Formulae for cause-deleted life tables.
Explore the source record for details and available documents.
Actuarial Analysis↗
Biomedical subjects
S C Newman
Publications and source records attributed to S C Newman.
Schizophrenia: lifetime co-morbidity in a community sample.
Twenty persons with schizophrenia were identified in a community sample of 2144 adult household residents interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The hierarchy-free lifetime prevalence for a variety of psychiatric disorders is compared in those with and without schizophrenia. Those with schizophrenia were found to have increased chances of having other disorders, all except one having had at least one other disorder. Major depressive episodes, obsessive compulsive disorder, phobia, alcohol abuse/dependence and drug abuse/dependence, each occurred in over half of the schizophrenics, and panic disorder, antisocial personality, and mania were each found in one sixth to one quarter of the schizophrenics. Although current diagnostic systems generally lack an empirical basis for hierarchies, the practical significance of co-morbidity must be determined from outcome studies, familial morbid risk data and possible differential effects of treatments.
Adult↗
Canadian trends in mortality from mental disorders, 1965-1983.
This report describes trends in the death rate for all mental disorders, presenile and senile dementia, and alcoholic psychoses and alcohol abuse/dependence in Canada for the period 1965-1983. It is demonstrated that overall there has been an increase in the death rate for each of these causes of mortality, both for males and females, and that in the case of presenile and senile dementia the increase has been particularly rapid. The older age groups appear to be contributing most to the observed changes. Conjectures are made as to the underlying reasons for the observed trends.
Adult↗
Recurrent and nonrecurrent depression. A family study.
The morbidity risks for unipolar depression were determined from all 763 first-degree relatives of 75 probands with unipolar depression who had been followed up for 12 to 18 years after their first lifetime admission. Significant independent differences were found according to the proband's age at onset and whether the proband had had a single episode or recurrent depression. The lowest morbidity risk in the relatives (3.4%) was associated with single-episode depression with late age at onset in the probands and the highest risk (17.4%) with early age at onset and recurrent depression, other results being intermediate. These findings offer a subclassification of unipolar depression based on age at onset and on whether the illness is single episode or recurrent, and they may explain some of the variability in morbidity risk found in well-conducted studies where these factors were not considered.
Adult↗
A study of the effect of weight and dietary fat on breast cancer survival time.
Female breast cancer patients who had participated in a case-control study conducted during 1973-1975 were followed up, using record linkage to the Statistics Canada mortality data base, to the end of 1980. A number of variables recorded for the case-control study, in particular body weight and daily intake of dietary fat near the time of diagnosis, were examined to see if they had any bearing on breast cancer mortality. The data were analyzed using the methods of Mantel and Cox. Dietary fat was not found to be related to patient survival. However, cases with greater than average body weight experienced a shortened survival time.
Adult↗
A generalization of life expectancy which incorporates the age distribution of the population and its use in the measurement of the impact of mortality reduction.
Explore the source record for details and available documents.
Actuarial Analysis↗
Mortality analysis and life table techniques.
Explore the source record for details and available documents.
Actuarial Analysis↗
A comparison of methods of scoring the General Health Questionnaire.
The General Health Questionnaire (GHQ) has been criticized for failing to detect individuals with chronic symptoms due to its focus on recent changes in one's usual state. Using data from a community survey in Edmonton, Canada, in which 3,258 subjects completed the 30-item GHQ and the Diagnostic Interview Schedule (DIS), the traditional method of scoring the GHQ was compared to a revised method proposed by Goodchild and Duncan-Jones. A case was defined to be someone with a history in the preceding month of one or more of the following DIS/DSM-III disorders: major depressive episode, phobia, panic disorder and obsessive-compulsive disorder. A receiver operating characteristic analysis demonstrated no difference in the two methods of scoring the GHQ.
Adolescent↗
Life events and the 1-year prevalence of major depressive episode, generalized anxiety disorder, and panic disorder in a community sample.
A community survey was conducted in Edmonton, Alberta, Canada, in which 3,070 respondents completed the Diagnostic Interview Schedule (DIS) and the Life Events Scale (LES) of Paykel. During the year before the interview, there were 222, 234, and 38 cases of major depressive episode (MDE), generalized anxiety disorder (GAD), and panic disorder (PD), respectively, where individuals may have had more than one disorder. It was not possible to time the onset of the disorder relative to the occurrence of life events, and so correlations, no casual relationships, were examined. The LES score showed an increasing trend across disorder categories defined as follows: MDE and GAD both absent; MDE absent and GAD present; MDE present and GAD absent; and MDE and GAD both present. A similar trend was observed for most of the LES subscales studied, but only in the case of events classified as "entrance," "undesirable," and "marital" was there statistical significance. The results suggest that stressful life events are correlated with both MDE and GAD, that individuals with MDE only tend to have a greater burden of stressful events and comorbid disorders than persons with GAD only, and that the presence of both disorders is associated with an even greater level of stress and number of comorbid disorders. The similar patterns across LES subscales suggest that MDE and GAD are not related to specific types of live events, at least not those covered by the LES questionnaire.
Adaptation, Psychological↗
Incidence of mental disorders in Edmonton: estimates of rates and methodological issues.
An incidence study was conducted in Edmonton, Alberta, Canada, in which 3956 community residents were interviewed using the Diagnostic Interview Schedule (DIS) and a sample of 1964 subjects were reinterviewed with the DIS an average of 2.8 years later. Incidence rates, estimated for a range of DSM-III disorders, were surprisingly large, raising questions about the reliability of DIS data. We examined major depression in detail to uncover possible sources of unreliability. There were 138 'incident' cases of major depression, giving an annual incidence rate for both sexes of 27.9 (per 1000). However, based on reinterview data, 106 (80%) of the incident cases reported an age of onset prior to the initial interview. These findings appear to be the result of a difference between the DIS definition of age of onset and the one used in our analysis of incidence. A syndrome called depressive spell is defined and used to demonstrate that the large number of incident cases is likely due, at least in part, to incomplete recall of lifetime depressive symptoms. Despite these potential sources of bias, the possibility remains that incidence rates and lifetime risks in Edmonton are larger than has generally been reported in the literature.
Adolescent↗
Treatment seeking for depression: role of depressive symptoms and comorbid psychiatric diagnoses.
BACKGROUND: General population research has indicated that many persons with lifetime major depression report they have never sought medical help for their illness. We examined the role played by both depressive symptoms and comorbid psychiatric diagnoses in treatment seeking. METHODS: From standardized psychiatric interviews of 7214 Edmonton residents, we identified 1348 subjects with lifetime depressive illness; 866 subjects (64%) had sought medical treatment. RESULTS: Psychomotor retardation (odds ratio, OR = 1.4), suicidal ideation (OR = 1.4), comorbid mania (OR = 9.5), comorbid panic disorder (OR = 3.0), and comorbid drug abuse/dependence (OR = 0.6) were significantly associated with treatment seeking in multivariate analysis. CONCLUSION: The finding that only a few depressive symptoms were associated with treatment seeking underlines the importance of public health education to address the undertreatment of depression.
Adult↗
The prevalence of depression in Alzheimer's disease and vascular dementia in a population sample.
BACKGROUND: Previous studies have shown that depression is more prevalent in vascular dementia than Alzheimer's disease (AD). Subjects for these studies were either psychiatry or neurology patients, raising the issue of whether factors leading to treatment might have introduced sampling bias. METHODS: Data for the present study came from the Canadian Study of Health and Aging (CSHA, 1994), a population-based prevalence study of dementia. AD was diagnosed using NINCDS-ADRDA criteria (McKhann et al., 1984), vascular dementia was diagnosed using draft ICD-10 criteria (World Health Organization, 1987) and the Ischemic Scale (Hachinski et al., 1975), major depression was diagnosed using an algorithm based on DSM-III-R criteria (American Psychiatric Association, 1987). The sample for the present study consisted of 481 subjects with AD and 140 with vascular dementia. RESULTS: The weighted prevalence rate of major depression was 3.2% for AD and 21.2% for vascular dementia, giving a crude odds ratio of 8.2 (95% Confidence Interval: 1.7-40.2). This finding was confirmed by a logistic regression analysis which adjusted for age, sex, place of residence (community, institution), self-reported health, severity of cognitive impairment, and antidepressant or beta-blocker use. LIMITATIONS: Data on depressive symptoms were more often missing in subjects with dementia resulting in differential loss of potential study subjects. Data on depressive symptoms were not sufficiently detailed to permit DSM-III-R criteria to be implemented rigorously. The method of diagnosing vascular dementia was subject to misclassification. CONCLUSIONS: This study confirms in a population sample that depression is more prevalent in vascular dementia compared to AD.
Aged↗
What happens to depressed men? Application of the Stirling County criteria.
In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.
Adolescent↗
Chronic airways obstruction leading to chronic hypoxemic respiratory failure: an estimate of the size and trend of the problem in Canada.
Chronic airways obstruction is a common cause of morbidity and mortality in Canada. It may progress to hypoxic respiratory failure and then to death. Only a few studies of the prevalence of chronic airways obstruction have been reported from Canada, but a number of studies have been reported from the United States and the United Kingdom, countries with similar socioeconomic conditions and ethnic compositions to those in Canada. The prevalence of chronic airflow limitation in these studies averages 9.3%. In each study, tobacco smoke exposure is the most prominent etiologic agent. Other contributing factors identified in the studies are air pollution, occupational exposure, respiratory infections and childhood respiratory illness. Endogenous modifiers of these risk factors demonstrated in the published studies include age, elevated peripheral blood leukocyte count and familial factors. Although epidemiologic studies have been able to identify the prevalence of functional impairment associated with chronic airways obstruction, risk factors associated with its development and modifiers of these risk factors, it is not possible to determine the prevalence of severe chronic airways obstruction resulting in hypoxemic respiratory failure. An estimate of this prevalence has been calculated based on certain assumptions. It was assumed that patients dying of chronic airways obstruction were likely, in a high proportion of cases, to have hypoxemic respiratory failure. It has been demonstrated that only one-half of all patients dying of chronic airways obstruction are correctly designated on death certificates. It was assumed, conservatively, that the median survival of patients with hypoxemic respiratory failure is two years. From these assumptions, it was estimated that the prevalence of hypoxemic respiratory failure in 1986 in Canada was 100 per 100,000 population. This is higher than the present rate of oxygen therapy, indicating that some patients currently eligible for this treatment may not be receiving it.
Canada↗
The analysis of hospital morbidity data using life table methods.
Explore the source record for details and available documents.
Actuarial Analysis↗
Mortality in a child welfare population: implications for policy.
The mortality rate in a one-year cohort of children with child welfare status in Alberta, Canada, was found to be significantly elevated. Specifically, neglected and abused children were apt to have died violently, while handicapped children were more likely to have died because of disease or infirmity. The proportion of children dying while in care did not differ from the proportion who died after leaving care. Death rates were elevated only for age-categories surrounding the point (18 years) at which child welfare support was withdrawn.
Adolescent↗
Cross-national epidemiology of major depression and bipolar disorder.
OBJECTIVE: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys. DESIGN AND SETTING: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand. PARTICIPANTS: Approximately 38000 community subjects. OUTCOME MEASURES: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression. RESULTS: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries. CONCLUSIONS: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.
Adolescent↗