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N Breslau

Publications and source records attributed to N Breslau.

At least 19 recordsLinked to original sources
PubMed1998

Post-traumatic stress disorder and somatization symptoms: a prospective study.

The objective of this study is to determine whether persons with a history of post-traumatic stress disorder (PTSD) are at increased risk for somatization symptoms. Using the NIMH Diagnostic Interview Schedule, 1007 21-30-year-old members of a large health maintenance organization in south-east Michigan were interviewed initially in 1989, with follow-up interviews conducted in 1992 and 1994. Prevalence of somatization syndrome and number of somatization symptoms in the 5-year follow-up period were compared in relation to PTSD status at baseline, using logistic regression. History of PTSD was associated with significantly more symptoms in each of the somatic symptom groups, except pain. In addition, persons with PTSD were more likely to report each of the symptoms of somatization, compared to those with other psychiatric disorders. Prospectively, baseline history of PTSD signaled an increased risk of pain (OR = 2.1) and conversion symptoms (OR = 2.3) in the follow-up interval, relative to those with no disorder. PTSD increased the risk of somatization symptoms beyond that expected by the presence of comorbid psychiatric disorders. The excess of somatization symptoms in persons with history of PTSD might be attributable to PTSD per se, or to the greater severity of the associated comorbidity, compared to persons with disorders other than PTSD.

Adult↗
PubMed1998

Epidemiology of alcohol and medication as aids to sleep in early adulthood.

STUDY OBJECTIVES: In a representative sample of adults 18-45 years of age, this study addressed three questions about the use of sleep aids in the general population: (1) what are the past-year prevalences of the use of alcohol, over-the-counter medication and prescription medication to facilitate sleep? (2) among those who use these substances for sleep problems, what are the patterns of use? and (3) are there social factors, independent of sleep characteristics, that increase the likelihood of alcohol and medication use to aid sleep? DESIGN: The 1996 Detroit Area Survey was a random-digit-dial, computer-assisted survey of a representative sample of 2,181 adults ages 18-45 in the Detroit primary metropolitan statistical area. Eligible household response rate was 86.8%. RESULTS: In the general population, use of alcohol and medication as sleep aids in the past year was found to be fairly common: 13% used alcohol, 18% used medications and 5% used both. The prevalence of any substance use to aid sleep was 26%. The duration of use was short for the majority of users, less than 1 week. However, duration of use was greater for the majority of those using prescription sleep aids. A substantial minority of users report regular use lasting longer than 1 month: 15%, 9%, and 36% for alcohol, OTC medications, and prescription medications, respectively. Both sociodemographic and sleep characteristics were associated with alcohol and medication use to aid sleep. Difficulty falling asleep was the factor most strongly associated with use of substances to improve sleep. Sex, race/ethnicity, work shift, marital status and education were also significantly associated with one or more types of sleep aid use adjusting for difficulty falling asleep.

Adolescent↗
PubMed1998

Major depression and stages of smoking. A longitudinal investigation.

BACKGROUND: Epidemiologic studies have reported an association between major depression and smoking. This prospective study examines the role of depression in smoking progression and cessation, and the role of smoking in first-onset major depression. METHODS: Data are from a 5-year longitudinal epidemiologic study of 1007 young adults. Incidence and odds ratios (ORs) are based on the prospective data. Hazards ratios are based on the combined lifetime data and estimated in Cox proportional hazards models with time-dependent covariates. RESULTS: Based on the prospective data, history of major depression at baseline increased significantly the risk for progression to daily smoking (OR, 3.0; 95% confidence interval, 1.1-8.2), but did not decrease significantly smokers' rate of quitting (OR, 0.8; 95% confidence interval, 0.4-1.6). History of daily smoking at baseline increased significantly the risk for major depression (OR, 1.9; 95% confidence interval, 1.1-3.4). These estimates were reduced somewhat when history of early (ie, before age 15 years) conduct problems was controlled. Estimates based on lifetime data were consistent with these results. CONCLUSIONS: The observed influences from major depression to subsequent daily smoking and smoking to major depression support the plausibility of shared etiologies. Separate causal mechanisms in each direction might also operate, including self-medication of depressed mood as a factor in smoking progression and neuropharmacologic effects of nicotine and other smoke substances on neurotransmitter systems linked to depression.

Adult↗
PubMed1998

Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.

BACKGROUND: The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD). METHODS: A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. RESULTS: The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. CONCLUSIONS: The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.

Adolescent↗
PubMed1998

Predicting the emergence and persistence of alcohol dependence in young adults: the role of expectancy and other risk factors.

The relationship of alcohol outcome expectancies and other risk factors: demographic, personality, and affectivity, to alcohol dependence status was examined over a 3.5-year interval in 1,007 young adults. Lifetime prevalence of alcohol dependence was 18.1% at baseline. Of persons classified as current alcohol dependent at baseline, 66.9% experienced remission at the 3.5-year follow-up. Of persons classified as remitted alcohol dependent at baseline, 11.3% were current alcohol dependent at the 3.5-year follow-up. At follow-up, 5% of persons with no history of alcohol dependence at baseline met criteria for current alcohol dependence. Male gender, higher extraversion, and lower positive affect scores predicted emergent current alcohol dependence at the 3.5-year interval. Persistent current alcohol dependence was predicted by the expectation of improved social and sexual experiences following alcohol use. The findings suggest that positive expectancies may be an important factor in persistence of alcohol dependence and that their modification may enhance treatment of alcohol dependence in young adults.

Adult↗
PubMed1997

Psychiatric sequelae of posttraumatic stress disorder in women.

BACKGROUND: The risk for first-onset major depression, anxiety, and substance use disorders associated with prior posttraumatic stress disorder (PTSD) was estimated in a sample of women. METHODS: The National Institute of Mental Health Diagnostic Interview Schedule, revised according to DSM-III-R, was used to measure lifetime psychiatric disorders in a stratified random sample of 801 mothers of children, who participated in a study of cognitive and psychiatric outcomes by level of birth weight. Cox proportional hazards models with time-dependent covariates were used to calculate the hazards ratios of first onset of other disorders following PTSD. RESULTS: The lifetime prevalence of traumatic events was 40% and of PTSD, 13.8%. Posttraumatic stress disorder signaled increased risks for first-onset major depression (hazards ratio, 2.1) and alcohol use disorder (hazards ratio, 3.0). The risk for major depression following PTSD was of the same magnitude as the risk for major depression following other anxiety disorders. Women with preexisting anxiety and PTSD had significantly increased risk for first-onset major depression. Additional analysis showed that preexisting major depression increased women's vulnerability to the PTSD-inducing effects of traumatic events and risk for exposure to traumatic events. CONCLUSIONS: Posttraumatic stress disorder influences the risk for first-onset major depression and alcohol use disorder. The causal explanation of these temporally secondary disorders is unclear and might involve the effect of PTSD or underlying vulnerabilities exposed by the traumatic experience.

Adult↗
PubMed1997

Sex differences in posttraumatic stress disorder.

BACKGROUND: Epidemiologic surveys in the general population documented a higher rate of posttraumatic stress disorder (PTSD) in women than in men. To date, the finding has received little scientific attention. This study examines the extent to which sex differences in PTSD might be explained by previously identified risk factors and whether the sex difference in PTSD varied by age at exposure to traumatic events. METHODS: The NIMH-DIS (NIMH Diagnostic Interview Schedule, Version III Revised) was used to measure DSM-IIIR disorders in a random sample of 1007 young adults. Cox proportional hazards models were used to estimate changes in the hazards ratio for PTSD associated with sex when potential risk factors were included. RESULTS: Lifetime prevalence of exposure to traumatic events and number of traumatic events did not vary by sex. The prevalence of PTSD was higher for women than for men exposed to traumatic events (hazards ratio, 2.3; 95% confidence interval, 1.5-3.6). Preexisting anxiety disorders or major depressive disorders played a part in the observed sex difference in PTSD. Family history of anxiety disorder and early separation from parents, although significant risk factors for PTSD in subjects of both sexes, were unrelated to the sex difference in PTSD. The sex difference in PTSD was markedly greater if exposure occurred in childhood than later on. CONCLUSIONS: Posttraumatic stress disorder is more likely to develop in females than in males after exposure to a traumatic event. Susceptibility to PTSD in females might be greater in childhood than after age 15 years. Explanations of the sex difference might involve characteristics of individuals and of the traumatic experiences.

Adult↗
PubMed1997

Does psychiatric history bias mothers' reports? An application of a new analytic approach.

OBJECTIVE: To evaluate whether mothers' psychiatric history biases reports of their children's behavior problems, mothers' and teachers' reports of children's behavior problems were compared using a recently developed statistical approach. METHOD: Child Behavior Checklists and Teacher's Report Forms were completed by mothers and teachers, respectively, about 801 six-year-old children. Mother's history of major depression, anxiety disorders, and substance use disorder was assessed by using the National Institute of Mental Health Diagnostic Interview Schedule. Generalized estimating equations were used for data analysis. RESULTS: According to both teachers and mothers, maternal history of major depression was associated with more internalizing problems; the association was significantly stronger when mothers were the informants. Mothers with history of any psychiatric disorder reported more externalizing problems in their children than expected, whereas teachers' reports of externalizing behaviors were unrelated to maternal psychiatric history. These findings could not be explained by variations in children's behaviors across settings. CONCLUSION: The generalized estimating equation models enabled simultaneous examination of whether children of depressed mothers have excess behavior problems and whether depressed mothers overreport behavior problems in their children. The results indicate that children of depressed mothers have more internalizing problems. In addition, depressed mothers overstate and overgeneralize their offspring's behavior problems. This study broadens the concerns with reporting bias beyond maternal depression to include other psychiatric problems. The results emphasize the potential for bias in family history studies that rely on informants.

Adult↗
PubMed1997

Daytime sleepiness: an epidemiological study of young adults.

OBJECTIVES: Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. METHODS: The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. RESULTS: The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. CONCLUSIONS: Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).

Adult↗
PubMed1996

Low birth weight and neurocognitive status at six years of age.

We examined the relationship between low birth weight (LBW) (< or = 2500 g) and specific neurocognitive abilities at 6 years of age in a large-scale nonconcurrent prospective study. In 1990-1992, we randomly selected and evaluated LBW and normal birth weight (NBW) children from the 1983-1985 newborn lists of two major hospitals in southeast Michigan, one serving an urban and the other a suburban population. LBW children (n = 473) scored significantly lower than NBW children (n = 350) on tests measuring language, spatial, fine motor, tactile, and attention abilities, controlling for population site, race, maternal IQ, and education. Gradient relationships were observed across levels of LBW with language, spatial, tactile, and attention tests. Exploratory analysis, using general additive models, revealed that test performance varied within birth weight levels and that performance continued to improve with increased birth weight well above 3000 g. Follow-up assessments as the children mature will shed light on the persistence of these associations and their implications for learning disorders.

Attention↗
PubMed1996

Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.

In a longitudinal epidemiological study of young adults, we estimated the association between sleep disturbance and psychiatric disorders, cross-sectionally and prospectively. A random sample of 1200 was drawn from all 21-30-year-old members of a large health maintenance organization (HMO) in Michigan; 1007 were interviewed in 1989 and 979 were reinterviewed in 1992. Lifetime prevalence of insomnia alone was 16.6%, of hypersomnia alone, 8.2%, and of insomnia plus hypersomnia, 8%. The gender-adjusted relative risk for new onset of major depression during the follow-up period in persons with history of insomnia at baseline was 4.0 (95% confidence interval [CI] 2.2-7.0) and in persons with baseline history of hypersomnia, 2.9 (95% CI 1.5-5.6). When history of other prior depressive symptoms (e.g., psychomotor retardation or agitation, suicidal ideation) was controlled for, prior insomnia remained a significant predictor of subsequent major depression. Complaints of 2 weeks or more of insomnia nearly every night might be a useful marker of subsequent onset of major depression.

Adult↗
PubMed1996

Comparison of nonrandomized trials with slow-release sodium fluoride with a randomized placebo-controlled trial in postmenopausal osteoporosis.

The results of slow-release sodium fluoride (SR-NaF) treatment in two nonrandomized trials involving 65 patients with postmenopausal osteoporosis from the primary site and 121 patients from collaborative sites were compared with those obtained from 54 treated patients and 56 patients taking placebo from a randomized controlled trial. Spinal fracture data were analyzed separately in mild to moderate bone loss of lumbar spine (baseline L2-L4 bone density [BD] > or = 65% young normal) and in severe bone loss (BD < 65%). Since demographic and fracture data were similar among fluoride-treated patients from the three trials at each stratum of bone loss, their data were combined. In mild to moderate bone loss, SR-NaF treatment in the combined group virtually eliminated new spinal fractures with 96.6% of patients remaining fracture-free. The Fluoride group had a markedly lower individual vertebral fracture rate (0.025 vs. 0.188/patient year, p = 0.0001) and group vertebral fracture rate (0.029 vs. 0.175/patient year, relative risk [RR] 0.12, p = 0.0001) than the Placebo group. In severe bone loss, the combined treated group had a significantly lower new spinal fracture rate than the Placebo group, although the differences were not as marked (group vertebral fracture rate of 0.150 vs. 0.276/patient year, RR 0.54, p = 0.03). In the combined fluoride-treated group, the L2-L4 bone mass rose by 4-6%/year for 4 years, and the femoral neck BD increased by 1-2%/year during first 2 years. The radial shaft BD did not change. The Placebo group did not show a change in bone mass at any site. The prevalence (percentage) of patients with related gastrointestinal side effects and nonvertebral fracture rates did not differ significantly between the combined SR-NaF group and the Placebo group (hip fracture rate of 0.0045/patient year in SR-NaF and 0.0053/patient year in Placebo; appendicular fracture other than hip (see text) rate of 0.0193/patient year in SR-NaF and 0.0159/patient year in Placebo). A subgroup analysis showed a low baseline L2-L4 BD, high prevalent spinal fractures, and reduced body weight to be important determinants of the development of spinal fracture during SR-NaF treatment. Concomitant medications (estrogen, vitamin D, thiazide and thyroid hormone) were not independent predictors of the spinal fracture risk. Only 17% of fluoride-treated patients were nonresponders (new spinal fractures or a fall/no change in L2-L4 bone mass). Thus, the effects of SR-NaF treatment on the spinal fracture rate from nonrandomized trials were similar to those of the treated group of the randomized trial but different from those of the Placebo group. The similarity of response of nonrandomized trials with that of the randomized controlled trial and the resultant combined analysis further validate the efficacy and safety of SR-NaF in the treatment of postmenopausal osteoporosis.

Bone Density↗
PubMed1996

Psychiatric sequelae of low birth weight at 6 years of age.

The study examined the association between low birth weight (LBW) (< or = 2,500 g) and attention deficit hyperactivity disorder (ADHD) in two socioeconomically disparate populations. LBW and normal birth weight (NBW) children from the 1983 to 1985 newborn lists of an urban and a suburban hospital in Southeast Michigan were randomly selected. A total of 823 children, 473 LBW and 350 NBW, participated. Data were gathered in 1990 to 1992, when the children were 6 to 7 years of age. The National Institute of Mental Health Diagnostic Interview Schedule for children-Parent version (DISC-P) was used to elicit information on DSM-III-R diagnoses of simple phobia, overanxious, separation anxiety, oppositional defiant, and ADHD. Teachers' ratings of behavior problems were obtained. LBW was associated with ADHD but not with childhood anxiety disorders or oppositional defiant disorder. The association was stronger in the urban than in the suburban population. Data from teachers' ratings revealed an association between LBW and attention problems. The prognostic significance of the observed psychopathology at 6 years of age requires follow-up assessment as the children mature.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Potential barriers to parent monitoring: social disadvantage, marital status, and maternal psychiatric disorder.

OBJECTIVE: To test whether social disadvantage, marital status, and history of psychiatric disorder might impair mothers' monitoring and supervision of their children. METHOD: An epidemiological sample of 673 mothers of 8- through 11-year-old children, who had been participants in a longitudinal study of children's development, completed standardized telephone interviews about their monitoring and supervision of children. Indicators of social disadvantage also were collected in the telephone interview, and maternal history of psychiatric disorder had been assessed using the National Institute of Mental Health Diagnostic Interview Schedule, administered when the children were 6 years old. RESULTS: Mothers who were never married were twice as likely to be in the lowest quintile of parent monitoring as those who were married (31% versus 16%, p = .001); a similar distribution was found for mothers who did not complete high school compared with those who attended college (31% versus 15%, respectively, p = .001). Mother's history of substance use disorder, anxiety disorder, or major depression was also linked to lower levels of monitoring. Mothers of girls reported higher levels of monitoring than mothers of boys (p < .001). CONCLUSIONS: This study indicates that social disadvantage and maternal psychiatric disorder could have a negative influence on mothers' monitoring behaviors. Although the causal role of these factors is still unclear, interventions that target parenting behaviors should be designed to take them into account.

Child↗
PubMed1996

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers.

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerström Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.

Culture↗
PubMed1996

Further evidence on the link between migraine and neuroticism.

Epidemiologic studies have demonstrated an association between migraine and neuroticism. In this report, we examine prospectively whether higher levels of neuroticism, measured at baseline by the Eysenck Personality Questionnaire, signaled increased risk for first incidence of migraine during a 5-year follow-up interval. The sample was randomly selected from the list of young adult members of a large Health Maintenance Organization in southeast Michigan. Follow-up data were available on 972 subjects, 97.2% of the initial sample. Neuroticism predicted the first incidence of migraine in females. The relative risk for migraine in females scoring in the highest quartile of the neuroticism scales versus the lowest quartile was 4.0 (95% CI 1.6, 10.3). Controlling for history of major depression and anxiety disorders at baseline reduced the estimate to 2.9 (95% CI 1.1, 7.7). Neuroticism did not predict migraine in males, although the results in males were limited greatly by the small number of incidence cases. Neuroticism might be causally related to migraine, or alternatively, might be an early correlate with shared etiologies.

Adult↗