Various clinical studies have documented associations between alcohol consumption and depressive disorders. In some circumstances, alcohol ingestion may cause or worsen depression, whereas in other circumstances the direction of causal effect may be reversed. The objective of this study was to evaluate associations between alcohol consumption and major depression in the Canadian population.
Data from the Canadian National Population Health Survey (NPHS) were analyzed. This survey, conducted by Statistics Canada in 1994, used a probability sample of 17,626 subjects. The NPHS included measures of alcohol ingestion and a diagnostic screen for major depression (Composite International Diagnostic Interview [CIDI] Short Form).
Subjects reporting any drinking in the year preceding the interview were more likely to have experienced an episode of major depression during that time than subjects reporting no drinking. Subjects reporting maximal ingestions of 5 or more drinks (and especially 10 or more drinks) on at least 1 occasion during the preceding year were also at greater risk of major depression than nondrinking subjects or subjects reporting smaller maximal ingestions. Neither the average amount consumed daily nor the frequency of drinking was associated with major depression.
In the general population, there is no simple relationship between the quantity or frequency of alcohol consumption and the prevalence of major depression. Any drinking and maximal consumption on 1 occasion, however, are related to the prevalence of major depression. Further research is needed to delineate causal mechanisms so that clinical and public-health interventions can be formulated.
To describe the use of alternative medicine (AM) by persons with major depression and to examine the factors associated with AM use among these individuals.
We used data from the 1994-1995 and 1996-1997 National Population Health Surveys. We selected subjects who had major depression according to the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). The prevalence of AM and conventional health service use by the subjects was calculated for each survey and was stratified by province. We employed logistic regression to examine the factors associated with AM use.
There was a temporal trend toward increasing use of AM among persons with major depression. The prevalence of AM use among subjects with major depression was 7.8% in 1994-1995 and 12.9% in 1996-1997. Female sex, having more than 12 years' education, and having 1 or more long-term medical conditions were associated with an increased likelihood of using AM. The sex difference in AM use depended on subjects' age in 1996-1997.
General practitioners, mental health specialists, and AM providers should be aware of their patients' use of both conventional medical services and AM because there may be interactions between conventional and alternative treatments. Communication and, if possible, cooperation may lead to improved outcomes in the management of depressive disorders.
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 provincial 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.
To investigate the clinical and pharmacoepidemiological determinants of delirium in a psychiatric inpatient population.
A case-control study design was used. Potential cases and potential controls were identified using hospital discharge data. The clinical record of each subject was reviewed using a validated protocol to confirm case and control status. Subsequently, exposure data were recorded from clinical records.
Subjects admitted to hospital with delirium tended to be older, to have pre-existing cognitive deficits, and to have diagnoses of substance use disorders. Subjects who developed delirium after their admission to hospital were older than control subjects, more likely to have a history of cognitive impairment, and were significantly more likely to be treated during the hospitalization with lithium or anticholinergic antiparkinsonian medications. Antipsychotic medication exposures were also associated with delirium, but only at standard or above-standard dosage levels. Antidepressant and sedative-hypnotic medications were not associated with delirium.
These findings indicate that using conservative dosages of antipsychotic medications and minimizing the use of anticholinergic medications for parkinsonian symptoms may help to prevent delirium in psychiatric inpatients. Anticonvulsant mood stabilizers may convey less delirium risk than lithium. Antidepressant medications and sedative-hypnotics were not important determinants of delirium in this population.
Exposure to certain drugs-angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, corticosteroids. H2 blockers, and sedative hypnotics-may be associated with an increased risk of depression. These drugs are commonly used in inpatient medical therapeutics. Since population attributable risk (PAR) is generally related both to strength of association and to the frequency of exposure to a risk factor, the PAR of depressive symptoms associated with these drug exposures is potentially high. The objective of this study was to estimate the depressive symptoms population attributable risk percent (PAR%) in a medical inpatient population.
A prospective cohort design was used in this study. Nondepressed, nondrug-exposed subjects (N = 178) were selected from a series of 369 newly admitted medical inpatients at the Calgary General Hospital. Eighty-six of these 178 subjects were prescribed one of the drugs in question, forming an exposed cohort. The remaining subjects formed a nonexposed cohort. Depressive symptoms and associated psychosocial variables were measured in both subgroups during the hospital stay.
Seventeen of the 86 exposed subjects and 5 of the 92 nonexposed subjects developed incident depressive symptoms during their stay in hospital. The PAR% associated with drug exposure (56.0%) exceeded that associated with poverty (17.9%) or unemployment (21.7%).
Drug exposures may have a sizeable impact on the incidence of depressive symptoms in medical inpatient populations.
To evaluate cross-sectional associations between depressive episodes and a set of potential biopsychosocial determinants in Calgary, Canada.
Random digit dialling (RDD) was used to select a sample consisting of 2,542 household residents in Calgary. These subjects were interviewed over the telephone using the Composite International Diagnostic Interview (CIDI) short form for major depression, and a questionnaire evaluating a variety of biopsychosocial variables.
The prevalence of major depression was associated with biological (family history of major depression, alcohol consumption, street drug use), psychological (ratings of stress, recent life events) and social factors (social support, marital status, income, level of education).
This study confirms that major depression is correlated with a diverse set of potential determinants in community populations, and that the impact of these determinants may differ between different populations. Prospective studies will be needed to further investigate these associations.
To compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and health care use in people with and without schizophrenia. SUBJECTS/MATERIALS AND METHODS: Data from the Canadian Community Health Survey (CCHS), cycle 3.1, were used. Prevalence of CV-RF, CV-D, and health care use were compared in those with and without schizophrenia using logistic regression analysis. Sampling weights and bootstrap variance estimates were used to account for survey design.
A total of 399 (0.3%) people with schizophrenia were identified and compared to 120,044 (97.7%) people without. Individuals with schizophrenia were significantly more likely to be obese (34.8% vs. 15.6%) and report diabetes (11.9% vs. 5.3%). After accounting for sociodemographic variables, schizophrenia was not independently associated with diabetes (adjusted odds ratio [aOR]: 0.86; 0.49-1.51). Individuals with schizophrenia were more likely to be hospitalized (21.9% vs. 8.0%; aOR: 2.37; 95% CI: 1.51-3.74) but no more likely to visit their physician (86.7% vs. 85.7%; aOR: 1.23; 95% CI: 0.65-2.35).
Our findings suggest that people with schizophrenia access the primary health care system at least as frequently as someone without schizophrenia, and the opportunity for management of modifiable CV-RF exists in this vulnerable population.
To evaluate epidemiological associations between self-reported diet pill consumption and major depressive episodes (MDEs), using data from a large-scale, cross-sectional survey of the Canadian population.
Data from the National Population Health Survey (NPHS) were used in this analysis. The NPHS interview included a brief version of the Composite International Diagnostic Interview (CIDI) depression section, known as the CIDI Short Form for Major Depression (CIDI-SFMD), as well as provision for self-reported medication use.
Approximately 0.5% of the population reported the use of diet pills. Diet pill use was more common among women than among men. At the time of data collection (1996-1997), the most commonly used medication was fenfluramine (since withdrawn from the market because of cardiovascular toxicity). The use of these medications was strongly associated with MDE: the annual prevalence among persons reporting use was 17.1% (95% CI, 8.6 to 25.6), approximately 4 times the underlying population rate.
Because the NPHS was a general health survey, and because self-reported exposure to these medications was relatively uncommon, the data did not permit a detailed multivariate analysis. These findings, however, indicate that depressive psychopathology is strongly associated with the use of appetite-suppressant medications.
Informed provision of population mental health services requires accurate estimates of disease burden.
We estimated the treated prevalence of bipolar disorders by mental health services in the Calgary Zone, a catchment area in Alberta with a population of over one million. Administrative data in a central repository provides information of mental health care contacts for about 95% of publically funded mental health services. We compared this treated prevalence against self-reported data in the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).
Of the 63 016 individuals aged 18 years plus treated in the Calgary Zone in 2002-2008, 3659 (5.81%) and 1065 (1.70%) were diagnosed with bipolar I and bipolar II disorder, respectively. The estimated treated population prevalence of these disorders was 0.41% and 0.12%, respectively. We estimated that 0.44% to 1.17% of the Canadian population was being treated by psychiatrists for bipolar I disorder from CCHS 1.2.
For bipolar I disorder the estimate based on local administrative data is close to the lower end of the health survey range. The degree of agreement in our estimates reinforces the utility of administrative data repositories in the surveillance of chronic mental disorders.