaints that confront the clinician. Yet the nature of the symptom and its implications for sleep-related disorders is poorly understood. This review provides the clinician with an understanding of the difficulties inherent in assessing the tired patient. The complaint of tiredness is commonly an expression of sleepiness and fatigue that arises as the result of sleep-wake–related disorders. Behavioural and physiological procedures are described in the assessment and management of sleepiness and fatigue in primary sleep disorders and sleep-related medical and psychiatric disorders. Improvement in the diagnosis and management of the fatigued or sleepy patient requires that residents in psychiatry and neurology be exposed to the behavioural and physiological techniques of sleep medicine as part of their post-graduate training programs.
Suicidal Ideation in Major Depression: Sex Differences and Impact of Comorbid Anxiety
Authors: Schaffer Ayal , Levitt Anthony J , Bagby R Michael , Kennedy Sidney H , Levitan Robert D , Joffe Russell T
Published: January 2017

Background:

Being female and having comorbid anxiety are both thought to increase suicidality in patients with major depression. Whether these effects are independent or related to severity of depression is not known.

Method

We conducted a retrospective review of 533 patients (190 men, 343 women) with major depression at the time of assessment.

Results

Suicidal ideation was present in 57.8% of all patients, and 43.2% of all patients had a lifetime anxiety disorder. Significantly more women than men experienced suicidal ideation, and both men and women with a lifetime anxiety disorder were more likely to be suicidal. Age and severity of depression did not account for these results.

Conclusions

In patients with a current major depression, being female and having a lifetime anxiety disorder increase suicidality independently of one another and independently of severity of depression.
Individual Predictors of Posttraumatic Distress: A Structural Equation Model
Authors: Regehr Cheryl , Hemsworth David , Hill John
Published: January 2017

Objective:

Recent research has called into question the “dose-effect” model of understanding response to trauma and has turned attention to the contribution of personality and environmental factors. This research seeks to model the interrelation of relational capacity (a component of personality), perceptions of social support, and posttraumatic distress.

Method:

A group of firefighters (n = 164) completed questionnaires that addressed exposure to traumatic events, social support, current level of distress, and relational capacity. Structural equation modelling was used to develop a framework for understanding traumatic reactions.

Results:

The overall fit of the hypothesized model was excellent. Relational capacity had a significant negative effect on support, indicating that perceived social support decreased as disturbances in relational capacity increased. Perceived social support had a significant negative effect on level of distress.

Conclusion:

While some emotional response to disturbing events may be normal, the severity of symptoms covaries with the ability of the individual to develop and sustain supportive relationships to buffer the impact of events.
Criminal Harassment by Patients with Mental Disorders
Authors: Adams Susan J , Pitre Nancy L , Smith Adrienne
Published: January 2017

Objective:

To assess whether there is a subgroup of persons with mental disorders who engage in criminal harassment and to determine whether substance abuse is a cofactor in this behaviour.

Method:

A cross-sectional casenote study was used to examine incidents of harassment by patients prior to admission to acute and forensic wards (n = 106) at a provincial psychiatric hospital.

Results:

Of 106 patients, 8 (7.5%) were found to have engaged in behaviour defined as criminal harassment prior to admission. Only 1 was charged under Section 264 of the Criminal Code. Alcohol was a cofactor in only 1 case.

Conclusions:

The number of persons with a mental disorder who engage in criminal harassment prior to admission is relatively small. The behaviour is not usually identified at any stage of the admission as criminal harassment. Although substance-abuse problems were prevalent, substance use was not a concomitant risk factor for behaviour defined as criminal harassment.
Consequences of Bullying in Schools
Authors: Rigby Ken
Published: January 2017

For the most part, studies of the consequences of bullying in schools have concentrated upon health outcomes for children persistently bullied by their peers. Conclusions have been influenced by how bullying has been conceptualized and assessed, the specific health outcomes investigated, and the research method and data analysis employed. Results from cross-sectional surveys suggest that being victimized by peers is significantly related to comparatively low levels of psychological well-being and social adjustment and to high levels of psychological distress and adverse physical health symptoms. Retrospective reports and studies suggest that peer victimization may contribute to later difficulties with health and well-being. Longitudinal studies provide stronger support for the view that peer victimization is a significant causal factor in schoolchildren's lowered health and well-being and that the effects can be long-lasting. Further evidence from longitudinal studies indicates that the tendency to bully others at school significantly predicts subsequent antisocial and violent behaviour.
An Electrophysiologic Study: Can Semantic Context Processes Be Mobilized in Patients with Thought-Disordered Schizophrenia?
Authors: Kostova Milena , Passerieux Christine , Laurent Jean-Paul , Hardy-Baylé Marie-Christine
Published: January 2017

Objective:

The aim of this study was to test the hypothesis that reinforcing the structuring of verbal material may bring about an improvement in contextualization processes in patients with formal thought-disordered schizophrenia.

Method:

A total of 38 schizophrenia patients with formal thought disorders and 24 matched healthy control subjects performed 2 lexical decision tasks, involving 2 levels of contextual structuring (with 16.7% and 33% of related words, respectively). The event-related potentials, N400 and late positive component (LPC), and behavioural variables (reaction times and error percentages) were analyzed.

Results:

A context-structuring effect was observed on LPC, but not on N400. In subjects with schizophrenia, the N400 anomalies (that is, increase in amplitude for the related words and reduction of the N400 effect) persisted in both context-structuring conditions. Similarly, a reduction in LPC amplitude for the unrelated word category, as well as a decrease in the LPC effect, was observed in these patients.

Conclusions:

The schizophrenia patients with formal thought disorders did not benefit from the structuring of the context to implement context integration strategies. This deficit appears to be stable. The results are discussed within the framework of a previously published model of language comprehension.
Managing Depression-Related Occupational Disability: A Pragmatic Approach
Authors: Bilsker Dan , Wiseman Stephen , Gilbert Merv
Published: January 2017

Objective:

To identify the crucial issues that arise for psychiatrists and other physicians when dealing with occupational disability in their patients with depression and to suggest practical strategies for responding more effectively to the challenges of this aspect of patient functioning.

Method:

We identify fundamental concepts in the occupational disability domain and draw crucial distinctions. The wider context for occupational disability is articulated, involving the workplace environment and the disability insurance industry. Research with direct relevance to clinical decision making in this area is highlighted. We make pragmatic suggestions for effective management of occupational disability in patients with depression.

Results:

To successfully manage issues of occupational disability, psychiatrists and other physicians must understand the distinction between impairment and disability. To make this decision fairly and accurately, the adjudicator requires particular types of information from the physician, with requirements varying across short-term or long-term disability claims; failing to provide relevant information may cause substantial stress or financial harm to the patient. Balanced and collaborative decision making regarding whether and for how long to take work absence will greatly help to maintain occupational function in the long term. Realistic expectations and support of the patient's sense of personal competence foster recovery of occupational function.

Conclusion:

Management of depression-related disability is challenging. Thoughtful evaluation of the patient's functional status, careful response to the requirements of disability determination, and a focus on functional recovery yield substantial benefits.
Comorbidity with ADHD Decreases Response to Pharmacotherapy in Children and Adolescents with Acute Mania: Evidence from a Metaanalysis
Authors: Consoli Angèle , Bouzamondo Anissa , Guilé Jean-Marc , Lechat Philippe , Cohen David
Published: January 2017

Objective:

To assess whether comorbid attention-deficit hyperactivity disorder (ADHD) influences response to treatment in young patients with acute mania.

Methods:

We conducted a metaanalysis of 5 open trials of 100, 35, 41, 60, and 37 children and adolescents. The pooled group included 273 children and adolescents with bipolar disorder (BD), divided into 2 subgroups: those with ( n = 132), and those without ( n = 141), ADHD comorbidity.

Results:

There was a moderate and significant reduction in relative risk (RR) favouring treatment response in children and adolescents with BD but without ADHD comorbidity (RR 0.822; 95%CI, 0.69 to 0.97; P = 0.021). The negative effect of ADHD comorbidity on treatment response was more significant in studies including adolescents only or subjects with BD I only.

Conclusion:

These findings suggest that children and adolescents with BD and ADHD tend to be less responsive to drugs used in treatment of acute mania.
Pharmacotherapy of Alzheimer Disease
Authors: Seow Dennis , Gauthier Serge
Published: January 2017

Objective:

To systematically review published clinical trials of the pharmacotherapy of Alzheimer disease (AD).

Method:

We searched MEDLINE for published English-language medical literature, using Alzheimer disease and treatment as key words. No other search engine was used. Our review focused on randomized clinical trials (RCTs) and corresponding metaanalyses.

Results:

Although there are many RCTs for the treatment of mild cognitive impairment (MCI), none have been successful in their primary analysis. The cholinesterase inhibitors donepezil, rivastigmine, and galantamine have demonstrated efficacy in 3- to 12-month placebo-controlled RCTs assessing cognitive, functional, behavioural, and global outcomes in patients with mildly to moderately severe AD. Recent data from patients with severe stages of AD demonstrate the efficacy of donepezil on cognitive and functional measures but not on behaviour. The N-methyl-D-aspartate receptor antagonist memantine has been demonstrated to be effective in 6-month, placebo-controlled RCTs of 6 months duration assessing cognitive, functional, and global outcomes of inpatients with moderate-to-severe AD (defined as a Mini Mental State Examination score below 20). Post hoc analyses have demonstrated a benefit in regard to agitation and (or) aggression, but this needs to be confirmed in a prospective RCT across Canada. Disease-modifying treatments are being tested in mild stages of AD in 18-month RCTs with cognitive and global outcomes as primary efficacy outcomes, primarily with drugs reducing amyloid synthesis or aggregation. Successful treatment in mild stages of AD could lead to RCTs in MCI and, possibly, in genetically high-risk asymptomatic individuals.

Conclusion:

The significant advances in the symptomatic pharmacotherapy of AD may be followed by disease-modification treatments.
The Associations between Health Risk Behaviours and Suicidal Ideation and Attempts in a Nationally Representative Sample of Young Adolescents
Authors: Afifi Tracie O , Cox Brian J , Katz Laurence Y
Published: January 2017

Objective:

To examine associations between health risk behaviours and suicidal ideation and attempts in Canadian adolescents aged 12 to 13 years. Young adolescents think about and attempt suicide. However, most existing research on suicide has been conducted on individuals aged 15 years and older.

Method:

The present study examined a nationally representative Canadian sample of adolescents aged 12 to 13 years ( n = 2090). Health risk behaviours included disruptive (shoplifting, physical fighting, damaging property, fighting with a weapon, carrying a knife, and gambling), sexual (petting below the waist and sexual intercourse), and substance use behaviours (smoking cigarettes, consuming alcohol, marijuana or hash, and glue or solvents). Unadjusted and adjusted (for all significant health risk behaviour and psychiatric symptoms) models were tested.

Results:

All health risk behaviours were common among male and female adolescents. In unadjusted models, almost all health risk behaviours were associated with suicidal ideation and attempts among adolescent boys. In adjusted models, only damaging property, sexual intercourse, and smoking cigarettes remained statistically associated with suicidal ideation, while smoking cigarettes and using marijuana or hash remained statistically associated with suicide attempts among adolescent boys. All health risk behaviours were statistically associated with suicidal ideation and attempts among female adolescents in unadjusted models. In adjusted models, only carrying a knife remained statistically associated with suicidal ideation, while shoplifting and gambling remained statistically associated with suicide attempts among adolescent girls.

Conclusions:

Health risk behaviours among young adolescents are associated with suicidal ideation and attempts among young adolescents. Recognizing health risk behaviours among young adolescents may be one means of understanding who among them is at increased risk of suicidality.
Previous Trauma Exposure and PTSD Symptoms as Predictors of Subjective and Biological Response to Stress
Authors: Regehr Cheryl , LeBlanc Vicki , Jelley R Blake , Barath Irene , Daciuk Joanne
Published: January 2017

Objective:

The immediate and long-term effects of traumatic exposure and subsequent posttraumatic stress reactions in people in high-risk occupations are well-documented. What is less evident is the impact of this traumatic exposure and subsequent traumatic stress symptoms on workers' response to acute stress situations. This study aimed to examine the association between prior traumatic exposure related to policing, current posttraumatic stress symptoms and biological markers of stress, and subjective appraisal of stress before, during, and after exposure to acutely stressful stimuli.

Method:

A stressful policing situation was created through the use of a video simulator room. Participants' responses to the simulated emergency were evaluated by monitoring heart rate, collecting salivatory samples for cortisol analysis, and repeated administration of a subjective measure of anxiety.

Results:

Biological indicators of stress, as measured by cortisol level and heart rate, were not associated with previous trauma exposure or trauma symptoms; however, biological response was associated with subjective anxiety. Vulnerability to psychological stress responses during an acute stress situation was also associated with lower levels of social support, previous traumatic exposures, and preexisting symptoms of traumatic stress. The importance of these factors became more pronounced as time progressed after the event.

Conclusion:

Previous trauma exposure did not put individuals at increased risk of biological distress during an acute stress situation. However, previous trauma and reduced social supports were associated with continuing psychological distress, confirming previous research and raising concerns about the cumulative negative effects of traumatic exposure on psychological health in emergency responders.
Reducing the Burden of Depression
Authors: Andrews Gavin
Published: January 2017

Objective:

To consider why the burden of depression persists.

Method:

The epidemiology and disability associated with depression were reviewed to consider whether depression persists because: the causes are overwhelming, prevention is ineffective, the disease is difficult to detect or diagnose, the condition remits and recurs, treatments do not work, individuals do not seek treatment, or effective care is not provided when they do seek it.

Results:

The first 5 possibilities were not considered significant reasons for the persistence of the burden.

Conclusion:

The burden persists because individuals do not seek treatment for their depression when they relapse and effective proactive treatment is not always provided when they do seek it.

Objectif:

Examiner pourquoi le fardeau de la dépression persiste.

Méthode:

L'épidémiologie et l'incapacité associées à la dépression ont été examinées pour déterminer si la dépression persiste parce que: les causes sont accablantes, la prévention est inefficace, la maladie est difficile à détecter ou à diagnostiquer, l'affection entre en rémission et revient, les traitements ne fonctionnent pas, les personnes ne veulent pas de traitement, ou des soins efficaces ne sont pas dispensés quand elles en veulent.

Résultats:

Les 5 premières possibilités n'ont pas été considérées comme étant des raisons significatives de la persistance du fardeau.

Conclusion:

Le fardeau persiste parce que les personnes ne veulent pas de traitement pour leur dépression quand elles rechutent, et qu'un traitement proactif efficace n'est pas toujours dispensé quand elles en veulent.
Cross-Cultural Validation of the Empathy Quotient in a French-Speaking Sample
Authors: Berthoz Sylvie , Wessa Michele , Kedia Gayannee , Wicker Bruno , Grèzes Julie
Published: January 2017

Objective:

The Empathy Quotient (EQ) is a self-report that was developed to measure the cognitive and affective aspects of empathy. We further evaluated its validity in 2 studies.

Method:

The psychometric qualities of the French version of the EQ, and its correspondence with 2 other measures of empathy (Interpersonal Reactivity Index and the Empathy Scale of the Impulsiveness-Venturesomeness-Empathy Questionnaire), and with dimensions of the emotional state (depression and anxiety), were evaluated in a sample of 410 students (201 men and 209 women). Second, the clinical validity of the EQ was investigated in participants expected to have dysfunctional empathy. For this purpose, EQ scores of 16 people with autistic spectrum disorder (ASD) were collected.

Results:

The EQ showed satisfying internal, convergent, test–retest and discriminant validity. The confirmatory factorial analyses suggested a 3-factor structure offered a good fit to the data. The women's superiority in empathy was replicated. As expected, the ASD EQ scores were very low.

Conclusion:

This study provides further evidence that the EQ is reliable in this population and should be recommended to estimate empathy problems, notably in individuals with troubled interpersonal interaction patterns.

Objectif:

Le quotient d'empathie (QE) est une autodéclaration qui a été élaborée pour mesurer les aspects cognitifs et affectifs de l'empathie. Nous en avons aussi évalué la validité dans 2 études.

Méthode:

Les qualités psychométriques de la version française du QE, et sa correspondance à 2 autres mesures de l'empathie (l'indice de réactivité interpersonnelle et l'échelle d'empathie du questionnaire sur l'impulsivité, l'esprit d'aventure, l'empathie), ainsi qu'à des dimensions de l'état émotionnel (dépression et anxiété), ont été évaluées dans un échantillon de 410 étudiants (201 hommes et 209 femmes). Deuxièmement, la validité clinique du QE a été vérifiée chez les participants qu'on prévoyait avoir une empathie dysfonctionnelle. À cette fin, les scores de QE de 16 personnes souffrant du trouble du spectre de l'autisme (TSA) ont été recueillis.

Résultats:

Le QE a démontré une validité interne, convergente, test-retest et discriminante satisfaisante. Les analyses factorielles confirmatoires suggéraient qu'une structure à 3 facteurs convenait bien aux données. La supériorité des femmes en empathie a été reproduite. Comme prévu, les scores de QE dans le TSA étaient très faibles.

Conclusion:

Cette étude amène d'autres données probantes que le QE est un instrument fiable qui devrait être recommandé pour estimer les problèmes d'empathie, notamment chez les personnes présentant des modèles problématiques d'interaction person.
High Anxieties: The Social Construction of Anxiety Disorders
Authors: Dowbiggin Ian R
Published: January 2017

Anxiety has always been part of the human condition, with accounts of its various manifestations, including acute shyness and stage fright, dating back to classical antiquity. Nonetheless, since the end of the Second World War, reported levels of anxiety have risen alarmingly. At the beginning of the 21st century, anxiety disorders constitute the most prevalent mental health problem around the globe, afflicting millions of people. What social factors account for this stunning development in the mental health field during the past half century? Some observers target the ever increasing pace and demands of modern life. Nonetheless, a larger body of evidence suggests that the prevalence of anxiety is due less to these pressures themselves than to a prevailing social ethos that teaches people that anxiety-related symptoms are a socially and medically legitimate response to life in the modern age.
Use of Brain Imaging (Computed Tomography and Magnetic Resonance Imaging) in First-Episode Psychosis: Review and Retrospective Study
Authors: Goulet Karine , Deschamps Benoit , Evoy François , Trudel Jean-François
Published: January 2017

Objective:

To identify and review available evidence on the diagnostic yield of brain computed tomographies (CTs) and magnetic resonance images (MRIs) in first-episode psychosis, and examine yield in our own institution (Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec).

Method:

Using MEDLINE (1966 to October 2007) and EMBASE (1980 to October 2007), we identified and analyzed studies that examined imaging yields in first-episode psychosis; yield being defined as the percentage of scans showing abnormalities that may result in psychosis. We also retrospectively analyzed diagnostic yields in 46 patients hospitalized in our institution between 2001 and 2006 for first-episode psychosis.

Results:

Five studies were deemed relevant. Including our own series, the sample comprised 384 CT and 184 MRI scans. Point estimate for diagnostic yield was 1.3% for CT and 1.1% for MRI scans. These yields likely overestimate clinical usefulness of findings. MRI scans also resulted in a sizeable number of fortuitous, clinically irrelevant findings.

Conclusions:

In first-episode psychosis, routine CT or MRI scans are of little benefit and should be reserved for situations where history or examination suggests neurological causation, or possibly for people aged 50 years and older.
Amygdala and Hippocampal Volumes in Relatives of Patients with Bipolar Disorder: A High—Risk Study
Authors: Hajek Tomas , Gunde Eva , Slaney Claire , Propper Lukas , MacQueen Glenda , Duffy Anne , Alda Martin
Published: January 2017

Objective:

Bipolar disorders (BD) have a strong genetic underpinning, yet no biological vulnerability markers for BD have yet been identified. To test whether amygdala or hippocampal volumes represent an endophenotype for BD, we measured mesiotemporal volumes in young affected and unaffected relatives of patients with BD (high-risk design).

Method:

High-risk participants (aged 15 to 30 years) were recruited from families multiply affected with BD. They included 20 affected and 26 unaffected offspring of parents with primary mood disorders, matched by age and sex with 31 control subjects without a personal or family history of psychiatric disorders. Amygdala and hippocampal volumes were measured on 1.5 Tesla 3-dimensional anatomical magnetic resonance images using standard methods.

Results:

We found comparable amygdala and hippocampal volumes among unaffected relatives, affected high-risk patients, and control subjects. The exclusion of 6 medicated patients did not change the results. There were no differences between participants with family history of BD I, compared with participants with family history of BD II, or between subjects with family history of BD with psychotic symptoms, compared with subjects with family history of BD without psychotic symptoms.

Conclusions:

Hippocampal and amygdala volume abnormalities were absent in unaffected and affected relatives of patients with BD and thus did not meet criteria for endophenotype.
Mental Health Service Use by Chinese Immigrants with Severe and Persistent Mental Illness
Authors: Chen Alice W , Kazanjian Arminée , Wong Hubert , Goldner Elliot M
Published: January 2017

Objective:

To investigate whether recent Chinese immigrants in British Columbia diagnosed with severe and persistent mental illness used mental health services at a lower rate than a similar group of nonimmigrants and longer-term immigrants.

Method:

Subjects were selected from linked immigration and health administrative databases. Their health service use records for the years 1992 to 2001 were extracted. Rates and rate ratios of use for severe psychiatric disorders for Chinese immigrants and the comparison group were calculated for 4 types of health services: mental health visits to general practitioners (GPs), visits to psychiatrists, psychiatric hospitalizations, and use of psychiatric medications. Rates and rate ratios of use for any mental health condition were calculated for the above 4 types of services, plus community mental health service and nonmental health visits to GPs.

Results:

The Chinese immigrants ( n = 786) and comparison subjects ( n = 3962) having severe and persistent mental illness were identified. For serious mental disorders, Chinese immigrants were more likely to visit psychiatrists (RR = 1.36) but less likely to use the other types of services, with rate ratios ranging from 0.51 to 0.81. Including all mental health conditions, Chinese immigrants were less likely to use all 6 types of services, with rate ratios ranging from 0.41 to 0.90.

Conclusions:

Except for psychiatric visits for serious disorders, recent Chinese immigrants diagnosed with severe and persistent mental illness used fewer mental health services than subjects from the comparison group. Seriously ill Chinese immigrants may experience problems with access to mental health services.
New Psychotherapies for Mood and Anxiety Disorders
Authors: Stirman Shannon Wiltsey , Toder Katherine , Crits-Christoph Paul
Published: January 2017

Objective:

To discuss psychotherapies for depression and anxiety that have emerged in recent years and to evaluate their current level of empirical support.

Method:

An electronic and a manual literature search of psychotherapies for mood and anxiety disorders were conducted.

Results:

Five new therapies for mood disorders and 3 interventions for posttraumatic stress disorder with co-occurring substance abuse met criteria for inclusion in this review. Fewer psychotherapies have been developed for other anxiety disorders. Although research for some of the psychotherapies has demonstrated superiority to usual care, none have firmly established efficacy or specific benefits over other established psychotherapies.

Conclusions:

A plurality of the new psychotherapies introduced and established in the past 5 years have been different assimilations of previously established cognitive-behavioural, interpersonal, or psychodynamic models. While initial results are promising for some, more rigorous efficacy trials and replications are necessary before conclusions can be drawn regarding their relative benefits.
What is Resilience?
Authors: Herrman Helen , Stewart Donna E , Diaz-Granados Natalia , Berger Elena L , Jackson Beth , Yuen Tracy
Published: January 2017

Objective:

While everyone—including front-line clinicians—should strive to prevent the maltreatment and other severe stresses experienced by many children and adults in everyday life, psychiatrists and other health professionals also need to consider how best to support, throughout the lifespan, those people affected by severe adversity. The first step in achieving this is a clear understanding of the definitions and concepts in the rapidly growing study of resilience. Our paper reviews the definitions of resilience and the range of factors understood as contributing to it, and considers some of the implications for clinical care and public health.

Method:

This narrative review took a major Canadian report published in 2006 as its starting point. The databases, MEDLINE and PsycINFO, were searched for new relevant citations from 2006 up to July 2010 to identify key papers considering the definitions of resilience and related concepts.

Results:

Definitions have evolved over time but fundamentally resilience is understood as referring to positive adaptation, or the ability to maintain or regain mental health, despite experiencing adversity. The personal, biological, and environmental or systemic sources of resilience and their interaction are considered. An interactive model of resilience illustrates the factors that enhance or reduce homeostasis or resilience.

Conclusions:

The 2 key concepts for clinical and public health work are: the dynamic nature of resilience throughout the lifespan; and the interaction of resilience in different ways with major domains of life function, including intimate relationships and attachments.
Epidemiology of Postpartum Depressive Symptoms among Canadian Women: Regional and National Results from a Cross-Sectional Survey
Authors: Dennis Cindy-Lee , Heaman Maureen , Vigod Simone
Published: January 2017

Objectives:

To describe national and regional prevalence rates for significant depressive symptoms in women after 12 weeks during the postpartum period, and to identify predictors of postpartum depressive symptoms during this later time period.

Methods:

Data from the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were analyzed. Participants completed a computer-assisted telephone interview between 5 and 14 months during the postpartum period ( n = 6421). Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Proportions and odds ratios with 95% confidence intervals were calculated using bootstrap methods to account for sample design and weighting adjustments.

Results:

About 8% of Canadian women exhibited depressive symptoms past 12 weeks during the postpartum period. Prevalence rates varied between regions. In multivariable analysis, previous history of depression (OR 1.87; 95% CI 1.43 to 2.45, P < 0.001), low household income (OR 1.64; 95% CI 1.27 to 2.11, P < 0.001), low postpartum social support (OR 3.95; 95% CI 2.77 to 5.62, P < 0.001), stressful life events (OR 2.43; 95% CI 1.88 to 3.15, P < 0.001), interpersonal violence (OR 1.40; 95% CI 1.04 to 1.87, P = 0.02), and poor self-perceived maternal health (OR 4.48; 95% CI 3.15 to 6.38, P < 0.001) were independently associated with postpartum depressive symptoms. Regional differences in correlates of postpartum depressive symptoms were found.

Conclusions:

The finding that depression rates are elevated throughout the first postpartum year is important because of the known negative impact of postpartum depression (PPD). Targeted public health interventions may be needed to reduce the prevalence of PPD and its associated impact.
Trends in Newspaper Coverage of Mental Illness in Canada: 2005–2010
Authors: Whitley Rob , Berry Sarah
Published: January 2017

Objectives:

Much research suggests that the general public relies on the popular media as a primary source of information about mental illness. We assessed the broad content of articles relating to mental illness in major Canadian newspapers over a 6-year period. We also sought to assess if such content has changed over time.

Methods:

We conducted a retrospective analysis of Canadian newspaper coverage from 2005 to 2010. Research assistants used a standardized guide to code 11 263 newspaper articles that mention the terms mental health, mental illness, schizophrenia, or schizophrenic. Once the articles were coded, descriptive statistics were produced for overarching themes and time trend analyses from 2005 to 2010.

Results:

Danger, violence, and criminality were direct themes in 40% of newspaper articles. Treatment for a mental illness was discussed in only 19% of newspaper articles, and in only 18% was recovery or rehabilitation a significant theme. Eighty-three per cent of articles coded lacked a quotation from someone with a mental illness. We did not observe any significant changes overtime from 2005 to 2010 in any domain measured.

Conclusion:

There is scope for more balanced, accurate, and informative coverage of mental health issues in Canada. Newspaper articles infrequently reflect the common realities of mental illness phenomenology, course, and outcome. Currently, clinicians may direct patients and family members to other resources for more comprehensive and accurate information about mental illness.
Teachers' Ratings of Childhood Behaviours Predict Adolescent and Adult Crime among 3016 Males and Females
Authors: Hodgins Sheilagh , Larm Peter , Ellenbogen Mark , Vitaro Frank , Tremblay Richard E
Published: January 2017

Objective:

To examine associations of teacher-rated conduct problems (CP) and hurtful and uncaring behaviours (HUB) at age 6 and 10 with criminal convictions up to age 24 among 1593 males and 1423 females, and to determine whether aggressive behaviour at age 12 mediated the associations of CP and HUB with criminal convictions.

Method:

Teachers assessed HUB and CP at ages 6 and 10 and ratings above the 90th percentile at each age and within each sex were used to assign participants to 1 of 4 groups. Teachers assessed proactive, reactive, indirect, and verbal aggression at age 12. Juvenile and adult criminal records were obtained.

Results:

High CP and HUB males, aged 6, were 4 times more likely than males with lower ratings to acquire convictions for violent crimes and 5 times more likely to acquire convictions for nonviolent crimes by age 24. High HUB and CP females, aged 6, were 5 times more likely than females with lower ratings to have a conviction for a nonviolent offence by age 24. Among males, both aged 6 and 10, high HUB without CP were associated with elevations at risk of convictions for violent and nonviolent crimes, while among females the elevations at risk were limited to convictions for nonviolent crimes. Different types of aggressive behaviour mediated associations of high HUB and CP with subsequent criminal convictions, but not the association of HUB without CP and crime.

Conclusions:

Teachers in elementary schools rated behaviours that, from age 6 onward, significantly predicted criminal convictions into early adulthood.
Maternal Pre-Pregnancy Body Mass Index and Internalizing and Externalizing Problems in Offspring
Authors: Van Lieshout Ryan J , Robinson Monique , Boyle Michael H
Published: January 2017

Objective:

To determine if maternal pre-pregnancy body mass index (BMI) is associated with increased levels of internalizing and externalizing symptomatology in offspring throughout childhood and adolescence, and if these links persist after adjusting for the confounders of these associations.

Method:

We examined links between maternal pre-pregnancy BMI and internalizing and externalizing symptoms in the offspring of 2785 members of the Western Australian Pregnancy (Raine) Cohort. Mothers rated these problems using the Child Behavior Checklist when their children were 5, 8, 10, 14, and 17 years of age. Growth curves were generated using multilevel linear regression to examine associations and to determine if changes in levels of these symptoms varied overtime by maternal BMI.

Results:

Increased maternal pre-pregnancy BMI was associated with stably elevated levels of externalizing problems, and exhibited a statistically significant interaction with internalizing problems over time, indicating that youth born to mothers with higher maternal pre-pregnancy BMIs had less rapid decreases in internalizing scores as they got older. Significant positive associations between maternal pre-pregnancy BMI and elevated levels of internalizing problems emerged at age 8 and increased through 17. These findings persisted despite adjustment for confounders.

Conclusions:

Exposure to elevated maternal pre-pregnancy BMI is associated with increased levels of internalizing and externalizing problems throughout childhood and adolescence. Further work is required to establish if these associations are causal. If elevated maternal pre-pregnancy BMI is causally linked to psychopathology in offspring, it could provide a potentially realizable target for the prevention of mental health problems in youth.
Developing an Evaluation Framework for Consumer-Centred Collaborative Care of Depression Using Input from Stakeholders
Authors: McCusker Jane , Yaffe Mark , Sussman Tamara , Kates Nick , Mulvale Gillian , Jayabarathan Ajantha , Law Susan , Haggerty Jeannie
Published: January 2017

Objective:

To develop a framework for research and evaluation of collaborative mental health care for depression, which includes attributes or domains of care that are important to consumers.

Methods:

A literature review on collaborative mental health care for depression was completed and used to guide discussion at an interactive workshop with pan-Canadian participants comprising people treated for depression with collaborative mental health care, as well as their family members; primary care and mental health practitioners; decision makers; and researchers. Thematic analysis of qualitative data from the workshop identified key attributes of collaborative care that are important to consumers and family members, as well as factors that may contribute to improved consumer experiences.

Results:

The workshop identified an overarching theme of partnership between consumers and practitioners involved in collaborative care. Eight attributes of collaborative care were considered to be essential or very important to consumers and family members: respectfulness; involvement of consumers in treatment decisions; accessibility; provision of information; coordination; whole-person care; responsiveness to changing needs; and comprehensiveness. Three inter-related groups of factors may affect the consumer experience of collaborative care, namely, organizational aspects of care; consumer characteristics and personal resources; and community resources.

Conclusion:

A preliminary evaluation framework was developed and is presented here to guide further evaluation and research on consumer-centred collaborative mental health care for depression.
Current Trends in the Empirical Study of Cognitive Remediation for Schizophrenia
Authors: Saperstein Alice M , Kurtz Matthew M
Published: January 2017

Cognitive remediation (CR) for schizophrenia is a learning-based behavioural skills training intervention designed to enhance neuro and (or) social cognitive skills, with the ultimate goal of generalization to improve psychosocial outcomes. This review summarizes conceptual approaches to CR for schizophrenia and the evidence for efficacy in clinical research settings. Four issues are at the forefront of ongoing research: the identification of techniques that produce the largest cognitive change, delineation of techniques that enhance transfer of cognitive skills to functional skills, the identification of CR methods that can be personalized to meet the specific cognitive and functional needs of each individual, and, all the while, ensuring that when CR methods are developed in a research setting, they remain scalable for delivery in the larger clinical community. In response to these issues, 3 prominent research trends have emerged: the rise of a new generation of computerized restorative cognitive training, the integration of CR with skills training to promote generalization, and the application of techniques to enhance motivation and learning during CR. As data on the neural basis of learning in people with schizophrenia become available, new technologies that harness the ability of the brain to make sustainable, functional changes may be integrated within a therapeutic context that promotes a personalized approach to learning. The development of transportable and scalable methods of CR that maximize the ability of people with schizophrenia to improve cognition will help them achieve personal goals for recovery.
Profiles and Mental Health Correlates of Alcohol and Illicit Drug Use in the Canadian Population: An Exploration of the J-Curve Hypothesis
Authors: Dumais Alexandre , De Benedictis Luigi , Joyal Christian , Allaire Jean-François , Lesage Alain , Côté Gilles
Published: January 2017

Objective:

Alcohol and (or) illicit drug use (AIDU) problems are associated with mental health difficulties, but low-to-moderate alcohol consumption may have mental health benefits, compared with abstinence. Our study aimed to explore the hypothesis of a nonlinear, or J-curve, relation between AIDU profiles and psychological distress, psychiatric disorders, and mental health service use in the general Canadian population.

Methods:

Data were collected from a representative sample of the Canadian population ( n = 36 984). Multiple correspondence analyses and cluster analyses were used to extract AIDU profiles. Sociodemographics, psychological distress, psychiatric disorders, and mental health service use were assessed and compared between profiles.

Results:

Seven AIDU profiles emerged, including 3 involving risky or problematic AIDU that correlate with major affective disorders, anxiety disorders, suicidal behaviours, and higher levels of psychological distress. No J-curve relation was found for psychiatric disorders and mental health service use. The lifetime-abstainer profile correlates with the lowest rates of psychiatric disorders and mental health service use. Lifetime abstainers are also more often female, immigrant, and unemployed. Compared with other profiles, spirituality is more important in their life.

Conclusions:

The hypothesis of a nonlinear relation between psychiatric disorders and AIDU was not supported. Lifetime AIDU abstainers have specific sociodemographic and cultural background characteristics in Canada.
Associations of School Connectedness with Adolescent Suicidality: Gender Differences and the Role of Risk of Depression
Authors: Langille Donald B , Asbridge Mark , Cragg Amber , Rasic Daniel
Published: January 2017

Objective:

Previous studies have not examined associations of school connectedness with adolescent suicidal behaviours stratified by gender, while including a measure of depression. We analyzed survey data to determine whether there are independent protective associations of higher school connectedness with suicidal behaviours in Canadian adolescents, while controlling for potential confounders, including risk of depression; and whether such associations differ by gender.

Method:

Using data from a stratified cluster sample of randomly selected classes of students in schools in 3 of Canada's Atlantic provinces, we used multiple logistic regression to examine whether associations of risk of depression, measured using the 12-item Center for Epidemiologic Studies-Depression scale, lessened protective associations of higher school connectedness with suicidal behaviours in grades 10 and 12 students, while stratifying by gender.

Results:

After adjusting for risk of depression, higher school connectedness was independently associated with decreased suicidal ideation in both genders and with suicidal attempt in females. In males, higher connectedness was no longer protective for suicide attempt when risk of depression was included in the model.

Conclusions:

School connectedness, which is felt to have positive influences on many types of adolescent behaviour, appears to also be both directly and indirectly protective for suicidality. These effects may occur through different pathways in females and males. Given the protection it offers both genders, including those at risk and not at risk of depression, increasing school connectedness should be considered as a universal adolescent mental health strategy. Studies that examine school connectedness should include analyses that examine potential differences between males and females.
Are There Special Considerations in the Prescription of Serotonin Reuptake Inhibitors for Women?
Authors: Stewart Donna E
Published: January 2017

Objective:

To present information on special considerations in the prescription of selective serotonin reuptake inhibitor (SSRI) antidepressant drugs to women.

Methods:

Literature review and analysis of adverse drug reactions to SSRIs reported to Health Canada between 1986 and 1996.

Results:

SSRIs are prescribed twice as often to women as to men. Special considerations are required of the social context in which the illness occurs, biological aspects of the illness, the effects of endogenous and exogenous sex steroids, menstruation, pregnancy, lactation, and menopause. Serious or fatal side effects are most commonly drug–drug or drug–alcohol interactions, and endocrine side effects are more common in women than men.

Conclusions:

Although SSRIs are relatively effective and safe when prescribed to women, further research is required for long-term follow-up of children exposed to these drugs in utero or during lactation. Continued study of the effects of sex steroids on pharmacodynamics and kinetics and ongoing monitoring and reporting of side effects in women is required. Special consideration of endocrine side effects and drug–drug and drug–alcohol interactions are needed for optimal safety.