bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review
Authors: Amari Erica , Rehm Jürgen , Goldner Elliot , Fischer Benedikt 
Published: January 2017

Objective: In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. Method: A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities. Results: Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. Conclusions: The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.
Mortality Associated with Major Depression in a Canadian Community Cohort
Authors: Patten Scott B , Williams Jeanne VA , Lavorato Dina , Wang Jian Li , Khaled Salma , Bulloch Andrew GM 
Published: January 2017

Objective: Prior studies have reported that major depressive episodes (MDEs) are associated with elevated mortality. However, the association has not always persisted after adjustment for other mortality risk factors. In our study, we examine this issue using data from a longitudinal Canadian study (the National Population Health Survey [NPHS]). The NPHS included a more comprehensive set of mortality determinants than prior studies, allowing a more comprehensive assessment of the effect of MDEs on mortality. Methods: The NPHS began data collection in 1994 and follow-up data were available to 2006 at the time of this analysis. The NPHS assessed depression using a short-form version of the Composite International Diagnostic Interview. Mortality was assessed as part of the cohort's follow-up, including linkage to vital statistics data. Results: During follow-up, 2019 deaths occurred in the eligible part of the NPHS cohort. Consistent with prior studies, MDEs were strongly predictive of mortality when basic adjustments were made for age and sex (hazard ratio [HR] 2.0, 95% Cl 1.4 to 2.9). The association disappeared with adjustment for other variables that predict mortality risk (HR 1.1, 95% Cl 0.7 to 1.7). Conclusions: MDE is a strong predictor of mortality in the general population. This analysis failed to identify an independent effect of MDE when adjustments were made for other risk factors. However, the lack of a strong independent effect on mortality does not preclude an etiologic impact of MDE. MDE itself is intertwined with health-related changes that predict mortality and its impact may be mediated by these variables.
Trends in Primary Methamphetamine-Related Admissions to Youth Residential Substance Abuse Treatment Facilities in Canada, 2005–2006 and 2009–2010
Authors: Verdichevski Marina , Burns Robin , Cunningham James K , Tavares Joey , Callaghan Russell C 
Published: January 2017

Objective: During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005–2006 that 21 % of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005–2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009–2010, as well as important trend information for these periods. Method: We developed a comprehensive list of all Canadian residential youth substance abuse treatment facilities. The executive director of each facility was asked about the site's annual caseload, and the proportion of cases primarily due to methamphetamine abuse within the past 12 months. Results: Our survey data for the periods of 2005–2006 and 2009–2010 show marked reductions in admissions. In 2009–2010, we found that about 6% of all admissions were due primarily to methamphetamine abuse, a substantial drop from the 21% reported in our 2005–2006 study. Conclusions: Our data show a significant national reduction in methamphetamine-related admissions. Other reports show that methamphetamine-related treatment admissions in the United States and Mexico declined sharply during 2005–2008, reportedly in association with Mexico's methamphetamine precursor chemical controls, raising the possibility that the controls may also be associated with the declines reported here.
Autism Spectrum Disorders and Maternal Serum alpha-Fetoprotein Levels during Pregnancy
Authors: Abdallah Morsi W , Grove Jakob , Hougaard David M , Nørgaard-Pedersen Bent , Ibrahimov Fuad , Mortensen Erik L 
Published: January 2017

Objective: Numerous studies have been trying to disentangle the complex pathophysiology of autism spectrum disorders (ASD). In our study, we explored the potential role of maternal serum (MS) alpha-fetoprotein (AFP) in the prediction and the pathophysiology of ASD. Methods: A total of 112 patients with ASD and 243 control subjects were included in a case–control study, using a historic birth cohort maintained at Statens Serum Institute. Measurements of MS-AFP were obtained from a multicentre screening program, whereas clinical data were obtained from nationwide registers. Association between MS-AFP and ASD status was analyzed using logistic regression models and nonparametric tests. Results: Crude, but not adjusted, estimates showed that MS-AFP levels were slightly, but significantly, higher in mothers of children with ASD, compared with their control subject counterparts. People with ASD had an odds ratio of 2.33, with 95% confidence intervals of 1.00 to 5.39, to have MS-AFP above 2.5 multiple of median. Excluding subjects with congenital malformation comorbidities did not alter the direction of our estimates (OR 2.60; 95% Cl 1.04 to 6.51, P = 0.04). Conclusion: Biologic plausibility of its role in the pathophysiology of ASD makes AFP a good candidate for further larger-scale studies to confirm such an association and to determine whether this pattern is unique to ASD or related to other psychiatric disorders as well.
Enculturation and Alcohol Use Problems among Aboriginal University Students
Authors: Currie Cheryl L , Wild T Cameron , Schopflocher Donald P , Laing Lory , Veugelers Paul J , Parlee Brenda , McKennitt Daniel W 
Published: January 2017

Objective: To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada. Methods: Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students ( n = 60) in 2008/2009. Results: Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards. Conclusions: This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting.
Effectively Working on Rehabilitation Goals: 24-Month Outcome of a Randomized Controlled Trial of the Boston Psychiatric Rehabilitation Approach
Authors: Swildens Wilma , van Busschbach Jooske T , Michon Harry , Kroon Hans , Koeter Maarten W J , Wiersma Durk , van Os Jim 
Published: January 2017

Objective: To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands. Method: A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR ( n = 80) or CAU ( n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved. Results: The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures. Conclusions: The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life.
Perception of Teratogenic Risk and the Rated Likelihood of Pregnancy Termination: Association with Maternal Depression
Authors: Walfisch Asnat , Sermer Corey , Matok Ilan , Einarson Adrienne , Koren Gideon 
Published: January 2017

Objective: Women are often exposed to various medications and medical conditions during pregnancy. Unrealistically high maternal teratogenic risk perception, related to these exposures, may lead to abrupt discontinuation of therapy and (or) termination of a wanted pregnancy. The association between maternal depression and the teratogenic risk perception has not been studied, nor were the actions resulting from this perception. Our objectives were to explore the association between maternal depression, teratogenic risk perception, and the rated likelihood to terminate pregnancy. Additionally, we evaluated possible benefits of counselling. Methods: We administered the Edinburgh Postnatal Depression Scale (EPDS) to all women who attended the Motherisk Clinic between October 2007 and April 2010. A visual analogue scale was used to determine maternal risk perception in relation to the specific exposure, and the rated likelihood to terminate the pregnancy, before and after counselling. Results: We analyzed data from 413 women. Maternal teratogenic risk perception and the rated likelihood to terminate the pregnancy were significantly lower following counselling. An EPDS score of 13 or more was significantly associated with a higher rated likelihood to terminate the pregnancy ( P = 0.03). In a multivariable regression analysis, an EPDS score of 13 or more was found to be an independent predictor of a higher personal teratogenic risk perception ( P = 0.03). Conclusions: Both maternal depression and exposure-directed counselling are associated with maternal risk perception and the rated likelihood to terminate pregnancy. Appropriate counselling may reduce fear of teratogenicity and the likelihood of pregnancy termination.
Patterns of Depression and Treatment in Pregnant and Postpartum Women
Authors: Bowen Angela , Bowen Rudy , Butt Peter , Rahman Kazi , Muhajarine Nazeem 
Published: January 2017

Objective: To determine the course of depression and the effects of treatment during pregnancy and into the postpartum period. Method: This is a longitudinal study of a community sample of 649 pregnant women who were assessed in early pregnancy (17.4 ± 4.9 weeks), late pregnancy (30.6 ± 2.7 weeks), and postpartum (4.2 ± 2.1 weeks) with the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were encouraged to seek assessment and treatment. We used generalized estimating equation modelling to determine the predicted mean depression scores, taking age, ethnicity, history of depression, and previous and present treatment status into account. Results: The unadjusted prevalence of depression (EPDS ≥ 12) was 14.1% ( n = 91) in early pregnancy, 10.4% ( n = 62) in late pregnancy, and 8.1% ( n = 48) postpartum. Twelve per cent of women were engaged in treatment. The predicted mean EPDS score decreased over the course of the pregnancy into the postpartum period, most significantly when women were engaged in counselling or taking psychotropic medication. Counselling was the more common method of treatment during pregnancy and medication in the postpartum period. Women who were depressed and untreated were more likely to be younger, more stressed, have less support, have a history of depression, and use alcohol. Conclusions: We confirm that depressive symptoms improve over the course of the pregnancy into the postpartum period, particularly for women who receive treatment. Our study is unique as it takes the history of depression, present and past treatment status, and the longitudinal nature of the data into account.
Predictors of Psychiatric Aftercare among Formerly Hospitalized Adolescents
Authors: Carlisle Corine E , Mamdani Muhammad , Schachar Russell , To Teresa 
Published: January 2017

Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare. Conclusions: Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.
Childhood Maltreatment and Substance Use Disorders among Men and Women in a Nationally Representative Sample
Authors: Afifi Tracie O , Henriksen Christine A , Asmundson Gordon J G , Sareen Jitender 
Published: January 2017

Objective: To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample. Method: Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders. Results: All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect. Conclusions: This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.
A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents
Authors: Patten Scott B , Waheed Waqar , Bresee Lauren 
Published: January 2017

Objective: In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. Methods: A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. Results: In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than North American studies (most of which were conducted in the United States). SGAs in children and adolescents are used more often in boys than in girls, and are increasingly used for treatment of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Conclusions: Determining the most appropriate frequency of SGA use in children and adolescents will ultimately depend on decisive clarification of risks and benefits. The currently available literature highlights large international differences in the frequency of use. These differences may reflect fundamental dissimilarities in the therapeutic stance adopted toward ADHD and CD by physicians practicing in different countries.
Mental Health of Canadian Forces Members While on Deployment to Afghanistan
Authors: Garber Bryan G , Zamorski Mark A , Jetly Col Rakesh 
Published: January 2017

Objective: The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed. Methods: Our study consisted of a cross-sectional survey of all 2779 CF personnel deployed to the province of Kandahar, Afghanistan, from February 15, 2010, to March 15,2010. Results: An important minority (8.5%) of the 1572 respondents (response rate = 57%) exceeded civilian criteria for symptoms of acute traumatic stress, major depression, or generalized anxiety. Prevalence of these 3 mental health problems increased with higher combat exposure and location in more isolated posts. A much larger fraction (31 %) reported suffering a stress, emotional, alcohol, or family problem during the deployment. Only a minority of respondents with a mental health problem (26%) were currently interested in getting help. Almost one-half of respondents with a mental health problem perceived occupational dysfunction as a result, though two-thirds of respondents with occupational dysfunction were in the group without the 3 mental health problems assessed. Conclusions: The needs base for psychosocial support extends beyond personnel who meet conventional questionnaire criteria for traumatic stress, depression, or generalized anxiety. Future research is needed to understand what precise problems are driving this larger needs base and what precise supports (clinical or nonclinical) would be most appropriate.
Adolescent Use of Prescription Drugs to Get High in Canada
Authors: Currie Cheryl L , Wild T Cameron 
Published: January 2017

Objective: To present epidemiologic information on adolescent use of prescription drugs to get high, and not for medical purposes, in Canada. Methods: Data were obtained from 44 344 adolescents in grades 7 to 12 living across Canada's 10 provinces who completed the Youth Smoking Survey in 2008/2009. Results: Nationally, 5.9% of adolescents in grades 7 to 12 reported the use of prescription drugs to get high in the past 12 months in 2008/2009. Females were more likely to report use of pain relievers, sedatives, or tranquilizers to get high, while males were more likely to report the use of prescription stimulants for this purpose. The use of prescription drugs to get high was elevated among older youth, those living in British Columbia, and those who identified as First Nations, Métis, or Inuit. School connectedness was associated with a reduction in this form of prescription drug misuse for all adolescents; however, this protective effect was particularly strong for Aboriginal youth, and may be an important preventative factor for this population. Conclusions: Use of prescription drugs to get high was prevalent among adolescents in Canada in 2008/2009. Findings highlight the need for clinicians to include questions about prescription drugs when screening adolescents for substance abuse in Canada. Findings also highlight the need for evidence-informed strategies to reduce prescription drug misuse among Aboriginal youth living outside First Nations communities in Canada. The results of this study suggest school connectedness may be a particularly important target for these interventions.