Orwik

The relationship between major depression and marital disruption is bidirectional.

BACKGROUND: Marital status is important to the epidemiology of psychiatric disorders. In particular, the high prevalence of major depression in individuals with separated, divorced, or widowed status has been well documented. However, the literature ... expand abstractis divided as to whether marital disruption results in major depression and/or vise versa. We examined whether major depression influences changes of marital status, and, conversely, whether marital status influences the incidence of this disorder. METHODS: We employed data from the longitudinal Canadian National Population Health Survey (1994-2004), and proportional hazards models with time-varying covariates. RESULTS: Major depression had no effect on the proportion of individuals who changed from single to common-law, single to married, or common-law to married status. In contrast, exposure to depression doubled the proportion of transitions from common-law or married to separated or divorced status (HR=2.0; 95% CI 1.4-2.9 P<0.001). Conversely an increased proportion of nondepressed individuals with separated or divorced status subsequently experienced major depression (hazard ratio, HR=1.3; 95% CI 1.0-1.5 P=0.04). CONCLUSION: The high prevalence of major depression in separated or divorced individuals is due to both an increased risk of marital disruption in those with major depression, and also to the higher risk of this disorder in those with divorced or separated marital status. Thus a clinically significant interplay exists between major depression and marital status. Clinicians should be aware of the deleterious impact of major depression on marital relationships. Proactive management of marital problems in clinical settings may help minimize the psycho-social "scar" that is sometimes associated with this disorder. collapse abstract

Prevalence of mental disorders in a Canadian household population with dementia.

BACKGROUND: Medical and mental health comorbidity in Alzheimer's disease and other dementias presents difficult challenges for health service delivery. However, existing studies have been conducted in clinical samples and may not be informative for p... expand abstractlanning community services. The Canadian Community Health Survey (CCHS) provides an opportunity to characterize associations between dementias and mental and physical comorbidity in a household population aged 55 and over. METHODS: Data were obtained from the 2005 CCHS-cycle 3.1. Weighted estimates for mood and anxiety disorders and other characteristics in Canadian population with dementia were calculated and were compared to those in people without the condition. RESULTS: According to the CCHS, the prevalence of Alzheimer' s disease and other dementia increases with age, more or less doubling every decade. The increase among women is monotonic, whereas among men in the household population the rate of dementia peaks at age 85-89 and falls thereafter. Mood and anxiety disorders were found to be substantially more frequent among people with Alzheimer's disease and other forms of dementia compared to those without the disease (mood disorders: 19.5% vs. 5.3% and anxiety disorders: 16.3% vs. 4.0%). Heart disease, stroke and obesity were associated with dementia as was a lower level of education. Furthermore, people with dementia were more likely than those without the disease to report activity restrictions. CONCLUSIONS: The high prevalence of mood and anxiety disorders in household population with Alzheimer's disease and other dementia demonstrates the burden of disease that is likely to worsen quality of life over time. collapse abstract

Patterns of benzodiazepine use in a Canadian population sample.

AIM: The objective of this study was to identify clinical and demographic factors that may be associated with benzodiazepine treatment, to describe the reported reasons for use of these medications and to appraise the pattern of use in relation to st... expand abstractandard guidelines in a general population sample. METHODS: Telephone survey methods were employed to select a sample of 3345 people between the ages of 18 and 64. A computer assisted telephone interview, including the Mini Neuropsychiatric Diagnostic Interview (MINI), was administered. Estimates were weighted for design features and population demographics. RESULTS: The overall prevalence of benzodiazepines use was 3.3% (95% confidence interval [CI] 2.6 to 4.1%). There was a higher frequency of medication use in women than men, among respondents who were widowed, separated or divorced, and those with lower levels of education. In relation to MINI diagnosis, diagnoses of Panic Disorder and Major Depression increased the probability of taking benzodiazepines. The reported main reason for use was "Sleep disorders" (68.9%), "Anxiety" (35.8%), "Depression" (27.8%) and "Pain management" (21.2%). More than 80% of subjects were taking benzodiazepines for more than one year. CONCLUSIONS: When compared to previous estimates, the lower frequency of benzodiazepines use suggests that there has been improvement in their evidence-based use at a population level. However our results once more confirm the difficulty stopping the use of these medications once they have been started. Further randomized control studies may help clinicians in having a better practical approach to rational benzodiazepine use. collapse abstract

Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study.

OBJECTIVE: To evaluate the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) in people with schizophrenia. METHOD: We conducted a period-prevalence study using a population-based cohort from Alberta administrative databases. Schizo... expand abstractphrenia was identified using billing codes; all other individuals served as non-schizophrenic controls. Modifiable CV-RF (hypertension, dyslipidemia, diabetes) and established CV-D (acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), stroke, arrhythmia) were identified using previously validated methods. Analyses were conducted using multivariable logistic regression. RESULTS: From 1995 to 2006, 28,755 people (1.2%) were identified with schizophrenia and compared with 2,281,636 non-schizophrenic controls. Individuals with schizophrenia were older (mean age 47.6 years vs. 45.3) and had lower socioeconomic status (59% received healthcare subsidies vs. 21%; OR: 5.55; 95% CI: 5.42-5.69) than controls. Of the CV-RF, diabetes was more common in those with schizophrenia than controls, particularly in younger males (ages 30-39, 3.8% vs. 1.4%, aOR: 1.57; 95% CI: 1.30-1.91) and females (ages 30-39, 5.8% vs. 2.4%, aOR: 1.72; 95% CI: 1.44-2.04). The prevalence of CV-D was significantly higher in people with schizophrenia than controls (27% vs. 17%, OR: 1.76; 95% CI: 1.72-1.81). CONCLUSIONS: On a population-wide basis, people with schizophrenia had a higher prevalence of diabetes and cardiovascular disease than those without schizophrenia, particularly at a younger age. Female sex offered no cardiovascular protection in those with schizophrenia. Our data suggest monitoring for diabetes and other cardiovascular risk factors should begin at the time of diagnosis of schizophrenia, particularly in females with schizophrenia. collapse abstract

Health status and health-related behaviors in epilepsy compared to other chronic conditions-A national population-based study.

Summary Purpose: The negative impact of epilepsy is disproportionate to its prevalence. Our objectives were to determine if health-related behaviors (HRBs) and health status differ between patients with epilepsy, migraine, or diabetes. Methods: The 2... expand abstract001-2005 Canadian Community Health Survey (N = 400,055) was used to explore health status and HRBs in patients with epilepsy, migraine, and diabetes and in the general population. Weighted estimates of association were produced as proportions with 95% confidence intervals (CIs). Logistic regression was used to explore the association between demographic variables and HRBs in epilepsy. Results: The prevalence of active epilepsy, migraine, and diabetes was 0.6%, 8.4%, and 3.8%, respectively. Those with epilepsy and diabetes were more likely than migraineurs to perceive their health as poor and to be physically inactive. Obesity and comorbidities were more likely in all chronic conditions studied compared to the general population. Those with epilepsy or migraine were significantly more likely to smoke compared to the general population or to those with diabetes. Those with epilepsy were more likely to ever have consumed more than 12 alcoholic drinks per week. Health monitoring did not differ between groups. In the logistic regression analysis, epilepsy was associated with physical inactivity and lower alcohol consumption in the past 12 months compared to the general population. Discussion: Our study demonstrated that those with epilepsy have a poorer pattern of HRBs and poorer health status compared to the general population. Screening for and managing comorbidities, and promoting exemplary HRBs, should improve overall health and quality-of-life in those with epilepsy. collapse abstract

Prospective evaluation of the effect of major depression on working status in a population sample.

OBJECTIVE: Numerous surveys have reported associations between major depressive episodes (MDEs) and occupational status, but cross-sectional studies cannot quantify the risks of employment transitions nor clarify their temporal direction. The goal of... expand abstract our study was to estimate the impact of MDE on subsequent employment status in a longitudinal community cohort. METHODS: Data from the National Population Health Survey (NPHS) were used. Proportional hazard models and logistic regression were employed to evaluate the effect of MDE on working status during the 1994 to 2004 interval among respondents who reported working at a job or business at baseline. RESULTS: MDE was associated with an increased risk of movement to nonworking status. People aged 26 to 45 years with MDEs have more than double the risk of this transition (HR = 2.6; 95% CI 1.8 to 3.6, P < 0.001). The probability of transition to nonworking status was higher, but the relative effect was smaller in people aged 46 to 65 years (HR = 1.2; 95% CI 0.7 to 2.0, P = 0.47). Retirement or perceived lack of availability of work did not contribute to the association. CONCLUSIONS: MDE is associated with an elevated risk of transition from working to nonworking status, especially in people aged 26 to 45 years. collapse abstract

Has 'lifetime prevalence' reached the end of its life? An examination of the concept.

Many cross-sectional surveys in psychiatric epidemiology report estimates of lifetime prevalence, and the results consistently show a declining trend with age for such disorders as depression and anxiety. In a closed cohort with no mortality, lifetim... expand abstracte prevalence should increase or remain constant with age. For mortality to account for declining lifetime prevalence, mortality rates in those with a disorder must exceed those without a disorder by a sufficient extent that more cases would be removed from the prevalence pool than are added by new cases, and this is unlikely to occur across most of the age range. We argue that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due to a variety of other factors, such as study design, forgetting, or reframing. Further, because lifetime prevalence is insensitive to changes in treatment effectiveness or demand for services, it is a parameter that should be dropped from the lexicon of psychiatric epidemiology. collapse abstract

Sleep medication use in Canadian seniors.

BACKGROUND: Difficulty sleeping is a common complaint by older people which leads to medication use to help attain sleep. OBJECTIVES: This study provides a population-based description of medication, specifically taken to help with sleep, by Canadian... expand abstracts over the age of 60. The proportion of this sleep medication that is prescribed, and the determinants of prescribed versus over the-counter (OTC) sleep medication use will also be presented. METHODS: The Canadian Community Health Survey, 2002, provided the study population of 9,393 respondents over the age of 60. RESULTS: Almost 16% of Canadians over 60 reported taking sleep medication over the past year, of which 85% was prescribed by physicians. Sleep medication is higher for women, increases with age, poor health, chronic illness and poor quality sleep,and was especially high for people with a recent major depressive episode. Prescribed sleep medication increased with age, low income, low education, poor health, chronic illness and residence in the province of Quebec. Adjusting for health status or insurance covering medication costs made little difference. CONCLUSIONS: This study provides important new information on the use of sleep medication by older Canadians. Overall sleep medication use and proportion of sleep medication prescribed are separate parameters with potentially different distributions, e.g., Quebec showed the same amount of sleep medication use as elsewhere, but a much higher proportion of it was prescribed. collapse abstract

Population-based service planning for implementation of MBCT: linking epidemiologic data to practice.

OBJECTIVE: The study explored population-based service planning for mindfulness-based cognitive therapy (MBCT). Evidence suggests the usefulness of MBCT in relapse prevention for individuals reporting three or more major depressive episodes. METHODS:... expand abstract Depression data were from the Canadian Community Health Survey. A simulation model estimated recurrence rates and population sizes to sustain MBCT therapists (each conducting two ten-person groups per year). RESULTS: Approximately 4.2% of the population are candidates for MBCT, and about 13 candidates would arise annually per 10,000 population. If MBCT was acceptable to 20%, for example, a population of 200,000 could support two therapists. CONCLUSIONS: A large proportion of the population is eligible for MBCT introduction; however, after introduction, the rate of emergence of candidates would yield a smaller patient pool, which may limit implementation in small population centers. Treatment acceptability is a key variable. These analyses highlight the potential value of epidemiologic data and simulation modeling in planning. collapse abstract

Costs associated with mood and anxiety disorders, as evaluated by telephone survey.

Costing studies are central to health policy decisions. Available costing estimates for mood and anxiety disorders in Canada may, however, be out of date. In this study, we estimated a set of direct health care costs using data collected in a provinc... expand abstractial telephone survey of mood and anxiety disorders in Alberta. The survey used random digit dialing to reach a sample of 3394 household residents aged 18 to 64. A telephone interview included items assessing costs without reference to whether these were incurred by the respondent, government or a health plan. The survey interview also included the Mini Neuropsychiatric Diagnostic Interview (MINI). Costs for antidepressant medications appear to have increased since the last available estimates were published. Surprisingly, most medication costs for antidepressants were incurred by respondents without an identified disorder. Also, an unexpectedly large proportion of medication costs were for psychotropic medications other than antidepressants and anxiolytic-sedative-hypnotics. These results suggest that major changes have occurred in the costs associated with antidepressant treatment. Available cost-of-illness data may be outdated, and some assumptions made by previous studies may now be invalid. collapse abstract

A longitudinal community study of major depression and physical activity.

BACKGROUND: The objective of this study was to determine whether major depressive episodes (MDEs) are associated transitions between active and inactive recreational activity patterns. METHODS: The data source was the Canadian National Population Hea... expand abstractlth Survey (NPHS). The NPHS included a brief instrument to assess MDEs and collected data on participation in recreational activities. In order to meaningfully categorize participation in recreational activities, the participation data was translated into overall estimated metabolic energy expenditure. A threshold of 1.5 kcal/kg per day was used to distinguish between active and inactive activity patterns. Proportional hazards models were used to compare the incidence of inactivity in initially active respondents with and without MDE and to compare the frequency of becoming active among initially inactive respondents with and without MDE. RESULTS: For active respondents with MDE, an elevated risk of transition into an inactive pattern was observed [adjusted hazard ratio (HR)=1.6; 95% CI 1.2-1.9]. However, MDE did not affect the probability of moving from an inactive to an active lifestyle (adjusted HR=1.0; 95% CI 0.78-1.19). CONCLUSIONS: Major depressive episodes are associated with an increased risk of transition from an active to an inactive pattern of activity. collapse abstract

The incidence of major depression in Canada: the National Population Health Survey.

OBJECTIVES: To estimate the cumulative incidence of major depressive episode (MDE) over 6 years and the associations between demographic and socioeconomic variables and MDE in a sample of the Canadian national population. METHODS: Data from the longi... expand abstracttudinal cohort of the Canadian National Population Health Survey (NPHS) were used. MDE was assessed using the Composite International Diagnostic Interview - Short Form for Major Depression. Participants of the 2000/01 NPHS were followed until 2006/07. Individuals with previous MDE were excluded from the analysis. Proportional hazard models were developed to assess the associations between demographic, socioeconomic characteristics and MDE. RESULTS: The cumulative incidence of MDE at 2002/03, 2004/05 and 2006/07 was 2.9% (95% confidence interval: 2.3%, 3.4%), 5.7% (95% confidence interval: 4.9%, 6.4%) and 7.2% (95% confidence interval: 6.4%, 8.1%). Women, youth, participants with one or more chronic medical conditions and those who reported family history of MDE were more likely to have developed MDE. Family history was the strongest risk factor for MDE (hazard ratio=2.01, 95% confidence interval: 1.51, 2.68). CONCLUSION: It may be valuable for primary and secondary prevention efforts to target women and young people. Family history is an important factor which should be considered in epidemiological studies about major depression, and also can assist in identifying those at high risk of new-onset MDE. collapse abstract

Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Introduction.

Designing a knowledge transfer and exchange strategy for the Alberta Depression Initiative: contributions of qualitative research with key stakeholders.

BACKGROUND: Depressive disorders are highly prevalent and of significant societal burden. In fall 2004, the 'Alberta Depression Initiative' (ADI) research program was formed with a mission to enhance the mental health of the Alberta population. A key... expand abstract expectation of the ADI is that research findings will be effectively translated to appropriate research users. To help ensure this, one of the initiatives funded through the ADI focused specifically on knowledge transfer and exchange (KTE). The objectives of this project were first to examine the state of the KTE literature, and then based on this review and a set of key informant interviews, design a KTE strategy for the ADI. METHODS: Face to face interviews were conducted with 15 key informants familiar with KTE and/or mental health policy and programs in Alberta. Interviews were transcribed and analyzed using the constant comparison method. RESULTS: This paper reports on findings from the qualitative interviews. Respondents were familiar with the barriers to and facilitators of KTE as identified in the existing literature. Four key themes related to the nature of effective KTE were identified in the data analysis: personal relationships, cultivating champions, supporting communities of practice, and building receptor capacity. These recommendations informed the design of a contextually appropriate KTE strategy for the ADI. The three-phased strategy involves preliminary research, public workshops, on-going networking and linkage activities and rigorous evaluation against pre-defined and mutually agreed outcome measures. CONCLUSION: Interest in KTE on the part of ADI has led to the development of a strategy for engaging decision makers, researchers, and other mental health stakeholders in an on-going network related to depression programs and policy. A similarly engaged process might benefit other policy areas. collapse abstract

Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low.

BACKGROUND: Most epidemiologic studies concerned with Major Depressive Disorder have employed cross-sectional study designs. Assessment of lifetime prevalence in such studies depends on recall of past depressive episodes. Such studies may underestima... expand abstractte lifetime prevalence because of incomplete recall of past episodes (recall bias). An opportunity to evaluate this issue arises with a prospective Canadian study called the National Population Health Survey (NPHS). METHODS: The NPHS is a longitudinal study that has followed a community sample representative of household residents since 1994. Follow-up interviews have been completed every two years and have incorporated the Composite International Diagnostic Interview short form for major depression. Data are currently available for seven such interview cycles spanning the time frame 1994 to 2006. In this study, cumulative prevalence was calculated by determining the proportion of respondents who had one or more major depressive episodes during this follow-up interval. RESULTS: The annual prevalence of MDD ranged between 4% and 5% of the population during each assessment, consistent with existing literature. However, 19.7% of the population had at least one major depressive episode during follow-up. This included 24.2% of women and 14.2% of men. These estimates are nearly twice as high as the lifetime prevalence of major depressive episodes reported by cross-sectional studies during same time interval. CONCLUSION: In this study, prospectively observed cumulative prevalence over a relatively brief interval of time exceeded lifetime prevalence estimates by a considerable extent. This supports the idea that lifetime prevalence estimates are vulnerable to recall bias and that existing estimates are too low for this reason. collapse abstract

Major depression and health-related quality of life in Parkinson's disease.

Depression is a common psychiatric condition in Parkinson's disease (PD), yet the burden of depression on health-related quality of life (HRQL) has not been clearly delineated in this patient population. OBJECTIVE: To evaluate the impact of depressio... expand abstractn and life stress on HRQL in the Canadian community dwelling population with PD. METHODS: A total of 259 respondents from the Canadian Community Health Survey (CCHS 1.1) with self-reported PD were interviewed. Measures included Health Utilities Index Mark 3 (HUI3), Composite International Diagnostic Interview Short Form for Major Depression and a single question regarding the amount of stress in their lives most days. Adjusted HUI3 scores were compared according to depression and life stress using ANCOVA models. RESULTS: Respondents without depression had overall HUI3 scores that were 0.29 units higher than respondents with depression [adjusted mean (95% CI) 0.49 (0.39-0.59) vs. 0.20 (0.03-0.37)]. The difference in overall HUI3 scores between respondents who reported high levels of stress as those who did not was 0.19 [adjusted mean (95% CI) 0.42 (0.29-0.55) vs. 0.23 (0.10-0.36)]. CONCLUSIONS: Substantial impact of depression and life stress, two modifiable factors, on HRQL is seen in PD. HRQL may be improved by clinical management of these nonmotor symptoms in PD. collapse abstract

Disability payments for persons with severe mental illness in Alberta, Canada.

OBJECTIVE: The authors measured the total expenditures for two key sources of social support in Alberta in 2005 for persons with severe and persistent mental illness and compared these expenditures with the total mental health expenditures. METHODS: ... expand abstractSocial services and assistance benefit data were from the federal government's Canada Pension Plan-Disability Benefits and from Alberta Services' Assured Income for the Severely Handicapped for beneficiaries with psychiatric diagnoses. These benefits were compared with the total public mental health expenditures in Alberta for budget year 2005-2006. RESULTS: A total of 7,456 adults with certified mental illness conditions received federal disability benefits, and 17,138 received provincial disability and medical benefits. The total for social support (income) benefits was $207 million Canadian compared with $405 million Canadian spent by the provincial government for mental health services for adults under age 65. CONCLUSIONS: Social assistance forms a substantial portion of Canadian federal and provincial government support for persons with mental illness. Whenever a government-payer perspective is taken, these costs should be factored into the analysis. collapse abstract

Non-adherence with psychotropic medications in the general population.

BACKGROUND: Non-adherence with medications is a general medical issue that has received much attention. However, the majority of studies have been on various clinical populations and the relevance of their results to the general population is unknown... expand abstract. In this study, we sought to determine the degree of non-adherence with antidepressants, antipsychotics, anxiolytics, mood stabilizers and sedative hypnotics, and to determine the reasons for non-adherence, in the general population of Canada. METHODS: We used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), conducted in 2002 (n = 36,984 adults), to produce population-based estimates of the degree of reported non-adherence with psychotropic medications and the reasons for non-adherence. RESULTS: The number of individuals taking psychotropic medications was 6,201. The prevalence of antipsychotic use over the last 12 months was estimated at 0.4% (95% CI 0.3-0.4). The corresponding estimates for sedative-hypnotics, anxiolytics, mood stabilizers and antidepressants were 10.2% (95% CI 9.8-10.7), 5.5% (95% CI 5.2-5.8), 1.1% (1.0-1.3) and 5.8% (95% CI 5.5-6.2), respectively. Non-adherence was estimated to be 34.6% (95% CI 25.5-44.9) for antipsychotics, 34.7% (95% CI 32.2-37.4) for sedative-hypnotics, 38.1% (95% CI 35.0-41.4) for anxiolytics, 44.9% (95% CI 38.1-51.9) for mood stabilizers and 45.9% (95% CI 43.1-48.7) for antidepressants. The degree of non-adherence decreased with age for antidepressants and anxiolytics. Forgetting was the main reported reason for non-adherence, but its degree varied with medication class. The proportion of respondents that reported forgetting as a reason was 36.3% (95% CI 32.0-40.8) for sedative-hypnotics, 46.7% (95% CI 41.3-52.2) for anxiolytics, 72.7% (95% CI 55.5-85.0) for antipsychotics, 74.2% (95% CI 64.0-82.3) for mood stabilizers and 74.5% (95% CI 70.7-77.9) for antidepressants. The degree of non-adherence and the frequency of forgetting were not associated with the level of interference by the associated condition with usual activities. The majority of these estimates were also not impacted by educational status, employment status, rural/urban residence, income or the presence of a comorbid physical condition. CONCLUSION: A high frequency of non-adherence was found with all five classes of psychotropic medication. Both the frequency of reported non-adherence and the reasons reported for it differ according to the medication. However, the degree of non-adherence was not affected by the level of interference of the associated condition. collapse abstract

The effect of major depression on participation in preventive health care activities.

BACKGROUND: The objective of this study was to determine whether major depressive episodes (MDE) contribute to a lower rate of participation in three prevention activities: blood pressure checks, mammograms and Pap tests. METHODS: The data source for... expand abstract this study was the Canadian National Population Health Survey (NPHS), a longitudinal study that started in 1994 and has subsequently re-interviewed its participants every two years. The NPHS included a short form version of the Composite International Diagnostic Interview (CIDI-SF) to assess past year MDE and also collected data on participation in preventive activities. Initially, we examined whether respondents with MDE in a particular year were less likely to participate in screening during that same year. In order to assess whether MDE negatively altered the pattern of participation, those successfully screened at the baseline interview in 1994 were identified and divided into cohorts depending on their MDE status. Proportional hazard models were used to quantify the effect of MDE on subsequent participation in screening. RESULTS: No effect of MDE on participation in the three preventive activities was identified either in the cross-sectional or longitudinal analysis. Adjustment for a set of relevant covariates did not alter this result. CONCLUSION: Whereas MDE might be expected to reduce the frequency of participation in screening activities, no evidence for this was found in the current analysis. Since people with MDE may contact the health system more frequently, this may offset any tendency of the illness itself to reduce participation in screening. collapse abstract

Major depression, antidepressant medication and the risk of obesity.

BACKGROUND: Cross-sectional studies have reported an association between major depressive episode (MDE) and obesity. The objective of this longitudinal analysis was to determine whether MDE increase the risk of becoming obese over a 10-year period. M... expand abstractETHOD: We used data from the Canadian National Population Health Survey (NPHS), a longitudinal study of a representative cohort of household residents in Canada. The incidence of obesity, defined as a body mass index (BMI) of > or =30, was evaluated in respondents who were 18 years or older at the time of a baseline interview in 1994. MDE was assessed using a brief diagnostic instrument. RESULTS: The risk of obesity was not elevated in association with MDE, either in unadjusted or covariate-adjusted analyses. The strongest predictor of obesity was a BMI in the overweight (but not obese) range. Effects were also seen for (younger) age, (female) sex, a sedentary activity pattern, low income and exposure to antidepressant medications. Unexpectedly, significant effects were seen for serotonin-reuptake-inhibiting antidepressants and venlafaxine, but neither for tricyclic antidepressants nor antipsychotic medications. CONCLUSIONS: MDE does not appear to increase the risk of obesity. The cross-sectional associations that have been reported, albeit inconsistently, in the literature probably represent an effect of obesity on MDE risk. Pharmacologic treatment with antidepressants may be associated with an increased risk of obesity, and strategies to offset this risk may be useful in clinical practice. collapse abstract

Cigarette smoking, stages of change, and major depression in the Canadian population.

OBJECTIVE: To describe the 12-month prevalence of major depression in relation to smoking status, nicotine dependence levels, commitment to quit, attempts to quit, and maintenance of smoking cessation in the Canadian general population. METHOD: Data ... expand abstractfrom Public Use Microdata File of the Canadian Community Health Survey: Health and Well-Being were used. The Composite International Diagnostic Interview--Short Form (CIDI-SF) for major depression was used to assess depressive disorder status. The survey also included a smoking module. There were 49,249 respondents assessed by the CIDI-SF, of whom 10,236 were administered the smoking module. Analyses used appropriate measures to deal with survey design effects. RESULT: The prevalence of major depression was highest in current smokers, followed by ever smokers, former smokers, and was lowest in the never smokers. This pattern persisted after stratification for age and sex. For quitting, the prevalence of major depression was highest among people who tried to quit, followed by those who considered quitting, those who quit in the past year, and lowest among those who maintained their smoking cessation status for longer than 1 year. The prevalence of depression among those with a high nicotine dependence level, as assessed by the Fagerstrom Tolerance Questionnaire, was about twice that of people with a low nicotine dependence level. CONCLUSION: The strikingly high prevalence of major depression among current smokers who are young, trying to quit, and with high nicotine dependence levels in the general population indicates that further longitudinal exploration of this topic is urgently needed. collapse abstract

Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study.

OBJECTIVE: To determine whether major depression (MD) leads to an increased risk of new-onset high blood pressure diagnoses. METHODS: The data source was the Canadian National Population Health Survey (NPHS). The NPHS included a short-form version of... expand abstract the Composite International Diagnostic Interview (CIDI-SF) to assess MD and collected self-report data about professionally diagnosed high blood pressure and the use of antihypertensive medications. The analysis included 12,270 respondents who did not report high blood pressure or the use of antihypertensive medications at a baseline interview conducted in 1994. Proportional hazards models were used to compare the incidence of high blood pressure in respondents with and without MD during 10 years of subsequent follow-up. RESULTS: After adjustment for age, the risk of developing high blood pressure was elevated in those with MD. The hazard ratio was 1.6 (95% Confidence Interval = 1.2-2.1), p = .001, indicating a 60% increase in risk. Adjustment for additional covariates did not alter the association. CONCLUSIONS: MD may be a risk factor for new-onset high blood pressure. Epidemiologic data cannot definitely confirm a causal role, and the association may be due to shared etiologic factors. However, the increased risk may warrant closer monitoring of blood pressure in people with depressive disorders. collapse abstract

Allergies and major depression: a longitudinal community study.

BACKGROUND: Cross-sectional studies have reported associations between allergies and major depression but in the absence of longitudinal data, the implications of this association remain unclear. Our goal was to examine this association from a longit... expand abstractudinal perspective. METHODS: The data source was the Canadian National Population Health Survey (NPHS). This study included a short form version of the Composite International Diagnostic Interview (CIDI-SF) to assess major depression and also included self report items for professionally diagnosed allergies of two types: non-food allergies and food allergies. A longitudinal cohort was followed between 1994 and 2002. Proportional hazards models for grouped time data were used to estimate unadjusted and adjusted hazard ratios. RESULTS: A slightly increased incidence of non-food allergies in respondents with major depression was observed: adjusted hazard ratio 1.2 (95% 1.0 - 1.5, p = 0.046). Some evidence for an increased incidence of major depression in association with non-food allergies was found in unadjusted analyses, but the association did not persist after multivariate adjustment. Food allergies were not associated with major depression incidence, nor was major depression associated with an increased incidence of food allergies. CONCLUSION: Findings from the present study support the idea that major depression is associated with an increased risk of developing non-food allergies. An effect in the opposite direction could not be confirmed. The observed effect may be due to shared genetic factors, epigenetic factors, or immunological changes that occur during depression. collapse abstract

A population-based study on ways of dealing with daily stress: comparisons among individuals with mental disorders, with long-term general medical conditions and healthy people.

OBJECTIVE: Stress plays an important role in the etiology of mental and physical disorders. The effect of stress on health may be moderated by how people deal with stress. The objectives of this analysis were to (1) estimate the population proportion... expand abstracts using various ways of dealing with stress in healthy people, in people with mental disorders and substance dependence and in individuals with general medical conditions only, and (2) identify factors associated with ways of dealing with stress. METHODS: Data from the Canadian Community Health Survey, Mental Health and Well-being (CCHS-1.2) were used (n = 36,984). This was a national mental health survey which used a probability sample and incorporated a version of the Composite International Diagnostic Interview. RESULTS: Participants with mental disorders differed from healthy people in ways of dealing with stress. Among participants with mental disorders, women were more likely to report that they "talk to others" and "eat more/less" to deal with stress. Men were more likely to use "avoid people" and "drink alcohol" to deal with stress than women. Age differences within groups in ways of dealing with stress were found and having a history of mental disorders was also associated with reported ways of dealing with stress. CONCLUSIONS: Ways of dealing with stress differ by gender and age, but there is no over-arching pattern of maladaptive coping associated with mental disorders that applies across illness, age and gender categories. Healthy behaviors should be promoted as ways to relieve stress, leading to better self-care skills. collapse abstract

The bipolar spectrum--a bridge too far?

OBJECTIVES: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by ran... expand abstractdomized controlled trials (RCTs) or cohort studies. METHODS: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. RESULTS: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. CONCLUSIONS: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts. collapse abstract