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Jette N, Fiest KM, Sauro KM, Wiebe S, Patten SB. Author response: Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology 2019; 89:641-642. [PMID: 28784639 DOI: 10.1212/wnl.0000000000004206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sajobi TT, Amoozegar F, Wang M, Wiebe N, Fiest KM, Patten SB, Jette N. Global assessment of migraine severity measure: preliminary evidence of construct validity. BMC Neurol 2019; 19:53. [PMID: 30947702 PMCID: PMC6448190 DOI: 10.1186/s12883-019-1284-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background In persons with migraine, severity of migraine is an important determinant of several health outcomes (e.g., patient quality of life and health care resource utilization). This study investigated how migraine patients rate the severity of their disease and how these ratings correlate with their socio-demographic, clinical, and psycho-social characteristics. Methods This is a cohort of 263 adult migraine patients consecutively enrolled in the Neurological Disease and Depression Study (NEEDs). We obtained a broad range of clinical and patient-reported measures (e.g., patients’ ratings of migraine severity using the Global Assessment of Migraine Severity (GAMS), and migraine-related disability, as measured by the Migraine Disability Scale (MIDAS)). Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 14-item Hospital Anxiety and Depression Scale (HADS). Median regression analysis was used to examine the predictors of patient ratings of migraine severity. Results The mean age for the patients was 42.5 years (SD = 13.2). While 209 (79.4%) patients were females, 177 (67.4%) participants reported “moderately severe” to “extremely severe” migraine on the GAMS, and 100 (31.6%) patients had chronic migraine. Patients’ report of severity on the GAMS was strongly correlated with patients’ ratings of MIDAS global severity question, overall MIDAS score, migraine type, PHQ-9 score, and frequency of migraine attacks. Mediation analyses revealed that MIDAS mediated the effect of depression on patient ratings of migraine severity, accounting for about 32% of the total effect of depression. Overall, migraine subtype, frequency of migraine, employment status, depression, and migraine-related disability were statistically significant predictors of patient-ratings of migraine severity. Conclusions This study highlights the impact of clinical and psychosocial determinants of patient-ratings of migraine severity. GAMS is a brief and valid tool that can be used to assess migraine severity in busy clinical settings.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Farnaz Amoozegar
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Meng Wang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalie Wiebe
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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153
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Adhikari K, Patten SB, Lee S, Metcalfe A. Adherence to and Persistence with Antidepressant Medication during Pregnancy: Does It Differ by the Class of Antidepressant Medication Prescribed? Can J Psychiatry 2019; 64:199-208. [PMID: 30252505 PMCID: PMC6405814 DOI: 10.1177/0706743718802809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pregnant women are often concerned about the impact of medication use on their pregnancy, such as congenital abnormalities. This study examined the rate of adherence to and persistence with antidepressant medications during pregnancy based on the class of antidepressants prescribed. METHODS Women who gave birth between 2012 and 2015 in Alberta, Canada; had ≥1 diagnosis of depression within 1 year of preconception in outpatient physician claims, emergency department, or hospitalization administrative data; and were adherent (medication possession ratio ≥80%) to ≥2 consecutive antidepressant prescriptions during the preconception year ( n = 1865) were included in this retrospective cohort study. The rates of adherence and persistence (prescription refill gap ≤30 days) were calculated by antidepressant class and were compared using chi-square tests. RESULTS During pregnancy, 834 (44.7%; 95% CI, 42.4% to 47.0%) women discontinued antidepressants. Among those continuing antidepressants, the overall rate of adherence was 62.6% (95% CI, 59.4% to 65.7%). The rate differed significantly by medication class ( P < 0.0001), with a rate of 75.1% (95% CI, 68.3% to 80.9%) for serotonin-norepinephrine inhibitors, 60.9% (95% CI, 57.2% to 64.5%) for selective serotonin reuptake inhibitors, 42.8% (95% CI, 19.9% to 69.3%) for nonselective monoamine reuptake inhibitors, and 37.5% (95% CI, 22.5% to 55.4%) for atypical antidepressants. Only, 40.7% (95% CI, 37.5 to 44.1) of women were persistent with antidepressants for the full pregnancy period-the rate differed significantly by medication class ( P < 0.0001). CONCLUSIONS Adherence to and persistence with antidepressants is low during pregnancy and varies by medication class. Low adherence and persistence can interfere with a therapeutic effect of antidepressants, which may contribute to the worsening of depression symptoms.
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Affiliation(s)
- Kamala Adhikari
- 1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- 1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sangmin Lee
- 1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- 1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,2 Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.,3 Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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154
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Adhikari K, Patten SB, Williamson T, Patel AB, Premji S, Tough S, Letourneau N, Giesbrecht G, Metcalfe A. Does neighborhood socioeconomic status predict the risk of preterm birth? A community-based Canadian cohort study. BMJ Open 2019; 9:e025341. [PMID: 30787092 PMCID: PMC6398791 DOI: 10.1136/bmjopen-2018-025341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study developed and internally validated a predictive model for preterm birth (PTB) to examine the ability of neighbourhood socioeconomic status (SES) to predict PTB. DESIGN Cohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families (AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON)) and neighbourhood SES data from the 2011 Canadian census. SETTING Calgary, Alberta, Canada. PARTICIPANTS Pregnant women who were <24 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. Overall, 5297 women participated in at least one of these cohorts: 3341 women participated in the AOF study, 2187 women participated in the APrON study and 231 women participated in both studies. Women who participated in both studies were only counted once. PRIMARY AND SECONDARY OUTCOME MEASURES PTB (delivery prior to 37 weeks of gestation). RESULTS The rates of PTB in the least and most deprived neighbourhoods were 7.54% and 10.64%, respectively. Neighbourhood variation in PTB was 0.20, with an intra-class correlation of 5.72%. Neighbourhood SES, combined with individual-level predictors, predicted PTB with an area under the receiver-operating characteristic curve (AUC) of 0.75. The sensitivity was 91.80% at a low-risk threshold, with a high false-positive rate (71.50%), and the sensitivity was 5.70% at a highest risk threshold, with a low false-positive rate (0.90%). An agreement between the predicted and observed PTB demonstrated modest model calibration. Individual-level predictors alone predicted PTB with an AUC of 0.60. CONCLUSION Although neighbourhood SES combined with individual-level predictors improved the overall prediction of PTB compared with individual-level predictors alone, the detection rate was insufficient for application in clinical or public health practice. A prediction model with better predictive ability is required to effectively find women at high risk of preterm delivery.
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Affiliation(s)
- Kamala Adhikari
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alka B Patel
- Applied Research and Evaluation- Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Shahirose Premji
- School of Nursing, Faculty of Health, York University, York, Canada
| | - Suzanne Tough
- Department of Paediatrics and Department of Community Health Science, University of Calgary, Calgary, Canada
| | | | - Gerald Giesbrecht
- Department of Community Health Sciences, and Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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155
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Bernstein CN, Hitchon CA, Walld R, Bolton JM, Sareen J, Walker JR, Graff LA, Patten SB, Singer A, Lix LM, El-Gabalawy R, Katz A, Fisk JD, Marrie RA. Increased Burden of Psychiatric Disorders in Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:360-368. [PMID: 29986021 PMCID: PMC6391845 DOI: 10.1093/ibd/izy235] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychiatric comorbidity in inflammatory bowel disease (IBD) is well known; however, data from a truly representative sample are sparse. We aimed to estimate the incidence and prevalence of psychiatric disorders in an IBD cohort compared with a matched cohort without IBD. METHODS Using population-based administrative health data from Manitoba, Canada, we identified all persons with incident IBD from 1989 to 2012 and a general population matched cohort (5:1). We applied validated algorithms for IBD, depression, anxiety disorders, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions post-IBD diagnosis and their lifetime and current prevalence. RESULTS There were 6119 incident cases of IBD and 30,573 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, and year, there was a higher incidence in the IBD cohort compared with controls for depression (incidence rate ratio [IRR], 1.58; 95% confidence interval [CI], 1.41-1.76), anxiety disorder (IRR, 1.39; 95% CI, 1.26-1.53), bipolar disorder (IRR, 1.82; 95% CI, 1.44-2.30), and schizophrenia (IRR, 1.64; 95% CI, 0.95-2.84). Incidence rate ratios were similar for Crohn's disease and ulcerative colitis between males and females and were stable over time. However, within the IBD cohort, the incidence rates of depression, anxiety, and bipolar disorders were higher among females, those aged 18-24 years vs those older than 44 years, urbanites, and those of lower socioeconomic status. The lifetime and current prevalence rates of psychiatric disorders were also higher in the IBD than the matched cohort. CONCLUSIONS The incidence and prevalence of psychiatric disorders are elevated in the IBD population.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine, MB, Canada,Address correspondence to: Charles N. Bernstein, MD, 804F-715 McDermot Avenue, University of Manitoba, Winnipeg, MB R3E3P4 ()
| | | | - Randy Walld
- Manitoba Centre for Health Policy, MB, Canada
| | | | | | - John R Walker
- Department of Clinical Health Psychology, MB, Canada
| | | | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Lisa M Lix
- Manitoba Centre for Health Policy, MB, Canada,Department of Community Health Sciences, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, MB, Canada,Department of Family Medicine, MB, Canada,Department of Community Health Sciences, MB, Canada
| | - John D Fisk
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, MB, Canada,Department of Family Medicine, MB, Canada
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156
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Patten SB, Williams JV, Bulloch AG. Major depressive episodes and mortality in the Canadian household population. J Affect Disord 2019; 242:165-171. [PMID: 30179790 DOI: 10.1016/j.jad.2018.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/22/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the association between major depressive episodes (MDE) and subsequent mortality in a representative sample of the general household population, with adjustment for other determinants of mortality. METHOD The analysis used four datasets from the Canadian Community Health Survey (CCHS); the CCHS 1.1 (conducted in 2000 and 2001), the CCHS 1.2 (conducted in 2002), the CCHS 2.1 (conducted in 2003 and 2004) and the CCHS 3.1 (conducted in 2005 and 2006). Each survey included an assessment of past-year major depressive episodes (MDEs) and was linked to mortality data from the Canadian Mortality Database for January 1, 2000 to December 31, 2011. The hazard ratio (HR) for all-cause mortality was estimated in each survey sample. Random effects, individual-level meta-analysis was used to pool estimates from the four survey data sets. Estimates were adjusted for other determinants of mortality prior to pooling in order to help quantify the independent contribution of MDE to all-cause mortality. RESULTS The unadjusted HR was 0.77 (95% CI 0.63-0.95). A naïve interpretation of this HR suggests a protective effect of MDE, but the estimate was found to be strongly confounded by age (age adjusted HR for MDE: 1.61, 95% CI 1. 34-1.93) and by sex (sex adjusted HR for MDE: 1.15, 95% CI 0.75-1.77). The age and sex adjusted HR was: 1.70 (95% CI 1.45-2.00). No evidence of effect modification by any determinant of mortality was found, including sex. After adjustment for a set of mortality risk factors, the pooled HR was weakened, but remained statistically significant, HR = 1.29 (I-squared = < 1%, tau-squared < 0.001, 95% CI 1.10-1.51). Smoking was the strongest single confounding variable. CONCLUSIONS MDE is associated with elevated mortality. The elevated risk is partially attributable to psychosocial, behavioral and health-related determinants. Since MDE itself may have caused changes to these variables, these estimates cannot fully quantify the independent contribution of MDE to mortality. However, these results suggest that clinical and public health efforts to counteract the effect of MDE on mortality may benefit from attention to a broad set of mortality risk factors e.g. smoking, physical activity, management of medical conditions.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.
| | - Jeanne Va Williams
- Department of Community Health Sciences, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Andrew Gm Bulloch
- Department of Community Health Sciences, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
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157
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Alam S, Lang JJ, Drucker AM, Gotay C, Kozloff N, Mate K, Patten SB, Orpana HM, Afshin A, Cahill LE. Assessment of the burden of diseases and injuries attributable to risk factors in Canada from 1990 to 2016: an analysis of the Global Burden of Disease Study. CMAJ Open 2019; 7:E140-E148. [PMID: 30819694 PMCID: PMC6397034 DOI: 10.9778/cmajo.20180137] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of the risk factors contributing to disease burden is critical for determining research priorities and informing national health policy. We aimed to identify the risk factor trends in Canada. METHODS As part of the Global Burden of Disease (GBD) study (1990-2016), we conducted an analysis of country-level estimates for Canada to assess the burden of diseases and injuries attributable to risk factors. For both 1990 and 2016, metabolic, environmental and behavioural risk factors were ranked according to their contribution to disability-adjusted life years (healthy years of life lost), total deaths and years lived with disability. RESULTS In 2016, the risk factors accounting for the largest percentage of disability-adjusted life years in Canada were (1) tobacco, (2) diet, (3) high body mass index, (4) high fasting plasma glucose, (5) high systolic blood pressure, (6) alcohol and drug use, (7) occupational risks, (8) high total cholesterol, (9) impaired kidney function and (10) air pollution. Risk factor rankings remained similar from 1990 to 2016 despite some substantial declines in burden, including a 47% (± 3%) decline in the age-standardized disability-adjusted life years rate attributable to tobacco since 1990. Risk factors with an increasing contribution to disability-adjusted life years rates from 1990 to 2016 included high body mass index, high fasting plasma glucose and alcohol and drug use. INTERPRETATION Metabolic and behavioural risk factors, including modifiable factors such as tobacco use and diet, remain the leading risk factors contributing to the burden of diseases and injuries in Canada. This work identifies priorities and targets for reducing premature death and disability burden in Canada.
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Affiliation(s)
- Samiah Alam
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Justin J Lang
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Aaron M Drucker
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Carolyn Gotay
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Nicole Kozloff
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Kedar Mate
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Scott B Patten
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Heather M Orpana
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Ashkan Afshin
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Leah E Cahill
- Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass
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Ishihara M, Harel D, Levis B, Levis AW, Riehm KE, Saadat N, Azar M, Rice DB, Sanchez TA, Chiovitti MJ, Cuijpers P, Gilbody S, Ioannidis JP, Kloda LA, McMillan D, Patten SB, Shrier I, Arroll B, Bombardier CH, Butterworth P, Carter G, Clover K, Conwell Y, Goodyear-Smith F, Greeno CG, Hambridge J, Harrison PA, Hudson M, Jetté N, Kiely KM, McGuire A, Pence BW, Rooney AG, Sidebottom A, Simning A, Turner A, White J, Whooley MA, Winkley K, Benedetti A, Thombs BD. Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4. Depress Anxiety 2019; 36:82-92. [PMID: 30238571 PMCID: PMC6321766 DOI: 10.1002/da.22841] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. METHODS Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. RESULTS A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). CONCLUSION The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.
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Affiliation(s)
- Miyabi Ishihara
- Department of Statistics, University of California Berkeley, Berkeley, California, USA
- PRIISM Applied Statistics Center, New York University, New York, New York, USA
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, New York, USA
| | - Daphna Harel
- PRIISM Applied Statistics Center, New York University, New York, New York, USA
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, New York, USA
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Alexander W. Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Kira E. Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Tatiana A. Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Matthew J. Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, VU University, Amsterdam, The Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - John P.A. Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA
| | | | - Dean McMillan
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Scott B. Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Peter Butterworth
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Australia
| | - Gregory Carter
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, New South Wales, Australia
| | - Kerrie Clover
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, New South Wales, Australia
- Psycho-Oncology Service, Calvary Mater Newcastle, New South Wales, Australia
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York
| | | | - Catherine G. Greeno
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Hambridge
- Liaison Psychiatry Department, John Hunter Hospital, Newcastle, Australia
| | | | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kim M. Kiely
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Anthony McGuire
- Department of Nursing, St. Joseph’s College, Standish, Maine, USA
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alasdair G. Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Adam Simning
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, New South Wales, Newcastle, Australia
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | | | - Mary A. Whooley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kirsty Winkley
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
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Abstract
BACKGROUND Depression often occurs in association with stressful events. However, people with depressive disorders may experience episodes in response to minor stressors or "out of the blue." Similar episodes can occur in people who do not have a disorder in response to severe events. This plurality of symptom patterns, occurring as it does in the absence of precise demarcation from normality has led to controversy over how depressive disorders should be defined, how common they are, and when treatment should be offered. Much of the controversy, however, may be illusory, arising from a tendency to view depressive disorders as defects or disease processes (the "clincian's illusion"). Avoiding the illusion involves understanding depression as a defense rather than a defect and requires consideration of aspects of signal detection theory and the associated "smoke detector" principle. This perspective may help to understand aspects of depressive disorders that are otherwise puzzling and controversial. METHODS In this paper, implications of signal detection theory and the "smoke detector principle" are explored: (1) conceptually, (2) using calculations performed in a spreadsheet and (3) using an agent-based model. Depressive episodes are conceptualized or represented as all-or-nothing phenomena activated in response to stressful life events. These events occur in an environment that also includes variable levels of baseline stress, creating a signal detection problem. The agent-based framework allows interaction with the environment as agents attempt to achieve an ideal level of adaptation. RESULTS The smoke detector principle, if valid, may explain otherwise puzzling and controversial features of the depressive disorders, such as their lack of precise demarcation from normality, the role of life events and stressors and their patterns of prevalence. CONCLUSIONS Signal detection concepts help to avoid the "clinician's illusion" in which aspects of functioning of the body's defenses are mistaken for a disease entity or defect. These principles emphasize inevitable difficulties that are encountered in attempts to conceptualize depressive disorders without reference to the environment in which they occur, and without addressing possible stochastic (randomly varying) elements. Because of the "clinicians illusion", current research priorities, as well as diagnosis and treatment strategies, may be flawed.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Department of Psychiatry, University of Calgary. 3rd Floor TRW Building, 3280 Hospital Drive NW, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Calgary, AB, T2N 4Z6, Canada.
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160
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Vallerand IA, Lewinson RT, Parsons LM, Hardin J, Haber RM, Lowerison MW, Barnabe C, Patten SB. Vitiligo and major depressive disorder: A bidirectional population-based cohort study. J Am Acad Dermatol 2018; 80:1371-1379. [PMID: 30528503 DOI: 10.1016/j.jaad.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vitiligo patients often report their mental health has an effect on their skin. However, it is unknown as to whether a common mental disorder, such as major depressive disorder (MDD), can also precipitate the onset of vitiligo. OBJECTIVE Evaluate a bidirectional relationship between MDD and vitiligo using The Health Improvement Network database. METHODS Incident MDD and referent cohorts were followed until the development of vitiligo. Also, incident vitiligo and referent cohorts were followed until the development of MDD. Cox proportional hazards models were used, and numerous covariates were adjusted for. RESULTS In adjusted models, MDD patients (n = 405,397) were at a 64% increased risk for vitiligo (hazard ratio 1.64, 95% confidence interval [CI] 1.43-1.87, P < .0001) compared with the referent cohort (n = 5,739,048). This risk was decreased in patients using antidepressants. Compared with the referent cohort (n = 6,137,696), patients with vitiligo (n = 7104) that were <30 years of age at diagnosis had a higher risk of developing MDD than patients ≥30 years of age (hazard ratio 1.31, 95% CI 1.14-1.50, P < .0001 vs 1.22, 95% CI 1.08-1.37, P = .001, respectively). LIMITATIONS This study did not evaluate the severity of MDD or vitiligo on outcome development. CONCLUSION These results highlight the burden of depression in patients with vitiligo and support the possible existence of pathophysiological connections between these 2 conditions.
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Affiliation(s)
- Isabelle A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Ryan T Lewinson
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Laurie M Parsons
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jori Hardin
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Richard M Haber
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark W Lowerison
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
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161
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Benedetti A, Wu Y, Levis B, Wilchesky M, Boruff J, Ioannidis JPA, Patten SB, Cuijpers P, Shrier I, Gilbody S, Ismail Z, McMillan D, Mitchell N, Ziegelstein RC, Thombs BD. Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis. BMJ Open 2018; 8:e026598. [PMID: 30518594 PMCID: PMC6286470 DOI: 10.1136/bmjopen-2018-026598] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting). METHODS AND ANALYSIS Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. ETHICS AND DISSEMINATION The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy. PROSPERO REGISTRATION NUMBER CRD42018104329.
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Affiliation(s)
- Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Yin Wu
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Machelle Wilchesky
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford School of Medicine, Stanford, California, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology and Amsterdam Public Health research institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Ian Shrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | | | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brett D Thombs
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Dicker D, Nguyen G, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abdurahman AA, Abebe HT, Abebe M, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Aggarwal R, Aghayan SA, Agrawal S, Agrawal A, Ahmadi M, Ahmadi A, Ahmadieh H, Ahmed MLCB, Ahmed S, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Anlay DZ, Ansari H, Ansariadi A, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asadi-Lari M, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Ataro Z, Atey TMM, Athari SS, Atique S, Atre SR, Atteraya MS, Attia EF, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awuah B, Ayala Quintanilla BP, Ayele HT, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Azzopardi-Muscat N, Badali H, Badawi A, Balakrishnan K, Bali AG, Banach M, Banstola A, Barac A, Barboza MA, Barquera S, Barrero LH, Basaleem H, Bassat Q, Basu A, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhala N, Bhatia E, Bhatt S, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Bisanzio D, Biswas T, Bjørge T, Bleyer A, Basara BB, Bose D, Bosetti C, Boufous S, Bourne R, Brady OJ, Bragazzi NL, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha T, Burke KE, Busse R, Butt ZA, Cahuana-Hurtado L, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Çavlin A, Cerin E, Chaiah Y, Champs AP, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chen W, Chiang PPC, Chimed-Ochir O, Chin KL, Chisumpa VH, Chitheer A, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Cohen AJ, Collado-Mateo D, Constantin MM, Conti S, Cooper C, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cucu A, Cunningham M, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Das Gupta R, das Neves J, Dasa TT, Dash AP, Weaver ND, Davitoiu DV, Davletov K, Dayama A, Courten BD, De la Hoz FP, De leo D, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Dellavalle RP, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dhimal M, Ding EL, Djalalinia S, Doku DT, Dolan KA, Donnelly CA, Dorsey ER, Douwes-Schultz D, Doyle KE, Drake TM, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, Elfaramawi M, El-Khatib Z, Ellingsen CL, Elyazar IRF, Enayati A, Endries AYY, Er B, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Fakhar M, Fakhim H, Farag T, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Feyissa GT, Fijabi DO, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Ford JA, Foreman KJ, Fornari C, Frank TD, Franklin RC, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Galan A, Gallus S, Gambashidze K, Gamkrelidze A, Gankpe FG, Garcia-Basteiro AL, Garcia-Gordillo MA, Gebre T, Gebre AK, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gessner BD, Getachew S, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Giussani G, Goenka S, Goli S, Gomez RS, Gomez-Cabrera MC, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Goulart BNG, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haririan H, Haro JM, Hasan M, 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Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Ye P, Yearwood JA, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, York HW, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zachariah G, Zadnik V, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeeb H, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang K, Zhang X, Zhou M, Zhu J, Zodpey S, Zucker I, Zuhlke LJJ, Lopez AD, Gakidou E, Murray CJL. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1684-1735. [PMID: 30496102 PMCID: PMC6227504 DOI: 10.1016/s0140-6736(18)31891-9] [Citation(s) in RCA: 575] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING Bill & Melinda Gates Foundation.
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Lang JJ, Alam S, Cahill LE, Drucker AM, Gotay C, Kayibanda JF, Kozloff N, Mate KKV, Patten SB, Orpana HM. Global Burden of Disease Study trends for Canada from 1990 to 2016. CMAJ 2018; 190:E1296-E1304. [PMID: 30397156 PMCID: PMC6217597 DOI: 10.1503/cmaj.180698] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Global Burden of Disease Study represents a large and systematic effort to describe the burden of diseases and injuries over the past 3 decades. We aimed to summarize the Canadian data on burden of diseases and injuries. METHODS We summarized data from the 2016 iteration of the Global Burden of Disease Study to provide current (2016) and historical estimates for all-cause and cause-specific diseases and injuries using mortality, years of life lost, years lived with disability and disability-adjusted life years in Canada. We also compared changes in life expectancy and health-adjusted life expectancy between Canada and 21 countries with a high sociodemographic index. RESULTS In 2016, leading causes of all-age disability-adjusted life years were neoplasms, cardiovascular diseases, musculoskeletal diseases, and mental and substance use disorders, which together accounted for about 56% of disability-adjusted life years. Between 2006 and 2016, the rate of all-cause age-standardized years of life lost declined by 12%, while the rate of all-cause age-standardized years lived with disability remained relatively stable (+1%), and the rate of all-cause age-standardized disability-adjusted life year declined by 5%. In 2016, Canada aligned with countries that have a similar high sociodemographic index in terms of life expectancy (82 yr) and health-adjusted life expectancy (71 yr). INTERPRETATION The patterns of mortality and morbidity in Canada reflect an aging population and improving patterns of population health. If current trends continue, Canada will continue to face challenges of increasing population morbidity and disability alongside decreasing premature mortality.
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Affiliation(s)
- Justin J Lang
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.
| | - Samiah Alam
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Leah E Cahill
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Aaron M Drucker
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Carolyn Gotay
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Jeanne F Kayibanda
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Nicole Kozloff
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Kedar K V Mate
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Scott B Patten
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
| | - Heather M Orpana
- Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.; Division of Dermatology, Department of Medicine (Drucker), and Department of Psychiatry (Kozloff), University of Toronto; Division of Dermatology, Department of Medicine (Drucker), Women's College Hospital; Women's College Research Institute (Drucker), Toronto, Ont.; School of Population and Public Health (Gotay), University of British Columbia, Vancouver, BC; Institut de la statistique du Québec (Kayibanda), Québec, Que.; Slaight Family Centre for Youth in Transition (Kozloff), Centre for Addiction and Mental Health, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences (Patten) and of Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont
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164
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Lewinson RT, Vallerand IA, LaMothe JM, Parsons LM, Frolkis AD, Lowerison MW, Patten SB, Barnabe C. Increasing Rates of Arthroplasty for Psoriatic Arthritis in the United Kingdom Between 1995 and 2010. Arthritis Care Res (Hoboken) 2018; 71:1525-1529. [PMID: 30354036 DOI: 10.1002/acr.23793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Arthroplasty requirements among patients with psoriatic arthritis (PsA) are not well known. This information is important to clinical and policy stakeholders for health-system planning and may serve as a surrogate for estimation of the efficacy of disease-modifying therapy. METHODS We utilized The Health Improvement Network (THIN), a large general practice medical records database in the UK, to assess rates of primary total arthroplasty among patients with PsA and the general population between the years 1995 and 2010. Linear regression was used to estimate arthroplasty rates for the 2 cohorts during the study period, and Poisson regression was used to determine age- and sex-adjusted incidence rate ratios (IRRs) between the PsA and general population cohorts. RESULTS We identified 5,619 patients with incident PsA and 5,090,814 eligible patients from the general population between 1995 and 2010. In total, 187 primary total arthroplasties were documented in patients with PsA, and 80,163 primary total arthroplasties were documented in the general population. A trend of increasing arthroplasty rates was observed for both the PsA (R2 = 0.809; P < 0.0001) and general population (R2 = 0.890; P < 0.0001) cohorts during the study period. After adjustment for age and sex, patients with PsA had a first arthroplasty incidence rate that was twice that of the general population (IRR 2.01 [95% confidence interval 1.73-2.34]; P < 0.0001), notably beyond the year 2003 when biologic therapies were introduced. CONCLUSION Both the general population and patients with PsA have experienced increasing rates of first arthroplasty from 1995 to 2010, although the overall incidence rate was significantly higher for those with PsA.
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Affiliation(s)
- Ryan T Lewinson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeremy M LaMothe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurie M Parsons
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mark W Lowerison
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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165
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Pham T, Jetté N, Bulloch AGM, Burton JM, Wiebe S, Patten SB. The prevalence of anxiety and associated factors in persons with multiple sclerosis. Mult Scler Relat Disord 2018; 19:35-39. [PMID: 29125968 DOI: 10.1016/j.msard.2017.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/22/2017] [Accepted: 11/02/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalence of anxiety and its association with sociodemographic and clinical factors is not well characterized in those with multiple sclerosis (MS). We aimed to estimate the prevalence and examine associated factors of anxiety in persons with MS. METHODS A cross-sectional analysis was conducted utilizing data from 244 participants from the Neurological Disease and Depression study. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics and multiple logistic regression was used to examine anxiety and associated factors. RESULTS Nearly 30.0% of participants had anxiety according to the HADS. The most prevalent symptom of anxiety was "worrying thoughts" (26.6%). After adjustment for various confounders, depression (OR: 7.31 95% CI 3.29-16.26) was found to be associated with higher odds of anxiety, while lower odds of anxiety were associated with higher education (OR: 0.51, 95% CI 0.28-0.94). Furthermore, anxiety was strongly associated with decreased quality of life. CONCLUSION Anxiety represents a substantial burden for those with MS and is associated with a variety of adverse outcomes including decreased quality of life. Our results further emphasize the importance of understanding the impact of anxiety in this population.
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Affiliation(s)
- Tram Pham
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; The Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; The Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
| | - Andrew G M Bulloch
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
| | - Jodie M Burton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; The Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; The Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
| | - Scott B Patten
- The Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
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166
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Bernstein CN, Zhang L, Lix LM, Graff LA, Walker JR, Fisk JD, Patten SB, Hitchon CA, Bolton JM, Sareen J, El-Gabalawy R, Marriott J, Marrie RA. The Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1867-1875. [PMID: 29668911 PMCID: PMC6124738 DOI: 10.1093/ibd/izy068] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We evaluated the validity and reliability of multiple symptom scales for depression and anxiety for persons with inflammatory bowel disease (IBD). METHODS IBD participants in a cohort study completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) and completed the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Kessler-6 Distress Scale, PROMIS Emotional Distress Depression Short-Form 8a (PROMIS Depression) and Anxiety Short-Form 8a (PROMIS Anxiety), Generalized Anxiety Disorder 7-item Scale, and Overall Anxiety and Severity Impairment Scale. We computed sensitivity, specificity, and positive and negative predictive values for the screening measures with the SCID diagnoses as the reference standard, conducted receiver operating curve (ROC) analysis, and assessed internal consistency and test-retest reliability. RESULTS Of 242 participants, the SCID classified 8.7% as having major depression and 17.8% as having anxiety disorders. Among the depression scales, the PHQ-9 had the highest sensitivity (95%). Specificity was generally higher than sensitivity and was highest for the HADS-D (cut-point of 11; 97%). The area under the ROC curve (AUC) did not differ significantly among depression scales. Among the anxiety scales, sensitivity was highest for the PROMIS (79%). Specificity ranged from 82% to 88% for all tools except the HADS-A (cut-point of 8; 65%). The AUC did not differ between depression and anxiety tools. CONCLUSIONS Overall, the symptom scales for depression and anxiety were similar in their psychometric properties. The anxiety scales did not perform as well as the depression scales. Alternate cut-points may be more relevant when these scales are used in an IBD sample.
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Affiliation(s)
| | - Lixia Zhang
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - John R Walker
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
- Departments of Anesthesia and Perioperative Medicine, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Marriott
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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167
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Orr J, Bernstein CN, Graff LA, Patten SB, Bolton JM, Sareen J, Marriott JJ, Fisk JD, Marrie RA. Factors associated with perceived need for mental health care in multiple sclerosis. Mult Scler Relat Disord 2018; 25:179-185. [PMID: 30096684 DOI: 10.1016/j.msard.2018.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Within the multiple sclerosis (MS) population, depression and anxiety are highly prevalent comorbidities that are associated with adverse outcomes such as diminished quality of life and disability progression. In the general population, many people who do not meet formal diagnostic criteria for depression or anxiety disorders still identify a need for mental health care. Limited data are available regarding the perceived need for mental health care among persons with MS. OBJECTIVE We aimed to determine factors associated with a perceived need for mental health care in the MS population. METHODS Participants with MS completed the Hospital Anxiety and Depression Scale (HADS) to assess severity of depression and anxiety symptoms, and reported whether they perceived a need for mental health care, in the context of a larger study examining the burden of psychiatric disorders in immune-mediated inflammatory disease. Participants were also evaluated using the Structured Clinical Interview for DSM-IV-TR (SCID) to diagnose depression or anxiety disorders. Participants reported their sociodemographic characteristics, and underwent physical assessments to determine their disability status. Descriptive analyses and binary logistic regression models were used to determine sociodemographic and clinical factors associated with perceived need for mental health care. RESULTS Of 255 participants enrolled, 251 were included in this analysis. Most participants were women, Caucasian, with post-secondary education, with a mean (SD) age at enrollment of 50.9 (12.9) years. They predominantly had a relapsing-remitting MS course. Nearly one-quarter of participants had a current SCID diagnosis of depression or anxiety (n = 57, 22.7%). Overall, 31.8% (n = 80) of participants reported a need for mental health care. These individuals were slightly younger at enrollment (p = 0.037), but otherwise did not differ with respect to sociodemographic characteristics, compared to participants not reporting this need. Those identifying need for mental health care also had an earlier age of MS symptom onset (p = 0.011). After adjusting for sociodemographic and clinical factors, elevated symptoms of depression (odds ratio [OR] 2.36; 95%CI: 1.06, 5.25) and anxiety (OR 6.08; 95%CI: 2.78, 13.3) were associated with an increased likelihood of reporting a need for mental health care. Any current SCID diagnosis of depression or anxiety was not associated with perceived need for mental health care after accounting for symptoms of depression and anxiety. CONCLUSIONS One-third of people with MS identified a need for mental health care. Symptoms of anxiety and depression, but not current diagnosed mental health disorders, were the predominant factors associated with a perceived need for care.
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Affiliation(s)
- Justine Orr
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Ruth Ann Marrie
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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168
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McIntyre L, Kwok C, Patten SB. The effect of child hunger on educational attainment and early childbearing outcomes in a longitudinal population sample of Canadian youth. Paediatr Child Health 2018; 23:e77-e84. [PMID: 30046272 DOI: 10.1093/pch/pxx177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Early childhood experiences of poverty are associated with adverse developmental outcomes that have impli cations for individual and population health. Low educational attainment and early childbearing are two such important outcomes that can perpetuate childhood poverty into adulthood. Child hunger, or severe food insecurity, is an extreme manifestation of household food insecurity that is associated with the stressful experience of deep family poverty. Life-course theories suggest that childhood experiences of hunger could have adverse effects in the developmental pathway. The objective of this study was to examine the independent contribution of the child hunger experience to subsequent educational attainment and early childbearing in young adult men and women, in consideration of other latent, cumulative or shock effects associated with child poverty. Methods We analyzed National Longitudinal Survey of Children and Youth data using logistic regression based on 15,468 Canadian children followed over 16 years. Results The prevalence of the experience of child hunger was 5.0%. Child hunger was independently predictive of youth leaving high school, yet was not a factor in the achievement of higher educational attainment if youth were able to graduate from high school. Having always lived in rental accommodation and repeated reports of child hunger over time were predictive of early childbearing. Conclusions Interventions directed at children and youth who are at risk of poor developmental outcomes because of severe food insecurity should focus on steering families toward their income entitlements, and providing support for youth to complete high school and to avoid early fertility.
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Affiliation(s)
- Lynn McIntyre
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Cynthia Kwok
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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169
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Litster B, Bernstein CN, Graff LA, Walker JR, Fisk JD, Patten SB, Bolton JM, Sareen J, El-Gabalawy R, Marrie RA. Validation of the PHQ-9 for Suicidal Ideation in Persons with Inflammatory Bowel Disease. Inflamm Bowel Dis 2018. [PMID: 29522100 DOI: 10.1093/ibd/izy032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide. Transition from suicidal ideation (SI) to suicide attempt is high within a year of SI onset. The risk of suicide and SI is elevated in persons with inflammatory bowel disease (IBD) versus the general population. We aimed to validate the Patient Heath Questionnaire (PHQ)-9 as a screening tool for SI in IBD and to determine factors associated with SI in IBD. METHODS IBD participants (n = 247) recruited from the community and clinics completed the PHQ-9 and participated in the Structured Clinical Interview for DSM-IV (SCID). We determined the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of the PHQ-9 in identifying SI as compared to the SCID. Using logistic regression we examined the association of SI with demographic and clinical factors. RESULTS SI was endorsed by 24 (9.7%) participants on the PHQ-9 and 5 (2.0%) based on the SCID. The PHQ-9 had good sensitivity (100%), specificity (92.2%), and NPV (100%) but low PPV (20.8%) for SI. On univariate analysis, factors strongly associated with SI were depression (OR 13.1; 95%CI: 4.46, 40.5), anxiety (OR 11.3; 95%CI: 4.46, 28.6), and active disease (OR 3.87; 95%CI: 1.54, 9.71). On multivariable analysis, depression (OR 5.54; 95%CI: 1.67, 18.4) and pain (OR 1.14; 95%CI: 1.03, 1.25) were associated with SI. CONCLUSIONS Overall the PHQ-9 is a valid screening tool for SI in IBD patients, and routine implementation of this tool would support screening for depression and SI effectively and efficiently in clinical practice.
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Affiliation(s)
- Brittany Litster
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - John R Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, CAN
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, CAN
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.,Department of Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.,Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
| | - R A Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.,Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN
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170
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Vallerand IA, Lewinson RT, Frolkis AD, Lowerison MW, Kaplan GG, Swain MG, Bulloch AGM, Patten SB, Barnabe C. Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study. RMD Open 2018; 4:e000670. [PMID: 30018804 PMCID: PMC6045711 DOI: 10.1136/rmdopen-2018-000670] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 12/29/2022] Open
Abstract
Objectives Major depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA. Methods A retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use. Results A cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA. Conclusion MDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.
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Affiliation(s)
- Isabelle A Vallerand
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ryan T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra D Frolkis
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark W Lowerison
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark G Swain
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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171
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Marrie RA, Hitchon CA, Walld R, Patten SB, Bolton JM, Sareen J, Walker JR, Singer A, Lix LM, El‐Gabalawy R, Katz A, Fisk JD, Bernstein CN. Increased Burden of Psychiatric Disorders in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:970-978. [PMID: 29438604 PMCID: PMC6033023 DOI: 10.1002/acr.23539] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We estimated the incidence and prevalence of depression, anxiety disorder, bipolar disorder, and schizophrenia in a population-based cohort with rheumatoid arthritis (RA) as compared to an age-, sex-, and geographically matched cohort without RA. METHODS Using population-based administrative health data from Manitoba, Canada, we identified persons with incident RA between 1989 and 2012, and a cohort from the general population matched 5:1 on year of birth, sex, and region of residence. We applied validated algorithms for depression, anxiety disorder, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions after the diagnosis of RA, and their lifetime and annual period prevalence. We compared findings between cohorts using negative binomial regression models. RESULTS We identified 10,206 incident cases of RA and 50,960 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, number of physician visits, and year, the incidence of depression was higher in the RA cohort over the study period (incidence rate ratio [IRR] 1.46 [95% confidence interval (95% CI) 1.35-1.58]), as was the incidence of anxiety disorder (IRR 1.24 [95% CI 1.15-1.34]) and bipolar disorder (IRR 1.21 [95% CI 1.00-1.47]). The incidence of schizophrenia did not differ between groups (IRR 0.96 [95% CI 0.61-1.50]). Incidence rates of psychiatric disorders declined minimally over time. The lifetime and annual period prevalence of depression and anxiety disorder were also higher in the RA than in the matched cohort over the study period. CONCLUSION The incidence and prevalence of depression, anxiety disorder, and bipolar disorder are elevated in the RA population as compared to a matched population.
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Affiliation(s)
- Ruth Ann Marrie
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Carol A. Hitchon
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Randy Walld
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Scott B. Patten
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - James M. Bolton
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Jitender Sareen
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - John R. Walker
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Alexander Singer
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Lisa M. Lix
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Renée El‐Gabalawy
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Alan Katz
- Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
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172
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Ismail Z, Pham T, Smith EE, Patten SB, Atta C, Bulloch A, Fiest KM, Sajobi T, Wang M, Wiebe S, Jette N. P2‐293: IS DEPRESSION REALLY DEPRESSION IN A MEMORY CLINIC? PREVALENCE, SCREENING AND DIAGNOSTIC ISSUES IN NEUROCOGNITIVE DISORDERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Zahinoor Ismail
- University of CalgaryCumming School of MedicineCalgaryABCanada
| | - Tram Pham
- University of British ColumbiaVancouverBCCanada
| | | | | | | | | | | | | | - Meng Wang
- University of CalgaryCalgaryABCanada
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173
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Abstract
BACKGROUND Use of second-generation antipsychotics (SGA) has increased in recent years; however, their use and effect on metabolic outcomes has been poorly characterised in population-level studies.AimsThis study aimed to determine the associations between SGA use and metabolic indicators in a general population. METHOD We used data from the Canadian Health Measures Survey, a cross-sectional survey of Canadian households. Participants were Canadians aged 3-79 years, living in one of the ten provinces. Several metabolic indicators were examined, including weight, body mass index, waist circumference, hypertension, diabetes and two definitions of metabolic syndrome. RESULTS The proportion of Canadians taking an SGA tripled over the study period. SGA use was significantly associated with hypertension (odds ratio 1.94, 95% CI 1.07-3.55) and abdominal obesity in adults, as defined by the National Cholesterol Education Program-Adult Treatment Panel III (odds ratio 2.62, 95% CI 1.45-4.71). CONCLUSIONS Evidence of metabolic dysfunction with SGAs is seen in the Canadian population, along with a rapid increase in prevalence of use since 2007.Declaration of interestNone.
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Affiliation(s)
- Lauren Hirsch
- Medical Student, Department of Community Health Sciences,Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary,Canada
| | - Scott B Patten
- Professor, Department of Community Health Sciences,Hotchkiss Brain Institute,Department of Clinical Neurosciences, andO'Brien Institute of Public Health, University of Calgary,Canada
| | - Lauren Bresee
- Adjunct Assistant Professor, Department of Community Health SciencesandO'Brien Institute of Public Health, University of Calgary,Canada
| | - Nathalie Jette
- Professor, Department of Community Health Sciences,Hotchkiss Brain Institute,Department of Clinical Neurosciences, andO'Brien Institute of Public Health, University of Calgary,Canada
| | - Tamara Pringsheim
- Associate Professor, Department of Community Health Sciences,Hotchkiss Brain InstituteandDepartment of Clinical Neurosciences,University of Calgary,Canada
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174
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Josephson CB, Engbers JDT, Jette N, Patten SB, Sajobi TT, Marshall D, Lowerison M, Wiebe S. Prescription trends and psychiatric symptoms following first receipt of one of seven common antiepileptic drugs in general practice. Epilepsy Behav 2018; 84:49-55. [PMID: 29753294 DOI: 10.1016/j.yebeh.2018.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 11/15/2022]
Abstract
We sought to examine the risk of psychiatric symptoms associated with a first prescription for specific antiepileptic drugs (AEDs) used in monotherapy in a general cohort of patients with epilepsy. We used The Health Improvement Network database (comprising the years 2000-2012) to identify incident patients with epilepsy. The index date was that on which they met the case definition for epilepsy, and analyses only included patients who remained on monotherapy or received no AED therapy following diagnosis to avoid confounding by polytherapy. Psychiatric symptoms were defined using mental health clinical or treatment (medical or therapeutic) code. We analyzed the AED of interest as a time-varying covariate in multivariate Cox proportional hazard regression models controlling for confounding factors. We identified 9595 patients with incident epilepsy, 7400 of whom (77%) received a first-recorded AED prescription. Prescriptions for newer generation AEDs (lamotrigine and levetiracetam) steadily increased (constituting over 30% of all AED prescriptions by 2012) while valproate use significantly declined in females (~40% in 2002 to just over 20% by 2012). A total of 2190 patients were first exposed to carbamazepine (29.3%) and 222 to lamotrigine (3%), both of which were associated with a lower hazard of any coded psychiatric symptom or disorder in multivariate analyses (hazard ratio [HR]: 0.84, 95% confidence interval [95% CI]: 0.73-0.97; p = 0.02 and HR: 0.83, 95% CI: 0.70-0.99; p = 0.03, respectively, for carbamazepine and lamotrigine). Carbamazepine was also associated with a lower hazard for depression (HR: 0.81; 95% CI: 0.69-0.96; p = 0.013) and anxiety (HR: 0.77; 95% CI: 0.63-0.95; p = 0.013) in secondary analyses. This study provides evidence that carbamazepine and lamotrigine are associated with lower hazards for psychiatric symptoms following a diagnosis of epilepsy. These estimates can be used in clinical settings, and the precision should improve with more contemporary data that include larger proportions of newer generation AEDs.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | | | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Deborah Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Mark Lowerison
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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175
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Marrie RA, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Psychiatric comorbidity increases mortality in immune-mediated inflammatory diseases. Gen Hosp Psychiatry 2018; 53:65-72. [PMID: 29929117 DOI: 10.1016/j.genhosppsych.2018.06.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We determined the association between any common mental disorder (CMD: depression, anxiety disorder, bipolar disorder) and mortality and suicide in three immune-mediated inflammatory diseases (IMID), inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), versus age-, sex- and geographically-matched controls. METHODS Using administrative data, we identified 28,384 IMID cases (IBD: 8695; MS: 5496; RA: 14,503) and 141,672 matched controls. We determined annual rates of mortality, suicide and suicide attempts. We evaluated the association of any CMD with all-cause mortality and suicide using multivariable Cox regression models. RESULTS In the IMID cohort, any CMD was associated with increased mortality. We observed a greater than additive interaction between depression and IMID status (attributable proportion 5.2%), but a less than additive interaction with anxiety (attributable proportion -13%). Findings were similar for MS and RA. In IBD, a less than additive interaction existed with depression and anxiety on mortality risk. The IMID cohort with any CMD had an increased suicide risk versus the matched cohort without CMD. CONCLUSION CMD are associated with increased mortality and suicide risk in IMID. In MS and RA, the effects of depression on mortality risk are greater than associations of these IMID and depression alone.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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176
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Hetherington E, McDonald S, Williamson T, Patten SB, Tough SC. Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. J Epidemiol Community Health 2018; 72:933-939. [PMID: 29921649 DOI: 10.1136/jech-2017-210274] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/25/2018] [Accepted: 05/28/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important. METHODS Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health. RESULTS Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety. CONCLUSION Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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177
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Lewinson RT, Vallerand IA, Parsons LM, LaMothe JM, Frolkis AD, Lowerison MW, Kaplan GG, Patten SB, Barnabe C. Psoriasis and the risk of foot and ankle tendinopathy or enthesopathy in the absence of psoriatic arthritis: a population-based study. RMD Open 2018; 4:e000668. [PMID: 29862046 PMCID: PMC5976107 DOI: 10.1136/rmdopen-2018-000668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/02/2018] [Accepted: 05/01/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Imaging studies in patients with cutaneous psoriasis have demonstrated asymptomatic bone and tendon changes, commonly of the foot and ankle. We sought to determine if patients with cutaneous psoriasis have an increased risk of clinically significant foot and ankle tendinopathy or enthesopathy compared with the general population. Methods Patients with cutaneous psoriasis and a general population cohort were identified in The Health Improvement Network, a general practice medical records database from the UK. All patients with psoriatic arthritis were excluded. Cox proportional-hazards models (α=0.05) estimated the HR for development of foot and ankle tendinopathy or enthesopathy among patients with psoriasis, with adjustment for numerous covariates. Results In total, 78 630 patients with cutaneous psoriasis and 5 983 338 persons from the general population were identified. In an unadjusted model, patients with cutaneous psoriasis had a 25% increased risk of developing foot and ankle tendinopathy or enthesopathy compared with the general population (HR 1.25, 95% CI 1.20 to 1.30, p<0.0001). The HR remained unchanged and statistically significant after adjusting for covariates, and in sensitivity analyses. Conclusions These data suggest that patients with psoriasis can have foot and ankle tendinopathy or enthesopathy without having psoriatic arthritis, presenting a diagnostic challenge to physicians. Further research is needed to elucidate mechanisms contributing to this increased risk.
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Affiliation(s)
- Ryan T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle A Vallerand
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurie M Parsons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeremy M LaMothe
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra D Frolkis
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark W Lowerison
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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178
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Levis B, Benedetti A, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Chiovitti MJ, Sanchez TA, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Steele RJ, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Beraldi A, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Chowdhary N, Clover K, Conwell Y, de Man-van Ginkel JM, Delgadillo J, Fann JR, Fischer FH, Fischler B, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Hambridge J, Harrison PA, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Isamail K, Jetté N, Khamseh ME, Kiely KM, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, Marsh L, McGuire A, Sidik SM, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van der Feltz-Cornelis CM, van Weert HC, Vöhringer PA, White J, Whooley MA, Winkley K, Yamada M, Zhang Y, Thombs BD. Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews. Br J Psychiatry 2018; 212:377-385. [PMID: 29717691 PMCID: PMC6415695 DOI: 10.1192/bjp.2018.54] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics. METHOD Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit. RESULTS A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15-3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98-10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7-15) (OR = 0.96; 95% CI = 0.56-1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26-0.97). CONCLUSIONS The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
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Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Andrea Benedetti
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve, Office/Workstation # 3D.59, Montréal, QC, H4A 3S5, Canada
| | - Kira E. Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Alexander W. Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Matthew J. Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Tatiana A. Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences and Hull York Medical School, University of York, Heslington YO10 5DD, United Kingdom
| | | | - Lorie A. Kloda
- Concordia University, 1455, boul. de Maisonneuve Ouest, FB-802, Montréal, QC, H3G 1M8, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences and Hull York Medical School, University of York, Heslington YO10 5DD, United Kingdom
| | - Scott B. Patten
- Department of Community Health Sciences, 3rd Floor, TRW Building, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Rd, Montréal, QC, H3T 1E2, Canada
| | - Russell J. Steele
- Department of Mathematics and Statistics, McGill University, 805 Rue Sherbrooke O., Montreal, QC, H3A 0B9, Canada
| | - Roy C. Ziegelstein
- Johns Hopkins University School of Medicine, Miller Research Building, 733 N. Broadway, Suite 115, Baltimore, MD, 21205, USA
| | - Dickens H. Akena
- Department of Psychiatry, Makerere University College of Health Sciences, P.O.Box 7062 Kampala, Uganda
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Ramat Gan, Bar Ilan University, 52900, Israel
| | - Hamid R. Baradaran
- Endocrinology and Metabolism Research Institute, Shariati Hospital Complex, North Kargar Avenue, Tehran, 14114-13137, Iran
| | - Murray Baron
- Jewish General Hospital, Suite A 725, 3755 Cote St Catherine Rd, Montréal, QC, H3T 1E2, Canada
| | - Anna Beraldi
- Auenstraße 6, D-82467 Garmisch-Partenkirchen, Germany
| | - Charles H. Bombardier
- Division of Clinical and Neuropsychology, Department of Rehabilitation Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Peter Butterworth
- Centre for Mental Health, Level 4, 207 Bouverie St, The University of Melbourne, Victoria 3010, Australia
| | - Gregory Carter
- Locked Bag #7, Hunter Region Mail Centre, NSW 2310, Australia
| | - Marcos H. Chagas
- University of São Paulo, Av. Bandeirantes, 3900, 14048-900-Ribeirão Preto, SP, Brazil
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Rushina Cholera
- UNC School of Medicine, Department of Pediatrics, CB# 7593, Chapel Hill, NC, 27599-7593, USA
| | - Neerja Chowdhary
- World Health Organization. Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Kerrie Clover
- Psycho-oncology #51, Calvary Mater Newcastle, Platt St, Waratah NSW 2301, Australia
| | - Yeates Conwell
- University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Janneke M. de Man-van Ginkel
- University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jaime Delgadillo
- Clinical Psychology Unit, University of Sheffield, Cathedral Court, Floor F, 1 Vicar Lane, Sheffield, S1 1HD, United Kingdom
| | - Jesse R. Fann
- Department of Psychiatry & Behavioral Sciences, Univerisity of Washington, Box 356560, Seattle, WA 98195
| | - Felix H. Fischer
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10098 Berlin, Germany
| | | | - Daniel Fung
- Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Bizu Gelaye
- Department of Epidemiology, 677 Huntington Ave, Room 505F, Boston, MA, 02115, USA
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, PB 92019, Auckland, 1142, New Zealand
| | - Catherine G. Greeno
- 2204 Cathedral of Learning, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Brian J. Hall
- Department of Psychology, Faculty of Social Sciences, Humanities and Social Sciences Building E21-3040, University of Macau, E21 Avenida da Universidade, Taipa, Macau, China
| | | | - Patricia A. Harrison
- City of Minneapolis Health Department, 250 S. Fourth St., Room 510, Minneapolis, MN 55415, USA
| | - Ulrich Hegerl
- University of Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Leanne Hides
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, 4072, Australia
| | - Stevan E. Hobfoll
- 1645 W. Jackson Blvd, Suite 400, Dept of Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60614, USA
| | - Marie Hudson
- Jewish General Hospital and Lady Davis Research Institute, 3755 Côte Ste-Catherine Rd, Room A725, Montréal, QC, H3T 1E2, Canada
| | - Thomas Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 451 10, Greece
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Khalida Isamail
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9AF, United Kingdom
| | - Nathalie Jetté
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, T2N 2T9, Canada
| | - Mohammad E. Khamseh
- Endocrinology and Metabolism Research Institute, Shariati Hospital Complex, North Kargar Avenue, Tehran, 14114-13137, Iran
| | - Kim M. Kiely
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Building 54 Mills Road, ACT 2601, Australia
| | - Femke Lamers
- VU University Medical Center, Department Psychiatry, A.J. Ernststraat 1187, room D2.14, 1081 HL Amsterdam, The Netherlands
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, Taiwan
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sonia R. Loureiro
- Rua Tenente Catão Roxo, 2650, CEP 14051-140, Ribeirão Preto, SP, Brazil
| | - Bernd Löwe
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Martinistr. 52, Gebäude O25, 20246 Hamburg, Germany
| | - Laura Marsh
- Mental Health Care Line, Michael E DeBakey VA Medical Center, Departments of Psychiatry and Neurology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Sherina Mohd Sidik
- Cancer Resource & Education Centre / Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Tiago N. Munhoz
- Depto Medicina Social, Programa Pós-graduação Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3º piso, 96020-220 - Pelotas, RS, Brasil
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, 1-5939, Suidocho, Chuo-ku, Niigata 951-8121, Japan
| | - Flávia L. Osório
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Avenida dos Bandeirantes 3900- 3 andar- alaC. Ribeirão Preto - São Paulo - Brasil - CEP 14049-900
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA 02119, USA
| | - Brian W. Pence
- Department of Epidemiology, UNC-Chapel Hill, McGavran-Greenberg 2103C, CB#7435, 135 Dauer Dr, Chapel Hill NC 27599-7435, USA
| | - Philippe Persoons
- Katholieke Universiteit Leuven, Department of Neurosciences, Research Group Psychiatry, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Angelo Picardi
- Italian National Institute of Health, Centre for Behavioural Sciences and Mental Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alasdair G. Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital Edinburgh, EH10 5HF, Scotland
| | - Iná S. Santos
- Depto Medicina Social, Programa Pós-graduação Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3º piso 96020-220 - Pelotas, RS, Brasil
| | - Juwita Shaaban
- School of Medical Science, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abbey Sidebottom
- Allina Health, 800 E 28th Street, MR 15521, Minneapolis, MN 55407-3799, USA
| | - Adam Simning
- Strong Behavioral Health, 300 Crittenden Blvd, Rochester, NY, 14642, USA
| | - Lesley Stafford
- Centre for Women’s Mental Health, The Royal Women’s Hospital, Locked Bag 300, Parkville Victoria 3052, Australia
| | - Sharon Sung
- Office of Clinical Sciences, Duke-NUS Medical School, 20 College Road, Level 6, 169856, Singapore
| | | | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | | | - Henk C. van Weert
- Dpt. General Practice, Academic Medical Centre Amsterdam, Meibergdree 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Jennifer White
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Sciences, Monash University, Kingston Centre, 400 Warrigal Rd, Cheltenham Victoria 3192, Australia
| | - Mary A. Whooley
- Department of Veterans Affairs Medical Center, 4150 Clement Street (111A1), San Francisco, CA 94121, USA
| | - Kirsty Winkley
- King’s College London & Institute of Psychiatry, Psychology & Neuroscience, Weston Education Centre, London SE5 9RS, UK
| | - Mitsuhiko Yamada
- National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Yuying Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Brett D. Thombs
- Room 302, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Cote Ste Catherine Road, Montréal, QC, H3T 1E4, Canada
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Goodkin K, Patten SB. Depressive Symptomatology, Syndromal Depression, and HIV-Associated Neurocognitive Disorder (HAND). Can J Psychiatry 2018; 63:284-286. [PMID: 29668329 PMCID: PMC5912305 DOI: 10.1177/0706743718754537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karl Goodkin
- 1 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Scott B Patten
- 2 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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180
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Prisnie JC, Sajobi TT, Wang M, Patten SB, Fiest KM, Bulloch AGM, Pringsheim T, Wiebe S, Jette N. Effects of depression and anxiety on quality of life in five common neurological disorders. Gen Hosp Psychiatry 2018; 52:58-63. [PMID: 29684713 DOI: 10.1016/j.genhosppsych.2018.03.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether anxiety and depression impact health-related quality of life (HRQoL) equally across neurological diseases. This study examines the association between anxiety or depression and HRQoL in select neurological disorders. METHODS HRQoL was measured using the Short Form Health Survey (SF-12) in neurological patients: epilepsy (n = 279), migraine (n = 268), multiple sclerosis (MS) (n = 222), stroke (n = 204), and Parkinson's disease (PD) (n = 224). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and Hospital Anxiety and Depression Scale (HADS-A), respectively. Multiple linear regression was used to evaluate variables associated with the SF-12 mental health component (MCS) and physical health component scores (PCS). Pratt index was used to estimate the relative importance of anxiety and depression on HRQoL. RESULTS Anxiety and depression had the largest contribution to PCS in stroke and to MCS in epilepsy. Overall, anxiety and depression had a larger contribution to MCS as compared to PCS, except in stroke patients. Different patterns were seen across neurological diseases, with mental health variables strongly affecting MCS in all conditions, with also a sizable contribution to PCS in migraine, MS, and stroke. CONCLUSIONS Anxiety and depression have varying impacts on HRQoL across neurological diseases. It is important for clinicians to be aware of how these patterns differ in each condition.
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Affiliation(s)
- Joey C Prisnie
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Tolulope T Sajobi
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Meng Wang
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research, University of Calgary, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada; Department of Critical Care Medicine, University of Calgary, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research, University of Calgary, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, United States.
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181
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Kadhim S, Pringsheim T, Le A, Fiest KM, Patten SB, Prisnie JC, Gill S, Bulloch AGM, Hu B, Jette N. Validating screening tools for depression in Parkinson's disease. Mov Disord 2018; 33:1184-1186. [PMID: 29573354 DOI: 10.1002/mds.27371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sandra Kadhim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada
| | - Anne Le
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Critical Care Medicine, University of Calgary, Alberta, Canada
| | - Scott B Patten
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Joey C Prisnie
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Stephanie Gill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Andrew G M Bulloch
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Bin Hu
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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182
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Pelletier L, Shanmugasegaram S, Patten SB, Demers A. Self-management of mood and/or anxiety disorders through physical activity/exercise. Health Promot Chronic Dis Prev Can 2018; 37:149-159. [PMID: 28493659 DOI: 10.24095/hpcdp.37.5.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Physical activity/exercise is regarded as an important self-management strategy for individuals with mental illness. The purpose of this study was to describe individuals with mood and/or anxiety disorders who were exercising or engaging in physical activity to help manage their disorders versus those who were not, and the facilitators for and barriers to engaging in physical activity/exercise. METHODS For this study, we used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. Selected respondents (n = 2678) were classified according to the frequency with which they exercised: (1) did not exercise; (2) exercised 1 to 3 times a week; or (3) exercised 4 or more times a week. We performed descriptive and multinomial multiple logistic regression analyses. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. RESULTS While 51.0% of the Canadians affected were not exercising to help manage their mood and/or anxiety disorders, 23.8% were exercising from 1 to 3 times a week, and 25.3% were exercising 4 or more times a week. Increasing age and decreasing levels of education and household income adequacy were associated with increasing prevalence of physical inactivity. Individuals with a mood disorder (with or without anxiety) and those with physical comorbidities were less likely to exercise regularly. The most important factor associated with engaging in physical activity/exercise was to have received advice to do so by a physician or other health professional. The most frequently cited barriers for not exercising at least once a week were as follows: prevented by physical condition (27.3%), time constraints/too busy (24.1%) and lack of will power/self-discipline (15.8%). CONCLUSION Even though physical activity/exercise has been shown beneficial for depression and anxiety symptoms, a large proportion of those with mood and/or anxiety disorders did not exercise regularly, particularly those affected by mood disorders and those with physical comorbidities. It is essential that health professionals recommend physical activity/exercise to their patients, discuss barriers and support their engagement.
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Affiliation(s)
| | | | - Scott B Patten
- Department of Community Health Sciences & Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Alain Demers
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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183
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McKay KA, Tremlett H, Fisk JD, Zhang T, Patten SB, Kastrukoff L, Campbell T, Marrie RA. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology 2018. [PMID: 29523642 DOI: 10.1212/wnl.0000000000005302] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population. METHODS This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multivariable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores. RESULTS A total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (β coefficient = 0.28, p = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (β coefficient = 0.31, p = 0.0004), but not men (β coefficient 0.22, p = 0.17). CONCLUSION Presence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.
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Affiliation(s)
- Kyla A McKay
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Tingting Zhang
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lorne Kastrukoff
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Trudy Campbell
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Marrie RA, Walld R, Bolton JM, Sareen J, Walker JR, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Physical comorbidities increase the risk of psychiatric comorbidity in immune-mediated inflammatory disease. Gen Hosp Psychiatry 2018; 51:71-78. [PMID: 29353127 DOI: 10.1016/j.genhosppsych.2018.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We tested the association between physical comorbidity and incident depression, anxiety disorder and bipolar disorder in three immune-mediated inflammatory diseases (IMID): inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus age-, sex- and geographically-matched controls. METHODS Using population-based administrative data we identified 6119 persons with IBD, 3514 persons with MS, 10,206 persons with RA and 97,727 matched controls. We identified incident cases of depression, anxiety disorder and bipolar disorder in these populations. We evaluated the association of physical comorbidities with incident psychiatric comorbidity using Cox regression, adjusting for sociodemographic factors and index year. RESULTS The risk of incident depression, anxiety disorders and bipolar disorder was higher in each IMID cohort versus their matched cohorts. The risk of incident psychiatric comorbidity increased with an increasing number of physical comorbidities for each psychiatric comorbidity evaluated, across all IMID. Adjustment for physical comorbidity did not attenuate the increased risk of psychiatric comorbidity in the IMID cohorts versus their matched cohorts. CONCLUSION The increased incidence of psychiatric comorbidity in IMID versus matched general population cohorts is not accounted for by their increased prevalence of physical comorbidities. However, within IMID cohorts, physical comorbidity increases the risk of psychiatric comorbidity.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John R Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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185
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Marrie RA, Patten SB, Berrigan LI, Tremlett H, Wolfson C, Warren S, Leung S, Fiest KM, McKay KA, Fisk JD. Diagnoses of Depression and Anxiety Versus Current Symptoms and Quality of Life in Multiple Sclerosis. Int J MS Care 2018; 20:76-84. [PMID: 29670493 PMCID: PMC5898919 DOI: 10.7224/1537-2073.2016-110] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies assessing the prevalence of depression and anxiety in multiple sclerosis (MS) have used various ascertainment methods that capture different constructs. The relationships between these methods are incompletely understood. Psychiatric comorbidity is associated with lower health-related quality of life (HRQOL) in MS, but the effects of past diagnoses of depression and anxiety on HRQOL are largely unknown. We compared the prevalence of depression and anxiety in persons with MS using administrative data, self-reported physician diagnoses, and symptom-based measures and compared characteristics of persons classified as depressed or anxious by each method. We evaluated whether HRQOL was most affected by previous diagnoses of depression or anxiety or by current symptoms. METHODS We linked clinical and administrative data for 859 participants with MS. HRQOL was measured by the Health Utilities Index Mark 3. We classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale. Multivariable linear regression examined whether diagnosed depression or anxiety affected HRQOL after accounting for current symptoms. RESULTS Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either administrative data or self-reported diagnoses. Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either administrative data or self-reported diagnoses. Previous diagnoses did not decrease HRQOL after accounting for current symptoms. CONCLUSIONS Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in MS; both substantially contribute to reduced HRQOL in MS.
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186
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Marrie RA, Zhang L, Lix LM, Graff LA, Walker JR, Fisk JD, Patten SB, Hitchon CA, Bolton JM, Sareen J, El-Gabalawy R, Marriott JJ, Bernstein CN. The validity and reliability of screening measures for depression and anxiety disorders in multiple sclerosis. Mult Scler Relat Disord 2018; 20:9-15. [DOI: 10.1016/j.msard.2017.12.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/13/2017] [Indexed: 01/21/2023]
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187
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Marrie RA, Graff L, Walker JR, Fisk JD, Patten SB, Hitchon CA, Lix LM, Bolton J, Sareen J, Katz A, Berrigan LI, Marriott JJ, Singer A, El-Gabalawy R, Peschken CA, Zarychanski R, Bernstein CN. Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study. JMIR Res Protoc 2018; 7:e15. [PMID: 29343461 PMCID: PMC5792704 DOI: 10.2196/resprot.8794] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood. OBJECTIVE The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants. METHODS Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations. RESULTS The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001). CONCLUSIONS This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.
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Affiliation(s)
| | | | | | | | | | | | - Lisa M Lix
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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188
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Patten SB, Williams JVA, Lavorato DH, Woolf B, Wang JL, Bulloch AGM, Sajobi T. Major depression and secondhand smoke exposure. J Affect Disord 2018; 225:260-264. [PMID: 28841490 DOI: 10.1016/j.jad.2017.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/09/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Epidemiological studies have consistently linked smoking to poor mental health. Among non-smokers, some studies have also reported associations between secondhand smoke exposure and psychological symptoms. However, an association between secondhand smoke exposure and depressive disorders has not been well established. METHODS This analysis used cross-sectional data from a series of 10 population surveys conducted in Canada between 2003 and 2013. The surveys targeted the Canadian household population, included a brief structured interview for past year major depressive episode (MDE) and included items assessing secondhand smoke exposure. We used two-stage individual-level random-effects meta-regression to synthesize results from these surveys. RESULTS Over the study interval, about 20% of non-smokers reported substantial exposure to secondhand smoke. In this group, the pooled annual prevalence of MDE was 6.1% (95% CI 5.3-6.9) compared to 4.0% (95% CI 3.7-4.3) in non-smokers without secondhand smoke exposure. The crude odds ratio was 1.5 (95% CI 1.4-1.7). With adjustment for a set of potential confounding variables the odds ratio was unchanged, 1.4 (95% CI 1.2 - 1.6). CONCLUSIONS These results provide additional support for public health measures aimed at reducing secondhand smoke exposure. A causal connection between secondhand smoke exposure and MDEs cannot be confirmed due to the cross-sectional nature of the data. Longitudinal studies are needed to establish temporal sequencing.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Canada.
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
| | - Dina H Lavorato
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
| | | | - Jian Li Wang
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Clinical Neurosciences, University of Calgary, Canada; O'Brien Institute for Public Health, Canada
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189
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Vallerand IA, Patten SB. Systemic retinoids and psychiatric disorders in patients with skin diseases: a multifactorial relationship. Br J Dermatol 2018; 178:305. [PMID: 28975606 DOI: 10.1111/bjd.16018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- I A Vallerand
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Leaders in Medicine Program, University of Calgary, Calgary, Canada
| | - S B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada
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190
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van der Maas M, Stuart H, Patten SB, Lentinello EK, Bobbili SJ, Mann RE, Hamilton HA, Sapag JC, Corrigan P, Khenti A. Examining the Application of the Opening Minds Survey in the Community Health Centre Setting. Can J Psychiatry 2018; 63:30-36. [PMID: 28665144 PMCID: PMC5788120 DOI: 10.1177/0706743717719079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Stigma has been identified as a complex and problematic issue. It acts as a major barrier to accessing care and can exacerbate the experience of a health condition, particularly for clients with mental illness and substance use issues. Scales designed to assess stigmatising attitudes towards those with mental illness and substance use problems among health care providers are necessary to evaluate programs designed to reduce that stigma. The goal of this study was to evaluate the internal reliability and external validity of the Opening Minds Survey for Health Care Providers (OMS-HC). METHODS The current study examined the use of the OMS-HC in assessing stigma held by Community Health Centre (CHC) staff towards clients with mental and/or substance use problems. Participants represented staff from 6 CHCs in the Greater Toronto Area ( n = 190). RESULTS The OMS-HC was found to have acceptable internal reliability for the 15-item version of the scale (α = 0.766) and mixed reliability for its subscales (α = 0.792-0.673). Confirmatory factor analysis showed good absolute (root mean square error of approximation = 0.013) and relative fit (Tucker-Lewis index = 0.996) for the current data. The OMS-HC was also shown to correlate with a series of scales commonly used in stigma research. CONCLUSIONS After testing for internal validity and comparing the OMS-HC to other commonly used scales for assessing stigma and attitudes concerning recovery, the scale was found to be appropriate for the CHC setting and may be advantageous over the use of multiple scales.
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Affiliation(s)
- Mark van der Maas
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Heather Stuart
- 2 Community Health and Epidemiology, Queen's University, Kingston, Ontario
| | - Scott B Patten
- 3 Deptartment of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Emily K Lentinello
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Sireesha J Bobbili
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Robert E Mann
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,4 Dalla Lana School of Public Health, Toronto, Ontario
| | - Hayley A Hamilton
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,4 Dalla Lana School of Public Health, Toronto, Ontario
| | - Jamie C Sapag
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
| | | | - Akwatu Khenti
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,4 Dalla Lana School of Public Health, Toronto, Ontario
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191
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Fiest KM, Greenfield J, Metz LM, Patten SB, Jetté N, Marrie RA. Discriminative ability of quality of life measures in multiple sclerosis. Health Qual Life Outcomes 2017; 15:246. [PMID: 29268750 PMCID: PMC5740906 DOI: 10.1186/s12955-017-0828-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background Though many people with multiple sclerosis (MS) have comorbidities, the use of generic and disease-specific health related quality of life (HRQOL) scales to discriminate the effects of comorbidity has not been established. The utility of these scales to discriminate differences between persons with varying levels of disability is also unknown. Methods Using online questionnaires, a convenience sample of Albertans with MS was recruited between July 2011 and March 2013. Participants completed demographic questions, a validated comorbidity questionnaire, a self-reported disability scale, and the following HRQOL scales: the Short Form (SF)-36, SF-6D, Health Utilities Index-Mark III (HUI-III), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). The ability of each HRQOL scale to distinguish between comorbidity groups was assessed using a one-way analysis of covariance, adjusting for age, sex, disease course, and disability level. Results Five hundred sixty three participants completed all relevant questionnaires. All HRQOL measures distinguished between persons with or without depression, while none were able to distinguish between participants with or without hypertension, thyroid disease, irritable bowel syndrome, or osteoporosis. The SF-36 physical scale, SF-6D, HUI-III, and MSQOL-54 physical scales were able to distinguish between all disability groups, though the HUI-III was better able to distinguish between individuals with moderate versus severe disability. Conclusions Disease-specific measures would discriminate better between those with and without comorbidities than generic-specific measures and the HUI-III would discriminate best between persons with differing severities of disability. Generic or disease-specific measures may be useful in future studies examining the effects of comorbidity in MS and the effects of treatment of comorbidities in MS. Electronic supplementary material The online version of this article (10.1186/s12955-017-0828-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsten M Fiest
- Department of Internal Medicine, University of Manitoba, GF533, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Jamie Greenfield
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, GF533, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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192
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Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, Patten SB. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol 2017; 178:76-85. [PMID: 28542914 DOI: 10.1111/bjd.15668] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MEDLINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate-to-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.
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Affiliation(s)
- I A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M S Farris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - C D Sibley
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M L Ramien
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - A G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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193
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Moll S, Zanhour M, Patten SB, Stuart H, MacDermid J. Evaluating Mental Health Literacy in the Workplace: Development and Psychometric Properties of a Vignette-Based Tool. J Occup Rehabil 2017; 27:601-611. [PMID: 28120136 DOI: 10.1007/s10926-017-9695-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Early intervention and support for workers with mental health problems may be influenced by the mental health literacy of the worker, their colleagues and their supervisor. There are gaps, however, in our understanding of how to develop and evaluate mental health literacy within the context of the workplace. The purpose of this study was to evaluate the psychometric properties of a new Mental Health Literacy tool for the Workplace (MHL-W). Methods The MHL-W is a 16-question, vignette-based tool specifically tailored for the workplace context. It includes four vignettes featuring different manifestations of mental ill-health in the workplace, with parallel questions that explore each of the four dimensions of mental health literacy. In order to establish reliability and construct validity, data were collected from 192 healthcare workers who were participating in a mental health training project. Baseline data was used to examine the scale's internal consistency, factor structure and correlations with general knowledge ratings, confidence ratings, attitudes towards people with mental illness, and attitudes towards seeking help. Paired t-tests were used to examine pre and post intervention scores in order to establish responsiveness of the scale. Results There was strong support for internal consistency of the tool and a one-factor solution. As predicted, the scores correlated highly with an overall rating of knowledge and confidence in addressing mental health issues, and moderately with attitudes towards seeking professional help and (decreased) stigmatized beliefs. It also appears to be responsive to change. Conclusions The MHL-W scale is promising tool to track the need for and impact of mental health education in the workplace.
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Affiliation(s)
- Sandra Moll
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada.
| | - Mona Zanhour
- College of Business Administration, California State University, Long Beach, Long Beach, CA, USA
| | - Scott B Patten
- Department of Community Health Sciences & Psychiatry, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4N1, Canada
| | - Heather Stuart
- Centre for Health Services and Policy Research, Queen's University, 21 Arch Street, Room 324B, Abramsky Hall, Kingston, ON, K7L 3N6, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, L8S 1C7, Canada
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Roseman M, Saadat N, Riehm KE, Kloda LA, Boruff J, Ickowicz A, Baltzer F, Katz LY, Patten SB, Rousseau C, Thombs BD. Depression Screening and Health Outcomes in Children and Adolescents: A Systematic Review. Can J Psychiatry 2017; 62:813-817. [PMID: 28851234 PMCID: PMC5714120 DOI: 10.1177/0706743717727243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Depression screening among children and adolescents is controversial. In 2009, the United States Preventive Services Task Force first recommended routine depression screening for adolescents, and this recommendation was reiterated in 2016. However, no randomized controlled trials (RCTs) of screening were identified in the original 2009 systematic review or in an updated review through February 2015. The objective of this systematic review was to provide a current evaluation to determine whether there is evidence from RCTs that depression screening in childhood and adolescence improves depression outcomes. METHOD Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, Cochrane CENTRAL and LILACS databases searched February 2, 2017. Eligible studies had to be RCTs that compared depression outcomes between children or adolescents aged 6 to 18 years who underwent depression screening and those who did not. RESULTS Of 552 unique title/abstracts, none received full-text review. No RCTs that investigated the effects of screening on depression outcomes in children or adolescents were identified. CONCLUSIONS There is no direct RCT evidence that supports depression screening among children and adolescents. Groups that consider recommending screening should carefully consider potential harms, as well as the use of scarce health resources, that would occur with the implementation of screening programs.
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Affiliation(s)
- Michelle Roseman
- 1 Department of Family and Community Medicine, University of Toronto, Ontario
| | - Nazanin Saadat
- 2 Lady Davis Institute, Jewish General Hospital, Montréal, Québec
| | - Kira E Riehm
- 2 Lady Davis Institute, Jewish General Hospital, Montréal, Québec
| | | | - Jill Boruff
- 4 Schulich Library of Science and Engineering, McGill University, Montréal, Québec
| | - Abel Ickowicz
- 5 Department of Psychiatry, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Franziska Baltzer
- 6 Montréal Children's Hospital, Montréal, Québec.,7 Department of Pediatrics, McGill University, Montréal, Québec
| | - Laurence Y Katz
- 8 Department of Psychiatry, University of Manitoba, Winnipeg
| | - Scott B Patten
- 9 Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Cécile Rousseau
- 10 Department of Psychiatry, McGill University, Montréal, Québec
| | - Brett D Thombs
- 2 Lady Davis Institute, Jewish General Hospital, Montréal, Québec.,10 Department of Psychiatry, McGill University, Montréal, Québec.,11 Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec.,12 Department of Medicine, McGill University, Montréal, Québec.,13 Department of Educational and Counselling Psychology, McGill University, Montréal, Québec.,14 Department of Psychology, McGill University, Montréal, Québec
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Bulloch AGM, Williams JVA, Lavorato DH, Patten SB. The depression and marital status relationship is modified by both age and gender. J Affect Disord 2017; 223:65-68. [PMID: 28732242 DOI: 10.1016/j.jad.2017.06.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/20/2017] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Marital status is associated with major depression prevalence, however, the strength of association may be modified by age and gender. METHODS The data sources were a series of cross sectional national health surveys of the Canadian population carried out by Statistics Canada during 1996-2013. These were cross-sectional files from the National Population Health Survey of 1996, together with the Canadian Community Health Surveys from 2000 to 2013; the respondents were 18 years and older. The data was analyzed with meta-analytic techniques and logistic regression. RESULTS In terms of gender, the odds ratios of depression were smaller for females (vs males) who were single, widowed or separated compared to married people. Regarding age, the odds ratios for depression showed a steady rise with increasing age for those in single and in common-law relationships compared to married people. In contrast the odds ratios for depression declined with age for those widowed, separated and divorced compared to married people. The strength of the interaction terms used to quantify these moderating effects showed no change from 1996 to 2013. LIMITATIONS Only one member of each household was included, so that relationship issues could not be studied. The generalizability of our findings requires international data. Also the diagnostic interviews used are not as accurate as clinical assessments. CONCLUSION Use of large numbers of participants has revealed some robust modifying effects of both gender and age on the depression/marital status relationship. The clinical significance of our findings is that the vulnerability to development of depression is not only related to marital status, but that this relationship is modified by age and gender.
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Affiliation(s)
- Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Dina H Lavorato
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Fiest KM, Hitchon CA, Bernstein CN, Peschken CA, Walker JR, Graff LA, Zarychanski R, Abou-Setta A, Patten SB, Sareen J, Bolton J, Marrie RA. Systematic Review and Meta-analysis of Interventions for Depression and Anxiety in Persons With Rheumatoid Arthritis. J Clin Rheumatol 2017; 23:425-434. [PMID: 28221313 PMCID: PMC5704737 DOI: 10.1097/rhu.0000000000000489] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved. OBJECTIVE The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA. METHODS We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators. RESULTS From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, -0.21; 95% confidence interval [CI], -1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, -0.79; 95% CI, -1.34 to -0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, -0.44; 95% CI, -0.96 to 0.08). Seven of the trials had an unclear risk of bias. CONCLUSIONS Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.
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Affiliation(s)
- Kirsten M. Fiest
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol A. Hitchon
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N. Bernstein
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A. Peschken
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R. Walker
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A. Graff
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed Abou-Setta
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B. Patten
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Patten SB. Featured Canadian Research on Child, Adolescent, and Young Adult Psychiatry. Can J Psychiatry 2017; 62:810-812. [PMID: 29194004 PMCID: PMC5714121 DOI: 10.1177/0706743717742864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marrie RA, Walld R, Bolton JM, Sareen J, Walker JR, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Estimating annual prevalence of depression and anxiety disorder in multiple sclerosis using administrative data. BMC Res Notes 2017; 10:619. [PMID: 29178935 PMCID: PMC5702192 DOI: 10.1186/s13104-017-2958-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Researchers have developed case definitions to estimate incidence and lifetime prevalence of depression and anxiety disorders in multiple sclerosis (MS) using administrative data. For policymakers however, the prevalence of a disease requiring ongoing treatment during a given period such as annual period prevalence may be more relevant for decision-making. We tested a case definition for annual period prevalence of depression and anxiety disorders in MS using administrative data. RESULTS Using population-based administrative (health claims) data from Manitoba, Canada we identified 1922 persons with incident MS from 1989 to 2012, and 11,392 age, sex and geographically-matched controls from the general population. As compared to controls, MS patients had an elevated annual prevalence ratio of depression (1.77; 95% confidence interval [CI] 1.64, 1.91), and anxiety disorders (1.46; 95% CI 1.35, 1.58). The annual prevalence of depression in our matched cohort was similar to that observed in the 2012 Canadian Community Health Survey, although the annual prevalence of anxiety was slightly higher. Administrative data can be used to estimate the annual period prevalence of psychiatric disorders in MS.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Health Sciences Center, GF-543, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John R. Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A. Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D. Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Kowalec K, McKay KA, Patten SB, Fisk JD, Evans C, Tremlett H, Marrie RA. Comorbidity increases the risk of relapse in multiple sclerosis: A prospective study. Neurology 2017; 89:2455-2461. [PMID: 29117961 DOI: 10.1212/wnl.0000000000004716] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association between comorbidity and relapse rate in individuals with multiple sclerosis (MS). METHODS We recruited individuals with prevalent relapsing-onset MS from 4 Canadian MS Clinics to participate in a 2-year prospective multicenter cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using questionnaires, and relapses were captured from medical records at each visit. The association between comorbidities at baseline and relapse rate over the subsequent 2-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status. RESULTS Of 885 participants, 678 (76.6%) were women, averaging age 48.2 years at baseline. Anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%), and hyperlipidemia (11.9%) were the most prevalent comorbidities. The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years 1 and 2 post-baseline. After adjustment, participants reporting ≥3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent 2 years (adjusted rate ratio 1.45, 95% confidence interval [CI] 1.00-2.08). Migraine and hyperlipidemia were associated with increased relapse rate (adjusted rate ratio 1.38; 95% CI 1.01-1.89 and 1.67; 95% CI 1.07-2.61, respectively). CONCLUSIONS Individuals with migraine, hyperlipidemia, or a high comorbidity burden (3 or more conditions) had an increased relapse rate over 2 years. These findings have potential implications for understanding the pathophysiology of MS relapses, and suggest that closer monitoring of individuals with specific or multiple comorbidities may be needed. Future research is needed to understand if the presence of comorbidity warrants a tailored approach to MS management.
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Affiliation(s)
- Kaarina Kowalec
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kyla A McKay
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Abstract
Depressive disorders occur in up to 50% of people living with multiple sclerosis (MS). Prevalence estimates are generally 2-3-times higher than those of the general population. Myriad aetiologic factors may contribute to the aetiology of depression in MS including biological mechanisms (e.g. hippocampal microglial activation, lesion burden, regional atrophy), as well as the stressors, threats, and losses that accompany living with an unpredictable and often disabling disease. Some prominent risk factors for depression such as (younger) age, (female) sex, and family history of depression are less consistently associated with depression in MS than they are in the general population. Management of depression in MS has not been well studied, but available data on detection and treatment align with general principles of depression management. While the validity of standard measurement scales has often been questioned, available evidence suggests that standard scales provide valid ratings. Evidence for the effectiveness of depression treatments in MS is limited, but available evidence supports the effectiveness of standard treatment approaches, including both cognitive behavioural therapies and antidepressant medications.
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Affiliation(s)
- Scott B Patten
- a Department of Community Health Sciences , University of Calgary, Calgary , Alberta , Canada
| | - Ruth Ann Marrie
- b Department of Internal Medicine (Neurology) , University of Manitoba , Manitoba , Canada.,c Department of Community Health Sciences , University of Manitoba , Manitoba , Canada
| | - Mauro G Carta
- d Department of Medical Sciences and Public Health , Quality of Care, University of Cagliari , Cagliari , Italy
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