bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Health Care Services for Psychological Distress by Immigrants in an Urban Multicultural Milieu
Authors: Kirmayer Laurence J , Weinfeld Morton , Burgos Giovani , du Fort Guillaume Galbaud , Lasry Jean-Claude , Young Allan
Published: January 2017

Objective:

Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system.

Methods:

A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean ( n = 264), Vietnam ( n = 234), or the Philippines ( n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events.

Results:

Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help.

Conclusion:

Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.
Problematic Physicians: A Comparison of Personality Profiles by Offence Type
Authors: Roback Howard B , Strassberg Donald , Iannelli Richard J , Finlayson AJ Reid , Blanco Mark , Neufeld Ron
Published: January 2017

Objective:

This exploratory study compares objective personality test findings among physicians exhibiting different forms of misconduct. The importance of delineating distinctive personality characteristics by type of offence is that such characterizations can direct therapy and prognosis for remediation.

Method:

Eighty-eight physicians referred to the Vanderbilt Comprehensive Assessment Program for Professionals (V-CAP) completed the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, or both, as part of their evaluation. On the basis of referral information, physicians were partitioned into 3 groups of offenders: “sexual boundary violators,” “behaviourally disruptive,” and “other misconduct.”

Results:

On both personality measures, the sexual boundary violators generated the greatest percentage of profiles indicative of character pathology.

Conclusions:

Although all 3 groups exhibited unacceptable behaviours, the pervasive personality features of the sexual boundary violators are associated with greater therapeutic challenge, and these individuals likely pose the greater risk of reoffending.
The Montreal Cognitive Assessment: Validity and Utility in a Memory Clinic Setting
Authors: Smith Tasha , Gildeh Nadia , Holmes Clive
Published: January 2017

Objective:

To prospectively validate the Montreal Cognitive Assessment (MoCA) in a UK memory clinic.

Method:

We administered the MoCA and Mini-Mental State Examination (MMSE) to 32 subjects fulfilling diagnostic criteria for dementia, to 23 subjects fulfilling diagnostic criteria for mild cognitive impairment (MCI), and to 12 memory clinic comparison subjects, at baseline and then at 6-month follow-up. Clinical diagnoses for dementia and MCI were made according to ICD-10 and Petersen criteria. The sensitivity and specificity of both measures were assessed for detection of MCI and dementia.

Results:

With a cut-off score of 26, the MMSE had a sensitivity of 17% to detect subjects with MCI, whereas the MoCA detected 83%. The MMSE had a sensitivity of 25% to detect subjects with dementia, whereas the MoCA detected 94%. Specificity for the MMSE was 100%, and specificity for the MoCA was 50%. Of subjects with MCI, 35% developed dementia within 6 months, and all scored less than 26 points on the MoCA at baseline.

Conclusions:

The MoCA is a useful brief screening tool for the detection of mild dementia or MCI in subjects scoring over 25 points on the MMSE. In patients already diagnosed with MCI, the MoCA helps identify those at risk of developing dementia at 6-month follow-up.
Community Treatment Orders in Toronto: The Emerging Data
Authors: Hunt Alison M , da Silva Angela , Lurie Steve , Goldbloom David S
Published: January 2017

Objective:

Over a 4-year period in Toronto, this study aimed to compare individuals on a community treatment order (CTO) with individuals not on a CTO in terms of sociodemographic and clinical variables, hospital use, and continued engagement with health services on exit from the case management program. Hospital stay reductions from preadmission into the program to various postadmission periods were compared across the 2 groups.

Methods:

Descriptive statistics and tests of statistical significance (chi-square and t test) were run on regularly collected administrative data for both groups.

Results:

Categorical data analysis indicated the 2 groups were statistically similar on a range of sociodemographic and clinical variables. Although both groups displayed reductions in hospital use, the CTO group displayed a significantly higher reduction in cumulative days in hospital per hospital admission within both the first and second 6-month period postadmission. This same group also had significantly greater reduction in hospital admissions during the second 6-month period postadmission. The CTO group also had a significantly higher portion of individuals exiting the program within these first two 6-month periods; as well, they were less likely to exit with support such as case management or assertive community treatment and more likely to continue with ongoing medical supervision than the comparison group.

Conclusion:

Although we were unable to rule out regression to the mean for hospitalization reductions, the Toronto experience has shown that CTOs are helpful in assisting individuals who historically refused services to remain engaged with treatment and support services. The study also calls for broadening operational measures of outcomes for CTO studies.
Epidemiology of Youth Gambling Problems in Canada: A National Prevalence Study
Authors: Huang Jiun-Hau , Boyer Richard
Published: January 2017

Objectives:

To describe the epidemiology of gambling problems among youth aged 15 to 24 years in Canada and to examine whether these gambling prevalence patterns differ by sex and (or) by geographic region.

Method:

We used data from The Canadian Community Health Survey: Mental Health and Well-Being. Gambling problems were determined according to the Canadian Problem Gambling Index. All prevalence estimates used appropriate sampling weights and bootstrap variance estimation procedures developed by Statistics Canada. Multivariate logistic regression modelling was also employed to supplement the above prevalence comparisons by age, sex, and region.

Results:

Among Canadian youth aged 15 to 24 years ( n = 5666), 61.35% gambled in the past 12 months and the national prevalence of moderate-risk or problem gambling was 2.22% (3.30% in male respondents and 1.10% in female respondents). Male respondents had significantly higher prevalence of gambling problems than female respondents. Regional prevalence estimates of youth moderate-risk or problem gambling were 1.37% in British Columbia, 2.17% in the Prairie provinces, 2.75% in Ontario, 2.12% in Quebec, and 1.71% in the Atlantic provinces.

Conclusions:

Youth, particularly young men, are at greater risk for gambling problems than adults. More prevention and research efforts are also needed to address the observed sex differences and interregional variability in the prevalence of gambling problems among youth. The national prevalence estimates from this study provide important baseline data against which future cohorts of Canadians can be monitored and measured.
Anxiety in a Socially High-Risk Sample of Pregnant Women in Canada
Authors: Bowen Angela , Bowen Rudy , Maslany George , Muhajarine Nazeem
Published: January 2017

Objective:

To determine if an anxiety dimension in the Edinburgh Postnatal Depression Scale (EPDS) could be identified in a sample of pregnant women with high social risk factors.

Method:

Four hundred women attending prenatal outreach programs, most of whom were single, low-income, and Aboriginal, participated in a study of feelings in pregnancy. The primary outcome measure was the EPDS. Data were also collected on sociodemographic, obstetrical–biological, psychological, and behavioural variables.

Results:

Factor analysis of the EPDS revealed 3 factors: anxiety, depression, and self-harm. The anxiety factor accounted for the greatest variance in the overall EPDS score. Comparisons of different groups of women revealed significantly more anxiety in the women aged under 19 years, compared with those over 25 years ( P < 0.01). Linear regression analysis showed anxiety was associated with age, stressors (that is, pregnancy, health of the baby, birth of the baby, money, and other), history of depression, and fluctuating moods.

Conclusions:

Anxiety symptoms were predominant in the emotional distress identified by the EPDS in this sample of socially high-risk pregnant women. Younger women appear to experience the highest levels of anxiety. Anxiety in pregnancy in socially high-risk women should not be normalized.

Objectif:

Déterminer si la dimension de l'anxiété à l'échelle de dépression postnatale d'Édimbourg (EPDS) pouvait être identifiée dans un échantillon de femmes enceintes ayant des facteurs de risque sociaux très élevés.

Méthode:

Quatre cents femmes assistant à des programmes prénataux de service d'approche, dont la plupart étaient célibataires, à faible revenu, et autochtones ont participé à une étude de sentiments durant la grossesse. La principale mesure des résultats était l'EPDS. Les données ont été recueillies sur des variables sociodémographiques, obstétrico–biologiques, psychologiques, et comportementales.

Résultats:

L'analyse factorielle de l'EPDS a révélé 3 facteurs: l'anxiété, la dépression, et l'automutilation. Le facteur anxiété représentait la plus grande variance dans le score global à l'EPDS. Les comparaisons de différents groupes de femmes ont révélé significativement plus d'anxiété chez les femmes de moins de 19 ans, comparativement à celles de plus de 25 ans ( P < 0,01). L'analyse de régression linéaire indiquait que l'anxiété était associée à l'âge, aux stresseurs (c'est-à-dire, la grossesse, la santé du bébé, la naissance du bébé, l'argent, et d'autres), aux antécédents de dépression, et aux humeurs changeantes.

Conclusions:

Les symptômes d'anxiété étaient prédominants dans la détresse émotionnelle identifiée par l'EPDS dans cet échantillon de femmes enceintes socialement à risque élevé. L'anxiété durant la grossesse chez les femmes socialement à risque élevé ne devrait pas être normalisée.
What Stress Does to Your Brain: A Review of Neuroimaging Studies
Authors: Dedovic Katarina , D'Aguiar Catherine , Pruessner Jens C
Published: January 2017

Objective:

Recent neuroimaging studies aimed at investigating effects of psychological stress on the neural activity have used a range of experimental paradigms to elicit an acute stress response. The goal of this review is to, first, summarize results from these studies from a perspective of task design and, second, assess the appropriateness of the different stress tasks used.

Method:

We completed a PubMed search on recent articles that have examined the effects of psychological stress on neural processes in a neuroimaging environment. Selected articles were arranged according to the stress task used in the following categories: script-driven stress stimuli, Stroop colour-word interference task, speech in front of an audience, serial subtraction, and Montreal Imaging Stress Task (MIST).

Results:

Only studies using serial subtraction or the MIST were able to induce a significant cortisol stress response in their participants. Most consistent findings include decreased activity in orbitofrontal regions in response to stress. Additional findings of note are increases in activity in the frontal lobes, particularly the anterior cingulate cortex, as well as deactivation of the limbic system, particularly the hippocampus.

Conclusion:

Research to date is beginning to outline the involvement of prefrontal and limbic regions in perception and modulation of psychological stress. However, additional research is needed in designing a neuroimaging stress task that will yield a significant cortisol stress response consistently, across populations and laboratories.
Imaging Stress Effects on Memory: A Review of Neuroimaging Studies
Authors: van Stegeren Anda H
Published: January 2017

Objective:

To review and give an overview of neuroimaging studies that look at the role of stress (hormones) on memory.

Method:

An overview will be given of imaging studies that looked at the role of stress (hormones) on memory. Stress is here defined as the acute provocation of the sympathetic adrenal medullar system and the hypothalamic–pituitary–adrenal axis in experimental designs. Stress hormone levels can be raised endogenously in response to stimulus material (for example, pictures and films) or social evaluative threat situations (stress tasks). Other studies use the exogenous application of drugs to enhance or decrease stress hormone levels. Finally, we review studies on chronic stress and memory.

Results:

Stress or emotional arousal, leading to increased noradrenaline or cortisol levels, led to better memory performance when it is applied during perception or encoding. Brain regions involved in this process were medial temporal lobe regions such as amygdala and hippocampus, and several parts of the prefrontal cortex (PFC). High stress levels accompanied by high cortisol levels during retrieval led to impaired memory performance. Sex effects on memory as well as lateralization effects on brain activation were found.

Conclusion:

High stress levels during encoding and consolidation of emotional material involve increased amygdala and hippocampus activation. The role of the anterior cingulate cortex and other parts of the PFC during perception and encoding of arousing material appears to be a modulating one. However, additional research is needed to shed more light on the nature of the brain changes during stress, especially during retrieval.
Cigarette Smoking, Nicotine Dependence, and Motivation for Smoking Cessation in Psychiatric Inpatients
Authors: Solty Heidi , Crockford David , White William D , Currie Shawn
Published: January 2017

Objective:

Cigarette smoking is the leading preventable cause of death and disease in Canada, and is disproportionately more frequent among psychiatric patients. Smoking cessation interventions can be successfully implemented with psychiatric patients, yet no Canadian studies have evaluated smoking prevalence, nicotine dependence, and motivation for smoking cessation in psychiatric inpatients. Our study did so to help plan appropriate interventions for these patients.

Method:

All inpatients aged 18 years or older admitted to acute-care psychiatry units at the Foothills Medical Centre in Calgary, Alberta, during a 6-month period completed a survey involving questions from the Canadian Tobacco Use Monitoring Survey, the Fagerstrom Test for Nicotine Dependence (FTND), the Readiness to Quit Ladder, and the Decisional Balance for Cigarette Smoking. Responses were analyzed for correlation with discharge diagnoses, age, and sex.

Results:

Among the total inpatients ( n = 342), 211 (62%) completed the survey. Among those, 55% were current cigarette smokers and 17.5% were former smokers. Nicotine dependence (FTND ≥ 6) was reported in 45.2% of smokers. Smoking prevalence and nicotine dependence severity was greatest in the substance use disorders (SUD) and psychotic disorders groups. Current smokers endorsed more negative than positive attributes of smoking. Regarding smoking cessation, 51% of patients were precontemplative, 12.7% contemplative, and 36.2% preparatory or action-oriented, despite few receiving advice to quit.

Conclusions:

Cigarette smoking and nicotine dependence are highly prevalent in psychiatric inpatients. However, self-reported motivation for smoking cessation is noteworthy, emphasizing that cessation advice and appropriate follow-up care should be provided to psychiatric inpatients who smoke.
A Comparison of Ziprasidone and Risperidone in the Long-Term Treatment of Schizophrenia: A 44-Week, Double-Blind, Continuation Study
Authors: Addington Donald E , Labelle Alain , Kulkarni Jayashri , Johnson Gordon , Loebel Antony , Mandel Francine S
Published: January 2017

Objective:

This randomized, double-blind, multicentre extension study compared the efficacy, tolerability, and safety of ziprasidone and risperidone for schizophrenia or schizoaffective disorder.

Methods:

Patients who had responded to treatment for an acute exacerbation of illness in an 8–week study received ziprasidone, 80 to 160 mg/day ( n = 62), or risperidone, 6 to 10 mg/day ( n = 77), for up to 44 additional weeks. Primary efficacy variables included changes in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impression Severity (CGI-S) score. Tolerability and safety assessments included movement disorders, adverse events, study discontinuation rates, and weight and metabolic parameters.

Results:

Both the ziprasidone and risperidone groups showed statistical improvement from baseline in PANSS and CGI-S scores at study end point with no significant differences between treatment groups. More risperidone-treated patients completed the study (41.6%) than ziprasidone-treated patients (33.9%), but the difference was not statistically significant. Ziprasidone-treated patients who completed the study showed greater improvement in depressive symptoms assessed by Montgomery and Asberg Depression Rating Scale than risperidone-treated patients ( P < 0.05). Ziprasidone was associated with a more favourable effect on extrapyramidal symptom (EPS) measures and prolactin as well as less weight gain than risperidone. Median dosages were ziprasidone 120 mg/day and risperidone 8 mg/day.

Conclusions:

Ziprasidone and risperidone demonstrated similar efficacy during long-term treatment of patients with schizophrenia or schizoaffective disorder. While more subjects on risperidone completed the extension study, ziprasidone was associated with fewer adverse effects on weight, EPS measures, and prolactin than risperidone.
Immediate and Sustained Effects of Parenting on Physical Aggression in Canadian Children Aged 6 Years and Younger
Authors: Benzies Karen , Keown Leslie-Anne , Magill-Evans Joyce
Published: January 2017

Objective:

To determine whether the effects of factors associated with the development of childhood (aged 6 years or younger) physical aggression were immediate (cross-sectional), sustained (longitudinal), or both.

Methods:

A longitudinal subsample ( n = 975) of children born between December 1994 and April 1995 was drawn from the Canadian National Longitudinal Survey of Children and Youth and followed from birth to 6 years of age. Using random- and fixed-effects logistic panel regression models, child (sex and preterm birth), maternal (education, employment, and positive or hostile/ineffective parenting), and family (lone-parent, older and younger siblings, and income) indicators were regressed on childhood physical aggression.

Results:

Hostile/ineffective parenting contributed significantly to explaining the variance in aggression. At each measurement time point (birth, 2, 4, and 6 years of age), a change in hostile/ineffective parenting had an effect on aggression, and this effect carried forward across time up to 6 years. Being a boy, having a mother with less education, and living in a lone-parent family with siblings also contributed significantly to aggression. Preterm birth, maternal employment, depressive symptoms, positive interaction, and income failed to contribute significantly to aggression.

Conclusions:

These results support the hypothesis that hostile/ineffective parenting has an immediate effect on aggression. Contrary to predictions that it would have an immediate effect only at the time it was occurring, hostile/ineffective parenting had a sustained effect on aggression that carried forward in time up to 6 years of age. The results suggest that hostile/ineffective parenting has an effect on aggression prior to any evidence of aggressive behaviour in the child.
A Case-Control Study of Bipolar Depression, Compared with Unipolar Depression, in a Regional Hospital in Hong Kong
Authors: Sze-Man Wong , Lai-Wah Dunn , Wai-Nang Tang , Wah-Fat Chan , Shiu-Yin Chong
Published: January 2017

Objective:

To determine the characteristics of diagnostic conversion from unipolar depression to bipolar depression in psychiatric outpatients, and to compare the profiles of the 2 groups of patients.

Method:

This is a case–control study in which outpatients newly diagnosed with unipolar depression were reviewed. Outpatients who had polarity conversion to bipolar depression were recruited as subjects and control subjects were matched. The diagnostic validity was enhanced by clinical interview, review of case records by an independent specialist psychiatrist, and administration of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders. Multivariate conditional logistic regression was carried out to identify the predictors of bipolar switch.

Results:

Eighty-eight subjects among those who maintained regular outpatient clinic follow-up ( n = 823) showed bipolar switch during the period under study. The incidence of polarity conversion was 10.7%. Bipolar switch was associated with family history of bipolar affective disorder, use of 3 or more different types of antidepressants in the first 5 years after presentation, an earlier age at presentation of depressive symptoms of less than 37 years, and males.

Conclusions:

Change in diagnostic polarity is not uncommon in Chinese psychiatric outpatients initially presenting with unipolar depression. They share some common risk factors as identified in Western studies. These can be helpful to clinicians as guidance for identification of patients with depression at high risk for a bipolar course.
Marital Status, Partner Satisfaction, and Depressive Symptoms in Older Men and Women
Authors: St John Philip Donald , Montgomery Patrick Roy
Published: January 2017

Objectives:

To determine if marital status is associated with depressive symptoms in men and women, and to determine if partner satisfaction is associated with depressive symptoms.

Methods:

Community-dwelling adults ( n = 1751) aged 65 years and older were sampled from a representative population-based registry. Age, sex, education, and marital status were self-reported. Satisfaction with living partner was assessed with an item from the terrible-delightful scale. The Center for Epidemiologic Studies—Depression was used to assess depressive symptoms, with a score of 15 or more indicating depressive symptoms.

Results:

Only 3% of the sample were dissatisfied with their living partner, and those who were dissatisfied with their living partner had higher levels of depressive symptoms. Proportions of men with depressive symptoms were: 20.6% for never married; 19.2% for separated or divorced; 17.3% for widowed; 7.3% for married (satisfied); and 38.1% for married (dissatisfied) (χ2 = 32.98, df = 4, P < 0.001). In women, the results were different: 11.8% for never married; 23.1% for separated or divorced; 15.4% for widowed; 14.4% for married (satisfied); and 41.9% for married (dissatisfied) (χ2 = 18.33, df = 4, P < 0.001). In logistic regression models, a significant interaction term was seen for Marital status x Sex. In stratified models, adjusting for age and education, an effect of marital status was seen in men, but not in women.

Conclusions:

The effects of marriage on depressive symptoms in men and women may be different, with lower levels of depressive symptoms in married men, compared with unmarried men, but similar rates in married women, compared with unmarried women. Dissatisfaction with their partner was uncommon, but highly associated with depressive symptoms.
Fetal Sex, Social Support, and Postpartum Depression
Authors: Xie Ri-Hua , He Guoping , Koszycki Diana , Walker Mark , Wen Shi Wu
Published: January 2017

Objective:

To examine the impact of prenatal and postnatal social support on the association between fetal sex and postpartum depression (PPD).

Method:

We conducted a prospective cohort study in Changsha, China, between February and September 2007. We first compared the sociodemographic and obstetric characteristics, and the prenatal and postnatal social support between women who gave birth to a female infant and those who gave birth to a male infant. We then examined the association between fetal sex and PPD by following logistic regression models: fetal sex as the independent variable; with adjustment for sociodemographic and obstetric factors; with adjustment for sociodemographic, obstetric factors, and prenatal social support; and with adjustment for sociodemographic, obstetric factors, and postnatal social support.

Results:

Postnatal social support scores were much lower in women who gave birth to a female infant than in those who gave birth to a male infant. The odds ratio of PPD for women who gave birth to a female infant, as compared with those who gave birth to a male infant, was 3.67 (95% CI 2.31 to 5.84). The increased risk of PPD for women who gave birth to a female infant remained after adjustment for sociodemographic and obstetric factors and prenatal social support, but disappeared after adjustment for postnatal social support score.

Conclusion:

We conclude that increased risk of PPD in Chinese women who give birth to a female infant is caused by lack of social support after childbirth.
Negative Attitudes toward Help Seeking for Mental Illness in 2 Population—Based Surveys from the United States and Canada
Authors: Jagdeo Amit , Cox Brian J , Stein Murray B , Sareen Jitender
Published: January 2017

Objectives:

To determine the prevalence and sociodemographic correlates of negative attitudes toward help seeking for mental illness among the general population in the United States and Ontario.

Methods:

Two contemporaneous population-based surveys (aged 15 to 54 years) were analyzed: the US National Comorbidity Survey (NCS) ( n = 5877) and the Ontario Health Survey (OHS) ( n = 6902). Multiple logistic regression analyses were used to examine the correlates of a derived negative attitudes composite variable obtained from questions assessing probability, comfort, and embarrassment related to help seeking for mental illness.

Results:

Negative attitudes toward help seeking for mental illness were prevalent in both countries. Fifteen percent of OHS and 20% of NCS respondents stated they probably or definitely would not seek treatment if they had serious emotional problems. Almost one-half of recipients in both surveys stated they would be embarrassed if their friends knew about their use of mental health services. Negative attitudes toward help seeking were highest among sociœconomically challenged young, single, lesser-educated men in Ontario and the United States. In both countries, substance abuse or dependence and antisocial personality disorder were associated with greater negative attitudes, as was not having sought treatment in the past.

Conclusions:

Negative attitudes toward mental health service use are prevalent in Ontario and the United States. They are most common in young adults, especially those with lower education and sociœconomic resources, and those with substance abuse or dependence problems. This information can be used to target educational efforts aimed at improving willingness to seek care for mental health problems.
Recurrence Rates in Ontario Physicians Monitored for Major Depression and Bipolar Disorder
Authors: Albuquerque Joy , Deshauer Dorian , Fergusson Dean , Doucette Steve , MacWilliam Cynthia , Kaufmann I Michael
Published: January 2017

Objective:

Physicians with recurrent conditions that may affect job performance are sometimes referred for monitoring to help ensure compliance with treatment, ongoing remission of illness, and patient safety. Little is known about recurrence rates among doctors monitored for mood disorders. Our primary objective was to describe recurrence rates among Ontario physicians monitored for recurrent unipolar depression and bipolar disorder (BD). Our secondary objective was to explore predictors of recurrence.

Method:

We used a retrospective cohort design to describe the time to recurrence, defined as either stopping work owing to symptoms or any re-emergence of symptoms meeting a pre-established clinical threshold. Our exploratory analysis of recurrence predictors included age, sex, psychiatric diagnosis, psychiatric comorbidity, medical comorbidity, number of past episodes, past hospitalizations, and family history of psychiatric disorder.

Results:

During a median observation of 24 months, 36% (18 of 50) of physicians stopped work owing to recurrence of symptoms, with the median time to stopping work being 11 months. As well, 52% (26 of 50) had a re-emergence of clinical symptoms, with the median time to any level of symptom re-emergence being 13 months. Physicians with psychiatric comorbidity stopped work sooner (hazard ratio [HR] 3.53; 95% CI 1.24 to 10.03, P = 0.01) and had more rapid symptom re-emergence (HR 2.96; 95% CI 1.34 to 6.52, P = 0.004) than those without comorbidity. The most common psychiatric comorbidity was a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, anxiety disorder.

Conclusion:

Recurrence rates are high among Ontario physicians referred for formal monitoring of recurrent unipolar depression and BD, and are markedly hastened by the presence of psychiatric comorbidity.
Regional and Individual Influences on Use of Mental Health Services in Canada
Authors: Diaz-Granados Natalia , Georgiades Katholiki , Boyle Michael H
Published: January 2017

Objective:

Knowledge is lacking on the extent to which area-level characteristics contribute to variations observed in the use of mental health services. This study examined the influence of area- and individual-level characteristics on the use of mental health services.

Methods:

Data from a nationally representative, population-based, cross-sectional survey, the Canadian Community Health Survey—Mental Health and Well-Being, consisting of adults aged 15 years or older ( n = 36 984), were linked to Canadian 2001 Census profiles according to health region boundaries ( n = 97). Multilevel multivariable logistic regression modelling was used to: estimate variation in 12-month self-reported use of health services for mental health reasons between health regions; and, estimate the effects of individual- and area-level need, health resources, and sociodemographic factors on self-reported 12-month use of medical services for mental health reasons.

Results:

There was a 2.1% and 3.5% regional variation for general practitioner-family physician (GP-FP) and psychiatric health service use during 12 months, respectively. Most of the regional variation observed was explained by number of physicians per health region and regional and individual need factors. Adults who were middle-aged, had a post-secondary education, low-income, were separated, widowed, or divorced, and Canadian-born were significantly more likely to use GP-FP and psychiatry services for mental health reasons at the individual level, even after adjusting for area- and individual-level need factors.

Conclusions:

Most area-level variation was explained by the availability of health region resources and individual-level need factors. After accounting for need, numerous sociodemographic factors retained their association with use of mental health services. Additional efforts are needed at the area and individual level to reduce inequities through appropriate targeted care.
The Relation between Types and Frequency of Gambling Activities and Problem Gambling among Women in Canada
Authors: Afifi Tracie O , Cox Brian J , Martens Patricia J , Sareen Jitender , Enns Murray W
Published: January 2017

Objective:

Canada experienced large-scale growth of the gambling industry during the 1990s. Clinical data have indicated that substantial proportions of people seeking help for gambling problems in Canada are women. A population health model was used to understand the relation between types and frequency of gambling activities and problem gambling among women in Canada.

Method:

Data used for the analysis were from the nationally representative Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2; n = 10 056, women aged 15 years and older; data collected in 2002).

Results:

The types of gambling associated with the highest odds of problem gambling among women in Canada were video lottery terminals (VLTs) outside the casino (OR 2.37 to 53.73; P < 0.01), VLTs inside the casino (OR 2.84 to 36.19; P < 0.001), and other casino games (OR 4.01 to 24.15; P < 0.001).

Conclusions:

These observations further our understanding of problem gambling among women in Canada and confirm that problem gambling among women is an important public health concern. Frequent VLT gambling, both outside and inside casinos, and other casino games are associated with the largest odds of problem gambling, which highlights an area of gambling in Canada that needs to be reassessed if problem gambling is to be prevented or reduced. Evidence-based research is necessary to inform healthy public policies on gambling in Canada. Findings from the current research have important research and policy implications.
Does Clozapine Promote Employability and Reduce Offending among Mentally Disordered Offenders?
Authors: Balbuena Lloyd , Mela Mansfield , Wong Stephen , Gu Deqiang , Adelugba Olajide , Tempier Raymond
Published: January 2017

Objective:

To compare employment pay, count of infractions, and clinical symptoms in psychiatric inmates treated with clozapine or other antipsychotics after 6 months of treatment.

Methods:

Clinical charts and institutional offence records of psychiatric inmates ( n = 98), comprised of those on clozapine ( n = 65) and on other antipsychotics ( n = 33), were reviewed at baseline and after 6 months of treatment. The outcome measures used were Brief Psychiatric Rating Scale (BPRS) scores, employment pay, medication compliance, and the frequency of institutional offences. A binary logistic regression model was used to analyze a categorical change in pay variable, while a negative binomial model was used to analyze the frequency of infractions.

Results:

Treatment with clozapine was associated with greater odds of a pay increase (OR = 3.13; 95% CI 1.3 to 7.53, P= 0.01). However, patients on other antipsychotics had a more favourable improvement in BPRS ( F= 5.44, df = 1,57, P= 0.02). Patients on other antipsychotics also had a higher count of posttreatment offences (Incidence Rate Ratio = 2.22; 95% CI 1.11 to 4.41, P = 0.02).

Conclusion:

Clozapine probably has a favourable effect on inmate behaviour and institutional adjustment. This effect can last up to 36 months after the initial dose.
Psychometric Properties of a Pictorial Instrument for Assessing Psychopathology in Youth Aged 12 to 15 Years: The Dominic Interactive for Adolescents
Authors: Bergeron Lise , Smolla Nicole , Valla Jean-Pierre , St-Georges Marie , Berthiaume Claude , Piché Geneviève , Barbe Catherine
Published: January 2017

Objectives:

Over the last 15 years, adequate psychometric properties of the different versions of the Dominic led to the development of the Dominic Interactive for Adolescents (DIA). The DIA is a Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision-based self-administered computerized pictorial instrument for assessing the most frequent mental disorders in adolescents aged 12 to 15 years. Our study aims to verify the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of this instrument.

Method:

The total sample included 607 adolescents living in the Montreal urban area recruited from the community (465 French-speaking) and the clinical population (142 French-speaking). Internal consistency was evaluated by Cronbach's alpha coefficients and test-retest estimate of reliability by the kappas and intraclass correlation coefficients (ICCs). Two criteria are indicative of criterion-related validity of the DIA: clinical judgment on the presence or absence of symptoms (scored independently by 3 judges) and the adolescents' referrals to outpatient psychiatric clinics.

Results:

For most symptom scales of the DIA, Cronbach's alpha coefficients varied from 0.69 to 0.89, test-retest kappas were 0.50 or greater, and ICCs ranged from 0.78 to 0.87. The criterion-related validity was demonstrated for symptoms, symptom scales, and the categories based on the symptom scale cut-off points.

Conclusion:

As no informant can be considered the criterion standard of psychopathology, the interview with adolescents regarding their own symptoms is necessary. Findings from our study reasonably support adequate psychometric properties of the DIA in adolescents aged 12 to 15 years.
Inequalities in Suicide Rates in the European Union's Elderly: Trends and Impact of Macro-Socioeconomic Factors between 1980 and 2006
Authors: Innamorati Marco , Tamburello Antonino , Lester David , Amore Mario , Girardi Paolo , Tatarelli Roberto , Pompili Maurizio
Published: January 2017

Objective:

To study suicide rates in elderly people in the former European Community, known as the European Union (EU) since late 1993, to identify differences between early members (admitted to the EU before 2004) and new members (admitted after 2004), and to evaluate the association between macro-socioeconomic variables and suicide rates.

Method:

We explored temporal trends in age-adjusted suicide rates for people aged 65 years and older residing in the EU from 1980 to 2006.

Results:

In the years examined in the study, there has been a general decrease in suicide rates in new and early members of the EU, although more slowly for elderly men than for women. The decrease in suicide rates of citizens aged 65 years and older was associated with a small but significant difference between new and early members of the EU (RR = 1.04, 95% CI 1.03 to 1.05; z = 11.95, P < 0.001). The macro-socioeconomic indices were strongly associated with age-adjusted suicide rates in EU senior citizens, except unemployment rates.

Conclusions:

Deaths by suicide in elderly people are declining in all EU nations, but inequalities in the suicide rates of men and women remain, especially in new EU members.
Associations between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample
Authors: Mota Natalie P , Burnett Margaret , Sareen Jitender
Published: January 2017

Objective:

Most previous studies that have investigated the relation between abortion and mental illness have presented mixed findings. We examined the relation between abortion, mental disorders, and suicidality using a US nationally representative sample.

Methods:

Data came from the National Comorbidity Survey Replication ( n = 3310 women, aged 18 years and older). The World Health Organization-Composite International Diagnostic Interview was used to assess mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and lifetime abortion in women. Multiple logistic regression analyses were employed to examine associations between abortion and lifetime mood, anxiety, substance use, eating, and disruptive behaviour disorders, as well as suicidal ideation and suicide attempts. We calculated the percentage of respondents whose mental disorder came after the first abortion. The role of violence was also explored. Population attributable fractions were calculated for significant associations between abortion and mental disorders.

Results:

After adjusting for sociodemographics, abortion was associated with an increased likelihood of several mental disorders—mood disorders (adjusted odds ratio [AOR] ranging from 1.75 to 1.91), anxiety disorders (AOR ranging from 1.87 to 1.91), substance use disorders (AOR ranging from 3.14 to 4.99), as well as suicidal ideation and suicide attempts (AOR ranging from 1.97 to 2.18). Adjusting for violence weakened some of these associations. Forall disorders examined, less than one-half of women reported that their mental disorder had begun after the first abortion. Population attributable fractions ranged from 5.8% (suicidal ideation) to 24.7% (drug abuse).

Conclusions:

Our study confirms a strong association between abortion and mental disorders. Possible mechanisms of this relation are discussed.
Are Antipsychotic Prescribing Patterns Different in Older and Younger Adults?: A Survey of 1357 Psychiatric Inpatients in Toronto
Authors: Sproule Beth A , Lake Jennifer , Mamo David C , Uchida Hiroyuki , Mulsant Benoit H
Published: January 2017

Objective:

To compare antipsychotic prescribing patterns in younger (aged 59 years or younger) and older (aged 60 years or older) patients with psychotic or mood disorders.

Method:

Pharmacy records of all patients discharged from the Centre for Addiction and Mental Health over a 21-month period were reviewed. A total of 1357 patients who were prescribed an antipsychotic at the time of their discharge were included in the analysis (956 with a primary psychotic disorder and 401 with a primary mood disorder). World Health Organization-defined daily doses were used as the standardized dosing unit.

Results:

Both in patients with a primary psychotic disorder and in patients with a primary mood disorder, the prescribing patterns were similar in older and younger patients, with no statistical difference in the proportions receiving first-generation antipsychotics, second-generation antipsychotics (SGAs), multiple antipsychotics, or long-acting (depot) antipsychotics. Overall, the mean daily antipsychotic doses were lower only in the older group of patients with a primary mood disorder. However, the mean dose of SGAs was about 30% lower in older patients in both diagnostic groups. Regardless of age, patients with a mood disorder were prescribed lower doses of antipsychotics than those with a psychotic disorder.

Conclusions:

Our data suggest that older patients are prescribed lower antipsychotic dosages primarily when using SGAs. This finding emphasizes the need for dose-finding studies assessing both the efficacy and the safety of antipsychotics in older patients with a psychotic or mood disorder.
Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review
Authors: Colins Olivier , Vermeiren Robert , Vreugdenhil Coby , van den Brink Wim , Doreleijers Theo , Broekaert Erik
Published: January 2017

Objective:

To provide a best estimate of the prevalence of psychiatric disorders among detained male adolescents, with particular emphasis on impairment, multi-informant assessment, and race or ethnicity.

Method:

Computer-assisted searches were executed to identify relevant studies.

Results:

Fifteen studies using adolescents as informants met inclusion criteria ( n = 3401), of which only 2 reported within a subsample on parent-derived diagnoses. The mean prevalence of any disorder was 69.9% (95% CI 69.5% to 70.3%); with conduct disorder occurring most frequently (46.4%, 95% CI 45.6% to 47.3%), followed by substance use disorder (45.1%, 95% CI 44.6% to 45.5%), oppositional defiant disorder (19.8%, 95% CI 19.2% to 20.3%), and attention-deficit hyperactivity disorder (13.5%, 95% CI 13.2% to 13.9%). Although lower, rates for internalizing disorders were still substantial, with any anxiety disorder found in 15.9% (95% CI 15.6% to 16.1%), major depression in 12.0% (95% CI 11.7% to 12.2%), and posttraumatic stress disorder in 9.6% (95% CI 9.2% to 10.0%). Three studies reported on psychotic disorders, finding low rates (1.35%, 95% CI 1.32% to 1.39%). Estimates of prevalence were only marginally different when impairment was not required, while consistency between adolescents and parents was poor. Findings on the relations between race or ethnicity were too scarce and inconsistent to interpret.

Conclusion:

Detained male adolescents bear substantial mental health needs, emphasizing the need to organize effective mental health services for this troubled group. However, our knowledge on mental disorders in detained youth should be enhanced, in particular regarding the reliability of adolescents, compared with parent report, and whether clinically relevant differences exist by race or ethnicity.
Life Course Perspectives on the Epidemiology of Depression
Authors: Colman Ian , Ataullahjan Anushka
Published: January 2017

Life course epidemiology seeks to understand how determinants of health and disease interact across the span of a human life, and has made significant contributions to understanding etiological mechanisms in many chronic diseases, including schizophrenia. The life course approach is ideal for understanding depression: causation in depression appears to be multifactorial, including interactions between genes and stressful events, or between early life trauma and later stress in life; timing of onset and remission of depression varies widely, indicating differing trajectories of symptoms over long periods of time, with possible differing causes and differing outcomes; and early life events and development appear to be important risk factors for depression, including exposure to acute and chronic stress in the first years of life. To better understand etiology and outcome of depression, future research must move beyond basic epidemiologic techniques that link specific exposures to specific outcomes and embrace life course principles and methods. Time-sensitive modelling techniques that are able to incorporate multiple interacting factors across long periods of time, such as structural equation models, will be critical in understanding the complexity of causal and influencing factors from early development to the end stages of life. Using these models to identify key pathways that influence trajectories of depression across the life course will help guide prevention and intervention.
Where to Position Clozapine: Re-Examining the Evidence
Authors: Agid Ofer , Foussias George , Singh Shayna , Remington Gary
Published: January 2017

Objective:

To review clozapine's position in treatment algorithms for schizophrenia.

Method:

Clozapine's status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects.

Results:

The hematologic monitoring implemented with clozapine's reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials.

Conclusions:

Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.