The changing pattern of inpatient antipsychotic drug use in Italy.
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Adolescent↗
Biomedical subjects
Scott B Patten
Publications and source records attributed to Scott B Patten.
Major depression and mental health care utilization in Canada: 1994 to 2000.
BACKGROUND: Major depression makes an important contribution to disease burden in Canada. In principle, the burden of major depression can be reduced by the provision of treatment within the health care system. In a previous data analysis, the National Population Health Survey (NPHS) reported an increase in antidepressant (AD) use between 1994 and 1998. In this paper, the analysis is extended to 2000, and additional aspects of health care utilization are described. METHODS: The NPHS provides a unique source of longitudinal data concerning major depression and its treatment in Canada. In this survey, probable cases of major depression were identified using a brief predictive instrument; health care utilization was evaluated using additional survey items; and the latest data release from Statistics Canada (that is, 2000) was used to make weighted estimates of the frequency of health care utilization in relation to major depression status. RESULTS: The use of ADs has continued to escalate. These increases have been largest in men and in persons aged under 35 years. There has been an increase in polypharmacy: in 2000, almost 9% of persons taking an AD reported taking more than 1 AD medication-a tripling since 1994. The frequency of consultations with alternative practitioners has also grown. Although the overall proportion of persons with major depression who report consulting with health professionals about their mental health has not increased, the number of persons with major depressive disorder reporting 6 or more visits to nurses, social workers, and psychologists may have. CONCLUSION: The provision of AD treatment continues to expand in Canada. This probably represents a changing pattern of practice, because the frequency of professional consultation has not increased. More detailed data are required to evaluate the extent to which treatment needs are being met.
Adult↗
Recall bias and major depression lifetime prevalence.
BACKGROUND: Epidemiological studies have reported lifetime prevalence rates for major depression that have typically ranged between 10 % and 20 %, and have typically been fairly stable across age groups. This contradicts the intuitive expectation that lifetime prevalence should accumulate with age. Some authors have hypothesized that a cohort effect may account for this puzzling pattern, but another possible explanation is recall bias. In principle, differential mortality could also account for a failure of age-specific lifetime prevalence to increase with age. The objective of this study was to describe the relationship between recall failure (failure to recall previous depressive episodes) and bias in the evaluation of age-specific lifetime major depression prevalence. METHOD: A framework recently described by Hill et al. was used in this analysis. Hill's model relates the slope of an age-specific prevalence curve for an irreversible disease to incidence and mortality. The model is applicable in the current context since lifetime major depression is, by definition, an irreversible condition (albeit one typically characterized by recurring episodes). In the current investigation, an extra term for recall failure was added to the model. In order to incorporate mortality, a structured literature review was conducted and the impact of plausible levels of differential mortality was explored. RESULTS: Relatively low rates of recall failure (e. g. 2-4 % per year) can account for a flat or declining age-specific lifetime prevalence curve in most age groups, with higher rates of recall failure being necessary in the adolescent age range. Among the elderly, where mortality rates are higher, differential mortality may also contribute to the pattern. CONCLUSIONS: Available data about the incidence of major depression, and the mortality associated with this condition, suggest that plausible rates of recall failure can explain a flat or declining lifetime major depression prevalence across age groups. A corollary of this result is that many existing estimates of major depression lifetime prevalence may be too low. A cohort effect can be inferred from cross-sectional lifetime prevalence data only when the diagnostic instruments employed make recall failure very unlikely.
Adolescent↗
Epidemiology of major depression in a predominantly rural health region.
BACKGROUND: Several large-scale cross-sectional studies have evaluated the prevalence of major depression in Canadian populations. Few studies have employed prospective methods, which are necessary to evaluate incidence, and few have focused on predominantly rural areas. METHODS: Subjects who had participated in a cross-sectional general health survey were invited to participate in a second wave of data collection 6 months later. These subjects were recontacted using a telephone interview. A brief diagnostic instrument for major depression was used in both waves,and a variety of other variables relevant to the epidemiology of major depression were measured. RESULTS: Of 801 subjects initially enrolled, 666 (83.1 %) consented to be recontacted, and 501 (75.2 %) of these were successfully reached. The incidence of major depression was 3.8%. The incidence was higher in women, although this difference did not attain statistical significance. Having a past history of depression and having a high level of perceived stress were predictors of risk. An exploratory comparison with data collected using similar methods in a nearby urban centre determined that the rural prevalence was lower than urban, and that a variety of factors (street drugs, deficits in social support, unemployment, recent life events) may contribute have to this difference. CONCLUSIONS: The 6-month cumulative incidence of depressive disorder was much higher than that reported by most previous studies. This may be a result of the diagnostic instrument employed, which captures a broader spectrum of depressive morbidity than the instruments used in most previous studies. Also, as the study did not exclude subjects with previous depressive episodes during their lifetime, the incidence rate reflects risks of major depressive episodes rather than major depressive disorders.
Adult↗
Irritable bowel syndrome: are incentives useful for improving survey response rates?
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders. There continues to be a need for community-based research into this condition. Unfortunately, response rates in community-based IBS surveys have typically been very low. In this study, we explore the use of incentives and multiple-response options as a means of increasing survey response rates. The study was conducted in three phases. In an initial phase, no incentive was offered; in the second phase, a 5.00 Canadian dollars incentive was offered; and in the third phase, a 20.00 Canadian dollars incentive was offered. Response rates were higher in the incentive groups: Individual response rates were 57.9%, 72.7%, and 84.7% in the three phases, respectively. A slightly higher estimate of IBS prevalence was obtained in the no incentive group. Selection bias is a possible explanation for this difference. A decision about whether to use incentives must be based on the specific goals of the study.
Adolescent↗
International differences in major depression prevalence: what do they mean?
The international literature concerned with major depression prevalence has been growing rapidly, providing a wealth of new information about prevalence in different countries. In understanding and using these rates, analytically oriented epidemiologists, decision makers, and administrators, however, need to be aware of a set of interpretive difficulties. Experience suggests that international major depression prevalence comparisons should be treated with caution. The portability of major depression diagnostic criteria across countries requires further confirmation, and existing diagnostic interviews have technical vulnerabilities that may render international comparisons vulnerable to measurement bias.
Cross-Cultural Comparison↗
Irritable bowel syndrome and health-related quality of life: a population-based study in Calgary, Alberta.
BACKGROUND: Little is known about the health-related quality of life (HRQOL) of nonclinical samples of people with irritable bowel syndrome (IBS) in Canada. In a pilot survey, the impact of IBS on HRQOL using a population-based, urban sample was examined. METHODS: A random sample of Calgary residents (18 years of age or older), selected by random digit dialing (n=1521), completed a structured questionnaire including ROME II Criteria and Medical Outcomes Study Short-Form 12-Item Health Survey, version 2 (SF-12v2). The mean scale and summary scores of SF-12v2 for those who did and did not meet ROME II criteria and for those who met ROME II criteria with and without visiting a physician in past three months were determined and compared using multiple regression analyses. RESULTS: Of the 951 households successfully contacted, 590 (62%) were willing to participate, of which 437 (74%) individuals were recruited. One hundred ten IBS cases (81 of which were women) and 327 non-IBS controls (180 of which were women) were identified. All of the eight mean scale scores and the two mean summary scores were significantly lower in people with IBS than in those without, whether or not adjusting for demographics. Forty-four of the 110 IBS cases (40%) sought medical help. Significantly lower mean physical component score and three scale scores (general health, social functioning and role physical) were found in those who sought medical help than in those who did not. CONCLUSIONS: People with IBS experience significant impairment in HRQOL, including both physical and mental well-being. People with IBS who seek medical help report worse physical health than those who do not, but their mental health is no different.
Alberta↗
Underuse of antidepressants.
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Antidepressive Agents↗
Prevention of depressive symptoms through the use of distance technologies.
Psychoeducational materials can be disseminated at minimal expense through the use of distance technologies, offering an opportunity for prevention. The objective of this project was to develop and evaluate a psychoeducational computer program designed to prevent depressive symptoms. The program was accessible through the Internet or by touch-tone telephone. A total of 786 participants were randomly assigned either to the preventive intervention or to an information-only control condition. Over a three-month follow-up period, no differences between the groups were observed. However, three of the target variables (cognitive style, activity level, and sleep quality) were found to be strong predictors of whether a participant had an episode of major depression during the follow-up period.
Adult↗
Mental health services received by depressed persons who visited general practitioners and family doctors.
OBJECTIVES: This study estimated the rates of mental health service provision and of specialist referral in primary care in Canada and investigated factors associated with receiving mental health services and with referral to mental health specialists among persons who reported major depressive episodes. METHOD: S: Data from the 1998-1999 Canadian National Population Health Survey were used. The 608 respondents who reported having major depressive episodes in the 12 months preceding the survey and who reported contacting a general practitioner or family doctor during that time were included in the study. The rates of provision of mental health services by general practitioners and family doctors and of referral to mental health specialists were calculated. Demographic, socioeconomic, and clinical characteristics associated with receiving mental health services and with referral to specialists were investigated. RESULTS: Among the 608 respondents who had contacted general practitioners or family doctors for any reason, 153 had contacted them for emotional or mental problems. Of this subgroup of 153, 64.5 percent received mental health services either from these practitioners or by referral to specialists, and 26 percent were referred to mental health specialists. Depressed respondents who reported having talked to a general practitioner or family doctor about mental health problems, who reported impairment, and whose depressive symptoms had lasted eight or more weeks were more likely to have received mental health services. Respondents aged 12 to 24 years were more likely to be referred to mental health specialists. CONCLUSION: S: Impairment associated with depression and chronicity of depressive symptoms appear to be the primary determinants of the decisions made by general practitioners and family doctors about providing mental health services. Patients' willingness to consult with general practitioners or family doctors for mental health problems may also be a key factor, both for effective management of depression in primary care settings and for referral to mental health specialists.
Adolescent↗
Effect of depression on stroke morbidity and mortality.
OBJECTIVES: This narrative review examines the evidence and discusses the clinical relevance of depression as a risk factor for stroke morbidity and mortality. It also proposes recommendations for future research. METHODS: We used the Medline computer database to search the relevant original studies published in English from January 1966 to December 2001. Our key words were as follows: depressive disorder, cerebrovascular disease, stroke, vascular risk factors, and mortality. Articles that investigated the relation between antecedent depression and subsequent stroke morbidity and mortality were collected and reviewed. RESULTS: Since 1990, 8 prospective studies have been published. Among these 8 studies, 6 addressed depression and stroke morbidity, 1 investigated the association of depression with stroke morbidity and stroke mortality, and 1 investigated the association with stroke mortality only. Of 7 studies examining the independent effect of depression on stroke morbidity, 6 were positive. With regard to stroke mortality, 2 studies found an independent association between depression and specific stroke mortality. The contributions and methodological limitations of these studies are discussed. CONCLUSIONS: Emerging data suggest an association between depressive symptoms and increased risk for stroke morbidity and mortality. More methodologically sound studies are needed to elucidate causal pathways that link depression and cerebrovascular disease. They are also needed to determine the effect of depression intervention on reducing the risk of cerebrovascular events. Information on author affiliations appears at the end of the article.
Adult↗
Depressive symptoms in a treated multiple sclerosis cohort.
BACKGROUND: Recent side effect data from clinical trials of interferon beta in multiple sclerosis (MS) have failed to confirm that these medications are associated with an increased risk of depression. However, these studies have used highly selected samples and the results may not be generalizable to real world settings. METHODS: Clinical data on subjects from southern Alberta who have applied for, or are receiving, public reimbursement for MS treatment are maintained in a database at the University of Calgary Multiple Sclerosis Clinic. Depression ratings obtained using the Center for Epidemiological Studies Depression Rating Scale (CES-D) are included in this database. In the current analysis, these longitudinal data were used to determine whether depressive symptoms were associated with disease-modifying treatments. RESULTS: At baseline, ratings were available for 163 subjects. Those choosing interferon beta resembled those choosing glatiramer acetate in most respects. During follow-up, no differences were observed in the prevalence or incidence of depression and CES-D scores were not found to differ between the treatment groups. CONCLUSIONS: The failure to identify higher rates of depression both in previous intervention studies and in the current observational study provides confirmation that these drugs are not substantially associated with the occurrence of depression.
Adjuvants, Immunologic↗
Can continuing benzodiazepine use be predicted?
The objective of the present study was to examine characteristics of benzodiazepine (BZD) users, as well as try to identify predictors of continuing BZD use. Health-related data were collected twice on the same sample of Canadians two years apart. Drug use was based on the question: "What medications did you take over the last two days?" while other variables used were age, sex, education, marital status, chronic conditions, non-BZD drug use, health status and pain level. Of the 11,624 respondents, 371 (3.2%) reported taking BZDs in 1994. Logistic regression results showed that the highest odds of BZD use were for antidepressant users (OR=10.7, P<0.05), followed by poor health (OR=5.0, P<0.05), pain (OR=3.9, P<0.05) and chronic conditions (OR=3.2, P<0.05). Of the 371 individuals who reported BZD use in 1994, 198 (53.4%) reported BZD use in 1996. Logistic regression showed that none of the variables mentioned above showed a significant association with continuing (including gaps in use) BZD use in 1996. Regarding individual BZDs, it could not be concluded definitively that any BZD is more likely to show continued use than any other, but the possibility of a linear relationship between the proportion of continued use and the half-life of the BZD should be investigated further. Thus, the main predictive factor for continuing use of BZD, as shown by this study, is that of previous use. Whenever a BZD is prescribed, regardless of whether it is a new or repeat prescription, it should be remembered that the likelihood of continuing use is considerable.
Adult↗
Interferon beta1a and depression in secondary progressive MS: data from the SPECTRIMS Trial.
Depression is a suspected side effect of treatment with interferon beta1a in MS. However, an association with depression has not been confirmed by rigorous studies. During the SPECTRIMS clinical trial of interferon beta1a (Rebif) in secondary progressive MS, depression ratings were obtained from 365 subjects treated either with interferon beta1a or with placebo. No significant differences between groups emerged during 36 months of follow-up. These data suggest that depression is not a side effect of interferon beta1a.
Adjuvants, Immunologic↗
Prospective study of frequent heavy alcohol use and the risk of major depression in the Canadian general population.
The objective of this study was to investigate the effect of persistent alcohol consumption on the risks of major and minor depression. A retrospective cohort study design was used. The data was derived from a large scale longitudinal national health study (Canadian National Population Health Survey). Depression status was evaluated by using the Composite International Diagnostic Interview-Short Form (CIDI-SF) for major depression. Subjects who did not have major depression at baseline were classified into groups according to the persistence of alcohol consumption during the follow-up period. The incidence of major depression in each group was calculated in men and in women separately and were stratified by age. The same procedures were repeated for minor depression. Women who reported having 5+ drinks on one occasion at least once a month were at an elevated risk of major depression. The same pattern was not observed among men in this analysis. However, no difference was found between the groups in terms of the incidence of minor depression. Frequent heavy alcohol use may be a causal factor for major depression among women. Reducing the frequency and quantities of alcohol consumption may offer an opportunity for prevention of major depression among women.
Adult↗
Modeling methods for facilitating decisions in pharmaceutical policy and population therapeutics.
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Decision Making↗
Major depression and its association with long-term medical conditions.
OBJECTIVE: To replicate previously reported associations between major depressive episodes (MDEs) and long-term medical conditions in a Canadian community sample. METHODS: A sample of 2542 household residents was selected using random digit dialing (RDD). Data were collected by telephone interview. The Composite International Diagnostic Interview (CIDI)-Short Form for major depression (CIDI-SFMD) was used to identify MDEs occurring in the previous 12 months. Long-term medical conditions were identified by self-report. RESULTS: The prevalence of MDE was elevated in those subjects who reported 1 or more long-term medical conditions. The association was not due to confounding by age, sex, social support, or stressful recent life events. CONCLUSION: This study replicates a previously reported association between depressive disorders and long-term medical conditions. These cross-sectional associations suggest that medical conditions may increase the risk of major depression or that major depression may increase the risk of medical conditions. Alternatively, comorbid medical conditions may influence the duration of depressive episodes, or vice versa. These explanations are not mutually exclusive.
Adult↗
The moderating effects of coping strategies on major depression in the general population.
OBJECTIVES: To evaluate the moderating effects of various coping strategies on the association between stressors and the prevalence of major depression in the general population. METHODS: Subjects from the Alberta buy-in component of the 1994-1995 National Population Health Survey (NPHS) were included in the analysis (n = 1039). Each subject was asked 8 questions about coping strategies that dealt with unexpected stress from family problems and personal crises. Major depression was measured using the World Health Organization's (WHO) Composite International Diagnostic Interview-Short Form (CIDI-SF) for major depression. The impacts of coping strategies in relation to psychological stressors on the prevalence of major depression were determined by examining interactions between coping and life stress on major depression using logistic regression modelling. RESULTS: No robust impact of coping strategies in relation to various categories of stress evaluated in the NPHS was observed. There was evidence that the use of "pray and seek religious help" and "talks to others about the situations" as coping strategies by women moderated the risk of major depression in the presence of financial stress and relationship stress (with a partner). Using emotional expression as a coping strategy by women might decrease the risk of major depression in the presence of 1 or more recent life events, personal stress, relationship stress (with a partner), and environmental stress. CONCLUSION: Different coping strategies may have a differential impact on the prevalence of major depression in specific circumstances. These findings may be important both to prevent and to treat depressive disorders.
Adaptation, Psychological↗