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PubMed2006

What does history teach us about factors associated with relapse in bipolar affective disorder? Presentation at Hilton hotel, Gateshead, 2 September 2005 at Symposium entitled managing The aftermath of mania.

When investigating treatments for any chronic condition it is essential to know the usual course of the illness concerned. The natural history of bipolar affective disorder has only been established relatively recently. This review examines the factors that affect the course of bipolar disorder from an historical perspective. These include the affective nature of the episodes and the influence of psychotic symptoms, age at onset of illness, length of episodes and cycles, gender, ethnicity, concurrent drug and alcohol use, occupational status and factors leading to chronicity. The pioneering work of Kraepelin and Angst established that episodes of illness in bipolar disorder increased in frequency over time and that earlier age of onset predicted more frequent episodes. More recent work has established that female subjects have a later onset of illness, that the frequency of episodes often decreases over time and that rapid cycling has a poorer response to treatment. Suggested criteria for inclusion of subjects into trials examining manic relapse are listed based on the findings from earlier work.

Antimanic Agents↗
PubMed1977

Pregnancy in Swedish teenagers. Perinatal problems and social situation.

Teenage pregnancies are considered a major problem, socially and medically, in the USA. In the present study, the scope of the problem in a Swedish population was investigated. Primiparas age 17 or less constituted 2% of all 8945 women delivered of babies at the University Hospital in Linköping, 1969-72. The most common obstetrical complications and operations did not occur more often in this age group. The incidence of deliveries before the 36th gestational week was increased 3-fold but no significant differences in intra-uterine growth retardation, asphyxia or perinatal mortality were found. One to two years after the delivery, 70% of the young mothers lived in ordinary nuclear families. Their economic position was worse than in a control group of women 21-29 years old. Barely 10% reached the median income of the control group. This disadvantageous situation was not thought to be caused by their early pregnancies, but rather considered part of the life pattern of an underprivileged group otherwise characterized by a low occupational status of their own fathers, a low educational level and a high frequency of teenage pregnancy among their own mothers.

Adolescent↗
PubMed1985

Participants and non-participants of different categories in a health survey. A cross-sectional register study.

Participants and non-participants in a health survey of asbestos cement workers were compared, using data from public registers, i.e. variables of socio-medical relevance. The plant closed down in 1976 and 3 years later all living subjects, 985 persons, were offered a health examination. The participation rate was 57%. The non-participants were divided into four categories: I, those who answered the invitation but refused to participate; II, those who did not answer even after three invitations; III, those who answered and accepted but did not participate; and IV, those who participated partly. A very consistent pattern of differences between participants and non-participants was observed, the latter being significantly more often registered for Public Assistance, for heavy drinking habits or criminal offences, and had significantly lower incomes and occupational status. The sickness absence, however, was not significantly shorter among the participants. The non-participating categories II and III differed most from the participants. Category I was more similar to the participants than to the other non-participating categories. This heterogeneity of the non-response/non-participation concept should be considered when health survey data are interpreted.

Absenteeism↗
PubMed1990

Severe frostbite of the upper extremities--a psychosocial problem mostly associated with alcohol abuse.

In the catchment area of Helsinki University Central Hospital (in total 16 surgical hospitals) amputation was performed on 9 patients with frostbite in the upper extremities during 1984-1985. The population during the study period in this area was 1.165,000 inhabitants, corresponding to 24% of the whole population in Finland. All 9 patients were male and the mean age was 49 years (range 31-75). All amputations performed were of the fingers, the third, fourth and fifth fingers most frequently affected. Alcohol was a marked etiologic or contributing factor in most of the frostbites. Two patients were chronic schizophrenics showing no signs of alcohol abuse, but the remaining 7 were either acutely or chronically alcohol intoxicated: 5 patients were chronic alcoholics, one was an alcohol abuser without a definite diagnosis of alcoholism, and one patient with no previous history of alcohol abuse was alcohol intoxicated. Based on the present study it is clear that, in addition to the cold winters in Finland, other factors contribute to severe frostbite. These include many psychosocial factors such as alcoholism or mental disease, unbalanced marital status, occupation handicap and lack of regular residence.

Adult↗
PubMed2004

Condom use with sex workers and abstinence behaviour among men in Nigeria.

Non-regular, non-cohabiting relationships and condom neglect are known to fuel the HIV/AIDS epidemic in Africa. Reproductive health needs of the men, the major decision-makers in this community, have been grossly neglected in this regard. This exploratory, community-based study assessed condom use among married men when with commercial sex workers (CSWs) and abstinent behaviour when their wives were unavailable for sex. (A CSW is one known to receive payment for sex.) Out of the 3,178 married respondents, 1,755 (55.2%) had ever used condoms. Of this number, 1,296 (73.8%) resided in urban locations while 459 (26.2%) resided in rural areas. Of these men, 137 had used CSWs in the six months prior to the study. Only 63 (46%) of these had used a condom at the last visit. Young age (<30 years) was the only predictor of condom use when with CSWs (p=0.03). Predictors of abstinence behaviour when the wife was unavailable for sex included: primary and secondary education, young age of the wife, low occupational status and monogamy. National HIV/AIDS control programmes should address men's risk-taking behaviour, empowering women to negotiate condom use and reduce long abstinence periods. Continued efforts should be made to reach sex workers and to make condoms much more widely available, acceptable and affordable, especially in rural areas.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Predictors of refusal to participate: a longitudinal health survey of the elderly in Australia.

BACKGROUND: The loss of participants in longitudinal studies due to non-contact, refusal or death can introduce bias into the results of such studies. The study described here examines reasons for refusal over three waves of a survey of persons aged >or=70 years. METHODS: In a longitudinal study involving three waves, participants were compared to those who refused to participate but allowed an informant to be interviewed and to those who refused any participation. RESULTS: At Wave 1 both groups of Wave 2 non-participants had reported lower occupational status and fewer years of education, had achieved lower verbal IQ scores and cognitive performance scores and experienced some distress from the interview. Those with an informant interview only were in poorer physical health than those who participated and those who refused. Depression and anxiety symptoms were not associated with non-participation. Multivariate analyses found that verbal IQ and cognitive impairment predicted refusal. Results were very similar for refusers at both Waves 2 and 3. CONCLUSIONS: Longitudinal studies of the elderly may over estimate cognitive performance because of the greater refusal rate of those with poorer performance. However, there is no evidence of bias with respect to anxiety or depression.

Activities of Daily Living↗
PubMed2006

Major depression, fibromyalgia and labour force participation: a population-based cross-sectional study.

BACKGROUND: Previous studies have documented an elevated frequency of depressive symptoms and disorders in fibromyalgia, but have not examined the association between this comorbidity and occupational status. The purpose of this study was to describe these epidemiological associations using a national probability sample. METHODS: Data from iteration 1.1 of the Canadian Community Health Survey (CCHS) were used. The CCHS 1.1 was a large-scale national general health survey. The prevalence of major depression in subjects reporting that they had been diagnosed with fibromyalgia by a health professional was estimated, and then stratified by demographic variables. Logistic regression models predicting labour force participation were also examined. RESULTS: The annual prevalence of major depression was three times higher in subjects with fibromyalgia: 22.2% (95% CI 19.4 - 24.9), than in those without this condition: 7.2% (95% CI 7.0 - 7.4). The association persisted despite stratification for demographic variables. Logistic regression models predicting labour force participation indicated that both conditions had an independent (negative) effect on labour force participation. CONCLUSION: Fibromyalgia and major depression commonly co-occur and may be related to each other at a pathophysiological level. However, each syndrome is independently and negatively associated with labour force participation. A strength of this study is that it was conducted in a large probability sample from the general population. The main limitations are its cross-sectional nature, and its reliance on self-reported diagnoses of fibromyalgia.

Adolescent↗
PubMed2005

An epidemiological survey of psychiatric disorders in Iran.

BACKGROUND: The nation-wide epidemiological survey of psychiatric disorders in term of lifetime prevalence is not adequately known in Iran. The prevalence of lifetime psychiatric disorders was estimated among the population of aged 18 and over on gender, age group, educational level, occupational status, marital status, and residential area. METHODS: The subjects were 25,180 individuals selected through a clustered random sampling method. The psychiatric disorders were diagnosed on the bases of Diagnostic and Statistical Manual of Mental Disorders-IV criteria. It is the first study in which the structured psychiatric interview administered to a representative sample of the Iranian population age 18 and over by the 250 trained clinical psychologist interviewers. The data was entered through EPI-Info software twice in an attempt to prevent any errors and SPSS-11 statistical software was also used for analyses. The odds ratios and their confidence intervals estimated by using logistic regression. RESULTS AND DISCUSSION: The prevalence of psychiatric disorders was 10.81%. It was more common among females than males (14.34% vs. 7.34%, P < 0.001). The prevalence of anxiety and mood disorders were 8.35% and 4.29% respectively. The prevalence of psychotic disorders was 0.89%; neuro-cognitive disorders, 2.78% and dissociative disorders, 0.77%. Among mood disorders, major depressive disorder (2.98%) and among anxiety disorders, phobic disorder (2.05%) had the higher prevalence. The prevalence of psychiatric disorders among divorced and separated 22.31%; residents of urban areas 11.77%; illiterates 13.80%; householders 15.48%; unemployed 12.33% that were more than other groups. CONCLUSION: The mental health pattern in Iran is similar to the western countries, but it seems that the prevalence of psychiatric disorders in Iran may be lower than these countries. It is estimated that at least about 7 millions of Iranian population suffer from one or more of the psychiatric disorders. It shows the importance of the role of the psychiatric disorders in providing preventive and management programs in Iran.

Journal Article↗
PubMed2002

Family satisfaction with inpatient palliative care in Japan.

Whereas satisfaction is one of the most important outcomes in palliative care settings, there have been no systematic studies investigating the effects of family- and organization-related variables on family satisfaction with care. To clarify factors contributing to family satisfaction with inpatient palliative care services, a cross-sectional mailed survey was performed. A 60-item questionnaire was mailed to 1026 bereaved subjects who had lost family members at one of 37 palliative care units in Japan to evaluate their sociodemographic characteristics and satisfaction levels with care. An institution survey was performed to collect organization-related variables. Caregiver satisfaction was rated on the Satisfaction scale for Family members receiving Inpatient Palliative Care (Sat-Fam-IPC). A total of 640 responses were analysed (response rate = 62%). The responses to overall satisfaction were 'satisfied' in 41 % and 'very satisfied' in 47%. The mean total score of the Sat-Fam-IPC was 82.4 +/- 13.2 on the 0-100 scale. The mean subscale scores were: 85.8 +/- 14.5 (Nursing Care), 81.5 +/- 18.4 (Symptom Palliation), 85.0 +/- 13.8 (Facility), 83.3 +/- 16.6 (Information), 83.1 +/- 17.3 (Availability), 78.3 +/- 18.9 (Family Care), and 79.8 +/- 17.3 (Cost). Significant determinants of family satisfaction identified were: nursing system, the number of nurses at night and presence of attending medical social workers (Nursing Care), patient age and the number of physicians (Symptom Palliation), floor space per bed (Facility), duration of admission and presence of attending medical social workers (Availability), patient age, family age, gender and occupational status (Family Care), patient age and the extra charge for a private room (Cost). In conclusion, informal caregivers are generally satisfied with inpatient palliative care services provided by members of the Japanese Association of Hospice and Palliative Care Units. The levels of satisfaction are influenced by various family- and organization-related variables.

Aged↗
PubMed1986

Delineating social phobia.

The natural history--including psychiatric symptoms, precipitating factors, onset and course of illness, and personality characteristics--of 47 social phobics, 80 agoraphobics, and 72 simple phobics was examined. The social phobia group differed from the agoraphobia group by having a lower mean age, fewer females and married members, and a higher educational and occupational status. They were less fearful generally, less obsessive, and less likely to follow a fluctuating or phasic course. There was overlap between the two groups with regard to main phobias, and they were similar with regard to adjacent symptomatology. Both the social and agoraphobia groups differed in similar and significant ways from simple phobics.

Adult↗
PubMed1988

The Camberwell Collaborative Depression Study. II. Investigation of family members.

Out of a consecutive series of 130 potential probands with recent onsets of depression, 124 were deemed 'in scope' for a family interview study of social and genetic influences on depression. We were able to interview first-degree relatives of 83 probands (67% of those families 'in scope'). Unexpectedly, interviewed first-degree relatives had, on average, a significantly lower occupational status than the depressed probands. However, the rates of depression among the first-degree relatives were high. Based on a PSE-Catego classification, 17.2% of 244 relatives were current 'cases' of depression at the time of interview. This was significantly greater than the estimated population prevalence. Using a Past History Schedule in combination with the PSE, the lifetime prevalence of depressive illness, expressed as the proportion who had ever fulfilled PSE-Catego case criteria, was 38.9%. High rates of psychiatric treatment were also found in family members. The lifetime prevalence of any form of hospital treatment for depression in 315 first-degree relatives was 15.5%. This gives an age-corrected morbidity risk to age 65 years of 24.6%, as compared with a population estimate of 8.9%. In common with previous studies, significantly higher rates of depression were found among female than among male first-degree relatives for broader categories of disorder, but there was a small and nonsignificant excess of men among those relatives who had received in-patient treatment for depression. This apparent lessening of sex differences with more severe categories was not supported by an examination of 'lifetime ever' depressive symptoms, where severity was expressed as highest ever PSE-Catego-ID level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Stressful life events and Graves' disease.

"The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2.7-14.7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3.6, 2.2-5.9). Slightly more patients than controls were divorced (1.8, 1.0-3.3) and reported a less frequent intake of alcohol (0.4, 0.2-0.8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease."

Case-Control Studies↗
PubMed1995

Episodes of care for first-ever psychiatric patients. A long-term case-register evaluation in a mainly urban area.

BACKGROUND: Psychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of 'survival analysis' have rarely been used for assessing such data. METHOD: A longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses. RESULTS: The duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts. CONCLUSIONS: The community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Adolescent↗
PubMed2000

Early termination of treatment in personality disorder treated in a psychotherapy hospital. Quantitative and qualitative study.

BACKGROUND: Factors underlying premature discontinuation of psychosocial in-patient treatment are still unclear. AIMS: Investigation of early discontinuation of specialised in-patient psychosocial treatment in a sample of people with personality disorder. METHOD: Out of 134 consecutive admissions to the Cassel Hospital, 42 early drop-outs and 92 patients who remained were compared on demographic and clinical variables. Early drop-outs were invited for in-depth interviews, to explore their hospital experiences. RESULTS: The early drop-out group and the group which remained showed significant differences in occupational status, borderline personality disorder (BPD) and the treatment programme to which they were allocated. All three independent variables predicted early discontinuation of treatment. The qualitative analysis of interview transcripts identified significant problems in institutional dimensions. CONCLUSIONS: Important subjects and process variables contributing to early drop-out in people with personality disorder were identified, with potential implications for clinical practice.

Adult↗
PubMed1978

Sex role conformity in homosexual and heterosexual males.

Nine principal components were extracted from the scores of 26 homosexual and 26 heterosexual males matched on age, education, occupation status, and sampling frame on Adjective Check List, Bem Sex Role Inventory, Chapin Social Insight Test, Experience Inventory, and Sixteen Personality Factor Questionnaire scales selected to represent a variety of "masculine" and "feminine" sex role attributes. The four most general varimax factors, accounting for 48% of the total variance, were: I) "Feminine Openness," II) "Masculine Boldness," III) "Reflection," and IV) "Novelty Seeking." Factor scores were constructed and indicated that the homosexual sample was significantly more identified with Factor I (p < .00l; 17% of total variance). There was no significant difference between the samples on Factor II, nor on the remaining two general factors which were not sex typed.

Journal Article↗
PubMed1997

Word association profiles of alcoholics.

A group of 100 alcoholic outpatient men were compared to 100 control participants, matched for race, age, and occupational status on 15 scales of the Karp Objective Word Association Test. Consistent with 2 of the 3 specific hypotheses of this study, a one-way multivariate analysis of variance found significant differences between the groups, with alcoholics offering more rejections (nonresponses) and more hostile associations than controls. Unexpectedly, alcoholics offered more synonyms than controls, congruent with a more positive diagnostic picture.

Adult↗
PubMed1995

Occupational outcome after temporal lobectomy for refractory epilepsy.

We evaluated employment after temporal lobectomy for refractory epilepsy in 86 patients (3.5 to 8 years of follow-up). Seventy-three patients qualified for the work force before and after surgery. Unemployment rates declined after surgery (18 patients [25%] unemployed before surgery, eight patients [11%] unemployed after surgery), and underemployment also tended to diminish. Improvement in occupational status related strongly to the degree of postoperative seizure relief. Seizure-free patients fared better (no unemployment, little underemployment) than patients with some seizure-free years and some years with seizures after surgery, whose high underemployment level persisted. Patients with seizures in each year after surgery fared worst (despite reduced seizure frequency), with increased unemployment after surgery. Age at surgery also influenced vocational outcome in patients who were unemployed before surgery. Historical, educational, cognitive, and behavioral measures did not correlate with vocational outcome. Employment gains came slowly; unemployed patients took up to 6 years to obtain work after surgery. Of 13 students at the time of surgery, 11 have graduated and nine are now employed. We conclude that seizures play a large role in limiting employment, and that by alleviating seizures, temporal lobectomy improves employability in people with refractory epilepsy. Surgery thereby provides benefit to individuals with epilepsy by increasing financial independence and to society by reducing unemployment.

Adult↗
PubMed2004

Predictors of length of hospital stay after acute myocardial infarction in Japan.

BACKGROUND: In Western countries, the length of hospital stay after acute myocardial infarction (AMI) has decreased dramatically during the past 3 decades and is now approximately 1 week. However, epidemiological data concerning the length of hospital stay, its predictors and trends based on a large-scale sample are still limited in Japan. METHODS AND RESULTS: The study group comprised 4,113 surviving AMI patients who were enrolled in the Osaka Acute Coronary Insufficiency Study from April 1998 to March 2003. The mean length of hospital stay was 31.2 days. Clinical factors (patient characteristics, severity of infarction, therapy, and in-hospital complications) only explained 26% of the variation in hospital stay. The mean hospital stay was significantly longer in 1998 than in 2002. In 2002, occupational status and admission to a high-volume hospital were independent predictors of a shorter hospital stay, but this association was not observed in 1998. CONCLUSIONS: The hospital stay is still extremely long in Japan and clinical factors do not provide an explanation. The findings of the present study suggest that the hospital stay could be reduced in some patients with AMI, but randomized studies are needed to examine the feasibility of early discharge.

Aged↗