Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations

Early onset major depressive disorder

The present paper provides an overview of the clinical diagnosis and presentation, epidemiology, coexisting problems, and treatment issues of child and adolescent depressive disorders, with a focus on major depressive disorder (MDD). Depression is a common and potentially debilitating disorder for youth; has significant comorbid, behavioural and systemic sequelae; and is associated with a significant suicidal risk. Although rigorous study of psychosocial and pharmacological treatment modalities is in its infancy, current treatment is also informed by judicious and patient-specific clinical judgment. In view of the duration of MDD, remission and recurrence rates, morbidity, and potential chronicity of impaired psychosocial functioning, both active treatment and research involving MDD are indicated.

Associations between physical activity and postpartum depressive symptoms

BACKGROUND

Postpartum women are at increased risk for developing depression, which can contribute to the ill health of the mother and her family. Previous research indicates that mothers who are physically active during leisure experience lower levels of postpartum depressive symptoms than do inactive mothers. The objective of this investigation was to examine the associations between total and domain-specific moderate to vigorous physical activity (MVPA) and depressive symptoms postpartum.

METHODS

Data were obtained from 550 women who participated in the Pregnancy, Infection, and Nutrition (PIN) Postpartum Study, a prospective cohort of mothers who delivered liveborn infants from October 2002 to December 2005 in North Carolina. Three-month postpartum MVPA was investigated as a predictor of 12-month postpartum depressive symptoms.

RESULTS

Those who participated in MVPA had two times the odds of developing elevated depressive symptoms at 12 months postpartum than those with no MVPA (odds ratio [OR] 2.00, 95% confidence interval [CI] 0.71-6.75). Different associations were suggested when examining domain-specific MVPA. Those participating in adult and child care and indoor household MVPA at 3 months postpartum had more than double the odds of developing elevated depressive symptoms at 12 months postpartum (OR 2.66, 95% CI 1.03, 8.11 and OR 2.72, 95% CI 0.96-10.18, respectively). Work MVPA conferred a doubling of the odds (OR 1.95, 95% CI 0.46-7.13), but recreational and outdoor household MVPA showed no associations with depressive symptoms.

CONCLUSIONS

Associations between MVPA and depressive symptoms differed by domain among postpartum women. Future studies of postpartum depressive symptoms should explore reasons for differences in physical activity by domain.

Gender differences in antidepressant drug response

Epidemiological studies suggest there are considerable differences in the prevalence and presentation of depression in men and women. Women are more than twice as likely to be diagnosed with depression and may also report more atypical and anxiety symptoms than men. Men and women also differ in the metabolism and distribution of antidepressants and the presence of oestrogen in women of childbearing age may interfere with the mechanism of action of a number of antidepressants. These differences have led many researchers to question whether antidepressants are equally effective and tolerated in men and women. While some reports suggest that selective serotonin re-uptake inhibitors (SSRIs) are more effective and result in fewer adverse drug reactions in women than tricyclic antidepressants (TCAs), gender differences in antidepressant response remains a controversial topic. The potential effects of antidepressant exposure in utero and in breast milk further complicate treatment options for antenatal and postnatal depression. While some research suggests the SSRI paroxetine is teratogenic, further carefully designed naturalistic studies are required to fully evaluate these effects. Finally, response to antidepressants and the occurrence of adverse drug reactions is marked by inter-individual variability which may be in part due to genetic differences. Future studies should therefore consider genotypes of the mother, foetus and infant in antidepressant response.

Changes in the prevalence of bipolar disorders between 1998 and 2008 in an Australian population

OBJECTIVE

To identify any changes in the prevalence of bipolar disorder (BD) between 1998, 2004, and 2008.

METHOD

Cross-sectional population-based surveys were conducted involving random and representative samples of South Australian adults aged ≥ 15 years. BD was assessed using the mood module of the Primary Care Evaluation of Mental Disorders instrument (PRIME-MD), a single question related to doctor-diagnosed BD and the Mood Disorder Questionnaire (MDQ), which defines bipolar spectrum disorder.

RESULTS

  The PRIME-MD-derived prevalence of BD increased significantly from 0.5% [95% confidence interval (CI): 0.27-0.79] in 1998 to 1.0% (95% CI: 0.61-1.31) in 2004 and 1.5% (95% CI: 1.05-1.91) in 2008, demonstrating a significant increased linear trend (χ² =13.91, df=2, p=0.002). Similarly, reported doctor-diagnosed BD increased significantly from 1.1% (95% CI: 0.75-1.51) in 1998 to 1.7% (95% CI: 1.26-2.18) in 2004 and 2.9% (95% CI: 2.28-3.48) in 2008 (Linear trend test χ²=24.55, df=2, p<0.001). The MDQ-derived diagnosis of bipolar spectrum disorder changed from 2.5% (95% CI: 1.96-3.08) in 2004 to 3.3% (95% CI: 2.66-3.94) in 2008 (χ² =3.22, df=1, p<0.10), but this difference did not attain statistical significance. Confining the analysis to those positive for BD on all three methods, there was a significant increase in the prevalence of the detection of BD using all three measures (χ² =4.43, df=1, p=0.03) between 2004 and 2008.

CONCLUSIONS

There has been an increased prevalence of BD in South Australia over the last decade, but this may be related to changing diagnostic practices rather than a true increase.

Sensitivity to the depressogenic effect of stress and HPA-axis reactivity in adolescence: a review of gender differences

Adolescence is characterized by major biological, psychological, and social challenges, as well as by an increase in depression rates. This review focuses on the association between stressful experiences and depression in adolescence, and the possible role of the hypothalamus-pituitary-adrenal cortex (HPA-)axis in this link. Adolescent girls have a higher probability to develop depressive symptoms than adolescent boys and preadolescents. Increasing evidence indicates that girls' higher risk of depression is partly brought about by an increased sensitivity for stressful life events, particularly interpersonal stressors, which are highly prevalent in adolescent girls. Genetic risk factors for depression, as well as those for stress sensitivity, are often expressed differently in girls and boys. Also environmental adversity tends to affect girls' stress responses more than those of boys. These gender-specific association patterns have been reported for both sensitivity to stressful life events and HPA-axis responses to social stress. Together, the findings suggest that girls are more malleable than boys in response to internal and external influences. This postulated greater malleability may be adaptive in many circumstances, but also brings along risk, such as an increased probability of depression.

DHA deficiency and prefrontal cortex neuropathology in recurrent affective disorders

Increasing evidence suggests that docosahexaenoic acid [DHA, 22:6(n-3)], the principal (n-3) fatty acid in brain gray matter, has neurotrophic and neuroprotective properties. Preliminary clinical evidence also suggests that the perinatal accrual, and the subsequent dietary maintenance of, cortical DHA is positively associated with cortical gray matter volumes. The pathophysiology of recurrent affective disorders, including unipolar and bipolar depression, is associated with (n-3) fatty acid deficiency, DHA deficits, impaired astrocyte mediated vascular coupling, neuronal shrinkage, and reductions in gray matter volume in the prefrontal cortex (PFC). Preclinical studies have also observed neuronal shrinkage and indices of astrocyte pathology in the DHA-deficient rat brain. Together, this body of evidence supports the proposition that DHA deficiency increases vulnerability to neuronal atrophy in the PFC of patients with affective disorders. Because projections from the PFC modulate multiple limbic structures involved in affective regulation, this represents one plausible mechanism by which (n-3) fatty acid deficiency may increase vulnerability to recurrent affective disorders.

Obstetric complications in women with diagnosed mental illness: the relative success of California's county mental health system

OBJECTIVE

To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness.

DATA SOURCE

Linked California hospital discharge (2000-2001), birth, fetal death, and county mental health system (CMHS) records.

STUDY DESIGN

This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors.

RESULTS

Compared with deliveries in the general non-mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis).

CONCLUSION

Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention.

Membrane omega-3 Fatty Acid deficiency as a preventable risk factor for comorbid coronary heart disease in major depressive disorder

Major depression disorder (MDD) significantly increases the risk for coronary heart disease (CHD) which is a leading cause of mortality in patients with MDD. Moreover, depression is frequently observed in a subset of patients following acute coronary syndrome (ACS) and increases risk for mortality. Here evidence implicating omega-3 (n-3) fatty acid deficiency in the pathoaetiology of CHD and MDD is reviewed, and the hypothesis that n-3 fatty acid deficiency is a preventable risk factor for CHD comorbidity in MDD patients is evaluated. This hypothesis is supported by cross-national and cross-sectional epidemiological surveys finding an inverse correlation between n-3 fatty acid status and prevalence rates of both CHD and MDD, prospective studies finding that lower dietary or membrane EPA+DHA levels increase risk for both MDD and CHD, case-control studies finding that the n-3 fatty acid status of MDD patients places them at high risk for emergent CHD morbidity and mortality, meta-analyses of controlled n-3 fatty acid intervention studies finding significant advantage over placebo for reducing depression symptom severity in MDD patients, and for secondary prevention of cardiac events in CHD patients, findings that n-3 fatty acid status is inversely correlated with other documented CHD risk factors, and patients diagnosed with MDD after ACS exhibit significantly lower n-3 fatty acid status compared with nondepressed ACS patients. This body of evidence provides strong support for future studies to evaluate the effects of increasing dietary n-3 fatty acid status on CHD comorbidity and mortality in MDD patients.

Childhood and adolescent psychiatric disorders as predictors of young adult disorders

CONTEXT

Most adults with a psychiatric disorder first met diagnostic criteria during childhood and/or adolescence, yet specific homotypic and heterotypic patterns of prediction have not been firmly established.

OBJECTIVE

To establish which childhood and adolescent psychiatric disorders predict particular young adult disorders when accounting for comorbidities, disaggregating similar disorders, and examining childhood and adolescent predictors separately.

DESIGN

Eleven waves of data from the prospective population-based Great Smoky Mountains Study (N = 1420) were used.

SETTING

The Great Smoky Mountains Study is a longitudinal study of the development of psychiatric disorder and need for mental health services in rural and urban youth. A representative sample of children was recruited from 11 counties in western North Carolina.

PARTICIPANTS

Children in the community aged 9 to 16, 19, and 21 years.

MAIN OUTCOME MEASURES

Common psychiatric disorders were assessed in childhood (ages 9-12 years) and adolescence (ages 13-16 years) with the Child and Adolescent Psychiatric Assessment and in young adulthood (ages 19 and 21 years) with the Young Adult Psychiatric Assessment.

RESULTS

Adolescent depression significantly predicted young adult depression in the bivariate analysis, but this effect was entirely accounted for by comorbidity of adolescent depression with adolescent oppositional defiant disorder, anxiety, and substance disorders in adjusted analyses. Generalized anxiety and depression cross-predicted each other, and oppositional defiant disorder (but not conduct disorder) predicted later anxiety disorders and depression. Evidence of homotypic prediction was supported for substance use disorders, antisocial personality disorder (from conduct disorder), and anxiety disorders, although this effect was primarily accounted for by DSM-III-R overanxious disorder.

CONCLUSIONS

Stringent tests of homotypic and heterotypic prediction patterns suggest a more developmentally and diagnostically nuanced picture in comparison with the previous literature. The putative link between adolescent and young adult depression was not supported. Oppositional defiant disorder was singular in being part of the developmental history of a wide range of young adult disorders.

Childhood onset major depressive disorder: course of illness and psychiatric comorbidity in a community sample

OBJECTIVE

To examine the effect of childhood-onset major depressive disorder (MDD) on course of illness and psychiatric comorbidity, as compared with adolescent- and adult-onset MDD, in a large nonclinical sample.

STUDY DESIGN

This study included 6778 civilian noninstitutionalized participants in the National Epidemiologic Survey on Alcohol and Related Conditions with nonpsychotic, non-substance-induced MDD. Subjects were divided into 3 groups on the basis of age at first episode of MDD: childhood-onset (CHLD; onset < or =12 yrs, n = 372), adolescent-onset (ADOL; onset 13 to 17 years, n = 854), and adult-onset (ADLT; onset > or =18 years, n = 5552).

RESULTS

Compared with subjects with ADLT, CHLD MDD was associated with a greater number of MDD episodes, longer episode duration, increased suicidality, and increased need for hospitalization for MDD compared with adult-onset illness. Subjects with CHLD had a higher rate of psychiatric comorbidity and were more likely to have a parental history of MDD. Among subjects treated for MDD, latency from MDD onset to treatment was greater among subjects with CHLD compared with subjects with ADLT. Data for subjects with ADOL was intermediate to those of subjects with CHLD and ADLT.

CONCLUSIONS

This epidemiologic study confirms and extends clinical findings of childhood-onset MDD as a more familial form of illness associated with increased comorbidity, suicidality, and treatment use.

Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women

It has been suggested that women experience depression most commonly in the childbearing years and that reproductive events such as pregnancy and child birth may coincide with the onset of mood and anxiety disorders in women. Therefore, a brief screening tool, with good sensitivity/specificity for psychiatric diagnoses that could be administered to pregnant women would be a valuable and useful proxy measure. We assessed the validity of the K-10, using the SCID as the gold standard, in a sample of 129 healthy pregnant women who presented for care at midwife obstetric units in Cape Town, South Africa. A receiver-operating characteristic curve (ROC) analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the receiver-operating characteristic curve, 0.66), posttraumatic stress disorder (0.69), panic disorder (0.71), and social phobia (0.76). The K-10 may be a useful screening measure for mood and anxiety disorders in pregnant women.

Executive functioning in children and adolescents with Major Depressive Disorder

The present investigation examined neurocognitive functioning, focusing on executive functioning (EF), in 39 children and adolescents with Major Depressive Disorder (MDD) and 24 healthy control subjects all ages 8 to 17 years. The Wechsler Intelligence Scale for Children-Third Edition along with several measures of executive functioning including the Wisconsin Card Sorting Task, Trail Making Test, Controlled Oral Word Association Test, and the Stroop Color Word Test were administered. The neurocognitive profiles for the group of depressed children and adolescents were grossly intact as most scores on intellectual and EF measures fell within the average range and did not differ from the comparison group. Mental processing speed was decreased in the MDD versus normal control group and 27% of the depressed group performed below average on the Trail Making Test. This investigation provided a good base from which to compare future literature on EF in outpatients with early-onset MDD.

Psychiatric disorders during adolescence and relationships with peers from age 17 to age 27

OBJECTIVE

To investigate normative patterns of peer relationships from ages 17 to 27, and to examine the impact of adolescent psychiatric disorders on peer relationships.

METHOD

Psychiatric disorders were measured at a mean age 16 years. At mean age 29, 200 participants completed detailed narrative interviews about their transition to adulthood. Monthly contact and conflict with peers were described in narratives covering ages 17-27.

RESULTS

Adolescent psychiatric disorders did not predict the frequency of peer contact in the young adult period. However, adolescent disruptive disorders predicted greater peer conflict regardless of contact frequency. Adolescents with major depressive or substance abuse disorders and subsequent high frequency of peer contact reported elevated peer conflict during the transition to adulthood. In contrast, among study participants with frequent peer contact during this period, those with adolescent anxiety disorders reported less peer conflict than did those without such a diagnostic history.

CONCLUSIONS

Adolescents with major depressive, disruptive, and substance abuse disorders may be at risk for long-term negative peer relationships, whereas those with anxiety disorders may subsequently avoid peer conflict.

ECT in pregnancy: a review of the literature from 1941 to 2007

OBJECTIVE

To review the literature on the use of electroconvulsive therapy (ECT) during pregnancy and to discuss its risks and benefits for treating severe mental illness during pregnancy.

METHOD

PubMed and PsycINFO databases were searched for English or English-translated articles, case reports, letters, chapters, and Web sites providing original contributions and/or summarizing prior data on ECT administration during pregnancy.

RESULTS

A total of 339 cases were found. The majority of patients were treated for depression and at least partial remission was reported in 78% of all cases where efficacy data were available. Among the 339 cases reviewed, there were 25 fetal or neonatal complications, but only 11 of these, which included two deaths, were likely related to ECT. There were 20 maternal complications reported and 18 were likely related to ECT.

CONCLUSIONS

Although there are limited available data in the literature, it seems that ECT is an effective treatment for severe mental illness during pregnancy and that the risks to fetus and mother are low.

[Characteristics of individuals and care delivered at the psychosocial care centers for children and adolescents]

This study aimed to provide an understanding of diagnosis, demographic characteristics, and treatment procedures for children and adolescents attending Psychosocial Care Centers (CAPSIS) in Brazil, 2003. It was a cross-sectional descriptive study using secondary data. The analysis considered three groups of variables related to: (a) the nature of the services; (b) patient profile; and (c) types of care. Seven CAPSIS that had recorded their procedures during all 12 months of 2003 participated in the study. The units involved treated 1,456 individuals, 62.8% of whom were males 11-13 years of age. Nearly half (49.3%) were treated in non-intensive care. The most frequent diagnoses were behavioral and emotional disorders (44.5%). There was no record of treatment related to use of psychoactive substances. The proportion of severe disorders was 19.4%. The CAPSIS operate in similar fashion to older outpatient units, but treat a variety of problems, creating a record according to types of activities. These services fill a historical gap in public mental health care for children and adolescents.

Impact of Hurricane Rita on Adolescent Substance Use

Little systematic research attention has been devoted to the impact of natural disasters on adolescent substance use. The present study examined relationships among exposure to Hurricane Rita, post-traumatic stress (PTS) symptoms, and changes in adolescent substance use from 13 months pre-disaster to seven and 19 months post-disaster. Subjects were 280 high school students in southwestern Louisiana who participated in a drug abuse prevention intervention trial prior to the hurricane. Two-thirds of participants were female and 68% were white. Students completed surveys at baseline (13 months pre-hurricane) and two follow-ups (seven and 19 months post-hurricane). Results indicated a positive bivariate relationship between PTS symptoms, assessed at 7 months post-hurricane, and increases in alcohol (p < .05) and marijuana use (p < .10) from baseline to the 7 months post-hurricane follow-up. When these associations were examined collectively with other hurricane-related predictors in multivariate regression models, PTS symptoms did not predict increases in substance use. However, objective exposure to the hurricane predicted increases in marijuana use, and post-hurricane negative life events predicted increases in all three types of substance use (ps < .10). These findings suggest that increased substance use may be one of the behaviors that adolescents exhibit in reaction to exposure to hurricanes.

The potential for PTSD, substance use, and HIV risk behavior among adolescents exposed to Hurricane Katrina

Adverse psychosocial outcomes can be anticipated among youth exposed to Hurricane Katrina. Adolescents are particularly vulnerable to the consequences of this natural disaster and may suffer lasting consequences in the form of psychological morbidity and the development of negative health behaviors due to their exposure. We review existing literature on the effects of exposure to natural disasters and similar traumas on youth and, where data on youth are unavailable, on adults. The effect of natural disasters is discussed in terms of risk for three negative health outcomes that are of particular concern due to their potential to cause long-term morbidity: post-traumatic stress disorder, substance use disorder, and HIV-risk behavior. Where available, data from studies of the effects of Hurricane Katrina are included.

The emerging importance of transporter proteins in the psychopharmacological treatment of the pregnant patient

P-glycoprotein, breast cancer resistance protein, and multidrug resistance proteins have physiological functions in placental tissue. Several antidepressants, antipsychotics, and anti-epileptic drugs have been found to be substrates of P-glycoprotein and other transporters. The extent that drugs pass through the placental barrier is likely influenced by drug transporters. The rational choice of psychoactive drugs to treat mental illness in women of child-bearing age should incorporate knowledge of both drug disposition as well as expected pharmacologic effects. This review summarizes the current data on drug transporters in the placental passage of medications, with a focus on medications used in clinical psychopharmacology.

Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women

OBJECTIVE

Validating self-reported questionnaires to detect depression during pregnancy, compared to depression during postpartum, has gained much less attention. Furthermore, it is unknown whether it is appropriate to use the same cutoff point to detect depression on different trimesters of pregnancy. The aims of this study, conducted in pregnant Taiwanese women, were: (a) to validate the Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of the Beck Depression Inventory (BDI-II); (b) to compare the EPDS-T and the BDI-II on their validity in detecting depression; and (c) to determine if these scales have different cutoff points in detecting major depressive disorder for different trimesters.

METHOD

One hundred eighty-five pregnant Taiwanese women who completed the EPDS-T and the BDI-II were interviewed by psychiatrists with the structural interview Mini-International Neuropsychiatric Interview (MINI) to establish a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of major depressive disorder. We analyzed and compared the sensitivity, specificity and validity of the EPDS-T and the BDI-II against the MINI diagnosis on the second and third trimesters.

RESULTS

We identified 12/13 as the optimal cutoff of the EPDS-T, at which the sensitivity of the scale was 83% and the specificity was 89%. The optimal cutoff of the BDI-II was 11/12, at which the sensitivity of the scale was 74% and the specificity was 83%. The area under the curve of the receiver operating characteristic analysis was 0.92 for the EPDS-T and 0.84 for the BDI. There exist different optimal cutoff points of the EPDS-T for detecting major depression during different trimesters: 13/14 for the second trimester and 12/13 for the third trimester. No different optimal cutoff point for the BDI-II was found for different trimesters.

CONCLUSION

The EPDS-T has satisfactory sensitivity and specificity and better validity than the BDI-II for detecting major depressive disorder during pregnancy in pregnant Taiwanese women. We suggest that more studies with larger sample sizes be performed to confirm if there exist different cutoff points in detecting depression for different trimesters of gestation.

Prevalence, comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century

The results of recent community epidemiological research are reviewed, documenting that major depressive disorder (MDD) is a highly prevalent, persistent, and often seriously impairing disorder, and that bipolar disorder (BPD) is less prevalent but more persistent and more impairing than MDD. The higher persistence and severity of BPD results in a substantial proportion of all seriously impairing depressive episodes being due to threshold or subthreshold BPD rather than to MDD. Although the percentage of people with mood disorders in treatment has increased substantially since the early 1990s, a majority of cases remain either untreated or undertreated. An especially serious concern is the misdiagnosis of depressive episodes due to BPD as due to MDD because the majority of depression treatment involves medication provided by primary care doctors in the absence of psychotherapy. The article closes with a discussion of future directions for research.

Constructing a Swiss health space model of self-perceived health

This study aims to analyse the relationship between self-reported health characteristics and to explore latent cultural structures in the Swiss health survey. Based on categorical principal component analysis, a conceptual model of 'health space' was constructed which can be interpreted as a collective perception of health. The first dimension of the constructed health space model reflects the 'level of general health', and the second dimension the 'composition of physical and mental health symptoms'. These dimensions may reflect deeply rooted cultural structures--the good vs. bad dichotomy as a generic categorization scheme of human thought and the body/mind dualism. These latent structures provide a framework of the health space model and allow a better interpretation of the relationships of health perception characteristics and its related socio-demographic aspects.

The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence

AIMS

To identify childhood risk factors that predict (a) age of first drink and (b) time from first use to alcohol dependence (AD) onset, using survival analysis.

PARTICIPANTS

The sample consisted of 1269 offspring (mean age = 20.1 years) of male twins from the Vietnam Era Twin Registry; 46.2% were offspring of alcohol-dependent fathers.

MEASUREMENTS

DSM-IV psychiatric diagnoses and substance use behaviors were assessed by structured telephone interview.

FINDINGS

First drink occurred on average at 15.7 years; AD onset at 19.1 years. A Cox proportional hazard regression analysis revealed conduct disorder (CD) as the most potent predictor of early alcohol initiation (HR 2.48; CI 1.85-3.32). Attention deficit hyperactivity disorder (ADHD), maternal AD, paternal AD, male gender and parental divorce were also associated with early first use (HR 1.20-1.52; CI 1.04-1.39-1.18-1.96). A Cox proportional hazard regression analysis modeling first drink to AD identified nicotine dependence (HR 3.91; CI 2.48-6.17) and generalized anxiety disorder (GAD) (HR 3.45; CI 2.08-5.72) as robust predictors of progression to AD. CD (HR 1.75; CI 1.10-2.77) and cannabis abuse (HR 1.88; CI 1.22-2.90) were also associated with rapid transition to AD.

CONCLUSIONS

Results highlight the role of psychiatric and substance use disorders in progression from first drink to AD, underscore the continuity of risk associated with CD and indicate that (with the exception of CD) different factors play a role in transition to AD than in initiation of alcohol use. Distinctions between stages are interpreted in a developmental framework.

Is there an epidemic of child or adolescent depression?

BACKGROUND

Both the professional and the general media have recently published concerns about an 'epidemic' of child and adolescent depression. Reasons for this concern include (1) increases in antidepressant prescriptions, (2) retrospective recall by successive birth cohorts of adults, (3) rising adolescent suicide rates until 1990, and (4) evidence of an increase in emotional problems across three cohorts of British adolescents.

METHODS

Epidemiologic studies of children born between 1965 and 1996 were reviewed and a meta-analysis conducted of all studies that used structured diagnostic interviews to make formal diagnoses of depression on representative population samples of participants up to age 18. The effect of year of birth on prevalence was estimated, controlling for age, sex, sample size, taxonomy (e.g., DSM vs. ICD), measurement instrument, and time-frame of the interview (current, 3 months, 6 months, 12 months).

RESULTS

Twenty-six studies were identified, generating close to 60,000 observations on children born between 1965 and 1996 who had received at least one structured psychiatric interview capable of making a formal diagnosis of depression. Rates of depression showed no effect of year of birth. There was little effect of taxonomy, measurement instrument, or time-frame of interview. The overall prevalence estimates were: under 13, 2.8% (standard error (SE) .5%); 13-18 5.6% (SE .3%); 13-18 girls: 5.9% (SE .3%); 13-18 boys: 4.6% (SE .3%).

CONCLUSIONS

When concurrent assessment rather than retrospective recall is used, there is no evidence for an increased prevalence of child or adolescent depression over the past 30 years. Public perception of an 'epidemic' may arise from heightened awareness of a disorder that was long under-diagnosed by clinicians.

Adolescent Cluster A personality disorder symptoms, role assumption in the transition to adulthood, and resolution or persistence of symptoms

Cluster A odd or eccentric personality disorder (PD) symptoms may reflect a schizophrenia spectrum biological vulnerability in at least some persons. Consequently, this symptom pattern may have particularly negative effects on the transition from adolescent to adult roles. A general population sample of 200 young adults was assessed on Cluster A PD at mean ages 17 and 22, and subsequently provided detailed narratives about their monthly experiences and behaviors between these two ages. Adolescent Cluster A PD was related to the developmental trajectories of residential, career, financial, romantic, and family formation roles during this period, and trajectories were related to a change in symptoms over this period. Symptoms were associated with early parenthood and less advanced education, but for other developmental outcomes tended to differ for men and women. These gender differences were attributable, in part, to the differential meaning and consequences of early parenthood for men and women.

Adolescent Drug Abuse Diagnosis (ADAD) vs. Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA) in clinical outcome measurement

BACKGROUND

The Adolescent Drug Abuse Diagnosis (ADAD) and Health of Nation Outcome Scales for Children and Adolescents (HoNOSCA) are both measures of outcome for adolescent mental health services.

AIMS

To compare the ADAD with HoNOSCA; to examine their clinical usefulness.

METHODS

Comparison of the ADAD and HoNOSCA outcome measures of 20 adolescents attending a psychiatric day care unit.

RESULTS

ADAD change was positively correlated with HoNOSCA change. HoNOSCA assesses the clinic's day-care programme more positively than the ADAD. The ADAD detects a group for which the mean score remains unchanged whereas HoNOSCA does not.

CONCLUSIONS

A good convergent validity emerges between the two assessment tools. The ADAD allows an evidence-based assessment and generally enables a better subject discrimination than HoNOSCA. HoNOSCA gives a less refined evaluation but is more economic in time and possibly more sensitive to change. Both assessment tools give useful information and enabled the Day-care Unit for Adolescents to rethink the process of care and of outcome, which benefited both the institution and the patients.

Major depressive disorder in adolescents: family psychiatric history predicts severe behavioral disinhibition

BACKGROUND

Major Depressive Disorder (MDD) becomes increasingly prevalent during adolescence and is associated with substantial psychiatric comorbidity and psychosocial impairment. The marked behavioral heterogeneity evident among adolescents with MDD suggests the possibility of distinct subtypes. This study was designed to determine whether family psychiatric histories differ between groups of MDD adolescents defined by the presence or absence of severe behavioral disinhibition.

METHODS

Adolescents with MDD (n = 71) completed the Buss-Durkee Hostility Inventory--Adapted, Adolescent Aggressive Incidents Interview (AAII), Measure of Aggression, Violence, and Rage in Children, Diagnostic Interview Schedule for Children, Suicidal Ideation Questionnaire-JR., Suicidal Behavior Inventory, and Reynolds Adolescent Depression Scale. Parents completed the Family Informant Schedule and Criteria, Children's Affective Liability Scale, AAII, and a partial DISC. Behavioral disinhibition (BD) measures were used to assign adolescents to MDD+BD (n = 41) and MDD-BD (n = 30) groups.

RESULTS

The MDD+BD group had a higher prevalence of drug use disorders in biological fathers than the MDD-BD group. The MDD+BD group also had higher proportions of paternal second degree relatives with alcohol use disorders, drug use disorders, and psychiatric hospitalizations, and a higher proportion of maternal second degree relatives with antisocial personality disorder.

LIMITATIONS

Limitations include reliance on single informants for family psychiatric histories and the failure to distinguish between child- and adolescent-onset depression.

CONCLUSIONS

Family psychiatric histories differentiated MDD adolescents grouped by the presence or absence of behavioral disinhibition, suggesting possible etiologic mechanisms. Further research on subtypes or comorbid presentations may assist in the development of targeted treatment strategies.

Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis

Selective serotonin reuptake inhibitors (SSRIs) are frequently used to treat depression during pregnancy and the postpartum period. These drugs are capable of crossing the placenta and being transferred to the newborn during lactation. This report reviews the available information regarding the effects of SSRIs on the fetus and newborn; including long-term neurodevelopmental outcomes.

The epidemiology of panic disorder and agoraphobia in Europe

A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7-2.2) and 1.3% (0.7-2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.

The use of selective serotonin reuptake inhibitors in pregnancy

OBJECTIVE

To provide an update of literature on the safety of using selective serotonin reuptake inhibitors (SSRIs) during pregnancy.

METHODS

MEDLINE was searched for English-language papers published from 1985 to 2003 on human studies of SSRIs, using the key words "serotonin reuptake inhibitors," "citalopram," "fluoxetine," "fluvoxamine," "paroxetine," and "sertraline."

RESULTS

The literature search yielded 12 338 publications. Previous studies on the safety of SSRIs in pregnancy were often based on small samples from medical centres, with heterogeneous design and outcome ascertainment methods, and had yielded inconsistent results. Consequently, the management of pregnant women with depression poses challenges to clinicians who are hesitant to prescribe anti-depression drugs, including SSRIs, because of concern about potential risks to the fetuses. Failure to adequately treat maternal depression can lead to progressively worsening depression that greatly compromises maternal-fetal health and can impair bonding and childcare in the postpartum period.

CONCLUSIONS

Because of the uncertainty regarding the safety of SSRI use during pregnancy, consultation with specialists experienced in treating depression may be helpful when treating pregnant women with SSRIs. Large-scale, population-based studies to comprehensively assess the safety of SSRIs in pregnancy are needed.

Age at onset in bipolar affective disorders: a review

Bipolar affective disorder (BPAD) is a multifactorial disorder with various clinical presentations. Etiologic heterogeneity may partly underlie the phenotypic heterogeneity. Efforts to dissect BPAD have been based on the course of the disorders (BP I versus BP II or rapid cycling), comorbidity pattern (panic attacks, suicide attempts, addiction or hyperactivity), differences between the sexes, and clinical pattern (cycloid and puerperal psychosis). The present article provides a comprehensive review of the existing data, showing that age at onset (AAO) identifies homogeneous sub-groups of patients with BPAD. Recent work has demonstrated the existence of three--early, intermediate and late--onset bipolar sub-groups based on AAO, following Kendell's criteria for validity (The American Journal of Psychiatry 2003; 160: 999). We will also show how these distinctions may be of use in the search for genetic vulnerability factors and other pathogenic influences. Following Kendell's criteria, we show that AAO of bipolar disorders has been tested with most of the available strategies for establishing the validity of clinical syndromes. We also present data from genetic epidemiologic studies in bipolar disorder, showing that AAO sub-groups may reduce the underlying genetic heterogeneity. No accurate AAO thresholds to define valid sub-groups have been identified precisely. Until recently, studies defined early- and late-onset as corresponding to early or mid-adulthood, not taking into account juvenile-onset bipolar disorder. A recently proposed theoretical model with three AAO sub-groups (onset age 17, 27 and 46) is discussed.

Age of First Onset Major Depression in Chinese Americans

Using data from the Chinese American Epidemiological Study, risk for experiencing an initial episode of major depression across the life course was examined. Data were collected on 1,747 U.S.-born and foreign-born Chinese Americans (ages 18-65 years). Results suggest that Chinese American women did not evidence higher risk than Chinese American men for experiencing a 1st major depressive episode. Risk for experiencing a 1st depressive episode decreased as length of residence in the United States increased. Although those who immigrated at younger ages evidenced greater overall risk, those who came at later ages were more likely to become depressed at or soon after arrival. Competing theories of acculturation-related risk are discussed and directions for future research are proposed.

Risk factors for adolescent alcohol use following a natural disaster

INTRODUCTION

On 29 March 1998, a series of category F-3 and F-4 tornadoes caused wide-spread destruction in four rural southern Minnesota counties in the United States. Extensive research has examined the impact of disaster exposure on adults' psychological functioning, including alcohol use. However, there has been little research on potential risk factors for adolescents' alcohol use following disaster exposure.

HYPOTHESIS

It was hypothesized that demographic variables such as age and gender, prior drinking involvement, extent of prior trauma history, level of disaster exposure, and current disaster-related, post-traumatic stress disorder (PTSD) symptomatology would predict alcohol use among adolescents.

METHODS

Six months following a natural disaster, survey data were collected from 256 adolescents assessing these factors. Risk factors for adolescents' alcohol use were identified using hierarchical, multiple regression and logistic regression analyses.

RESULTS

Greater age, prior drinking involvement, and the extent of prior trauma history were significantly associated with higher levels of binge drinking. Prior trauma history and current levels of disaster-related PTSD symptomatology were significant risk factors for adolescents' report of increases in their alcohol consumption since the tornado.

CONCLUSION

In general, the extent of trauma exposure was associated with greater binge drinking among adolescents. Similar to adults, post-traumatic stress symptoms experienced in the aftermath of a disaster can lead to increased alcohol consumption among adolescents.

Risk of Fetal Exposure to Tricyclic Antidepressants

OBJECTIVES

(1) To review the literature on the risk of fetal exposure to tricyclic antidepressants (TCAs). (2) To estimate the frequency of TCA exposure in pregnant women in the Canadian province of Saskatchewan.

METHODS

MEDLINE was searched for English-language papers published from 1953 to 2003, using the key words "tricyclic antidepressants (TCAs)," "amitriptyline," "amoxapine," "clomipramine," "desipramine," "doxepin," "imipramine," "lofepramine," "maprotiline," "nortriptyline," "protriptyline," and "trimipramine." The search was restricted to human studies. To estimate potential exposure to TCAs during pregnancy, data from the outpatient prescription drug database of Saskatchewan, Canada, were analyzed.

RESULTS

The number of women of reproductive age (16 to 44 years) with at least 1 prescription of genotoxic TCAs was 3501 in 1977, 2959 in 1991, and 1330 in 1999. Corresponding figures for non-genotoxic TCAs were 3403, 4200, and 5493, respectively. Based on these figures, the rates of prescriptions given to women of reproductive age in any particular calendar year were 1.30% (95% confidence interval [CI], 1.25%-1.35%) for genotoxic TCAs, and 2.32% (95% CI, 2.25%-2.39%) for non-genotoxic TCAs.

CONCLUSIONS

Prescription of TCAs to women of reproductive age is quite frequent, and there has been no apparent decline in prescriptions in recent years. The frequent prescription of potentially toxic TCAs to pregnant women may be due to increases in unplanned pregnancies in industrial countries, lack of adequate scientific evidence on the adverse effects of TCAs, and conflicting needs to treat maternal diseases and to protect fetuses. Consultation with specialists experienced in treating depression may be helpful when treating pregnant women with TCAs. Large-scale epidemiologic studies to assess the potential adverse effects of TCAs use in pregnancy on a broad spectrum of fetal and infant outcomes are needed. The findings from such studies will have direct implication on the use of TCAs in the clinical treatment of depression in pregnancy.

Anxiety and depression: a 40-year perspective on relationships regarding prevalence, distribution, and comorbidity

OBJECTIVE

Building on a report about the prevalence of depression over time, this paper examines historical trends regarding anxiety in terms of its prevalence, its distribution by age and gender, and its comorbidity with depression. Methods for conducting such time trend analysis are reviewed.

METHOD

Representative samples of adults were selected and interviewed in 1952, 1970, and 1992. Logistic regressions were used for statistical analysis.

RESULTS

Although twice as common as depression, the prevalence of anxiety was equally stable. Anxiety was consistently and significantly more characteristic of women than men. A re-distribution of rates in 1992 indicated that depression but not anxiety had significantly increased among younger women (P = 0.03). Throughout the study, approximately half of the cases of anxiety also suffered depression.

CONCLUSION

The relationships between anxiety and depression remained similar over time with the exception that depression came to resemble anxiety as a disorder to which women were significantly more vulnerable than men. Social and historical factors should be investigated to assess their relevance to this change.

Mental health, life stress and social support among young Norwegian adolescents with immigrant and host national background

The first aim of the study was to investigate differences in level of mental health, life stress and social support among adolescents with immigrant and domestic background. A second aim was to identify culture group and gender specific sources of risk and protective factors and their relation to mental health. Questionnaire data were collected from 633 students, aged 13, in Oslo, Norway. Immigrant adolescents reported higher level of psychological distress and lower social support than host students. Of the four gender-culture groups, immigrant boys reported the highest level of problems, with a 28% prevalence of anxiety/depression. There were no significant differences in prevalence among the girls. Specific patterns of relationships between life stress, support, and mental health were found across gender and culture. The results were discussed within a framework of culture differences in values and gender role expectancies, underscoring the importance of studying each gender/culture group separately.

Association between scores on the SAAST (a direct measure of alcohol misuse) and CAL scale (an indirect measure of alcohol misuse) among medical patients admitted for treatment of alcohol dependence

Patients with medical or social problems related to alcohol abuse or alcohol dependence frequently are seen in the health care delivery system. Direct and indirect screening methods are available, but contemporary data describing their combined effectiveness have not been reported. We determined the sensitivity of (a) an empirically derived, item-weighted, relatively "indirect" screening measure for alcohol misuse (the Common, Alcohol, Logistic [CAL] scale for the MMPI), (b) a "direct" approach to screening for alcohol misuse (the Self-Administered Alcohol Screening Test [SAAST]), and (c) their combined application. We obtained the responses to both measures from an archival sample of 361 medical patients (89 women, 272 men) who had been diagnosed with alcohol dependence by DSM-III-R criteria. The CAL scale and the SAAST both demonstrated high sensitivity. However, results favored the simultaneous use of a direct-in this study, the SAAST-and an indirect-in this study, the CAL scale-screening procedure.

Chronic episodic disorders in women

Chronic episodic disorders, such as depressive disorders, IBS, migraine, and FMS, have important commonalities, including cormorbidities, an absence of classic anatomic pathology in the tissues, a lack of objective findings on physical examination, and a lack of abnormal findings by routine laboratory and radiologic tests. These CED are more prevalent in women (perhaps due to changes in estrogen levels), are generally worsened by stress (with resultant hyperactivity of the HPA axis), and often improve with aerobic exercise and common classes of medications affecting serotonin function, such as antidepressants. Thus, an increased understanding of the CED may result in improved treatment and functioning of many patients.

Psychiatric disorders during pregnancy

Treating women with psychiatric disorders during pregnancy is a challenge for numerous reasons. Balancing the risks and benefits of symptoms and treatments is particularly important during pregnancy because both medication and maternal illness may have adverse effects on the fetus. Communication of options in the management of psychiatric disorders in pregnancy is vital to optimal treatment. One barrier to effective communication has been a paucity of research from which clinicians can draw information, particularly in the area of pharmacological treatment. However, emerging evidence points to the low risk of many psychotropic medications during pregnancy. Uncertainty must not prevent frank risk-benefit discussions from occurring between treating physicians and their pregnant patients. Psychiatrists can prepare themselves for management decisions by reviewing the current literature.

Auditory P3 in female alcoholics

BACKGROUND

The P3 (P300) has been considered to be a phenotypical marker of the risk for alcoholism. Although reductions in visual P3 in male and female alcoholics have been replicated, studies of auditory target P3 have been inconsistent. Our objective was to study the magnitude of auditory P3 reduction in female alcoholics and to establish the association between P3 reduction and alcoholism while taking into account comorbid depression and psychoactive drug dependence. The characteristics of P3 reduction were further examined by studying the reduction in family history-positive and -negative individuals.

METHODS

Auditory target P3s recorded from 61 scalp electrodes in female alcoholics (n = 71) were compared with P3s from female controls (n = 159) ranging in age from 18 to 50 years. The amplitudes and latencies were statistically analyzed, by using repeated-measures ANOVA, in six regional electrode arrays and at representative electrode sites, with age and comorbid depression as covariates. The effects of family density and clinical variables such as depression and drug dependence were also examined with correlation analysis.

RESULTS

Alcoholic women had significantly lower P3 amplitudes in all six regions and at midline electrode sites. The reductions were not associated with comorbid depression, as shown by low correlations and similar P3 amplitudes at Pz in female alcoholics with and without depression. The P3 amplitudes in women with a high family density were smaller than those in women with a low family density of alcohol dependence. Drug dependency did not influence P3 amplitude, as shown by similar responses in drug-dependent and non-drug-dependent alcoholic women.

CONCLUSIONS

These findings highlight the significance of P3 reductions associated with alcoholism in women, independently of comorbid depression. Family density effects further support the evidence that these findings are heritable. These results suggest that P3 can be considered as a phenotypical marker of vulnerability to alcoholism in women.

Predictors of response to treatment in children and adolescents with mood disorders

Depression and bipolar disorder are frequently chronic disorders, with onset often beginning in childhood. Mood disorders are becoming more recognized in children and adolescents, and treatment of these disorders has received much attention, particularly in the past 10 years. Recent studies have demonstrated efficacy of antidepressant medications (particularly SSRIs) and specific psychotherapies (primarily CBT). Rates of remission (little or no symptoms) in these studies, however, have remained quite low (35% to 40% in most acute studies). Furthermore, recurrence is common in this population, and affects 40% to 50%. Early onset mood disorders are also associated with increased risk of developing other psychiatric disorders, substance abuse, and suicide, and having poor academic, work, and social functioning. The lifelong implications are serious. Identifying factors that may predict response to treatment, both in general and to specific treatments, may lead to improved outcomes for these patients. Unfortunately, studies have typically been inconsistent. Most studies do not identify demographic variables as predictive of outcome, although older age has been associated with poor prognosis in several studies. Psychosocial factors have yielded some results, particularly with regard to family environments. Generally, intact families with positive interaction styles and less dysfunction have been associated with better outcomes. Psychiatric disorders among parents not only predicts the development of the disorder, but is also associated with poorer prognosis. Finally, several clinical factors have been linked to poorer outcome in children and adolescents with mood disorders. More frequent episodes, increased severity (particularly suicidality and psychosis), and comorbid disorders are likely to lead to fewer recoveries, longer episodes, and increased rate of recurrence. Recent attention has focused on mediators and moderators of outcomes to treatment. In general, the theory is that enumerable factors contribute to the course of an individual's mood disorder, but that by identifying some of the variables that have more impact may allow for more specific or modified treatments to improve outcome. Many of the predictive factors explored in this article are examples of mediators and moderators that affect outcome. Each one alone may not provide definitive answers for predicting response to treatment, but each must be taken into account at the outset of treatment. It is clear that treatments must be individualized for each patient. Furthermore, selecting only one treatment exclusively for patients may hinder progress. The first step is to attempt to identify some of the underlying causes and the consequences of the disorder itself (i.e., decreased social interaction). The next step in successful treatment is to address both the causes and consequences of the disorder, through medication, psychotherapy, skills training, family intervention, or any other methods needed to assist the child to begin functioning better in all domains (social, academic, work, family, and so forth). Such a biopsychosocial approach to treatment of these disorders will likely improve overall outcome.

Depressive symptoms among pregnant women screened in obstetrics settings

OBJECTIVES

This study aimed to describe the prevalence of depressive symptomatology during pregnancy when seen in obstetric settings, the extent of treatment in this population, and specific risk factors associated with mood symptoms in pregnancy.

METHODS

A total of 3472 pregnant women age 18 and older were screened while waiting for their prenatal care visits in 10 obstetrics clinics using a brief (10 minute) screening questionnaire. This screen measured demographics, tobacco and alcohol (TWEAK problem alcohol use screening measure), and depression measures, including the Center for Epidemiological Studies-Depression scale (CES-D), use of antidepressant medications, past history of depression, and current treatment (i.e., medications, psychotherapy, or counseling) for depression.

RESULTS

Of women screened, 20% (n = 689) scored above the cutoff score on the CES-D, and only 13.8% of those women reported receiving any formal treatment for depression. Past history of depression, poorer overall health, greater alcohol use consequences, smoking, being unmarried, unemployment, and lower educational attainment were significantly associated with symptoms of depression during pregnancy.

CONCLUSIONS

These data show that a substantial number of pregnant women screened in obstetrics settings have significant symptoms of depression, and most of them are not being monitored in treatment during this vulnerable time. This information may be used to justify and streamline systematic screening for depression in clinical encounters with pregnant women as a first step in determining which women may require further treatment for their mood symptoms. As elevations in depressive symptomatology have been associated with adverse maternal and infant outcomes, further study of the impact of psychiatric treatment in gravid women is essential.

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization's composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.

An examination of the response styles theory of depression in third- and seventh-grade children: a short-term longitudinal study

The goal of this study was to test the response styles theory of depression in a sample of 3rd- and 7th-grade children. In addition, we examined whether the relationship between rumination and increases in depressive symptoms is mediated by hopelessness and low self-esteem. The procedure involved an initial assessment in which depressive symptoms, response styles, hopelessness, and self-esteem were assessed. The procedure also involved a follow-up assessment, 6 weeks later, in which depressive symptoms, hopelessness, and self-esteem were reassessed. Children with a ruminative response style exhibited increases in depressive symptoms over the 6-week period. In addition, the relationship between rumination and increases in depressive symptoms was mediated by both hopelessness and low self-esteem. Last, contrary to our hypotheses, neither distraction nor problem-solving response styles predicted decreases in depressive symptoms over the course of the study.

Use of the reasons for depression questionnaire with adolescents

The Reasons For Depression Questionnaire (RFD) was developed to examine the explanations that people give for being depressed. In its original form it was evaluated with samples of non-depressed and depressed university students and other adults. The data reported here were used to evaluate the use of the RFD with a community sample of New Zealand adolescents. While the underlying eight-factor structure reported by the original authors was confirmed, with the addition of a ninth biological factor, additional principal component-factor analysis supported the existence of a six-factor solution for adolescents. The revised factor structure incorporated a revision of the scale's item content. It is proposed that an abbreviated scale (RFD-A) using 35 of the original 48 items would be more appropriate for use with adolescents.

Postpartum disorders in primary care: diagnosis and treatment

Postpartum psychiatric illness consists of a highly prevalent group of disorders, which can result in serious dysfunction and require treatment. Patients are more likely to seek help for these disorders from their primary care physicians rather than mental health professionals. While severe postpartum depression and psychoses are easily recognized, milder or more insidious forms of depressive illness frequently are missed. Heightened sensitivity to and screening for the presence of these prevalent psychiatric disorders facilitates and enhances recognition of postpartum disorders and leads to more expeditious treatment.

The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey

PURPOSE

Recently we found that the early onset of regular tobacco use is as predictive of lifetime drug use and depressive disorders as it is of alcohol use disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. This finding, which paralleled findings regarding early onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], suggested that early regular use of any drug might simply be an indicator of risk for a constellation of problem behaviors. The purpose of the present study is to test this hypothesis as well as to study the strength and patterns of associations among these problem behaviors already present among youth. The results will permit description of more precise profiles to identify groups of children at risk.

METHODS

Using data for respondents aged 12-16 from the Third National Health and Nutrition Examination Survey (NHANES III), descriptive statistics were calculated and logistic regression models were estimated.

RESULTS

Descriptive analyses indicated that in comparison with those who never smoked, or who simply experimented, early-onset regular smokers, both those who began at age 13 or younger and those who did so between 14 and 16, were those most likely to use alcohol and other drugs as well as have school problems and early sexual experiences culminating in pregnancy. Multivariate logistic regression analyses were conducted to assess the associations among these high-risk behaviors.

IMPLICATIONS

These results support the hypothesis that early onset of smoking is but an indicator of a syndrome of problem behaviors already in place during childhood. They also suggest that the significance of an age onset variable may differ depending on the age of the sample used. As follow-up data are collected, we expect to learn much about the natural course of the distinct risk groups identified in the analyses by studying longitudinally this nationally representative group of early adolescents.