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Kinkead R, Ambrozio-Marques D, Fournier S, Gagnon M, Guay LM. Estrogens, age, and, neonatal stress: panic disorders and novel views on the contribution of non-medullary structures to respiratory control and CO 2 responses. Front Physiol 2023; 14:1183933. [PMID: 37265841 PMCID: PMC10229816 DOI: 10.3389/fphys.2023.1183933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
CO2 is a fundamental component of living matter. This chemical signal requires close monitoring to ensure proper match between metabolic production and elimination by lung ventilation. Besides ventilatory adjustments, CO2 can also trigger innate behavioral and physiological responses associated with fear and escape but the changes in brain CO2/pH required to induce ventilatory adjustments are generally lower than those evoking fear and escape. However, for patients suffering from panic disorder (PD), the thresholds for CO2-evoked hyperventilation, fear and escape are reduced and the magnitude of those reactions are excessive. To explain these clinical observations, Klein proposed the false suffocation alarm hypothesis which states that many spontaneous panics occur when the brain's suffocation monitor erroneously signals a lack of useful air, thereby maladaptively triggering an evolved suffocation alarm system. After 30 years of basic and clinical research, it is now well established that anomalies in respiratory control (including the CO2 sensing system) are key to PD. Here, we explore how a stress-related affective disorder such as PD can disrupt respiratory control. We discuss rodent models of PD as the concepts emerging from this research has influenced our comprehension of the CO2 chemosensitivity network, especially structure that are not located in the medulla, and how factors such as stress and biological sex modulate its functionality. Thus, elucidating why hormonal fluctuations can lead to excessive responsiveness to CO2 offers a unique opportunity to gain insights into the neuroendocrine mechanisms regulating this key aspect of respiratory control and the pathophysiology of respiratory manifestations of PD.
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Andrews KL, Jamshidi L, Nisbet J, Teckchandani TA, Price JAB, Ricciardelli R, Anderson GS, Carleton RN. Mental Health Disorder Symptoms among Canadian Coast Guard and Conservation and Protection Officers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315696. [PMID: 36497767 PMCID: PMC9741097 DOI: 10.3390/ijerph192315696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 05/16/2023]
Abstract
Canadian public safety personnel (PSP) screen positive for one or more mental health disorders, based on self-reported symptoms, at a prevalence much greater (i.e., 44.5%) than the diagnostic prevalence for the general public (10.1%). Potentially psychologically traumatic event (PPTE) exposures and occupational stressors increase the risks of developing symptoms of mental health disorders. The current study was designed to estimate the mental health disorder symptoms among Canadian Coast Guard (CCG) and Conservation and Protection (C&P) Officers. The participants (n = 412; 56.1% male, 37.4% female) completed an online survey assessing their current mental health disorder symptoms using screening measures and sociodemographic information. The participants screened positive for one or more current mental health disorders (42.0%; e.g., post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, alcohol use disorder) more frequently than in the general population diagnostic prevalence (10.1%; p < 0.001). The current results provide the first information describing the prevalence of current mental health disorder symptoms and subsequent positive screenings of CCG and C&P Officers. The results evidence a higher prevalence of positive screenings for mental health disorders than in the general population, and differences among the disorder-screening prevalence relative to other Canadian PSP. The current results provide insightful information into the mental health challenges facing CCG and C&P PSP and inform efforts to mitigate and manage PTSI among PSP. Ongoing efforts are needed to protect CCG and C&P Officers' mental health by mitigating the impacts of risk factors and operational and organizational stressors through interventions and training, thus reducing the prevalence of occupational stress injuries.
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Affiliation(s)
- Katie L. Andrews
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
- Correspondence:
| | - Laleh Jamshidi
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
| | - Jolan Nisbet
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
| | - Taylor A. Teckchandani
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
| | - Jill A. B. Price
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
| | - Rosemary Ricciardelli
- Fisheries and Marine Institute, Memorial University of Newfoundland, St. John’s, NL A1C 5R3, Canada
| | - Gregory S. Anderson
- Faculty of Science, Thompson Rivers University, Kamloops, BC V2C 0C8, Canada
| | - R. Nicholas Carleton
- Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK S4S 0A2, Canada
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Abstract
Background Nurses face regular exposures to potentially psychologically traumatic events as part of their occupational responsibilities. Cumulative stress due to repeated exposure to such events is associated with poor mental health and an increased risk of developing clinically significant symptoms consistent with some mental disorders. Purpose The current study was designed to estimate rates of mental disorder symptoms among nurses in Canada and identify demographic characteristics that are associated with increased risk for mental disorder symptoms. Method An online survey was conducted with Canadian nurses in both English and French. Participants were recruited largely through the Canadian Federation of Nurses Unions (CFNU) member unions, non-CFNU member unions, and social media. The survey assessed current mental disorder symptoms using well-validated screening measures. Results A total of 4267 participants (93.8% women) completed the survey. Almost half of participants screened positive for a mental disorder (i.e., 47.9%). No gender differences emerged. Significant differences in proportions of positive screens based on each measure were found across demographic groups (e.g., age, province of residence, type of nurse). Conclusions The rate of positive screens appears much higher than mental disorder prevalence rates in the general Canadian population, but there were important methodological differences. The current results provide potentially important information to support researchers and healthcare administrators to investigate possible ways to mitigate and manage mental health in nursing workplaces.
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Affiliation(s)
- Andrea M. Stelnicki
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
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Lee J, Kim H, Woo J, Chang SM, Hong JP, Lee DW, Hahm BJ, Cho SJ, Park JI, Jeon HJ, Seong SJ, Park JE, Kim BS. Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality: a Nationwide Study in Korea. J Korean Med Sci 2020; 35:e319. [PMID: 32959544 PMCID: PMC7505730 DOI: 10.3346/jkms.2020.35.e319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/23/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people. METHODS We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed. RESULTS Never-married status over the mean marriage age was associated with agoraphobia, obsessive-compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.36-7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49; 95% CI, 1.04-2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46-7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders. CONCLUSION Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.
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Affiliation(s)
- Jimin Lee
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Hyerim Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Dong Woo Lee
- Department of Psychiatry, Inje University College of Medicine, Seoul, Korea
| | - Bong Jin Hahm
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Psychiatry, Gachon University College of Medicine, Incheon, Korea
| | - Jong Ik Park
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Su Jeong Seong
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Korea.
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Zelekha Y, Zelekha O. Income and clinical depression versus non-clinical mental health: Same associations or different structures? A dissociation strategy using a national representative random survey based on EUROHIS (INHIS-2). PLoS One 2020; 15:e0234234. [PMID: 32516345 PMCID: PMC7282651 DOI: 10.1371/journal.pone.0234234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
We use a unique, large survey on health conditions conducted in Israel (10,331 respondents, 52.8% females, mean age 49.8) to explore whether clinical determined depression and/or anxiety has different associations in compare to non-clinical determined terms such as mental health. We find that absolute income is significantly associated with a decrease in negative mental health but have no significant association with depression and/or anxiety prevalence, whereas relative income is significantly associated with a decrease in depression and/or anxiety prevalence but have no significant association with negative mental health. The two specifications differed also with respect to several important risk factors, including personal attributes such as being of African origin, of a non-Jewish Arab minority or divorced. However, they were similar with general characteristics, such as participation in sport and smoking activities, whether a person has children, age and gender. Our results put forth sever questions about the wide use of non-clinical mental health, happiness and wellbeing as a sole proxy for a person's true wellbeing or utility.
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Affiliation(s)
- Yaron Zelekha
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
- * E-mail:
| | - Orly Zelekha
- The Israel Ministry of Health's: Israel Center for Disease Control, Ramat Gan, Israel
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Carleton RN, Ricciardelli R, Taillieu T, Mitchell MM, Andres E, Afifi TO. Provincial Correctional Service Workers: The Prevalence of Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072203. [PMID: 32218316 PMCID: PMC7177517 DOI: 10.3390/ijerph17072203] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
Correctional service employees in Ontario, Canada (n = 1487) began an online survey available from 2017 to 2018 designed to assess the prevalence and correlates of mental health challenges. Participants who provided data for the current study (n = 1032) included provincial staff working in institutional wellness (e.g., nurses) (n = 71), training (e.g., program officers) (n = 26), governance (e.g., superintendents) (n = 82), correctional officers (n = 553), administration (e.g., record keeping) (n = 25), and probation officers (n = 144, parole officers). Correctional officers, workers in institutional administration and governance positions, and probation officers reported elevated risk for mental disorders, most notably posttraumatic stress disorder (PTSD) and major depressive disorder. Among institutional correctional staff, 61.0% of governance employees, 59.0% of correctional officers, 43.7% of wellness staff, 50.0% of training staff, and 52.0% of administrative staff screened positive for one or more mental disorders. In addition, 63.2% of probation officers screened positive for one or more mental disorders. Women working as correctional officers were more likely to screen positive than men (p < 0.05). Across all correctional occupational categories positive screens for each disorder were: 30.7% for PTSD, 37.0% for major depressive disorder, 30.5% for generalized anxiety disorder, and 58.2% for one or more mental disorders. Participants between ages 40 and 49 years, working in institutional governance, as an institutional correctional officer, or as a probational officer, separated or divorced, were all factors associated (p < 0.05) with screening positive for one or more mental disorders. The prevalence of mental health challenges for provincial correctional workers appears to be higher than federal correctional workers in Canada and further supports the need for evidence-based mental health solutions.
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Affiliation(s)
- R. Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada;
| | - Rosemary Ricciardelli
- Memorial University of Newfoundland, Saint John’s, NL A1C 5S7, Canada;
- Correspondence: ; Tel.: +1-(709)-864-7446
| | - Tamara Taillieu
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; (T.T.); (T.O.A.)
| | - Meghan M. Mitchell
- Department of Criminal Justice, University of Central Florida, Orlando, FL 32810, USA;
| | - Elizabeth Andres
- Memorial University of Newfoundland, Saint John’s, NL A1C 5S7, Canada;
| | - Tracie O. Afifi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; (T.T.); (T.O.A.)
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Inoue T, Kimura T, Inagaki Y, Shirakawa O. Prevalence of Comorbid Anxiety Disorders and Their Associated Factors in Patients with Bipolar Disorder or Major Depressive Disorder. Neuropsychiatr Dis Treat 2020; 16:1695-1704. [PMID: 32764945 PMCID: PMC7369363 DOI: 10.2147/ndt.s246294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/05/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Comorbid anxiety disorders in patients with mood disorders have a negative impact on outcomes, such as persistence of depressive symptoms, deterioration of quality of life (QoL), increased suicide risk, mood instability with antidepressant treatment, but often go underrecognized in clinical practice. To identify features useful for supporting the confirmation of comorbid anxiety disorders, we investigated the prevalence of comorbid anxiety disorders and their associated factors in Japanese patients with mood disorders using data from our previously reported JET-LMBP study. PATIENTS AND METHODS Patients with bipolar disorder (BD; n=114) and patients with major depressive disorder (MDD; n=334), all with major depressive episodes (DSM-IV-TR) were analyzed. Comorbid anxiety disorders were confirmed using the Mini-International Neuropsychiatric Interview. Demographic and clinical features were assessed using patient background forms, including the Quick Inventory of Depressive Symptomatology-Self Report Japanese version, 36-Item Short-Form Health Survey (SF-36), and Child Abuse and Trauma Scale (CATS). Multivariate logistic regression analysis adjusted for age, sex, and severity of depressive symptoms was used to identify factors associated with comorbid anxiety disorders (post hoc analysis). RESULTS The prevalence of comorbid anxiety disorders was significantly higher in patients with BD (53.2%) than in patients with MDD (37.2%). Factors associated with comorbid anxiety disorders in BD included no spouse, interpersonal rejection sensitivity, higher CATS sexual abuse scores, and lower SF-36 mental component summary scores. In MDD, factors included hypersomnia, pathological guilt feelings, higher CATS neglect scores, and lower SF-36 physical component summary scores. CONCLUSION Comorbid anxiety disorders were commonly seen in Japanese patients with mood disorders. Childhood abuse, atypical depression symptoms, and deterioration of health-related QoL were commonly associated with comorbid anxiety disorders in BD and MDD, suggesting that the presence of these features may be useful to support the confirmation of comorbid anxiety disorders in these patients.
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Affiliation(s)
- Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Toshifumi Kimura
- Medical Affairs Department, Medical Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Yoshifumi Inagaki
- Medical Affairs Department, Medical Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
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Luo Z, Li Y, Hou Y, Liu X, Jiang J, Wang Y, Liu X, Qiao D, Dong X, Li R, Wang F, Wang C. Gender-specific prevalence and associated factors of major depressive disorder and generalized anxiety disorder in a Chinese rural population: the Henan rural cohort study. BMC Public Health 2019; 19:1744. [PMID: 31881870 PMCID: PMC6935131 DOI: 10.1186/s12889-019-8086-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/15/2019] [Indexed: 12/29/2022] Open
Abstract
Background This study aims to investigate the prevalence and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD) by gender in Chinese rural adults. Methods A total of 29,993 participants aged from 18 to 79 years from the Henan Rural Cohort Study were included in this study. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were used to assess MDD and GAD through a face-to-face interview. Multivariate logistic regression model was conducted to analyze the associated factors for MDD and GAD. Results The age-standardized prevalence of MDD and GAD (and 95%CI) in the total sample were 5.41% (5.17–5.66%) and 4.94% (4.71–5.18%), respectively. Besides, the crude prevalence in women were significantly higher than men for both MDD (6.81% vs. 4.77%) and GAD (6.63% vs. 3.93%) (both P < 0.001). Tetrachoric correlation test showed high comorbidity between MDD and GAD (r = 0.88, P = 0.01). Further analysis revealed that age, sex, marital status, educational level, per capita monthly income, drinking, physical activity, and body mass index were associated with MDD and GAD in the overall sample. Gender difference was found among age groups for MDD (Pinteraction < 0.001). Conclusions These findings showed that Chinese rural adults were at low risk for prevalence of MDD and GAD. Women had higher prevalence and risks for MDD and GAD compared with men, indicating that women deserved more attention. Gender-specific interventions on the modifiable associated factors are urgently needed to improve the mental conditions for Chinese rural population. Clinical trial registration The Henan Rural Cohort Study has been registered in the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.
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Affiliation(s)
- Zhicheng Luo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yitan Hou
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Jingjing Jiang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Xue Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Dou Qiao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China
| | - Fang Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, People's Republic of China.
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MacKenzie A, Tomblin Murphy G, Audas R. A dynamic, multi-professional, needs-based simulation model to inform human resources for health planning. HUMAN RESOURCES FOR HEALTH 2019; 17:42. [PMID: 31196188 PMCID: PMC6567915 DOI: 10.1186/s12960-019-0376-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date. METHODS The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach. RESULTS The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH. CONCLUSION This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.
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Affiliation(s)
- Adrian MacKenzie
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Gail Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Nova Scotia Health Authority, Halifax, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Besser A, Döhnert M, Stadelmann S. [Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:345-358. [PMID: 31099287 DOI: 10.1024/1422-4917/a000668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents Abstract. Objective: Socioeconomic status (SES) is an important risk factor for psychiatric disorders in children and adolescents. Various SES parameters are included in research efforts. This paper investigates the predictive value of different individual SES measures and the combination thereof regarding internalizing and externalizing disorders in children and adolescents. Method: We used data from N = 381 8- to 14-year-olds who had been recruited in child and adolescent psychiatric facilities and in the general population. Based on a diagnostic parent interview (K-SADS-PL), we divided the sample into internalizing and externalizing groups and a healthy control group. The SES data of both parents were collected. Education, occupational status, and income were integrated as single factors as well as combined factor to form the SES index. Additionally, we assessed unemployment. Results: Using multivariate analyses, we controlled for age and sex. All single factors turned out to be significant risk factors for internalizing and externalizing disorders. Occupational status was the most important single factor. The explained variance for the SES index was as high as for occupational status. Unemployment was not predictive when examined simultaneously with the SES index. Conclusion: Future studies should integrate the SES as risk factor and use the SES index or occupational status as single factor. The integration of unemployment is not necessarily needed.
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Affiliation(s)
- Anna Besser
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig.,2 HELIOS Hanseklinikum Stralsund GmbH, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Stralsund
| | - Mirko Döhnert
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
| | - Stephanie Stadelmann
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
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11
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Tseng TJ, Wu YS, Tang JH, Chiu YH, Lee YT, Fan IC, Chan TC. Association between health behaviors and mood disorders among the elderly: a community-based cohort study. BMC Geriatr 2019; 19:60. [PMID: 30819099 PMCID: PMC6394040 DOI: 10.1186/s12877-019-1079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND According to a WHO report, nearly 15% of adults aged 60 and over suffer from a mental disorder, constituting 6.6% of the total disability for this age group. Taipei City faces rapid transformation towards an aging society, with the proportion of elderly in the total population rising from 12% in 2008 to 16% in 2016. The aim of this study is to identify the prevalence of mental disorders among the elderly in Taipei City and to elucidate risk factors contributing to mental disorders. METHODS The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2012. A total of 86,061 people underwent publicly funded health examinations, with 348,067 visits. Each year, there are around 43,000 elderly persons in Taipei City using this service. We used a mental health questionnaire including five questions to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of the elderly. Mood disorders were measured with the Brief Symptom Rating Scale (BSRS-5) questionnaire. Age, education level, gender, marital status, living alone, drinking milk, eating vegetables and fruits, long-term medication, smoking status, frequency of alcohol consumption, frequency of physical activity, BMI, and number of chronic diseases were included as covariates. RESULTS The results show that being male (odds ratio (OR) 0.57; 95% CI = 0.56, 0.59), higher education (OR 0.88; 95% CI = 0.82, 0.95), no long-term medication (OR 0.57; 95% CI = 0.56, 0.58), and exercising three or more times per week (OR 0.94; 95% CI = 0.91, 0.98) were all positively correlated with better emotional status. However, being divorced (OR = 1.22, 95% CI = 1.09, 1.36), not drinking milk (OR = 1.12, 95% CI = 1.09, 1.14), not eating enough vegetables and fruits every day (OR = 1.78, 95% CI = 1.73, 1.83), daily smoking (OR = 1.15, 95% CI = 1.01, 1.32), and having more chronic diseases (OR = 1.02, 95% CI = 1.01, 1.03) were all correlated with poor mental status among the elderly. CONCLUSIONS The findings of this research can both estimate the prevalence of mood disorders at the community level, and identify risk factors of mood disorders at the personal level.
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Affiliation(s)
- Tzu-Jung Tseng
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Yi-Syuan Wu
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jia-Hong Tang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yen-Hui Chiu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Ting Lee
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - I-Chun Fan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of History and Philology, Academia Sinica, Taipei, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Nasreen S, Brar R, Brar S, Maltby A, Wilk P. Are Indigenous Determinants of Health Associated with Self-Reported Health Professional-Diagnosed Anxiety Disorders Among Canadian First Nations Adults?: Findings from the 2012 Aboriginal Peoples Survey. Community Ment Health J 2018; 54:460-468. [PMID: 28887731 DOI: 10.1007/s10597-017-0165-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
We estimated the prevalence of self-reported health professional-diagnosed anxiety disorders among Canadian First Nations adults living off-reserve, and assessed the relationship between anxiety disorders and Indigenous determinants of health (Status Indian, residential school attendance, knowledge of Indigenous language, and participation in traditional activities) using the 2012 Aboriginal Peoples Survey. Multivariable logistic regression models were performed using bootstrap weights. The prevalence of anxiety disorders was 14.5% among off-reserve First Nations adults. There was an increased odds of anxiety disorders among those participating in traditional activities compared to their counterparts (aOR 1.46, 95% CI 1.12-1.90). No association was found between anxiety disorders and other Indigenous determinants of health. There is a high prevalence of self-reported anxiety among First Nations adults living off-reserve. However, further studies are warranted to identify and assess the role of Indigenous determinants of health for anxiety disorders and other prevalent mental health conditions in this population.
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Affiliation(s)
- Sharifa Nasreen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Ramanpreet Brar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Samanpreet Brar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Abstract
OBJECTIVE To define the prevalence of psychiatric symptoms of anxiety and depression in patients at the time of their first seizure presentation to a neurologist. METHODS Our pilot study uses a cohort approach with multimodal data (clinical, social, structural [3T magnetic resonance imaging], and functional [electroencephalogram]). We screened 105 patients referred to the Halifax First Seizure Clinic between 2014 and 2016 and 51 controls. All participants completed two screening questionnaires: Neurological Disorders Depression Inventory for Epilepsy and Generalized Anxiety Disorder 7-Item. After applying the exclusion criteria, the study population consisted of 57 patients with unprovoked first seizure and 31 controls. The prevalence of anxiety and depression was based on cutoff scores of >15 and >14 respectively. RESULTS Unprovoked first seizure patients showed higher prevalence of depression (33%) compared with control (6%) with an odds ratio (OR) of 2.75 (95% confidence interval [CI], 0.72-10.5). There was no significant difference in the prevalence of anxiety between control subjects (9.7%) and unprovoked first seizure patients (23%). Subcategory analysis conducted after diagnosis confirmation revealed significantly increased OR of depression in patients diagnosed with new-onset epilepsy (OR, 11.6; 95% CI, 2.1-64.0) and newly diagnosed epilepsy (OR, 20.0; 95% CI,2.2-181), but not first seizure only patients (OR, 2.2; 95% CI,0.28-17.6) compared with control. CONCLUSIONS Our study supports a bidirectional relationship between the first seizure and depression. Prevalence rate of depression increased with duration of undiagnosed epilepsy at the time of first clinical assessment.
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Carleton RN, Afifi TO, Turner S, Taillieu T, Duranceau S, LeBouthillier DM, Sareen J, Ricciardelli R, MacPhee RS, Groll D, Hozempa K, Brunet A, Weekes JR, Griffiths CT, Abrams KJ, Jones NA, Beshai S, Cramm HA, Dobson KS, Hatcher S, Keane TM, Stewart SH, Asmundson GJG. Mental Disorder Symptoms among Public Safety Personnel in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:54-64. [PMID: 28845686 PMCID: PMC5788123 DOI: 10.1177/0706743717723825] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. METHODS An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. RESULTS There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. INTERPRETATION The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.
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Affiliation(s)
- R Nicholas Carleton
- 1 Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | - Sarah Turner
- 2 University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | | - Rose Ricciardelli
- 4 Memorial University of Newfoundland, Saint John's, Newfoundland and Labrador, Canada
| | | | | | - Kadie Hozempa
- 3 University of Regina, Regina, Saskatchewan, Canada
| | | | - John R Weekes
- 8 Correctional Service of Canada, Ottawa, Ontario, Canada
| | | | - Kelly J Abrams
- 10 Canadian Health Information Management Association, Regina, Canada
| | | | - Shadi Beshai
- 3 University of Regina, Regina, Saskatchewan, Canada
| | | | | | | | - Terence M Keane
- 13 National Center for Post Traumatic Stress Disorder, White River Junction, Vermont, USA
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Meng X. What characteristics are associated with earlier onset of first depressive episodes: A 16-year follow-up of a national population-based cohort. Psychiatry Res 2017; 258:427-433. [PMID: 28867409 DOI: 10.1016/j.psychres.2017.08.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/26/2017] [Accepted: 08/26/2017] [Indexed: 11/25/2022]
Abstract
This study examined characteristics associated with earlier onset of first depressive episodes. A nationally representative Canadian sample was randomly selected and followed from 1994 to 2011. At baseline complete data on depression history (Yes/No) and related diseases was available for 12,227 study subjects. Proportional hazard models were used. Meta-analyses were also applied to sync results across studies. Being younger, a woman, a Caucasian, a regular smoker, and having a chronic disease were significantly associated with the expedited trajectory for the onset of the first depressive episode. People were at the greater risk of having earlier onset of first depressive episodes at the 2-year follow-up (p < 0.001), with the risk declining after four years (p < 0.001). Women and men had different sets of characteristics associated with earlier onset of first depressive episodes. In meta-analyses, those having a chronic disease (HRpooled = 1.31) and being a woman (HRpooled = 1.43) were more likely to have earlier onset of first depressive episodes. This study provides solid evidence on the timing effect of these characteristics on first depressive episodes. Approaches focused on these identified risk characteristics should be prioritized to reduce the risk and postpone the onset of major depressive episode.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada.
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de Ornelas Maia ACC, Sanford J, Boettcher H, Nardi AE, Barlow D. Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment. J Psychiatr Res 2017; 93:30-36. [PMID: 28575646 DOI: 10.1016/j.jpsychires.2017.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/25/2017] [Accepted: 05/25/2017] [Indexed: 12/20/2022]
Abstract
Patients with multiple mental disorders often experience sexual dysfunction and reduced quality of life. The unified protocol (UP) is a transdiagnostic treatment for emotional disorders that has the potential to improve quality of life and sexual functioning via improved emotion management. The present study evaluates changes in quality of life and sexual functioning in a highly comorbid sample treated with the UP in a group format. Forty-eight patients were randomly assigned to either a UP active-treatment group or a medication-only control group. Treatment was delivered in 14 sessions over the course of 4 months. Symptoms of anxiety and depression were assessed using the Beck Anxiety Inventory and Beck Depression Inventory. Sexual functioning was assessed by the Arizona Sexual Experience Scale (ASEX), and quality of life was assessed by the World Health Organization Quality of Life-BREF scale (WHOQOL-BREF). Quality of life, anxiety and depression all significantly improved among participants treated with the UP. Some improvement in sexual functioning was also noted. The results support the efficacy of the UP in improving quality of life and sexual functioning in comorbid patients.
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Affiliation(s)
- Ana Claudia Corrêa de Ornelas Maia
- Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil; Center for Anxiety and Related Disorders, Boston University, USA.
| | - Jenny Sanford
- Center for Anxiety and Related Disorders, Boston University, USA.
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders, Boston University, USA.
| | - Antonio E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil; Visiting Professor, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
| | - David Barlow
- Center for Anxiety and Related Disorders, Boston University, USA.
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Meng X, Brunet A, Turecki G, Liu A, D'Arcy C, Caron J. Risk factor modifications and depression incidence: a 4-year longitudinal Canadian cohort of the Montreal Catchment Area Study. BMJ Open 2017; 7:e015156. [PMID: 28601831 PMCID: PMC5734363 DOI: 10.1136/bmjopen-2016-015156] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Few studies have examined the effect of risk factor modifications on depression incidence. This study was to explore psychosocial risk factors for depression and quantify the effect of risk factor modifications on depression incidence in a large-scale, longitudinal population-based study. METHODS Data were from the Montreal Longitudinal Catchment Area study (N=2433). Multivariate modified Poisson regression was used to estimate relative risk (RR). Population attributable fractions were also used to estimate the potential impact of risk factor modifications on depression incidence. RESULTS The cumulative incidence rate of major depressive disorder at the 2-year follow-up was 4.8%, and 6.6% at the 4-year follow-up. Being a younger adult, female, widowed, separated or divorced, Caucasian, poor, occasional drinker, having a family history of mental health problems, having less education and living in areas with higher unemployment rates and higher proportions of visible minorities, more cultural community centres and community organisations, were consistently associated with the increased risk of incident major depressive disorder. Although only 5.1% of the disease incidence was potentially attributable to occasional drinking (vs abstainers) at the 2-year follow-up, the attribution of occasional drinking doubled at the 4-year follow-up. A 10% reduction in the prevalence of occasional drinking in this population could potentially prevent half of incident cases. CONCLUSIONS Modifiable risk factors, both individual and societal, could be the targets for public depression prevention programmes. These programmes should also be gender-specific, as different risk factors have been identified for men and women. Public health preventions at individual levels could focus on the better management of occasional drinking, as it explained around 5%~10% of incident major depressive disorders. Neighbourhood characteristics could also be the target for public prevention programmes. However, this could be very challenging. A cost-effectiveness analysis of a variety of prevention efforts is warranted.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Alain Brunet
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Aihua Liu
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Carl D'Arcy
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Jean Caron
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Loukine L, O'Donnell S, Goldner EM, McRae L, Allen H. Health status, activity limitations, work-related restrictions and level of disability among Canadians with mood and/or anxiety disorders. Health Promot Chronic Dis Prev Can 2016; 36:289-301. [PMID: 27977084 PMCID: PMC5387796 DOI: 10.24095/hpcdp.36.12.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study provides the first overview of the perceived general and mental health, activity limitations, work-related restrictions and level of disability, as well as factors associated with disability severity, among Canadian adults with mood and/or anxiety disorders, using a population-based household sample. METHODS We used data from the 2014 Survey on Living with Chronic Diseases in Canada- Mood and Anxiety Disorders Component. The sample consists of Canadians aged 18 years and older with self-reported mood and/or anxiety disorders from the 10 provinces (n = 3361; response rate 68.9%). We conducted descriptive and multinomial multivariate logistic regression analyses. RESULTS Among Canadian adults with mood and/or anxiety disorders, over one-quarter reported "fair/poor" general (25.3%) and mental (26.1%) health; more than one-third (36.4%) reported one or more activity limitations; half (50.3%) stated a job modification was required to continue working; and more than one-third (36.5%) had severe disability. Those with concurrent mood and anxiety disorders reported poorer outcomes: 56.4% had one or more activity limitations; 65.8% required a job modification and 49.6% were severely disabled. Upon adjusting for individual characteristics, those with mood and/or anxiety disorders who were older, who had a household income in the lowest or lower-middle adequacy quintile or who had concurrent disorders were more likely to have severe disability. CONCLUSION Findings from this study affirm that mood and/or anxiety disorders, especially concurrent disorders, are associated with negative physical and mental health outcomes. Results support the role of public health policy and programs aimed at improving the lives of people living with these disorders, in particular those with concurrent disorders.
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Affiliation(s)
- L Loukine
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - S O'Donnell
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - E M Goldner
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - L McRae
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - H Allen
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Machado Junior SB, Celestino MIO, Serra JPC, Caron J, Pondé MP. Risk and protective factors for symptoms of anxiety and depression in parents of children with autism spectrum disorder. Dev Neurorehabil 2016; 19:146-53. [PMID: 24950424 DOI: 10.3109/17518423.2014.925519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The severity of symptoms of anxiety and depression was evaluated in 102 parents of children with autism spectrum disorders (ASD) and correlated with the severity of their child's behavioral symptoms. DESIGN An observational, cross-sectional study. METHODS The Portuguese versions of the Hospital Anxiety and Depression Scale and the Aberrant Behavior Checklist were used to assess symptoms in the parents and in their children. MAIN OUTCOMES AND RESULTS Depression was present in 26.7% of parents and anxiety in 33.7%. Severe behavioral symptoms in the child increased the likelihood of severe anxiety and depression symptoms in the parents by a factor of 35. If the child had severe behavioral symptoms and the father lived in the family home, the likelihood of severe symptoms of anxiety and depression in the parents was 95.2% lower. CONCLUSION The presence of the father living in the family home acted as a buffer against parents' symptoms.
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Affiliation(s)
- Samuel Bezerra Machado Junior
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Meline Ivone Oliveira Celestino
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Juliane Penalva Costa Serra
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Jean Caron
- b Douglas Mental Health Institute, McGill University , Montreal , Quebec , Canada
| | - Milena Pereira Pondé
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
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MARTINEZ CC, GURGEL LG, PLENTZ RDM, REPPOLD CT, CASSOL M. Qualidade de vida e ansiedade relacionadas às alterações vocais: revisão sistemática. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2015. [DOI: 10.1590/0103-166x2015000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Este estudo objetivou revisar sistematicamente na literatura as relações entre a disfonia e a ansiedade e qualidade de vida. Como estratégia de busca, foram utilizados os termos "ensaio clínico randomizado", "ansiedade", "voz", "distúrbios da voz", "qualidade da voz" e "treinamento da voz", nas bases de dados MedLine (PubMed), Cochrane Central, Embase, PsycINFO, Lilacs e SciELO. Incluíram-se ensaios clínicos randomizados de fonoterapia vocal com os desfechos ansiedade e qualidade de vida. Utilizou-se a abordagem Grades of Recommendation, Assessment, Development and Evaluation, que tem o objetivo de determinar a qualidade da evidência para cada desfecho. Dos 137 estudos identificados, apenas três atenderam aos critérios de inclusão e foram considerados como relevantes para a composição da amostra deste trabalho. A maioria dos estudos encontrados apresentavam limitações metodológicas, resultados imprecisos e ausência de razão de chances. Dentre as limitações desta revisão, destaca-se que parte dos achados esteve relacionada ao autorrelato do paciente e que dois ensaios foram realizados com a mesma amostra. Apesar do pequeno número de estudos, constata-se que a ansiedade e a qualidade de vida estão associadas à disfonia.
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Affiliation(s)
| | | | | | | | - Mauriceia CASSOL
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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MacLeod MA, Bauer GR, Robinson M, MacKay J, Ross LE. Biphobia and Anxiety Among Bisexuals in Ontario, Canada. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015. [DOI: 10.1080/19359705.2014.1003121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The trajectory of neuropsychological dysfunctions in bipolar disorders: a critical examination of a hypothesis. J Affect Disord 2015; 175:396-402. [PMID: 25678172 DOI: 10.1016/j.jad.2015.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/14/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The hypothesis of a progressive nature of neuropsychological deficits in bipolar disorders is often accepted as an axiom by many clinicians and researchers in the field. However, contradictory pieces of data and a number of methodological concerns put it under debate. METHOD We reviewed findings from three different approaches to the study of the trajectory of cognitive features in bipolar disorders: longitudinal evaluation of cognition in affected subjects, cross-sectional neuropsychological assessment of patients belonging to different age groups, and exploration of the risk of dementia in bipolar subjects. RESULTS An increased risk of developing dementia was found in bipolar subjects. However, evidence from cross-sectional studies did not show more severe cognitive deficits in patients with longer illness duration. Furthermore, longitudinal studies revealed that bipolar subjects׳ cognitive performance did not change between different points in time. CONCLUSIONS After a thorough discussion of these findings and the limitations of the different approaches, we argue that, at present, there is no consistent evidence supporting that bipolar disorders, as a group, have a progressively deteriorating course of cognitive functions. Furthermore, we highlight the possible influence of psychotropic agents and metabolic factors on neuropsychological outcomes. Finally, we discuss the clinical implications of these findings and propose targets for forthcoming research.
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Diagnosis of bipolar disorder in primary and secondary care: what have we learned over a 10-year period? J Affect Disord 2015; 174:225-32. [PMID: 25527992 DOI: 10.1016/j.jad.2014.10.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement. METHODS The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ). RESULTS From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact. LIMITATIONS Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available. CONCLUSIONS Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice.
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Molina MRAL, Spessato B, Jansen K, Pinheiro R, Silva R, Souza LDDM. Prevalence of comorbidities between mood and anxiety disorders: associated factors in a population sample of young adults in southern Brazil. CAD SAUDE PUBLICA 2014; 30:2413-2422. [DOI: 10.1590/0102-311x00012614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/04/2014] [Indexed: 11/22/2022] Open
Abstract
This research aims to evaluate factors associated with the presence of comorbidities between mood and anxiety disorders in young adults aged 18 to 24 years, from Pelotas, Rio Grande do Sul State, Brazil. This was a cross-sectional, population-based study with a probabilistic sample by conglomerates. The Mini International Neuropsychiatric Interview (MINI) was used to assess mood and anxiety disorders. The prevalence of mental disorders in the sample (n = 1,561) was of 26.8% of which 9.7% had comorbidities between mood and anxiety disorders. The prevalence of comorbidities on mood and anxiety disorders is almost three times higher among women than men (p < 0.001). Lower education levels, socioeconomic status (p < 0.001) and a history of divorced parents (p < 0.050) was associated with comorbidities between mood and anxiety disorders. The main conclusion is that social factors are highly associated with comorbidities between mood and anxiety disorders. Prevention strategies on mental health should focus particularly on women in vulnerable social conditions.
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Abstract
PURPOSE OF REVIEW Mental disorders take a major toll, economically, socially, and psychologically, on individuals, families, and societies. Prevention provides an important and realistic opportunity to overcome this major health problem. This review outlines a conceptual framework for mental health prevention and effective strategies and programs for the prevention of mental disorders. RECENT FINDINGS Risk and protective factors for mental illness provide leverage points for prevention interventions. A life course perspective, looking at disease from conception, pregnancy, parenting, infancy, childhood, adolescence, adulthood to aging, emphasizes the importance of targeting prevention efforts as early as possible in life. Currently available effective and realistic preventions targeting major phases of life including both universal (community) and selective high-risk approaches are noted. The Internet and its associated technologies are seen to have great potential for prevention. SUMMARY Common mental disorders are preventable, and prevention is cost-effective. Although the evidence base for the prevention of mental disorders needs to be expanded with rigorous large-scale pragmatic trials of promising effective programs, we have at our disposal strong evidence and effective tools on which to base prevention efforts. These facts need to be fully communicated to providers, policy makers, and the population at large, and acted upon.
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Meng X, D'Arcy C. The projected effect of risk factor reduction on major depression incidence: a 16-year longitudinal Canadian cohort of the National Population Health Survey. J Affect Disord 2014; 158:56-61. [PMID: 24655766 DOI: 10.1016/j.jad.2014.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Few studies have examined the effect of risk factor modification on depression incidence. This study estimated the effect of risk factor modification on depression incidence. METHODS Data analyzed were from the Canadian National Population Health Survey (NPHS) - a longitudinal population-based cohort study. The study followed-up a national cohort sample over a 16-year period from 1994 to 2010. Multivariate modified Poisson regression was used to estimate relative risk. RESULTS The cumulative incidence rate of depression during the 16-year follow-up was 12.07%. Being younger adult, female, Caucasian, poor, occasional/abstainer/former drinker, regular smoker, and having chronic disease were significantly associated with an increased risk of developing depression. About 40% of depression incidence (850,000 cases) was potentially attributable to modifiable risk factors (poor income, smoking, and having a chronic disease). A 10% reduction in the prevalence of these modifiable risk factors could potentially prevent about 165,000 cases of depression. LIMITATIONS The calculation of PAFs assumes that there is a causal relationship between a risk factor and depression. However, major depression has multiple causes. The potential effect of risk factor modification on depression incidence may vary by the profile of risk factors assessed in a particular study. Several potentially important risk factors were not included in this study. CONCLUSION Public health campaigns targeted at significant modifiable risk factors could have a profound effect on future depression incidence. Prevention trials are needed to directly evaluate the effect of single and/or multiple risk factors modification on depression incidence.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada S7N 0W8
| | - Carl D'Arcy
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada S7N 0W8; School of Public Health, University of Saskatchewan, Saskatoon, Canada S7N 0W8
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Subic-Wrana C, Beutel ME, Brähler E, Stöbel-Richter Y, Knebel A, Lane RD, Wiltink J. How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population? PLoS One 2014; 9:e91846. [PMID: 24637792 PMCID: PMC3956759 DOI: 10.1371/journal.pone.0091846] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 02/16/2014] [Indexed: 11/19/2022] Open
Abstract
Objective The Levels of Emotional Awareness Scale (LEAS) as a performance task discriminates between implicit or subconscious and explicit or conscious levels of emotional awareness. An impaired awareness of one's feeling states may influence emotion regulation strategies and self-reports of negative emotions. To determine this influence, we applied the LEAS and self-report measures for emotion regulation strategies and negative affect in a representative sample of the German general population. Sample and Methods A short version of the LEAS, the Hospital Anxiety and Depression Scale (HADS) and the Emotion Regulation Questionnaire (ERQ), assessing reappraisal and suppression as emotion regulation strategies, were presented to N = 2524 participants of a representative German community study. The questionnaire data were analyzed with regard to the level of emotional awareness. Results LEAS scores were independent from depression, but related to self-reported anxiety. Although of small or medium effect size, different correlational patters between emotion regulation strategies and negative affectivity were related to implict and explict levels of emotional awareness. In participants with implicit emotional awareness, suppression was related to higher anxiety and depression, whereas in participants with explicit emotional awareness, in addition to a positive relationship of suppression and depression, we found a negative relationship of reappraisal to depression. These findings were independent of age. In women high use of suppression and little use of reappraisal were more strongly related to negative affect than in men. Discussion Our first findings suggest that conscious awareness of emotions may be a precondition for the use of reappraisal as an adaptive emotion regulation strategy. They encourage further research in the relation between subconsious and conscious emotional awareness and the prefarance of adaptive or maladaptive emotion regulation strategies The correlational trends found in a representative sample of the general population may become more pronounced in clinical samples.
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Affiliation(s)
- Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Rhinland-Palatinate, Germany
- * E-mail:
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Rhinland-Palatinate, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Saxony, Germany
| | - Yve Stöbel-Richter
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Saxony, Germany
| | - Achim Knebel
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Rhinland-Palatinate, Germany
| | - Richard D. Lane
- Department of Neuroscience, College of Social and Behavioral Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Rhinland-Palatinate, Germany
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Paholpak S, Kongsakon R, Pattanakumjorn W, Kanokvut R, Wongsuriyadech W, Srisurapanont M. Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry. Neuropsychiatr Dis Treat 2014; 10:803-10. [PMID: 24868157 PMCID: PMC4031243 DOI: 10.2147/ndt.s57019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). METHODS The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery-Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. RESULTS Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). CONCLUSION A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.
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Affiliation(s)
- Suchat Paholpak
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ronnachai Kongsakon
- Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Chiang Mai, Thailand
| | | | - Roongsang Kanokvut
- Department of Psychiatry, Buddhachinaraj Hospital, Phitsanulok, Chiang Mai, Thailand
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Gili M, García Toro M, Armengol S, García-Campayo J, Castro A, Roca M. Functional impairment in patients with major depressive disorder and comorbid anxiety disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:679-86. [PMID: 24331287 DOI: 10.1177/070674371305801205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyze the potential for different aspects of anxiety to modify the effect of impaired functioning in major depressive disorder (MDD). METHODS Participants (n = 1226) were psychiatric outpatients with MDD. A cross-sectional, multicentre, nationwide study was designed. The 12-item version of the World Health Organization Disability Assessment Schedule II was used to assess functional limitation. Anxiety was measured using the Hamilton Anxiety Rating Scale and the State-Trait Anxiety Inventory (STAI). Depression severity was measured using the Quick Inventory of Depressive Symptomatology. RESULTS About 43.1% of patients had a comorbid MDD and anxiety disorder. Poorer functioning correlated significantly with severity of depression (Pearson r = 0.78, P = 0.001), severity of anxiety (r = 0.65, P = 0.001), and higher anxiety trait scores (r = 0.40, P = 0.001), but not significantly with STAI-State scores (r = 0.03, P = 0.26). The overall regression model was significant and explained 66% of the functioning variability in patients with MDD, mostly attributable to depression severity. Results indicate that anxiety has a moderate impact on functioning impairment in patients with MDD. CONCLUSIONS Our findings suggest that MDD and anxiety severity appear to be associated significantly with impaired functioning in patients with MDD but explains only a moderate proportion of variance.
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Affiliation(s)
- Margalida Gili
- Professor, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain; Senior Researcher, Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RediAPP), Palma de Mallorca, Spain
| | - Mauro García Toro
- Professor, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain; Senior Researcher, Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RediAPP), Palma de Mallorca, Spain
| | | | - Javier García-Campayo
- Associate Professor, Department of Psychiatry, Miguel Servet Hospital, University of Zaragoza, Zaragoza, Spain
| | - Adoración Castro
- Doctoral Student, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Miquel Roca
- Professor, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain; Senior Researcher, Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RediAPP), Palma de Mallorca, Spain
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Dennis CL, Coghlan M, Vigod S. Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory? J Affect Disord 2013; 150:1217-20. [PMID: 23764383 DOI: 10.1016/j.jad.2013.05.049] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/11/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study assessed the stability of maternal anxiety and concordance between State-Trait Anxiety Inventory (STAI) scores in the immediate postpartum period to 8 weeks postpartum. METHODS A population-based sample of 522 mothers completed the STAI at 1, 4, and 8 weeks postpartum. Sensitivity, specificity, and predictive power of the 1-week STAI in relation to identifying mothers with elevated STAI scores at 4 and 8 weeks was determined. Predictive power of the STAI was further assessed using odds ratios and receiver operator characteristic (ROC) curves. RESULTS At 1 week postpartum, 22.6% of mothers scored >40 on the STAI, decreasing to 17.2% at 4 weeks and 14.8% at 8 weeks. Using the cut-off score of >40, the 1-week STAI accurately classified 84.0% mothers at 4 weeks and 83.6% at 8 weeks with or without anxiety symptomatology. The 1-week STAI was significantly correlated to the 4-week (r=0.68, p<0.001) and 8-week (r=0.64, p<0.001) STAI. Mothers with a 1-week STAI score >40 were 15.2 times more likely at 4 weeks (95% CI=8.9-26.1) and 14.0 times more likely at 8 weeks (95% CI=7.9-24.8) to exhibit postpartum anxiety symptomatology. LIMITATIONS Psychiatric interviews were not completed in collaboration with the STAI and specific types of anxiety disorders were not identified. CONCLUSIONS A cut-off score of >40 on the STAI administered early in the postpartum period is recommended in a 2-phase identification program in order to not miss mothers with postpartum anxiety.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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Patterson B, Kyu HH, Georgiades K. Age at immigration to Canada and the occurrence of mood, anxiety, and substance use disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:210-7. [PMID: 23547644 DOI: 10.1177/070674371305800406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The process of migration and resettlement has been associated with increased risk for psychiatric illness. Our study sought to examine the association between age at immigration and risk for mood, anxiety, and substance use disorders (SUDs) among adult immigrants in Canada. METHOD Data from the Canadian Community Health Survey: Mental Health and Well-Being, a cross-sectional study of psychiatric disorder conducted in 2002, was used to identify a representative sample of adult immigrants in Canada (n = 4946). Logistic regression was used to examine the association between age at immigration (0 to 5 years, 6 to 17 years, and 18 years and older) and 12-month prevalence of mood and anxiety disorders, and SUDs. RESULTS Immigrants who arrived prior to age 6 years reported the highest risk for mood (OR 3.41; 95% CI 1.7 to 7.0) and anxiety disorders (OR 6.89; 95% CI 3.5 to 13.5), compared with those who immigrated at the age of 18 years or older, after adjusting for covariates, including duration of residence. CONCLUSIONS Younger age at immigration was associated with increased risk of having a current mood disorder, anxiety disorder, or SUD. These findings speak to the importance of developing and evaluating targeted prevention programs for young immigrant children and adolescents.
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