bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unmet Need for the Treatment of Depression in Atlantic Canada
Authors: Starkes Jill M , Poulin Christiane C , Kisely Stephen R 
Published: January 2017

Objective: Most people with depression do not receive treatment, even though effective interventions are available. Population-based data can assist health service planners to improve access to mental health services. This study aimed to examine the determinants of untreated depression in Canada's Atlantic provinces. Method: This study used data from the Canadian Community Health Survey Cycle 1.1. Logistic regression models explored the prevalence of depression and associated patterns of mental health service use among population subgroups. Results: Of the respondents, 7.3% experienced major depression in the previous year, as measured by the Composite International Diagnostic Interview Short Form. Individuals with the following characteristics were at increased risk for depression: female sex; widowed, separated, or divorced marital status; low income; and 2 or more comorbid medical conditions. Only 40% of respondents with probable depression reported any consultation about their condition with a general practitioner or mental health specialist. Less than one-quarter of Atlantic Canadians with depression reported receiving levels of care consistent with practice guidelines. Vulnerable groups, including older individuals, people with low levels of education, and those living in rural areas, were significantly less likely to receive treatment in either primary or specialty care. Conclusions: These findings suggest inequitable access to services and the need to target interventions to at-risk populations by raising awareness among the public and health care providers. Health systems in the Atlantic region must work toward achieving consistent longitudinal care for a larger proportion of individuals suffering from depression by studying the underlying factors for service use among underserved groups.
Area Variations in the Prevalence of Substance Use and Gambling Behaviours and Problems in Quebec: A Multilevel Analysis
Authors: Kairouz Sylvia , Nadeau Louise , Siou Géraldine Lo 
Published: January 2017

Objectives: This study aimed to examine whether variations among regions in Quebec existed after we controlled for individual characteristics in the prevalence of 1) alcohol, cannabis, and gambling behaviours and 2) substance-related disorders and pathological gambling. Methods: Using data derived from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), we nested 5332 respondents from the province of Quebec within 374 regions equivalent to census subdivisions (CSDs). Outcome variables included 1) drinking status (past 12 months), alcohol consumption (last week), and 12-month diagnosis of alcohol dependence; 2) cannabis use (past 12 months and lifetime) and diagnosis of illicit drug dependence; and 3) gambling status, severity of gambling problems, and number of reported gambling activities (past 12 months). Multilevel regression models with individuals (Level 1) nested in regions (CSDs, Level 2) assessed the variations among regions in the prevalence of various outcomes and disorders when individual characteristics were controlled for. Results: Variance component models revealed that all alcohol-related variables, the prevalence of cannabis use (12 months), and problem gambling did not vary among areas. Gambling rates and the average number of reported gambling activities varied among areas, even when individual-level variables were accounted for in the models, whereas for lifetime cannabis use, variations among areas became nonsignificant. Conclusion: Intervention programs may need to address the environment as a relevant determinant of health-related behaviours and lifestyles.
Is the Statistical Association between Sex and the Use of Services for Mental Health Reasons Confounded or Modified by Social Anchorage?
Authors: Drapeau Aline , Lesage Alain , Boyer Richard 
Published: January 2017

Objective: Confounding and interaction have differing implications for the interpretation of findings and the design of research, mental health services, and policy. This study aimed to verify whether the association between sex and the use of services for mental health reasons is confounded or modified by social anchorage. Methods: We undertook a case–control study nested in Cycle 1.2 of the Canadian Community Health Survey. Cases were defined as users of general medical services for mental health reasons in the previous 12 months, and control subjects were defined as never-users of any services for mental health reasons. The pattern of social anchorage was described by the roles of parent, spouse, worker, and their combination. Results: Overall, women are 2.9 times more likely than men to use general services for mental health reasons. However, this inequality between women and men decreases substantially or subsides in individuals who are less anchored to Canadian society. For instance, in single parents and in unemployed parents, the odds of using general services for mental health reasons are similar in women and in men. The pattern of social anchorage tends to modify, but not to confound, the association between sex and the use of services. Conclusions: Ignoring the interaction between sex and the pattern of social anchorage distorts the interpretation of the inequality between women and men in the use of general medical services for mental health reasons and may affect the design of comprehensive mental health services and policy.
Correlates of Depressive and Anxiety Disorders among Young Canadians
Authors: Nguyen Cat Tuong , Fournier Louise , Bergeron Lise , Roberge Pasquale , Barrette Geneviève 
Published: January 2017

Objective: The current study presents data on the prevalence of depressive and anxiety disorders in the Canadian population aged between 15 and 24 years and examines their potential correlates. Methods: The study is based on the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). This survey was administered to a representative sample of 36 984 Canadians. A subsample of 5673 Canadians aged between 15 and 24 years was available for the analyses. We used descriptive analyses to calculate lifetime and 12-month prevalence of depressive and anxiety disorders, and we used logistic regressions to measure odds ratios. Results: Among Canadian youths, 10.2% had suffered from depressive disorders during their lifetime, whereas 12.1% had suffered from anxiety disorders. For 12-month prevalence, the rates were 6.4% and 6.5% for depressive and anxiety disorders, respectively. Depressive disorders were more frequent among youth aged 20 to 24 years and among those no longer in school. Both disorders were more common among women and people under extreme stress. Conclusions: The prevalence rates found are comparable with other studies, and most of the correlates are concordant with the literature. Results indicate that there is a turning point for depression between late adolescence and adulthood that could be crucial for intervention planning.
Perceived Need for Mental Health Treatment in a Nationally Representative Canadian Sample
Authors: Sareen Jitender , Cox Brian J , Afifi Tracie O , Clara Ian , Yu Bo Nancy 
Published: January 2017

Objective: The optimal method of determining how many people in the general population need help for emotional problems remains unclear. This study aimed to examine the prevalence and correlates of self-perceived need for mental health services (that is, help seeking and perceived need) in a large, population-based sample. Methods: Data came from the Canadian Community Health Survey 1.2 ( n = 36 816, respondent age 15 years and over, and response rate 77%). Respondents were asked whether they had sought help in the past year from any professional for emotional problems and whether they felt they needed help for emotional symptoms but had not sought treatment. The Composite International Diagnostic Interview (CIDI) was used to make DSM-IV mental disorder diagnoses. Results: The past-year prevalences of help seeking and perceived need were 8.7% and 2.9%, respectively. After adjusting for the presence of DSM-IV disorders assessed in the survey, sociodemographic factors, illness severity, social supports, and the presence of physical health conditions were associated with help seeking and perceived need. Independent of DSM diagnoses, sociodemographics, and social supports, perceived need and help seeking were associated with increased levels of distress, disability, and suicidal ideation and attempts. Conclusions: This study illustrates that, in addition to the presence of a DSM diagnosis, the respondent's self-perceived need for mental health treatment is important in the assessment of need for mental health services in the community.
Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program
Authors: Voshaar Richard C Oude , Gorgels Wim J , Mol Audrey J , van Balkom Anton J , Mulder Jan , van de Lisdonk Eloy H , Breteler Marinus H , Zitman Frans G 
Published: January 2017

Objective: To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial. Method: We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition, randomized, controlled benzodiazepine discontinuation trial in general practice. Results: Of 180 patients, we completed follow-up for 170 (94%). Of these, 50 (29%) achieved long-term success, defined as no use of benzodiazepines during follow-up. Independent predictors of success were as follows: offering a taper-off program with group therapy (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.5 to 3.9) or without group therapy (HR 2.9; 95%CI, 1.8 to 4.8); a lower daily benzodiazepine dosage at the start of tapering off (HR 1.5; 95%CI, 1.2 to 1.9); a substantial dosage reduction by patients themselves just before the start of tapering off (HR 2.1; 95%CI, 1.4 to 3.3); less severe benzodiazepine dependence, as measured by the Benzodiazepine Dependence Self-Report Questionnaire Lack of Compliance subscale (HR 2.4; 95%CI, 1.1 to 5.2); and no use of alcohol (HR 1.7; 95%CI, 1.2 to 2.5). Patients who used over 10 mg of diazepam equivalent, who had a score of 3 or more on the Lack of Compliance subscale, or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence. Conclusions: Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality, benzodiazepine dosage, psychopathology, and personality characteristics. An identifiable subgroup needs referral to specialized care.
Mental Health Treatment Seeking by Military Members with Posttraumatic Stress Disorder: Findings on Rates, Characteristics, and Predictors from a Nationally Representative Canadian Military Sample
Authors: Fikretoglu Deniz , Brunet Alain , Guay Stéphane , Pedlar David 
Published: January 2017

Objective: The goal of this study was to identify rates, characteristics, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD). Method: Our sample was drawn from the 2002 Canadian Community Health Survey–Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable. Results: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without. Conclusions: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.
Interventions to Improve Employment Outcomes for Workers Who Experience Mental Illness
Authors: Krupa Terry 
Published: January 2017

Objective: To review employment interventions for individuals who experience mental illness. Method: I reviewed employment interventions described in the mental health, disability, and rehabilitation literature for the period 1990 to 2005 and organized these interventions into a framework. Results: The framework develops 7 distinct individual-level employment interventions as well as interventions directed at the employer and at workplace organization. It also considers factors that will affect access to these interventions. Although there is a sense of optimism about the potential of these interventions, research in the area is limited. Conclusion: Physicians who are knowledgeable about the nature and scope of employment interventions for individuals with mental illness are in a good position to effect positive change in the work lives of the individuals they serve.
Longitudinal Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: A 2-Year Prospective Study
Authors: Grilo Carlos M , Sanislow Charles A , Skodol Andrew E , Gunderson John G , Stout Robert L , Bender Donna S , Yen Shirley , Shea M Tracie , Morey Les C , Zanarini Mary C , McGlashan Thomas H 
Published: January 2017

Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for borderline personality disorder (BPD). Methods: At baseline, we used semistructured diagnostic interviews to determine criteria and diagnoses; blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (specifically, conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, with the independent BPD diagnosis at follow-up used as the standard. Results: Longitudinal diagnostic efficiencies for the BPD criteria varied, with the criteria of suicidality or self-injury and unstable relationships demonstrating the most predictive utility. Conclusions: BPD criteria differ in their predictive utility for the diagnosis of BPD when considered longitudinally. These findings have implications both for clinicians who are considering diagnoses and for researchers concerned with forthcoming revisions of our nosological system.
Clozapine-Induced Hypersalivation: A Review of Treatment Strategies
Authors: Sockalingam Sanjeev , Shammi Chekkera , Remington Gary 
Published: January 2017

Objective: Clozapine-induced hypersalivation (CIH) is a significant side effect affecting about one-third of patients treated with clozapine. CIH can be stigmatizing, can affect quality of life, and can result in discontinuation of clozapine treatment. The purpose of this review is to provide an understanding of CIH, specifically, its pathophysiology, measurement, and the evidence for CIH treatment alternatives. Methods: We searched MEDLINE from 1980 to June 2006 for all reported pharmacologic treatment studies related to CIH. We identified additional references by a manual search of the bibliographies of retrieved articles. Results: Several studies reported improvement of CIH with both selective and nonselective anticholinergic medications. However, with the exception of local anticholinergic agents such as ipratropium bromide and atropine eye drops, potential systemic adverse effects limit the effectiveness of this class of medications. Open-label studies of clonidine, an alpha2 antagonist, suggest that it may be beneficial in managing CIH. Other pharmacologic treatments, such as amisulpride and botulinum toxin, may be useful in refractory CIH cases. Conclusion: Although few randomized controlled trials were found in the literature, this review highlights potential treatment alternatives for this common and disabling cause of hypersalivation. Prompt and effective treatment of CIH may assist with treatment tolerability, adherence, and outcomes in patients with treatment-refractory schizophrenia.
Starson v. Swayze: The Supreme Court Speaks out (Not All That Clearly) on the Question of “Capacity”
Authors: Sklar Ronald 
Published: January 2017

Objectives: The decision in Starson v. Swayze interpreting the “understanding” requirement for capacity in the Ontario Health Care Consent Act (HCCA) provoked concern and criticism from psychiatric quarters. This article seeks to explain the decision and its implications for Ontario and other provinces. Method: The majority and minority opinions in the Starson case, and 4 cases decided in Ontario since Starson, were closely analyzed. The literature on capacity was examined. The decision's constitutional implications were considered. Results: Patients need not be able to understand that their condition constitutes an illness to be found capable of consenting to or refusing treatment. The focus should be on their ability to understand that they are affected by the condition's manifestations. A patient's “best interests” are not relevant to the capacity determination. The majority opinion departed from the traditional role accorded to a patient's denial of illness in determining capacity. Contrary to the views of some commentators, the Court's discussion of the actual benefits and risks of the treatments prescribed for Starson had no bearing on the capacity issue. Three of the post-Starson cases examined complied with the Court's holding; one did not. The majority's distinction regarding what patients must be able to understand about their condition is likely not a “principle of fundamental justice” under the Canadian Charter of Rights and Freedoms (the Charter). The right of the capable patient to refuse treatment and the irrelevance of the patient's best interests likely do constitute such principles. Conclusions: Patients in Ontario cannot be found incapable because they deny they are ill. Ability to recognize the manifestations of their condition suffices. This distinction is probably only binding in Ontario. The capable patient's right to refuse treatment and the irrelevance of the patient's best interests likely are binding throughout Canada.
Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment
Authors: Zikos Eugenia , Gill Kathryn J , Charney Dara A 
Published: January 2017

Objective: To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Method: Patients with alcohol use disorders ( n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Results: Using the results of the SCID-II ( n = 138), the sample was divided into 3 groups—that is, no PD 41% ( n = 57), Cluster B PD 32% ( n = 44), and other PD 27% ( n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. Conclusions: This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.
Optimizing DSM-IV-TR Classification Accuracy: A Brief Biosocial Screen for Detecting Current Gambling Disorders among Gamblers in the General Household Population
Authors: Gebauer Line , LaBrie Richard , Shaffer Howard J 
Published: January 2017

Objective: To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers. Method: We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population. Results: We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificiy (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified). Conclusions: Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others).