bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Consumption and Major Depression: Findings from a Follow-up Study
Authors: Wang JianLi , Patten Scott B 
Published: January 2017

Objective: To investigate whether alcohol consumption predicts major depressive disorder episodes (MDEs) in the general population. Method: The respondents without depression (n = 12 290) in the longitudinal cohort of the Canadian National Population Health Survey (NPHS) were classified into cohorts based on any drinking, frequency of drinking, maximum number of drinks on a maximal drinking occasion, and average daily alcohol consumption, based on data collected in the 1994–1995 survey. Major depression frequency 2 years later, in 1996–1997, was evaluated and compared across drinking categories. Results: The respondents who reported any drinking, drinking daily, having more than 5 drinks on a maximal drinking occasion, and having more than 1 drink daily on average, did not have an elevated risk of major depression. A trend in the data suggested that women who reported having more than 5 drinks on a maximal drinking occasion might be at a higher risk of major depression. No evidence of confounding or effect modification by demographic, psychological, and clinical variables was found. Conclusion: In a general population sample, alcohol consumption levels were not associated with major depression. Having more than 5 drinks on a maximal drinking occasion, however, may be associated with an increased risk of major depression among women. Extreme patterns of alcohol consumption, which tend to characterize clinical samples, are associated with depression. These patterns of drinking, however, are relatively uncommon in the general population, and the current analysis may have lacked power to detect these associations.
Comorbidity of Major Depression with Substance Use Disorders
Authors: Currie Shawn R , Patten Scott B , Williams Jeanne VA , Wang JianLi , Beck Cynthia A , El-Guebaly Nady , Maxwell Colleen 
Published: January 2017

Objectives: In the Canadian adult population, we aimed to 1) estimate the 12-month prevalence of major depressive disorder (MDD) in persons with a diagnosis of harmful alcohol use, alcohol dependence, and drug dependence; 2) estimate the 12-month prevalence of harmful alcohol use, alcohol dependence, and drug dependence in persons with a 12-month and lifetime diagnosis of MDD; 3) identify socioeconomic correlates of substance use disorder–major depression comorbidity; 4) determine how comorbidity impacts the prevalence of suicidal thoughts; and 5) determine how comorbidity affects mental health care used. Methods: We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Results: The 12-month prevalences of MDD in persons with a substance use disorder (SUD) were 6.9% for harmful alcohol use (95% confidence interval [CI], 5.2 to 8.5), 8.8% for alcohol dependence (95%CI, 6.6 to 11.0), and 16.1% for drug dependence (95%CI, 10.3 to 21.9). Conversely, the 12-month prevalences of harmful alcohol use, alcohol dependence, and drug dependence in persons with a 12-month diagnosis of MDD were 12.3% (95%CI, 9.4 to 15.2), 5.8% (95%CI, 4.3 to 7.3), and 3.2% (95%CI, 2.0 to 4.4), respectively. Regression modelling did not identify any socioeconomic predictors of SUD–MDD comorbidity. Substance dependence and MDD independently predicted higher prevalence of suicidal thoughts and mental health treatment use. Conclusions: SUDs cooccur with a high frequency in cases of MDD. Clinicians and mental health services should consider routine assessment of SUDs in depression patients.
A Controlled Study of Alexithymia in Adolescent Patients with Persistent Somatoform Pain Disorder
Authors: Burba Benjaminas , Oswald Ronald , Grigaliunien Viktorija , Neverauskiene Simona , Jankuviene Odeta , Chue Pierre 
Published: January 2017

Objective: To study the differences in levels of alexithymia, depression, and anxiety between a sample of adolescents diagnosed with ICD-10 persistent somatoform pain disorder (defined by the DSM-IV as a pain disorder associated with psychological factors) and healthy adolescent control subjects. Method: Using the Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale, we investigated the point prevalence of alexithymia, anxiety, and depression among adolescents aged 12 to 17 years, with somatoform disorder, who were hospitalized in Kaunas Medical University Hospital, Lithuania ( n =120), and a healthy control group ( n = 60) of adolescents aged 12 to 17 years, who were randomly selected from 6 schools in Kaunas, Lithuania. Results: The rate of alexithymia in adolescents with somatoform disorder was 59%, which was significantly higher than that in healthy control subjects (1%, P < 0.001). Similarly, the rate of anxiety was significantly higher in the patient group (62%), compared with control subjects (15%, P < 0.001). The rate of depression was low in both groups and did not differ significantly between groups. Conclusions: Adolescents with somatoform disorder have higher levels of alexithymia and anxiety than healthy adolescent control subjects, but adolescents with somatoform disorder and adolescent control subjects do not have significantly different levels of depression.
Chronic Disease Management for Depression in Primary Care: A Summary of the Current Literature and Implications for Practice
Authors: Kates Nick , Mach Michele 
Published: January 2017

Objective: To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada. Methods: We reviewed all RCTs conducted between 1992 and 2006, including other reviews and analyses of pooled data. Using various search terms, we searched PsycINFO, Cinahl (1982 to May 2005), MEDLINE (1995 to 2005), EMBASE, The Cochrane Library, and PubMed. Results: There is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care. Most studies have demonstrated improved outcomes in terms of symptom reduction, relapse prevention, functioning in the community, adherence to treatment, community and workplace involvement, and satisfaction with care received. Conclusions: Primary care practices need to examine how they can incorporate different concepts and models for managing depression. Components to consider include case registries, care managers or coordinators, treatment algorithms, follow-up and monitoring after a treated episode, care and relapse prevention plans, visits by psychiatrists, and training and ongoing education for all providers.
Health Service Patterns Indicate Potential Benefit of Supported Self-Management for Depression in Primary Care
Authors: Bilsker Dan , Goldner Elliot M , Jones Wayne 
Published: January 2017

Objective: To examine health service delivery in a Canadian province (British Columbia) to consider how Canadian health care services might be developed to best address the large number of individuals with mildly to moderately severe depressive illnesses. Method: We used provincial administrative data to describe patterns of medical services provided to individuals suffering from depression during 3 different time periods (1991–1992, 1995–1996, and 2000–2001) and to determine the frequency with which depression patients receive treatment from primary care physicians and psychiatrists. We then used these findings to consider the feasibility and potential applicability of the various approaches that have been described to decrease the burden of disease related to depression. Results: In the fiscal year 1991–1992, the “treated prevalence” rate was 7.7%; in 1995–1996, it was 8.7%; and in 2000–2001, it was 9.5%. In each cohort over the 10-year period, the proportion of individuals who received a diagnosis of depression and who were then treated by primary care physicians alone (no psychiatric services were provided) remained constant at 92%. Conclusions: Supported self-management is identified as a promising intervention that could be integrated into primary health care within the context of the Canadian health care system. It constitutes a feasible and practical approach to enhance the role of family physicians in the delivery of services to individuals with milder forms of depression and promotes the active engagement of individuals in their recovery and in prevention of future episodes.
Psychiatric Advance Directives and the Right to Refuse Treatment in Canada
Authors: Ambrosini Daniel L , Crocker Anne G 
Published: January 2017

Objective: To provide a Canadian perspective on psychiatric advance directives (PADs) and assess whether these documents can be implemented as an adjunct to mental health services to empower people with mental illness. Method: We reviewed Canadian jurisprudence over the past 15 years related to people with mental illness and the right to refuse medical treatment. Provincial mental health legislation is explained to discern PADs' possible effect in Canada. Results: Evidence is accumulating that legal and mental health professionals see PADs as useful documents to promote patient autonomy. Canadian jurisprudence, mental health legislation, and psychological research suggest that PADs could be implemented by legal and mental health professionals. Mental health legislation has the power to prohibit or facilitate choices regarding the right to refuse medical treatment. Conclusions: This review suggests the need for greater empirical research to be conducted in Canada to determine stakeholders' perceptions of whether PADs could successfully be implemented and their interaction with legislation.
Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy
Authors: Bellino Silvio , Rinaldi Camilla , Bogetto Filippo 
Published: January 2017

Objective: Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD. Method: Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant. Results: Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P. Conclusions: Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.
Efficacy and Tolerability of Antidepressants for Treatment of Depression in Coronary Artery Disease: A Meta-Analysis
Authors: Dowlati Yekta , Herrmann Nathan , Swardfager Walter L , Reim Elyse K , Lanctôt Krista L 
Published: January 2017

Objective: Depression occurs in 18% to 45% of patients with coronary artery disease (CAD) where it is associated with an increased risk of acute coronary events and mortality. Our objective was to quantitatively summarize the data on the efficacy and tolerability of antidepressant (AD) treatment for depression in CAD. Methods: We performed a meta-analysis of randomized, placebo-controlled, double-blind trials with a database search of the English literature (to March 2008) and manual search of references. Results: Four clinical trials with ADs (mirtazapine, citalopram, fluoxetine, and sertraline) of a 9- to 24-week duration involving 798 subjects (402 ADs, 396 placebo) with documented CAD and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for depression were included. ADs were superior to placebo for decreasing Hamilton Depression Rating Scale (HDRS) scores (402 ADs, 396 placebo; weighted mean difference 1.41, 95% CI 0.53 to 2.29, P = 0.002) and Beck Depression Inventory (BDI) scores (373 ADs, 369 placebo; weighted mean difference 2.27, 95% CI 0.60 to 3.94, P = 0.008). The proportion of patients (216 ADs, 213 placebo) who responded (a 50% or more reduction in HDRS scores, OR 1.72, 95% CI 1.17 to 2.54) and remitted (HDRS of 8 or less at final assessment, OR 1.80, 95% CI 1.18 to 2.74), were also significantly higher with AD, compared with placebo, with no significant differences between the 2 groups for overall dropouts (OR 0.84, 95% CI 0.42 to 1.68) or dropout owing to adverse events (OR 1.30, 95% CI 0.75 to 2.25). The combined studies were homogeneous except for overall dropout rate ( P = 0.01). Conclusion: Treatment with ADs for depression in CAD results in significant therapeutic effects without substantially increased rates of discontinuation.
Adults with Mood Disorders Have an Increased Risk Profile for Cardiovascular Disease within the First 2 Years of Treatment
Authors: Taylor Valerie , McKinnon Margaret C , Macdonald Kathryn , Jaswal Gurpreet , MacQueen Glenda M 
Published: January 2017

Objectives: People with bipolar disorder (BD) and major depressive disorder (MDD) are at risk for premature death from various physical illnesses. A large component of this risk may be accounted for by an elevated risk of metabolic syndrome (MeS) and coronary heart disease (CHD). The objective of our study was to examine patients' physical health prior to first treatment and over 2 years of follow-up. Methods: Ten-year risk for CHD and incidence of MeS were calculated for newly diagnosed patients with MDD ( n = 30) and BD ( n = 24) at baseline and over a 2-year follow-up. Age and sex-matched control subjects were obtained from the National Health and Nutrition Examination Survey III dataset. Results: At baseline, 11.2% of patients met diagnostic criteria for MeS and this increased to 16.8% at follow-up. Women had higher rates of MeS but rates were similar across diagnosis. There was a significant increase within all MeS criteria. The 10-year CHD risk was low for patients at baseline and follow-up but increased across the follow-up period. Changes in CHD and MeS risk were not associated with a specific type of pharmacotherapy, as all medication classes appeared to increase risk. Conclusion: Prior to treatment, MeS and CHD risk rates for patients were similar to the general population, but their risk of CHD increased appreciably.
One-Year Incidence of Psychiatric Disorders in Quebec's Older Adult Population
Authors: Préville Michel , Boyer Richard , Vasiliadis Helen-Maria , Grenier Sébastien , Voyer Philippe , Hudon Carol , Streiner David L , Cairney John , Brassard Joëlle ,   Study Scientific Committee of the ESA
Published: January 2017

Objective: To examine the incidence of psychiatric disorders in the Quebec older adult population. Method: Data from the Enquěte sur la Santé des Aînés (ESA) study conducted in 2005 to 2008 using a representative sample (n = 2784) of community-dwelling adults aged 65 years and older were used. Results: The ESA study's results indicate that 12.0% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. Our results also indicate that the 12-month rate of incident cases of DSM-IV disorders was 6.2%. The proportion of incident cases was higher for the depression group (3.4%) than for the anxiety disorders group (2.3%). The results showed that the probability to develop an incident psychiatric condition after 1 year of follow-up, compared with the noncases group, varied according to sex (OR 2.18; 95% CI 1.39 to 3.44). Our results also showed that the number of chronic health problems (OR 1.20; 95% CI 1.09 to 1.33) and the change in the number of chronic health problems reported between the baseline and the second interview (OR 1.14; 95% CI 1.01 to 1.30) increased the probability to be an incident case at Time 2. The results indicated that social support did not influence the probability to develop a psychiatric disorder. Conclusion: These results indicate that sex and physical health status have an impact on the incidence of DSM-IV disorders in the elderly. This finding underscores the need for improved recognition and treatment of psychiatric disorders associated with physical illness in the older population.
Concept de soi physique et adolescents présentant une déficience intellectuelle: Effets de l'âge, du sexe et de la catégorie de poids
Authors: Bégarie Jérôme , Maïano Christophe , Ninot Grégory 
Published: January 2017

Objectif: Etudier les effets de l'âge, du sexe, du poids et de leurs interactions sur l'estime globale de soi (EGS) et le concept de soi physique d'adolescents présentant une déficience intellectuelle (DI). Méthode: Un échantillon de 353 adolescents DI, âgés de 12 à 18 ans, a participé à cette étude. La version très courte de l'inventaire du soi physique pour adolescents DI (communément appelée PSI-VSF-ID) a été utilisée pour évaluer l'EGS et les perceptions du soi physique (la valeur physique perçue [VPP], la compétence sportive [CS], la condition physique, l'apparence physique et la force). Résultats: Les analyses de covariances multivariées montrent: (i) des niveaux d'EGS et de soi physique inférieurs (à l'exception de la VPP) chez les filles par rapport aux garçons; (ii) une diminution des scores d'EGS, de VPP, de CS et d'apparence physique perçue (APP) au cours de l'adolescence; (iii) des scores d'EGS, de VPP, et d'APP inférieurs chez les adolescents obèses comparés à leurs pairs en surpoids ou de poids normal; et (iv) que les filles obèses présentent des scores d'APP inférieurs à ceux des autres adolescents. Conclusion: Les résultats obtenus pour le sexe et l'âge sont quasiment conformes à ceux de la littérature en population générale. En revanche, ils s'en éloignent pour l'effet principal de la catégorie de poids.
Supported Self-Management: A Simple, Effective Way to Improve Depression Care
Authors: Bilsker Dan , Goldner Elliot M , Anderson Ellen 
Published: January 2017

Objectives: To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system. Method: SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients. Results: SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers. Conclusion: The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.
Stepped Care: A Method to Deliver Increased Access to Psychological Therapies
Authors: Richards David A 
Published: January 2017

Objective: To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation. Method: Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing high-volume services for common mental health problems are derived from this experience. Results: Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidence-based treatments, access to telephony, and smart patient management informatics systems. Conclusions: Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems.