Major depression in 6050 former drinkers: association with past alcohol dependence

BACKGROUND: The association between alcoholism and major depression in the general population has been explained as misdiagnosed alcohol intoxication and withdrawal effects mistaken for depressive syndromes. To investigate whether this could account for the entire relationship, the association of past alcohol dependence with current major depression (ie, nonoverlapping time frames) was investigated in individuals who no longer drink or who drink very little. We conducted the study using data from the National Longitudinal Alcohol Epidemiologic Survey, a representative sample. METHODS: Former drinkers who did not use drugs or smoke in the past year (n = 6050) were divided into those with and without past DSM-IV alcohol dependence. These 2 groups were compared for the presence of current (last 12 months) DSM-IV major depression. The association between prior alcohol dependence and current major depression was tested with linear logistic regression, controlling for other variables. RESULTS: Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold. This relationship was not attenuated by control variables. The majority of subjects with major depression last used substances 2 or more years prior to the interview, which eliminates acute intoxication or withdrawal effects as an explanation of their depressions. CONCLUSIONS: The strong, specific association between prior alcohol dependence and current or recent major depression in a nationally representative sample of former drinkers indicates that the association is not entirely an artifact of misdiagnosed intoxication and withdrawal effects. A better understanding of the nature of the relationship between the 2 disorders should be sought and will have important public health significance.     

Panic and suicidal ideation and suicide attempts: results from the National Comorbidity Survey

Our objective was to determine the association between panic attacks (PAs) and panic disorder (PD), and suicidal ideation (SI) and suicide attempts (SAs) in a nationally representative sample of adults in the community. Data were drawn from the National Comorbidity Survey (n=5,877), a representative household sample of adults ages 15-54 in the United States. Multiple logistic regression analyses were used to examine the relationship between current and lifetime PA and PD and SI and SA, adjusting for differences in demographic characteristics, comorbid mental disorders (major depression, alcohol dependence, and substance dependence), childhood trauma (physical and sexual abuse), and number of lifetime mental disorders. Past-year and lifetime PA and PD were associated with increased SI (both past year and lifetime), and persisted after adjusting for comorbidity and early trauma. Associations between PA and SA were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with lifetime SA, but these associations were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with past-year SA, and this association persisted after adjusting for demographics, comorbidity, and number of lifetime mental disorders. These findings are consistent with previous results, and further help to clarify the relationships between panic and suicide behavior by identifying potential methodological reasons for inconsistencies in results from previous studies.     

The Content of Substance Abuse and Mental Health Counseling Reported by Patients in a National Survey

This study examined counseling content reported by a national sample of persons receiving care for alcohol, drug or mental health (ADM) problems in a year. The sample included 2,722 individuals over 18 who reported past year mental health or substance abuse care or assessments in a nationally representative survey conducted in 2000–2001. Counseling domains approximating commonly practiced or evidence-based approaches for depression, anxiety, or substance abuse were assessed. Patient self-report may be one useful way of tracking whether components of standard therapies are implemented in practice.     

Broad and specific personality dimensions associated with major depression in a nationally representative sample

Separate lines of research using select study groups have identified both broad (neuroticism, extraversion) and specific (self-criticism, interpersonal dependency) personality dimensions associated with major depression. The current study sought to extend research on personality and depression to a large, nationally representative sample. Participants were from the National Comorbidity Survey Part II (N = 5,877). A detailed psychosocial battery that included items from established indices of neuroticism, extraversion, self-criticism, and three facets of interpersonal dependency was administered to all respondents. Separate regression analyses indicated that each of the personality dimensions was significantly associated with lifetime major depression. In a hierarchical multivariate regression analysis that controlled for sociodemographic variables, history of anxiety disorders, alcohol or substance abuse or dependence, dysthymic disorder, and current emotional distress, self-criticism was the only personality dimension that remained significantly associated with major depression. The inclusion of self-criticism also significantly improved the overall statistical model. Results from this nationally representative mental health survey indicate that self-criticism is robustly associated with major depression. In contrast, several other personality dimensions may be associated with major depression because of shared variance with psychiatric history and current emotional distress.     

Violence, alcohol, and completed suicide: a case-control study

OBJECTIVE: Violent behavior may represent a risk factor for suicide. The authors tested the hypothesis that violent behavior in the last year of life is associated with completed suicide, even after controlling for alcohol use disorders. METHOD: The authors analyzed data from the 1993 National Mortality Followback Survey, a nationally representative survey conducted by telephone interview with decedents' next of kin. Data on 753 victims of suicide were compared with data on 2,115 accident victims. Decedents ranged in age from 20 to 64. Dichotomous measures of violent behavior in the past year and history of alcohol misuse were derived by using the four-item CAGE questionnaire. Multiple logistic regression was used to evaluate the interactions of violent behavior with alcohol misuse, gender, and age, respectively, in predicting suicide versus accidental death. Education and race were included as covariates. RESULTS: Violent behavior in the last year of life was a significant predictor of suicide; the relationship was especially strong in individuals with no history of alcohol misuse, those who were younger, and women. CONCLUSIONS: Violent behavior distinguished suicide victims from accident victims, and this finding is not attributable to alcohol use disorders alone. Given that violent behavior increases the risk of suicide, violence prevention initiatives may serve to decrease the risk of suicide as well.     

Mental health service use in a nationally representative Canadian survey.

BACKGROUND: Previous Canadian surveys have noted a wide range of prevalence rates for mental health service use and found no consistent relation between type of contact with mental health professionals and severity of illness. This study is the first investigation to examine the prevalence and correlates of mental health service use in a nationally representative Canadian survey. METHODS: The Canadian Community Health Survey Cycle 1.1 was conducted between 2000 and 2001 (n = 125,493; respondent age 12 years and over; response rate; 84.7%). Respondents were asked whether they had contacted a professional because of emotional symptoms in the past year and about their experience of barriers to treatment. DSM-IV major depression and alcohol dependence diagnoses were assessed with the Composite International Diagnostic Interview Short Form. The relation between a range of measures of clinical severity and the type of professional contacted for emotional symptoms was examined. RESULTS: The prevalence of 12-month help seeking for emotional symptoms was 8.3% (99%CI, 8.10 to 8.55); an additional 0.6% (99%CI, 0.49 to 0.62) of the sample perceived a need for treatment without seeking care. Respondents endorsing contact with multiple professionals or with psychiatrists only had higher levels of severity than those who had contact with family doctors only or nonphysician professionals only. CONCLUSIONS: Although untreated depression remains a significant problem in Canada, more severe illness was more likely to be associated with seeing a psychiatrist (or multiple professionals), indicating a relation between greater severity of mental illness and receiving more specialized care.     

Mental health care for adults with suicide ideation

OBJECTIVE: To estimate mental health and substance abuse services use for adults with and without suicide ideation. METHOD: 2000-2001 follow-up of respondents to a nationally representative survey. Measures include self-reports of suicide ideation, specialty and primary care mental health services use, past year counseling, psychotropic medications and perceived need. RESULTS: The percentage of respondents who reported suicide ideation was 3.6%; 74% of them had a probable psychiatric disorder for which effective treatments exist. Nearly half of those with suicide ideation did not perceive a need for care, including some who received care. Of those with suicide ideation and a probable disorder, almost 40% received no treatment. Of those with suicide ideation who perceived a need for alcohol, drug or mental health (ADM) care, almost 40% received no care or inadequate care. In a multivariate model, having a probable psychiatric disorder, perceived need and being white were associated with increased likelihood of treatment use, among persons with suicide ideation. CONCLUSIONS: Many adults with suicide ideation do not perceive a need for care or receive treatment in the same year. Even among those perceiving a need for care, many experience difficulties in obtaining it. It is critical to understand barriers to treatments for this high-risk group.     

Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States

BACKGROUND: There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. It is also not known which clinical and sociodemographic factors are associated with these disorders. SUBJECTS AND METHODS: We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses. RESULTS: Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder. CONCLUSIONS: Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders.     

Impact of the New Mental Health Services on Rates of Suicide and Hospitalisations by Attempted Suicide,Psychiatric Problems,and Alcohol Problems in Brazil

A sizeable proportion of all suicides have mental health issues in the background. The association between access to mental health care in the community and decreased suicide rates is inconsistent in the literature. Brazil undertook a major psychiatric reform strengthening psychiatric community-based care. To evaluate the impact of the new Brazilian community mental health care units (CAPS-Psychosocial-Community-Centres) on municipal rates of suicide, and hospitalisations by attempted suicide, psychiatric and alcohol problems. We performed robust multivariable negative binomial regression models with fixed effect for panel data from all 5507 Brazilian municipalities. Suicide and hospitalization rates were calculated by sex and standardised by age for each municipality and year from 2008 to 2012. The main variable of interest was municipal CAPS coverage. CAPS municipal coverage was associated with lower suicide rates but this was not statistically significant (RR: 0.981; 95% CI 0.952–1.011). However, increased CAPS coverage was associated with lower hospitalizations for attempted suicide (RR: 0.887; 95% CI 0.841–0.935), psychiatric (RR: 0.841; 95% CI 0.821–0.862), and alcohol problems (RR: 0.882; 95% CI 0.860–0.904). Our results suggest that access to community mental health services seems to reduce hospitalisations due to attempted suicide, psychiatric and alcohol problems but not suicidal rates. Therefore, increased investments in community mental health services in low-middle-income countries might decrease costs associated with potentially avoidable hospitalizations.     

The impact of comorbidity of mental and physical conditions on role disability in the US adult household population

CONTEXT: There is limited information that accounts for comorbidity on the impact of role disability associated with a wide range of mental and physical disorders in population-based samples. OBJECTIVE: To estimate the comparative effects of common mental and physical conditions on role disability in the general population using a novel method that accounts for comorbidity. DESIGN: Direct interviews about physical and mental conditions during the past year. SETTING: The National Comorbidity Survey Replication, a nationally representative series of face-to-face interviews. PATIENTS: A nationally representative sample of adults living in households (N = 5962 respondents, 18 years and older). MAIN OUTCOME MEASURE: Disability in major life roles was assessed with the World Health Organization Disability Assessment Schedule. Simulations that allow for complex interactions among conditions were used to estimate the conditions' effects on disability days, when respondents were completely unable to carry out their usual daily activities because of problems with mental or physical health, in the past 12 months. RESULTS: An estimated 53.4% of US adults have 1 or more of the mental or physical conditions assessed in the survey. These respondents report an average 32.1 more role-disability days in the past year than demographically matched controls, equivalent to nearly 3.6 billion days of role disability in the population. Musculoskeletal disorders and major depression had the greatest effects on disability days. Mental conditions accounted for more than half as many disability days as all physical conditions at the population level. Associations of specific conditions with disability decreased substantially after controlling for comorbidity, suggesting that prior studies, which generally did not control for comorbidity, overestimated disease-specific effects. CONCLUSION: The staggering amount of health-related disability associated with mental and physical conditions should be considered in establishing priorities for the allocation of health care and research resources.     

Parental involvement and mental health among Thai adolescents

The objective of this analysis was to examine the associations between parental involvement and mental health in Thai middle school students. Data from the 2671 school-going adolescents aged 12–15 y who participated in the nationally representative Global School-based Student Health Survey in Thailand in 2008 were analysed. About 16.5% of students reported symptoms of depression, and about 8.6% reported having seriously considered suicide in the past year. High levels of parental involvement – homework checks, monitoring of free time and seeking to understand children's problems – were associated with significantly lower odds of symptoms of depression and suicidal thoughts for both boys and girls. Skipping school without permission was associated with significantly increased odds of poor mental health, including loneliness and anxiety. Active parenting and effective communication between schools and parents about truancy may contribute to the promotion of adolescent mental health and early detection of psychological problems.     

Bipolar disorder and co-occurring cannabis use disorders: Characteristics,co-morbidities and clinical correlates

This study examines rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). Data were drawn from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC Wave 1, 2001–2002), a nationally representative sample of adults living in the United States. Among individuals with lifetime prevalence of bipolar disorder (N=1905) rates of CUD in the past 12 months were 7.2%, compared to 1.2% in the general population. Logistic regression models adjusting for sociodemographic variables indicated that individuals with bipolar disorder and co-occurring CUD were at increased risk for nicotine dependence (Adjusted Odds Ratio (AOR)=3.8), alcohol (AOR=6.6) and drug (AOR=11.9) use disorders, as well as antisocial personality disorder (AOR=2.8) compared to those without CUD. Among individuals with co-occurring CUD, age of onset of bipolar disorder was significantly lower and median number of manic, hypomanic and depressive episodes per year was significantly greater compared to individuals without CUD. Co-occurring CUD is associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder. Comprehensive evaluation of patients with bipolar disorder should include a systematic assessment of CUD.     

Outpatient medical and mental healthcare utilization models among military veterans: results from the 2001 National Survey of Veterans

Using Andersen's (1995) [Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 1995;36:1-10] behavioral model of healthcare use as our theoretical framework, we examined predisposing (i.e., sociodemographic), enabling (i.e., access resources), and need (i.e., illness) models of outpatient medical and mental healthcare utilization among a national sample of US veterans. Participants were 20,048 nationally representative participants completing the 2001 National Survey of Veterans. Outcomes were healthcare use variables for the past year, including the number of Veterans Affairs (VA) and non-VA outpatient healthcare visits, and whether VA and non-VA mental health treatment was used. Univariate results demonstrated that numerous predisposing, enabling and need variables predicted both VA and non-VA healthcare use intensity and mental healthcare use. In multivariate analyses, predisposing, enabling and need variables demonstrated significant associations with both types of healthcare use, but accounted for more variance in mental healthcare use. Need variables provided an additive effect over predisposing and enabling variables in accounting for medical and mental healthcare use, and accounted for some of the strongest effects. The results demonstrate that need remains an important factor that drives healthcare use among veterans and does not seem to be overshadowed by socioeconomic factors that may create unfair disparities in treatment access.     

Correlates of mental health service use intensity in the National Comorbidity Survey and National Comorbidity Survey Replication

OBJECTIVE: This study explored sociodemographic and mental health correlates of intensity of mental health care use in two large-scale surveys, aiming to discover the set of correlates with the greatest predictive capacity. METHODS: Data were examined from persons aged 15 to 54 in two nationally representative U.S. household surveys: the National Comorbidity Survey (NCS) (N=5,877), which gathered information from 1990 to 1992, and the NCS Replication (N=4,320), which gathered information from 2001 to 2003. Outcome variables were the number of mental health care visits in the past year to mental health providers, social service providers, and medical providers. This study implemented state-of-the-art statistical methods designed for modeling such outcomes as treatment intensity-that is, visit counts. RESULTS: Across provider types, significant univariate associations were found for intensity of mental health care use based on access variables (for example, employment and health insurance) and two need variables-psychiatric diagnoses and psychiatric disability. Demographic variables and treatment need variables were not consistent service use correlates. Multivariate regression accounting for excessive zero values demonstrated that after the analyses controlled for sociodemographic and access variables, mental disorders (mood, anxiety, and substance use disorders) and psychiatric disability added incrementally to variance in visit counts for mental health care. However, when mental health service use was dichotomized (any use versus no use) demographic and access variables, as well as psychiatric disorders, emerged as correlates. In both sets of analyses, different patterns of psychiatric disorder and disability were associated with provider service use. CONCLUSIONS: These findings extend research on correlates of mental health care use, addressing intensity of use, suggesting that sociodemographic factors and presence of a psychiatric disorder and associated disability drive the initial use of services, whereas presence of a psychiatric disorder and associated disability are associated with continued service use.     

Hopelessness,impulsiveness and intent among suicide attempters with major depression,alcohol dependence,or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Factors associated with receipt of behavioral health services among persons with substance dependence

OBJECTIVE: This study sought to identify demographic and clinical variables that predict use of behavioral health services among persons with substance dependence. METHODS: Interviews were conducted with 1,893 adults who endorsed items on the National Household Survey on Drug Abuse in 1995 and 1996 that were consistent with a DSM-IV-TR diagnosis of dependence on at least one substance, excluding cigarettes. Logistic regression analyses were conducted to identify significant predictor variables. RESULTS: Among persons with substance dependence, only 18.3 percent had sought substance abuse or mental health treatment, or both, in the previous year. Female sex, high family income, a history of being arrested or booked, concurrent psychiatric comorbidity, self-perception of having a drug or alcohol problem, and the number of substances involved all predicted treatment use. One-third of substance-dependent individuals who used services reported receiving mental health care that did not include any substance use component. Persons with higher education levels were more likely to use mental health care only. In contrast, persons who used public insurance or were uninsured, had been booked or arrested, or perceived themselves as having a drug or alcohol problem were less likely to obtain mental health care only. CONCLUSIONS: Several clinical and demographic variables were predictive of some type of treatment use by substance-dependent individuals. Persons who used mental health care only were more likely to be female, to be of higher socioeconomic status, not to have a history of involvement with the legal system, and to have problems with alcohol or marijuana but not to perceive themselves as needing addiction treatment.     

Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders

OBJECTIVES: This study contributes to knowledge of the processes underlying help seeking by those with mental and substance use disorders by examining relationships among need, service use, and satisfaction with mental health care in a population-based sample. METHODS: Secondary data analyses were performed on responses to the 2002 Canadian Community Health Survey (N=36,984). Diagnostic algorithms classified respondents by past-year diagnostic status, including substance dependence and selected mood and anxiety disorders. Logistic regressions examined associations between diagnostic status and service use, satisfaction, and unmet need for care. RESULTS: Ten percent of Canadians and 39% of Canadians with a mental disorder or substance dependence sought services in the year preceding data collection. Although those with co-occurring substance dependence and mental disorders reported the poorest mental health and were most likely to seek care, the presence of a mental disorder, regardless of co-occurring substance dependence, contributed primarily to help seeking. Among those who sought services, the use of informal sources of care, including self-help groups, was more common among those with substance dependence. Those with co-occurring disorders reported the lowest satisfaction with care and the greatest prevalence of unmet need. CONCLUSIONS: The differential use of services, satisfaction, and unmet need across diagnostic status allowed for speculation on differing levels of disability and stigma in the help-seeking process for different types of disorders. The strong association between co-occurring disorders and unmet need for care, including a large proportion of respondents who stated they preferred to self-manage their symptoms, is particularly troubling and deserves future research attention.     

Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication

Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Objective: Studies have shown an association between allergies and suicidality, and a seasonality of suicide has also been described. We hypothesize an association between history of seasonal allergies and suicide ideation and attempt. Method: Data came from the National Comorbidity Survey Replication, a nationally representative sample (n = 5692) of adults living in the US. Logistic regression models were used to calculate adjusted odds ratios (OR) controlling for the following: age, sex, race, smoking, asthma and depression. Results: After weighting and adjustment, a positive and statistically significant association was found between history of seasonal allergies and history of suicidal ideation [adjusted OR = 1.27 (1.01–1.58)]. We found no association between history of seasonal allergies and history of suicide attempts [adjusted OR = 1.17 (0.89–1.52)]. Conclusion: Findings from a population‐based sample support the hypothesized relationship between allergies and suicidal ideation.     

Attempted suicide among young adults: progress toward a meaningful estimate of prevalence.

OBJECTIVE: The results of epidemiologic surveys on attempted suicide are often difficult to interpret; they compare and provide varying estimates of the prevalence of attempted suicide. The authors sought to estimate the prevalence of attempted suicide in a young adult population and to define more precisely what respondents mean when they report a suicide attempt. METHOD: Survey respondents were a representative sample of all 18-24-year-old freshman students at a major public university. The self-administered, anonymous survey included questions about suicidal thoughts and behaviors and about any injury and need for medical care resulting from reported attempts. RESULTS: Of the 694 respondents, 374 (54%) reported having ever considered suicide and 181 (26%) had considered suicide during the preceding 12 months. Thirteen (2%) students reported having attempted suicide during the preceding 12 months, and 72 (10%) reported ever having attempted suicide. The number of students answering affirmatively to questions about injuries sustained, medical care sought, and hospitalization as a result of attempted suicide decreased progressively: only 18 (3%) students reported having ever sought medical care due to a suicide attempt, and seven (1%) were ever hospitalized. CONCLUSIONS: The prevalence of self-reported attempted suicide is not representative of the prevalence of self-injury and provides little information concerning the seriousness of the attempt. The use of specific questions similar to those used in this study should be considered in future surveys.     

Antidepressant utilization in Canada

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. Disclaimer: this research and analysis were based on data from Statistics Canada. The opinions expressed in this paper do not represent the views of Statistics Canada. This research was presented at the Canadian Academy for Psychiatric Epidemiology 2004 Annual Scientific Symposium on October 14, 2004 in Montreal, Canada.