This paper uses the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering to review the internalizing disorders of childhood. This review surveys the internalizing disorders from the point of view of early intervention, for their prevalence, course, risk, early indicators, associated impairment, and responses to intervention. In general, the internalizing disorders have little effect on the community. When coupled with other disorders such as conduct disorder, or when dealing with suicide, the community's concern for these disorders increases and allocation of resources to target populations who are at risk becomes an important public health goal.
To identify early predictors of suicidal ideation in young adults, and to determine when specific time-varying determinants become important in predicting later suicidal ideation.
Data were available for 877 participants in the Nicotine Dependence in Teens study, an ongoing prospective cohort of students aged 12 to 13 years at cohort inception in 1999. Time-invariant covariates included age, sex, mother's education, language, and self-esteem. Time-varying covariates included depression symptoms, family stress, other stress, alcohol use, cigarette use, and team sports. Independent predictors of past-year suicidal ideation at age 20 years were identified in 5 multivariable logistic regression analyses, one for each of grades 7, 8, 9, 10, and 11.
Eight per cent of participants (mean age 20.4 years [SD 0.7]; 46% male) reported suicidal ideation in the past year. In grade 7, none of the potential predictor variables were statistically significantly associated with suicidal ideation. In grade 8, participation in sports teams in and (or) outside of school protected against suicidal ideation (OR 0.6; 95% CI 0.4 to 0.8; P = 0.002). Depression symptoms in grades 9, 10, and 11 were independent predictors of suicidal ideation (OR 2.2; 95% CI 1.5 to 3.2, OR 1.6; 95% CI 1.0 to 2.5, and OR 1.9; 95% CI 1.1 to 3.4, respectively). No other variables were statistically significant in the multivariate models.
Depression symptoms as early as in grade 9 predict suicidal ideation in early adulthood. It is possible that early detection and treatment of depression symptoms are warranted as part of suicide prevention programs.
The mental health of parturients 1-2 months after delivery was assessed. The study was carried out using a questionnaire between September and November 1992 in connection with the postpartum visits of mothers to the maternity health care center. The need for psychological help was assessed using a 12-item questionnaire (General Health Questionnaire), according to which 28% of the subjects needed psychological help. These mothers did not differ from the others in terms of age, marital status, education, or financial situation. Nor was the need for psychological help associated with health habits, with traumatic life events or conflicts during childhood and adolescence, or with delivery-related factors. Mothers needing psychological help were more depressed and considered the social support they were receiving to be inadequate more often than the others. These women also more often reported marital problems during pregnancy and after delivery. None of the mothers had sought help because of mental health problems. It is concluded that antenatal and postnatal clinics should pay more attention to the mental health of mothers.
At least one in 10 pregnant women experiences depression. Other health risks during pregnancy include family violence, substance abuse, inadequate nutrition, financial challenges, environmental hazards and lack of social support. Public health nurses are in a unique position to enhance perinatal health by assessing for antenatal psychosocial risk factors. During 2005-06 in a suburban/rural community near Edmonton, Alberta, public health nurses initiated a one-year demonstration project with the goal of increasing the number of health and community services accessed by pregnant women as a result of an interactive appointment with a public health nurse. Eight family physicians in WestView Primary Care Network and three midwives from WestView's Shared Care Maternity Program referred local pregnant clients to the public health nursing unit at WestView Health Centre in Stony Plain. Each woman was assessed by a public health nurse for a variety of psychosocial risk factors. Results of the assessment determined the type of additional health services to which the pregnant women were referred. Care providers were unanimous in their support for public health nurses' continuing to provide antenatal assessments to an expanded population of suburban/rural communities in the Capital Health region.
Although it is generally recognized that poverty and depression can coexist among single parents receiving social assistance, there is insufficient research on this topic. The goals of this study therefore were to investigate the prevalence, correlates and health care expenditures associated with depression among sole-support parents receiving social assistance.
Sole-support parents who had applied for social assistance in 2 regions of southwestern Ontario were included in the study. Depression was diagnosed with the 1994 University of Michigan Composite International Diagnostic Interview short forms.
The 12-month prevalence rate of depressive disorder among the parents interviewed was 45.4% (345/760). A total of 247 (32.5%) had major depressive disorder alone, 19 (2.5%) had dysthymia, and 79 (10.4%) had both major depressive disorder and dysthymia ("double depression"). Those with major depressive disorder, particularly double depression, had significantly higher rates of coexisting psychiatric disorder than those without depressive disorders. Parents with depression reported higher rates of developmental delay and behaviour problems in their children than parents without depression. Expenditures for health care services were higher for parents with depression and for their children than for parents without depressive disorder and their children.
Single parents receiving social assistance have high rates of depression. Such parents with depression also have higher rates of other psychiatric disorders and higher expenditures for health care services, and their children have higher rates of developmental delay and behaviour problems.
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