An examination of two samples of children seen one year apart at a community mental health service indicated that a significant proportion had also been involved with the child welfare system (44% of the 119-member older sample and 32% of the 160 individuals from the current sample). A reanalysis of the latter sample one year later showed that the caseload overlap had increased to 39%.
Age-cohort variation in childhood trauma was examined in the present study. The data were taken from the 1994/95 Canadian National Population Health Survey of household residents (n = 15,106). Childhood trauma was measured by a seven-item index (items reflected physical abuse, fearful experiences, hospitalization, being sent away from home, and parental disturbance). Reported prevalence of childhood trauma increased with each successively younger age-cohort (range = 31% to 60%). Females showed a larger change than males, and age differences grew more pronounced as trauma exposure increased. The data suggest that childhood trauma has been on the increase over the last few decades. This is in accord with findings from other studies which showed that depression and social problems have also been on the rise. This suggests that adult psychiatric sequelae of early trauma can be expected to show an increase in future years.
The aim of this study was to extend an earlier retrospective cohort study of schizophrenia via a prospective study to a follow-up of 34 years, with an emphasis on describing the life-course of the illness.
Subjects were 128 first-ever admissions for schizophrenia in 1963 to either of two mental hospital in Alberta, Canada. Follow-up continued until death or 1997. A symptom severity scale, with scores ranging from 0 (no symptoms) to 3 (hospitalized), was used to collect time-series data on each subject and create life-course curves. Indices were constructed to summarize the information in each curve. Information on social functioning was also collected.
Results were similar for men and women. The life-course curves showed marked variability of symptom severity across subjects and over time. The average score over the entire period of follow-up for the cohort indicated 'moderate' symptoms, and the change in average score from beginning to end of follow-up demonstrated a slight worsening of symptoms. The measures of social functioning indicated that only about one quarter of the patients had a good to excellent outcome.
The long-term course in schizophrenia is one of varying symptom severity, and for many patients, there is a poor overall outcome.
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.
To determine whether youth in Alberta who had completed suicide were more likely to be younger than their classmates on entering grade 1 (that is, showed a relative age effect).
Records were obtained for all deaths by suicide by individuals under the age of 20 years in Alberta during the years 1979-1992. The relative age of each of these persons was determined by comparing his or her month of birth to the birth months of the appropriate school-grade cohort.
A disproportionate number of the subjects were born in the second half of the "school eligibility year," indicating a higher probability that those who completed suicide were younger than their classmates.
Previous research indicates that relative age is strongly related to school performance and success in sports. The present study demonstrates that the relative age effect is also a factor in youth suicide. It is suggested that the higher incidence of youth suicide in the group of relatively younger school children may have resulted from poorer school performance, which in turn led to lowered confidence and self esteem. Past research suggests that these conditions may predispose children to hopelessness and depression, which are often thought to be essential components of suicide. Research aimed at neutralizing the negative effects of relative age should have important personal and social consequences.
The prevalence of mental disorders is often assessed using survey techniques. Although providing good estimates of prevalence, these techniques are time-consuming and expensive.
To estimate the prevalence of mental disorders among children aged 0 to 17 years living in Alberta, Canada, using health care administrative data.
This was a cross-sectional study. International Classification of Diseases, Ninth Revision, Clinical Modification chapter 5 diagnostic codes from physician billing data were used. Codes were grouped into 10 categories. Prevalence rates for each category were calculated, stratified by age, sex, and premium subsidy status (a proxy for socioeconomic status). The age pattern, times of greatest risk, and the effect of sex on type and prevalence of mental disorder were estimated.
All fee-for-service health care venues in Alberta between April 1, 1995, and March 31, 1996, providing services to children registered with the Alberta Health Care Insurance Commission on March 31, 1996.
Prevalence of mental disorders varied by disorder category, age, sex, and premium subsidy status. For boys, maximum prevalence of 9.5% occurred at age 10 years; for girls, maximum prevalence of 12.0% occurred at age 17 years. Mental disorders were most common in young boys and adolescent girls and among children receiving welfare. Distinct patterns of disorder were evident and comorbidity was common.
Administrative data can be used to estimate the prevalence of mental disorders in a pediatric population. The estimates made are lower than those obtained by using surveys of similar populations, perhaps indicating the difference between treated and untreated prevalence. Strengths of this study are that the estimates reflect the entire population, are more easily and obtained at less cost, and are useful for the planning of mental health services.
The comorbidity of disorders and chronology of first symptoms of depression, agoraphobia, and panic disorder were investigated. The Diagnostic Interview Schedule was administered to 3258 household residents. Strong associations were shown among all three disorders. However, the comorbidity of agoraphobia and panic disorder seemed to be accounted for by the relationship of both disorders with depression. The mean age at appearance of first symptoms was earlier for agoraphobia (low teens) than for depression or panic disorder (both about age 20). The results do not support the view that panic disorder is an integral component of agoraphobia, but rather that it is more closely associated with depression. The fact that agoraphobia precedes depression casts doubt on the thesis that depression is primary to anxiety disorders. Interpretation should, however, be viewed with caution because of the retrospective nature of the diagnostic instrument.
Few studies have examined the relationship between perceived responsibilities by workers and job characteristics and experiences of stress.
To examine the relationship between job stress and work responsibilities and job characteristics.
We analyzed data from 2737 adults who were labor force participants in the province of Alberta, Canada. A logistic regression model was employed to examine factors associated with high job stress.
About 18% of the studied workers considered their job as being "highly stressful." Workers who were male, did not consider their job a career or who were highly satisfied with their jobs were significantly less likely to identify their jobs as "highly stressful." The probability of describing a job as "highly stressful" significantly increased as workers perceived their actions have an affect on those around them or when their jobs required additional or variable hours.
A number of factors are associated with experiencing high work stress including being more engaged with work. This is an important finding for employers, offering insight into where interventions may be targeted.
A conceptual model of self-regulating service delivery is proposed for use by governments, planners, and policymakers to help children reach optimal adult functioning. It addresses most problems of present service delivery and is applicable to children in the general population and registered consumers of mental health, child welfare, special education, drug dependency, and juvenile justice (young offender) services. It has four essential components: (1) outcome measurements that reflect the mental health statuses of children in services and in the general population; (2) regular feedback of these measurements to governments, the public, and service delivery organizations; (3) powerful and significant rewards and incentives for the most desired outcomes to increase their salience and to motivate provider behavior; and (4) decision making that can affect all entities that contribute to the health of children. The evaluable expected benefits are improved mental health for children and greater efficiency within the "system."
The purpose of this study was to determine the extent of the association between psychiatric disorders and various social problems. The Diagnostic Interview Schedule was administered to a community sample of 3258 individuals and the association between eight "core" psychiatric disorders and eight social problem behaviours was determined. The results confirmed findings from many clinical studies that had previously found a strong relationship between social problem behaviours and mental illness. However, certain disorders tended to be associated with specific problems. In addition, a positive association was found between the number of social problems exhibited and the prevalence of psychiatric disorder. These data suggest the presence of a common underlying factor (or factors) and call into question the common practice of creating separate services for each definable social problem that arises.