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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Most psychiatric epidemiologic studies have used cross-sectional methods, resulting in a lack of information about the longitudinal course of depressive disorders. The objective of our study was to describe the longitudinal epidemiology of major depressive episodes (MDEs) in a Canadian sample using data from the National Population Health Survey (NPHS). Methods: The NPHS started data collection in 1994 and has evaluated past-year MDE using repeat interviews of the same cohort every 2 years since then. In our study, we examined the number of weeks depressed during years when MDEs occurred, the proportion of respondents having MDEs at consecutive cycles, and MDE counts during follow-up. Results: A sizable proportion of MDEs were brief: about one-half of respondents with past-year MDE reported 8 or fewer weeks of depression during that year. Less than 10% reported that they were depressed for the entire year. However, a larger proportion (19.1%) fulfilled criteria for MDE on consecutive interview cycles, suggesting either persistence or rapid recurrence. The mean number of detected MDEs among those with at least 1 detected MDE up to 2006 was 2. Positive family history, evidence of comorbidity, negative cognitive style, stress, pain, and smoking were associated with a more negative course. Conclusions: The longitudinal course of MDE in the general population is heterogeneous, including a mixture of brief and more protracted MDEs. Many risk factors for MDE are also associated with a negative course, exceptions being (younger) age and sex. These epidemiologic observations may assist with identification of patients requiring more intensive management in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: There has been a trend toward increasing antidepressant (AD) use in recent decades. We used data from the National Population Health Survey (NPHS) to determine whether this trend is continuing and to provide updated estimates of the frequency of use. Methods: The NPHS is a longitudinal general health survey that began collecting data in 1994. The NPHS evaluates past-year major depressive episodes (MDEs) using a brief diagnostic instrument. At each biannual interview (from 1994 to 2006) current medication use is recorded. We estimated the frequency with which ADs were taken by respondents (aged 12 years and older) with and without past-year MDEs. These frequencies were cross-tabulated by sex, year of interview, and the reported duration of symptoms. Results: ADs are taken by about 5.4% of the household population at any point in time. Most respondents taking ADs did not report past-year MDEs but 63.9% of respondents taking ADs in the absence of past-year episodes reported previous episodes or being diagnosed by a health professional with depression. This pattern is consistent with long-term treatment for relapse prevention. The overall frequency of use of ADs is increasing only in respondents without past-year episodes. Conclusions: AD use among community residents with past-year MDEs is no longer increasing. The continued increase in the overall frequency of use may point toward broadening indications for AD treatment and may indicate that people are taking these medications for longer periods of time. [ABSTRACT FROM AUTHOR]

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 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% Cl 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% Cl 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. [ABSTRACT FROM AUTHOR]

Objective: Population-based data about depression treatment are largely restricted to estimates of the frequency of antidepressant (AD) use. Such frequencies are difficult to interpret in the absence of information about dosages, reasons for taking the medications, and participation in nonpharmacologic treatment. The objective of this study was to describe the pattern of treatment for major depression (MD) in Alberta.Method: Telephone survey methods were employed. Random digit dialing was used to select a sample of 3345 household residents aged 18 to 64 years in Alberta. A computer-assisted telephone interview that included the Mini Neuropsychiatric Diagnostic Interview and questions about pharmacotherapy and psychotherapy was administered. Estimates were weighted for design features and population demographics.Results: The point prevalence of MD was 4.4% (95% confidence interval [CI], 3.4% to 5.5%), and the overall prevalence of current AD use was 7.4% (95% CI, 6.2% to 8.6%). The ADs taken most commonly, serotonin-specific reuptake inhibitors, were taken at therapeutic dosages 87.4% of the time. Most (80.7%) of those taking ADs reported taking them for more than 1 year. The frequency of receiving counselling, psychotherapy, or talk therapy was 3.9% overall and 14.3% in respondents with MD. However, most of these subjects were unable to name the type of counselling they were receiving.Conclusions: When compared with previous estimates, these results suggest continued progress in the delivery of evidence-based care to the population. There is room for additional improvement, especially in the provision of nonpharmacologic treatment. [ABSTRACT FROM AUTHOR]

Background Occupational mental health research has been focusing on the relationship between work stress and depression. However, the impacts of work stress on anxiety disorders and of imbalance between work and family life on workers' mental health have not been well studied. This analysis investigated the association between levels of perceived work stress and of imbalance between work and family/personal lives and current mood/anxiety disorders. Method This was a cross-sectional study using data from the Canadian Community Health Survey—Mental Health and Well-being (CCHS-1.2) (n=36,984). Mood and anxiety disorders were measured using the World Mental Health—Composite International Diagnostic Interview. Results The 1-month prevalence of mood and anxiety disorders among those with a work stress score at the 75th percentile value and above was 3.6% and 4.0%. Among those who reported that their work and family/personal lives ''never'' balanced in the past month, the 1-month prevalence of mood and anxiety disorders was 21.2% and 17.9%. In multivariate analyses, work stress and imbalance between work and family/personal lives were independently associated with mood and anxiety disorders. There was no evidence that perceived work stress interacted with imbalance between work and family/personal lives to increase the likelihood of having mental disorders. Gender was associated with anxiety disorders, but not with major depressive disorder and mood disorders. Conclusions Work stress and imbalance between work and family/personal lives may be part of the etiology of mood and anxiety disorders in the working population. Community based longitudinal studies are needed to delineate the causal relationships among work stress, imbalance between work and family/personal lives and mental disorders. [ABSTRACT FROM AUTHOR]

Objective: The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) is the first national study to use a full version of the Composite International Diagnostic Interview. For this reason, and because of its large sample size, the CCHS 1.2 is capable of providing the best currently available description of major depression epidemiology in Canada. Using the CCHS 1.2 data, our study aimed to describe the epidemiology of major depression in Canada.Method: All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling.Results: The lifetime prevalence of major depressive episode was 12.2%. Past-year episodes were reported by 4.8% of the sample; 1.8% reported an episode in the past 30 days. As expected, major depression was more common in women than in men, but the difference became smaller with advancing age. The peak annual prevalence occurred in the group aged 15 to 25 years. The prevalence of major depression was not related to level of education but was related to having a chronic medical condition, to unemployment, and to income. Married people had the lowest prevalence, but the effect of marital status changed with age. Logistic regression analysis suggested that the annual prevalence may increase with age in men who never married.Conclusions: The prevalence of major depression in the CCHS 1.2 was slightly lower than that reported in the US and comparable to pan-European estimates. The pattern of association with demographic and clinical variables, however, is broadly similar. An increasing prevalence with age in single (never-married) men was an unexpected finding. [ABSTRACT FROM AUTHOR]

Objective: Antidepressant utilization can be used as an indicator of appropriate treatment for major depression. The objective of this study was to characterize antidepressant utilization in Canada, including the relationships of antidepressant use with sociodemographic variables, past-year and lifetime depression, number of past depressive episodes, and other possible indications for antidepressants.Method: We examined data from the Canadian Community Health Survey (CCHS) Cycle 1.2. The CCHS was a nationally representative mental health survey (N=36,984) conducted in 2002 that included a diagnostic instrument for past-year and lifetime major depressive episodes and other psychiatric disorders and a record of past-year antidepressant use.Results: Overall, 5.8% of Canadians were taking antidepressants, higher than the annual prevalence of major depressive episode (4.8%) in the survey. Among persons with a past-year major depressive episode, the frequency of antidepressant use was 40.4%. After application of adjustments for probable successful outcomes of treatment, the estimated frequency of antidepressant use for major depression was more than 50%. Frequency of antidepressant treatment among those with a history of depression but without a past-year episode increased with the number of previous episodes. Among those taking antidepressants over the past year, only 33.1% had had a past-year episode of major depression. Migraine, fibromyalgia, anxiety disorder, or past depression was present in more than 60% of those taking antidepressants without a past-year episode of depression.Conclusions: The CCHS results suggest that antidepressant use has increased substantially since the early 1990s, and also that these medications are employed extensively for indications other than depression. [ABSTRACT FROM AUTHOR]

Objectives: This study had the following objectives: 1) to estimate the 12-month prevalence of conventional and unconventional mental health service use by individuals with major depressive disorder (MDD) or mania in the past year, and 2) to identify factors associated with the use of conventional mental health services by individuals with MDD or mania in the past year. Methods: We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Respondents with MDD (n = 1563) or manic episodes (n = 393) in the past 12 months were included in this analysis. Results: An estimated 63.9% of respondents with MDD and 59.0% of those with manic episodes reported having used some type of help in the past 12 months; 52.9% of those with MDD and 49.0% of those with manic episodes used conventional mental health services. Approximately 21% of respondents with either MDD or manic episodes used natural health products specifically for emotional, mental health, and drug or alcohol use problems. Respondents who reported comorbid anxiety disorders and long-term medical conditions were more likely to have used conventional mental health services. Conclusions: Relative to previous Canadian literature, our analysis suggests that the frequency of conventional mental health service use among persons with MDD has not increased significantly in the past decade. Further, the rate of conventional mental health service use by persons with manic episodes is unexpectedly low. These findings may reflect the lack of national initiatives targeting mood disorders in Canada. They have important implications for planning future education, promotion, and research efforts. [ABSTRACT FROM AUTHOR]

Background:. The possibility of a rural and urban difference in the prevalence of major depression has been of interest to researchers and mental health service providers. The objectives of this analysis were to determine the rural and urban difference in the 12-month prevalence of major depressive episode(s) (MDE) in Canada and whether participants in rural and urban areas differed in the impairment levels due to depressive symptoms and in mental health service utilization. Methods:. Data from the 1998–1999 Canadian National Population Health Survey (NPHS) were used in this study. In the NPHS, MDE was measured by the Composite International Diagnostic Interview—Short Form for Major Depression. Two-week disability and daily life interference due to depressive symptoms were used as indicators of impairment in this analysis. The prevalence of MDE in rural and urban areas, at national and regional levels, was calculated. The association between urbanicity and MDE was evaluated by Odds Ratios, controlling for potential confounders. Impairment levels and mental health service utilization were also compared between the rural and urban groups. Results:. NPHS participants in rural areas had a lower prevalence of MDE than those in urban areas, controlling for the effects of race, immigration status, working status and marital status. Non-immigrants and those who are white in rural areas had a lower prevalence of MDE than did those in urban areas, and such differences depended on age and geographic regions. Rural and urban participants did not differ in 2-week disability and daily life interference due to depressive symptoms. However, rural participants were less likely to have contacted health professionals for mental health problems. Conclusions:. The reasons for the rural and urban differences in the prevalence of MDE are complex. This may depend on individuals’ age, immigration status, race, working status, marital status and the provinces where they live. These differences should be considered in future mental health service planning, particularly at provincial levels. There may be gaps between rural and urban areas in terms of availability of mental health services. This should be addressed in future studies and in mental health service planning. [ABSTRACT FROM AUTHOR]

Background:. Previous studies suggest that single mothers are at a higher risk of major depression and more likely to use mental health services than are married mothers. The objectives of this analysis were to provide estimates of the prevalence of major depressive syndrome among single and married mothers, to investigate the factors which may affect the difference in the prevalence of major depressive syndrome among single and married mothers and to estimate the health care service utilization by single and married mothers. Methods:. This was a cross-sectional study using the data from the 1996–97 Canadian National Population Health Survey (NPHS). Major depressive syndrome was evaluated using the Composite International Diagnostic Interview—Short Form for major depression. The prevalence of major depressive syndrome was calculated among 3030 single and 10195 married mothers. The effects of demographic, socioeconomic and biological variables on the association between single-mother status and major depressive syndrome were evaluated by stratified analyses. Results:. In the NPHS, the difference between single and married mothers in the prevalence of major depressive syndrome was found among women who were between the ages of 25 and 50. The association in this age group depended on race and on whether they had one or more jobs. Education,problem drinking, daily smoking, having one or more long-term medical illnesses, financial hardship and social support did not affect the association between single-mother status and major depressive syndrome. Single mothers were more likely to visit health professionals for mental problems than were married mothers. Conclusion:. The difference between single and married mothers in the prevalence of major depression is age-specific. Single mothers who reported having had one or more jobs and who are non-white had an increased risk of having major depressive syndrome, compared to married mothers. Future studies need to replicate the findings of this analysis and investigate why single mothers with ethnic minority backgrounds and those who are working are at high risk of having depressive disorders. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the 12-month prevalence of suicidal behaviours by gender and to investigate the gender-specific factors associated with suicidal behaviours and to describe health service utilization by suicidal adolescents. Methods: This was a cross-sectional study. The baseline data of the Adolescent Health Study conducted in northern Nova Scotia were used. Results: Female students were more likely to report suicidal behaviours than male students (p>0.005). There was no gender difference in injurious suicide attempts. Depression was the strongest risk factor for suicidal behaviours in the two genders (p>0.005). Female students who reported drug use and living in a non-intact family were at higher risk of suicide attempts. Low self-esteem was positively associated with suicidal ideation and suicide planning among male students. Suicidal girls were more likely to seek professional help for emotional disturbance than boys. Family doctors were the most frequently contacted professional by suicidal adolescents. Conclusions: Some factors associated with suicidal behaviours among adolescents may be gender specific. Suicidal behaviours have been considered a depressive symptom. Most suicidal students, however, had not contacted a health professional for an emotional problem in this population. This presents challenges for prevention of suicidal behaviours among adolescents. [ABSTRACT FROM AUTHOR]