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Jitender Sareen

Publications and source records attributed to Jitender Sareen.

33 records · Page 2Linked to original sources
PubMed2005

Childhood adversity and perceived need for mental health care: findings from a Canadian community sample.

Previous community surveys have demonstrated that individuals with self-perceived need for mental health treatment in combination with meeting DSM-III-R criteria display the greatest levels of impairment in the community and have a higher likelihood of reporting parental psychopathology. The current investigation aims to replicate and extend these findings by examining the association between a wide range of childhood adversities with self-perceived need for mental health treatment and DSM-III-R diagnosis in a Canadian community sample (N = 8116). All respondents were questioned about their childhood experiences (physical and sexual abuse, emotional neglect, parental discord/separation, parental death, and parental psychopathology). After controlling for covariates in a multiple logistic regression, we found that emotional neglect (OR = 2.07), physical abuse (OR = 2.16), sexual abuse (OR = 2.39), paternal psychopathology (OR = 2.41), and maternal psychopathology (OR = 2.70) were independently and significantly associated with respondents meeting DSM criteria for a mental disorder and perceiving a need for treatment. These findings underscore the importance of future longitudinal studies considering the influence of a wide range of early childhood adversities on adult psychopathology and perceived need for treatment.

Adolescent↗
PubMed2005

Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey.

This study examined the relationship between anxiety disorders and suicidal ideation or suicide attempts in a nationally representative sample (N = 5877; age, 15-54; response rate, 82.4%). A modified version of the Composite International Diagnostic Interview was used to make DSM-III-R mental disorder diagnoses. Two multivariate logistic regression analyses were performed with suicidal ideation (N = 754) and suicide attempts (N = 259) as dependent variables. In each regression, the independent variables entered were lifetime social phobia, panic disorder, agoraphobia, generalized anxiety disorder, simple phobia, and posttraumatic stress disorder (PTSD). Covariates in the analyses were sociodemographics, lifetime mood disorders, substance use disorders, nonaffective psychosis, antisocial personality disorder, and presence of three or more lifetime DSM-III-R diagnoses. PTSD was significantly associated with suicidal ideation (adjusted odds ratio = 2.79; p < 0.01) and suicide attempts (adjusted odds ratio = 2.67; p < 0.01). None of the other anxiety disorders were significantly associated with suicidal ideation or attempts. The robust association between PTSD and suicide attempts has important implications for psychiatric assessment of suicidal behavior. Future research is required to investigate the mechanisms underlying the relationship between PTSD and suicidal behavior.

Adolescent↗
PubMed2005

The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: a Canadian population-based survey.

OBJECTIVES: Prevalence estimates of mental disorders were designed to provide an indirect estimate of the need for mental health services in the community. However, recent studies have demonstrated that meeting criteria for a DSM-based disorder does not necessarily equate with need for treatment. The current investigation examined the relation between self-perceived need for mental health treatment and DSM diagnosis, with respect to quality of life (QoL) and suicidal ideation. METHODS: Data came from an Ontario population-based sample of 8116 residents (aged 15 to 64 years). The University of Michigan Composite International Diagnostic Interview was used to diagnose mood, anxiety, substance use, and bulimia disorder according to DSM-III-R criteria. We categorized past-year help seeking for emotional symptoms and (or) perceiving a need for treatment without seeking care as self-perceived need for treatment. We used a range of variables to measure QoL: self-perception of mental health status, a validated instrument that measured well-being, and restriction of activities (current, past 30 days, and long-term). RESULTS: Independent of subjects' meeting criteria for a DSM-III-R diagnosis, self-perceived need for treatment was significantly associated with poor QoL (on all measures) and past-year suicidal ideation. CONCLUSIONS: Self-perceived need for mental health treatment, in addition to DSM diagnosis, may provide valuable information for estimating the number of people in the population who need mental health services. The relation between self-perceived need for treatment and objective measures of treatment need requires future study.

Activities of Daily Living↗
PubMed2005

Perceived need for mental health treatment in a nationally representative Canadian sample.

OBJECTIVE: The optimal method of determining how many people in the general population need help for emotional problems remains unclear. This study aimed to examine the prevalence and correlates of self-perceived need for mental health services (that is, help seeking and perceived need) in a large, population-based sample. METHODS: Data came from the Canadian Community Health Survey 1.2 (n = 36,816, respondent age 15 years and over, and response rate 77%). Respondents were asked whether they had sought help in the past year from any professional for emotional problems and whether they felt they needed help for emotional symptoms but had not sought treatment. The Composite International Diagnostic Interview (CIDI) was used to make DSM-IV mental disorder diagnoses. RESULTS: The past-year prevalences of help seeking and perceived need were 8.7% and 2.9%, respectively. After adjusting for the presence of DSM-IV disorders assessed in the survey, sociodemographic factors, illness severity, social supports, and the presence of physical health conditions were associated with help seeking and perceived need. Independent of DSM diagnoses, sociodemographics, and social supports, perceived need and help seeking were associated with increased levels of distress, disability, and suicidal ideation and attempts. CONCLUSIONS: This study illustrates that, in addition to the presence of a DSM diagnosis, the respondent's self-perceived need for mental health treatment is important in the assessment of need for mental health services in the community.

Adolescent↗
PubMed2005

Mental health service use in a nationally representative Canadian survey.

BACKGROUND: Previous Canadian surveys have noted a wide range of prevalence rates for mental health service use and found no consistent relation between type of contact with mental health professionals and severity of illness. This study is the first investigation to examine the prevalence and correlates of mental health service use in a nationally representative Canadian survey. METHODS: The Canadian Community Health Survey Cycle 1.1 was conducted between 2000 and 2001 (n = 125,493; respondent age 12 years and over; response rate; 84.7%). Respondents were asked whether they had contacted a professional because of emotional symptoms in the past year and about their experience of barriers to treatment. DSM-IV major depression and alcohol dependence diagnoses were assessed with the Composite International Diagnostic Interview Short Form. The relation between a range of measures of clinical severity and the type of professional contacted for emotional symptoms was examined. RESULTS: The prevalence of 12-month help seeking for emotional symptoms was 8.3% (99%CI, 8.10 to 8.55); an additional 0.6% (99%CI, 0.49 to 0.62) of the sample perceived a need for treatment without seeking care. Respondents endorsing contact with multiple professionals or with psychiatrists only had higher levels of severity than those who had contact with family doctors only or nonphysician professionals only. CONCLUSIONS: Although untreated depression remains a significant problem in Canada, more severe illness was more likely to be associated with seeing a psychiatrist (or multiple professionals), indicating a relation between greater severity of mental illness and receiving more specialized care.

Adolescent↗
PubMed2005

Perceived need and help-seeking for mental health problems among Canadian provinces and territories.

Perceived need for mental health care, professional help-seeking, use of self-help groups, and reasons for not seeking professional care for mental health problems were investigated in the Canadian Community Health Survey (N = 129,543). Regional differences were found for all variables. The greatest level of Perceived Need Without Seeking Help, Professional Help-Seeking, and Use of Self-Help Groups were found in the Yukon/Northwest Territories/Nunavut. These findings likely reflect rural isolation and differences in socioeconomic levels associated with different regions in Canada. Regional differences indicate that efforts to improve the delivery of care need to be tailored to specific areas in Canada.

Adolescent↗
PubMed2004

Do antipsychotics ameliorate or exacerbate Obsessive Compulsive Disorder symptoms? A systematic review.

BACKGROUND: Paradoxically, some reports in the literature support the use of antipsychotics in the treatment of Obsessive Compulsive Disorder (OCD), while other reports suggest that antipsychotics can exacerbate OCD symptoms. To date, there is no published systematic review of the relationship between OCD symptoms and antipsychotic drugs. METHODS: A Medline and PsychInfo search (1980-2003) was conducted to collect published reports of the interactions between antipsychotics and OCD symptoms. RESULTS: In the treatment of refractory OCD, case series, open label trials and placebo-controlled trials were found suggesting efficacy of antipsychotic augmentation to ongoing antidepressant treatment. In the placebo-controlled trials with haloperidol, risperidone, olanzapine, and quetiapine, a significantly higher response rate (46-71%) was found for the antipsychotic groups, compared to no response for the placebo groups. Reports of exacerbation of OCD symptoms with the use of atypical antipsychotics were limited to individuals with a primary psychotic disorder. LIMITATIONS: Definition of response in most of these treatment studies was based on a modest reduction of OCD symptoms, and no studies were available on long-term efficacy. There were also no published reports that systematically evaluated the incidence of OCD symptoms associated with atypical antipsychotics. CONCLUSIONS: All antipsychotics mentioned above had short-term controlled evidence to support their use as augmenting agents in the treatment of refractory OCD. The suggested management of OCD induction/exacerbation due to atypical antipsychotics is to increase the dose of the atypical antipsychotic and/or add a selective serotonin reuptake inhibitor.

Antidepressive Agents↗
PubMed2004

Does a U-shaped relationship exist between alcohol use and DSM-III-R mood and anxiety disorders?

BACKGROUND: In recent community surveys, abstainers and heavy drinkers of alcohol have reported more mood and anxiety symptoms than moderate drinkers (U-shaped relationship). The present study was aimed at extending this finding by investigating this potential U-shaped relationship using structured diagnostic interviews to assess mood and anxiety disorders. METHODS: Data came from two contemporaneous surveys, the National Comorbidity Survey (NCS; N=6780) and the Mental Health Supplement of the Ontario Health Survey (OHS-MHS; N=7001). The University of Michigan Revision of the Composite International Diagnostic Interview (UM-CIDI) was used to make DSM-III-R psychiatric diagnoses in both surveys. Three mutually exclusive lifetime alcohol use categories were compared: (1) Alcohol abstainers-individuals reporting no alcohol use or less than 12 drinks in any year throughout their life. (2) Moderate drinkers-individuals that did not meet criteria for alcohol abstainers or problem drinkers. (3) Problem drinkers-DSM-III-R lifetime alcohol abuse, dependence or hazardous levels of alcohol use. RESULTS: After controlling for demographic variables, alcohol abstainers were not found to have significantly higher rates of mood and anxiety disorders in comparison with moderate drinkers. However, problem drinking was significantly associated with mood and anxiety disorders. CONCLUSIONS: Across both surveys, there was no evidence of a U-shaped relationship between lifetime alcohol consumption and lifetime mood and anxiety disorders.

Adult↗
PubMed2004

Understanding comorbidity of anxiety disorders with antisocial behavior: findings from two large community surveys.

Although a positive association between antisocial behavior and anxiety disorders may seem clinically counterintuitive, some previous studies have in fact found a higher co-occurrence of anxiety disorders and antisocial behavior than in the general population. We investigated the relationship between anxiety disorders and antisocial behavior in two contemporaneous community surveys (National Comorbidity Survey, Ontario Health Survey). A significant association was found between any DSM-III-R anxiety disorder diagnosis and any DSM-III-R antisocial diagnosis (National Comorbidity Survey, odds ratio = 3.05, p <.01; Ontario Health Survey, odds ratio = 2.37, p <.01). This association remained significant after controlling for sociodemographics, depression, and alcohol and drug use disorders. Posttraumatic stress disorder and social phobia complex subtype (i.e., multiple social fears) produced the largest odds ratios. People with comorbid anxiety and antisocial diagnoses displayed high levels of distress, neuroticism, and disability, and poor quality of life. Clinicians and health policy makers need to be aware of the co-occurrence of anxiety disorders and antisocial behavior.

Adolescent↗
PubMed2002

Increased amygdala activation to angry and contemptuous faces in generalized social phobia.

BACKGROUND: Generalized social phobia (GSP) is characterized by fear of social interactions and sensitivity to disapproval by others. Given the established role of the amygdala as part of a distributed neural system for the processing of emotional cues, we hypothesized that subjects with GSP would exhibit greater amygdala activation in response to harsh (angry, fearful, and contemptous) vs accepting (happy) facial emotional expressions compared with healthy control subjects (HCs). METHODS: Fifteen subjects with DSM-IV GSP and 15 age-, sex-, handedness-, and education-matched HCs, free of psychotropic medication for at least 12 weeks, viewed 60 color photographs from a standardized set of human facial stimuli, during which the task was to identify the sex of the person in the photograph. Data were collected across 3 functional (echo-planar) runs using a Siemens 1.5-T magnet, and analyzed using Analysis of Functional Neuroimaging software (Medical College of Wisconsin, Milwaukee). RESULTS: In the left allocortex (including the amygdala, uncus, and parahippocampal gyrus), subjects with GSP produced a significantly greater percent blood oxygen level-dependent signal change than did HCs for contemptous compared with happy faces (GSP: 0.72% vs HC: -0.01%; F(1,29) = 9.56, P =.004, Cohen d = 1.15) and for angry compared with happy faces (GSP: 0.45% vs HC: -0.09%; F(1,29) = 6.78, P =.02, Cohen d = 1.00). Subjects with GSP and HCs did not produce a statistically different percent signal change for fearful or nonexpressive faces compared with the happy faces in this region. CONCLUSIONS: These findings are consistent with a role for differential amygdala (and associated limbic) functioning in GSP. The pronounced response to contemptuous and angry facial expressions suggests that the amygdala in GSP may be particularly active in the processing of disorder-salient stimuli.

Adult↗
PubMedDate not supplied

Suicide attempts and externalizing psychopathology in a nationally representative sample.

Suicide is most often associated with internalizing disorders such as depression; however, recent evidence suggests that externalizing psychopathology (substance dependence disorders, antisocial personality disorder) may have an independent relationship with suicidal behavior. The aim in the present study was to examine the relationship between lifetime suicide attempts and lifetime externalizing psychopathology in the US National Comorbidity Survey data set (n = 5877). First, hierarchical regression was performed to explore the associations between internalizing and externalizing disorders and suicide attempts. Externalizing psychopathology was significantly associated with lifetime suicide attempts (adjusted odds ratio = 3.47; P < .001) and significantly improved the model beyond that including only the sociodemographic variables and internalizing psychopathology (chi(2) difference = 73.12; df = 1; P < .001). A second logistic regression was used to investigate the association between specific patterns of psychopathology and suicidality. Externalizing disorders were significantly associated with suicide attempts even in the absence of internalizing disorders (adjusted odds ratio = 5.98; 95% confidence interval = 3.07-11.67; P < .001). These findings add to the growing literature that suggests that externalizing psychopathology is an important psychiatric correlate of suicidal behavior.

Adolescent↗
PubMedDate not supplied

Genital anaesthesia persisting six years after sertraline discontinuation.

Sexual side-effects, in general, are common with selective serotonin-reuptake inhibitors (SSRIs). Genital anaesthesia is a rare side-effect previously described with sertraline and fluoxetine use. With SSRI discontinuation, the sexual side-effects are expected to resolve. We report a case of a 26-year-old male who experienced genital anaesthesia during sertraline treatment and continued to be symptomatic despite medication discontinuation 6 years previously. To date, there have been no published reports of SSRI-induced sexual side-effects persisting beyond SSRI discontinuation. This case highlights the complex interplay of psychopharmacologic and psychodynamic factors that can occur in patients with sexual dysfunction.

Adult↗