Depression and suicide in epileptic victims: a population-based study of suicide victims during the years 1988-2002 in northern Finland

Patients with epilepsy are known to have comorbid affective disorders and a higher risk for suicide compared with the general population. Epilepsy, depression, and suicidal behavior have been shown to have common pathogenic mechanisms in their etiology. We evaluated the association between epilepsy, suicidal behavior, and depression by using the comprehensive database of all suicides (n=1877) committed in northern Finland during the years 1988-2002 with information on all hospital-treated somatic and psychiatric disorders. Hospital-treated epilepsy occurred in 1.3% of the victims. Compared with other suicide victims, those with epilepsy were more often female, were older, and had significantly more often suffered from depression. Epilepsy was first diagnosed 8.8 (3.9-11.6) years before suicide, and depression, about 1 year after epilepsy diagnosis. Interictal depression among patients with chronic epilepsy is often classified as atypical or chronic depression, or it can mimic a dysthymic disorder. Therefore, diagnosis and treatment of depression among patients with epilepsy constitute a great challenge in clinical practice.     

Changes in alcohol consumption during a ten-year follow-up among Finnish men aged 55-74 years

Drinking patterns, changes in alcohol consumption from 1974 to 1984 and socioeconomic, social, health and health-related variables associated with changes were studied in a male cohort born 1900-1919 and living either in eastern or in southwestern Finland. The average alcohol consumption and drinking pattern did not change to any significant extent among these Finnish men with increasing age, though some individual changes happened. Most aging or aged Finnish men did not react to social stressors or worsening of health by changing alcohol consumption.     

Trends in validated cases of fatal and nonfatal stroke, stroke classification, and risk factors in southeastern New England, 1980 to 1991 : data from the Pawtucket Heart Health Program

BACKGROUND AND PURPOSE: Recent US data suggest there is a slowing of the decline in stroke mortality rates, accompanied by a constant morbidity rate. Hospital discharge rates for patients with stroke are influenced by numerous factors, and community-based surveillance data for validated cases are rare. Thus, reasons for the observed trends remain unclear. In the present study, we examined trends in validated cases of stroke for 1980 to 1991 in the combined populations of the Pawtucket Heart Health Program study communities and examined concomitant trends in classification, use of diagnostic procedures, and levels of risk factors. METHODS: Discharges for residents aged 35 to 74 years with International Classification of Diseases, Ninth Revision codes 431, 432, and 434 to 437 were identified through retrospective surveillance. A physician reviewed the medical records to validate case status. RESULTS: Between 1980 and 1991, 2269 discharges were confirmed as representing definite or probable strokes (59.5% of 3811 cases reviewed). The fatal stroke rate declined (P<0.005) and the nonfatal stroke rate remained constant in both sexes. Case-fatality rates declined significantly (P=0.003), and among strokes, the relative odds of death in 1990 versus 1980 was 0.50 (95% CI 0.34 to 0.72). The proportion of stroke discharges in which the patient received a CT scan or MRI increased 120%, and fewer strokes were classified as ill defined. Hypertension prevalence, treatment, and control rates remained constant in these populations. CONCLUSIONS: Although causes for the observed trends remain unclear, results suggest that the decline in mortality rates is due to improved survival rates for patients with stroke. However, constant morbidity rates combined with constant rates of hypertension highlight the need for improved prevention to reduce the impact of stroke.     

Relationship between suicide, homicide and accidental deaths among the aged in Finland in 1951-1979

Time trends for suicide, homicide and accident mortality among the Finnish population 65 years or over in 1951-1979 are presented. From 1951 to 1967 suicide, motor-vehicle accident mortality and overall accident mortality among elderly males tended to follow more or less similar patterns. In 1951-1979 male suicide rates correlated positively and significantly over time with male motor-vehicle accident mortality and with male total accident mortality. The results from this mortality analysis in the elderly population are compared with those obtained by Holinger et al. in the total population. There is also a brief discussion of the methodological problems of the study. The results suggest that self-destructive tendencies are not a central variable in female accident mortality among the aged population. On the other hand, it is possible that they play some role in motor-vehicle accident mortality in the aged male population. No suggestions about self-destructive tendencies in homicides among the aged could be made.     

Suicidal ideation and suicide attempts among Hispanic subgroups in the United States: 1991-1992 and 2001-2002

Objective

To compare the prevalence of suicidal ideation/attempts among Hispanic subgroups in the US in 1991-1992 and 2001-2002, and identify high-risk groups.

Method

Data were drawn from the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES, n = 42,862) and the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 43,093), two nationally representative surveys of individuals aged 18 years and older.

Results

1) Puerto Ricans are the Hispanic ethnic subgroup with the highest rates of suicide attempts; 2) 45- to 64-year-old Puerto Rican women are a high-risk group for suicide attempts; 3) Over the 10 year period between the two surveys, the lifetime prevalence of suicide attempts significantly increased among 18- to 24-year-old Puerto Rican women and Cuban men, and among 45- to 64-year-old Puerto Rican men.

Conclusion

Hispanics in the US are not a homogeneous group. We identify high-risk groups among Hispanics. Specific interventions for subgroups of Hispanics at high risk for suicidal behaviors may be required.     

Stressful events and severity of memory complaints in cognitively normal adults aged from 25 to 85 years

The relationships between subjective cognitive difficulties and stressful events (SE) have rarely been examined. Broadbent et al. (1982) suggested that such difficulties disclose a high sensitivity to stress, independently of depression and personality. Objective: To explore the relationships between the severity of memory complaints and SE occurred during the previous year. Methods: 260 cognitively normal subjects, aged from 25 to 85 years were examined in a Memory clinic through one year. The severity of memory complaints was globally assessed by asking the participants to qualify the intensity of their subjective difficulties as major or minor, and quantitatively, by using a 8-item subjective memory scale. SE were assessed by asking the subjects whether they experienced one or more events that had negative effects on their physic or mental well-being in the domains of health, family, social environment and financial position during the last 12 months. Affective status was assessed by the Zung's depression (ZD) and anxiety (ZA) scales, and by a Wellbeing questionnaire, QBE. Cognition was assessed using a semi-computerized battery exploring memory and several cognitive abilities. Results: SE were reported in 156 subjects (60%). No differences were found between subjects with or without SE according to age, genre, familial status and activity, as well as cognitive performance. Subjects with SE reported more severe complaints and higher scores on ZD and ZA scales, and lower scores on the QBE. Severity of memory complaints was mainly correlated to QBE in subjects with SE and to ZA scale in subjects without. Subjects with age <?50 years reported more SE than subjects aged ≥ 50 years. No difference was found between the two age groups according to the type of SE in the domain of health, family, and finances, but higher SE were reported in younger subjects in the domain of social environment. The main correlates of the severity of memory complaints were depression in younger subjects with or without SE, and anxiety in absence of SE and QBE in presence of SE in older subjects. However, the affective scores explained only a weak part of the variance of the severity of memory complaints. Conclusion: SE do not seem to play a direct role in the severity of memory complaints, but they increase the affective disturbances. We suggest that anxiety and various factors such as decrease in self-esteem and modification of self-identity result in a psychological vulnerability which contribute to memory complaints.     

Trends in insomnia and excessive daytime sleepiness among US adults from 2002 to 2012

ObjectiveInsomnia is a prevalent disorder in the United States and elsewhere. It has been associated with a range of somatic and psychiatric conditions, and adversely affects quality of life, productivity at work, and school performance. The objective of this study was to examine the trend in self-reported insomnia and excessive daytime sleepiness among US adults.MethodsWe used data of participants aged ≥18 years from the National Health Interview Survey for the years 2002 (30,970 participants), 2007 (23,344 participants), and 2012 (34,509 participants).ResultsThe unadjusted prevalence of insomnia or trouble sleeping increased from 17.5% (representing 37.5 million adults) in 2002 to 19.2% (representing 46.2 million adults) in 2012 (relative increase: +8.0%) (P trend <0.001). The age-adjusted prevalence increased from 17.4% to 18.8%. Significant increases were present among participants aged 18–24, 25–34, 55–64, and 65–74 years, men, women, whites, Hispanics, participants with diabetes, and participants with joint pain. Large relative increases occurred among participants aged 18–24 years (+30.9%) and participants with diabetes (+27.0%). The age-adjusted percentage of participants who reported regularly having excessive daytime sleepiness increased from 9.8% to 12.7% (P trend <0.001). Significant increases were present in most demographic groups. The largest relative increase was among participants aged 25–34 years (+49%). Increases were also found among participants with hypertension, chronic obstructive pulmonary disease, asthma, and joint pain.ConclusionsGiven the deleterious effects of insomnia on health and performance, the increasing prevalence of insomnia and excessive daytime sleepiness among US adults is a potentially troubling development.     

Prevalence and psychological correlates of eating disorders among females aged 18-30 years in the general population

OBJECTIVE: The prevalence of eating disorders (ED) according to DSM-IV, and also correlates of ED, were examined. METHOD: This study represented the first phase of a questionnaire-based prospective study. The subjects consisted of 1157 women randomly selected from the general population of females aged 18-30 years in Sweden. RESULTS: Lifetime and point prevalences of 7.8% and 2.6%, respectively, were reported for ED. Subjects with ED reported lower self-esteem, less perceived social support from the family and higher concern about body shape than controls. CONCLUSION: Establishing the prevalence and correlates of ED simultaneously and longitudinally among females in the general population may promote our understanding of the development, course and maintenance of ED.     

广州市城乡养老院60岁及其以上人群痴呆检出率的调查

目的调查广州市城乡养老院老年人痴呆患病情况。方法采用分层整群抽样方法，将广州地区养老院分为市级、区级、民营、厂矿及农村乡镇，每层各抽取1个养老院进行调查。应查者为抽中养老院的人住者，年龄≥60岁。实查1105人，失访12人（1．07％）。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆。结果（1）检出率：在1105名老人中，查出痴呆患者324例，检出率为29．32％。其中阿尔茨海默病（AD）为20、36％（225例）、血管性痴呆（VD）为7、69％（85例）、混合性痴呆为0145％（5例）、帕金森病痴呆为0．27％（3例）、其他类型痴呆为0、54％（6例）。（2）女性痴呆患者235例，检出率（31．8％）高于男性（89例，24．3％；P〈0．05）。（3）痴呆检出率随年龄增长而上升。（4）痴呆患者中轻度71例（占21、9％）、中度103例（占31．8％）、重度150例（占46．3％）。结论广州地区养老院老人的痴呆检出率为29．32％，其中AD检出率高于VD，女性高于男性，以重度者多见，且痴呆检出率随年龄的增长而升高。     

Psychiatric morbidity among people aged 85+ in 1987. A follow-up study at two and a half years: Associations with changes in psychiatric morbidity

This article reports findings from a longitudinal survey of very elderly people living at home in London. The research aimed to identify social, psychological and physical characteristics associated with positive ageing and successful survival in the community in later life and its converse—negative ageing—as well as the associated policy implications. Associations with psychiatric morbidity, measured using the General Health Questionnaire, among sample members without cognitive impairment between the baseline interviews in 1987 and at follow-up, two and a half years later in 1990, are reported. Twenty-five per cent of survivors scored over the threshold of the GHQ in 1987 and 30% scored over the threshold in 1990. Half of those with a score over the threshold in 1990 also scored over the threshold in 1987. Hierarchical regression (using residualized change analysis) was used to estimate the effects of the independent variables on changes in psychiatric morbidity. The most significant predictor of psychiatric morbidity (GHQ score) in 1990 was baseline GHQ score, followed by health and functional status scores. Health and functional status were also the strongest predictors of baseline (1987) GHQ scores. The uniqueness of the study lies in the collection of follow-up data on a sample of very elderly people, given that most surveys are corss-sectional and contain too few people aged 85+ to merit separate analysis. It contributes to the small body of literature on outcome of depression. The lack of consistent associations with recovery from psychiatric morbidity in the literature enhances the importance of studies aiming to identify factors associated with different outcomes.     

Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls

Sleep disordered breathing in children is a common but largely underdiagnosed problem. It ranges in severity from primary snoring to obstructive sleep apnea syndrome (OSAS). Preliminary evidence suggests that children with severe OSAS show reduced neurocognitive performance, however, less is known about children who snore but do not have severe upper airway obstruction. Participants included 16 children referred to the Ear, Nose and Throat/Respiratory departments of a Children's Hospital for evaluation of snoring and 16 non-snoring controls aged 5-10 years. Overnight polysomnography (PSG) was carried out in 13 children who snored and 13 controls. The PSG confirmed the presence of primary snoring in seven and very mild OSAS (as evidenced by chest wall paradox) in eight children referred for snoring while controls showed a normal sleep pattern. To test for group differences in neurocognitive functioning and behavior, children underwent one day of testing during which measures of intelligence, memory, attention, social competency, and problematic behavior were collected. Compared to controls, children who snored showed significantly impaired attention and, although within the normal range, lower memory and intelligence scores. No significant group differences were observed for social competency and problematic behavior. These findings suggest that neurocognitive performance is reduced in children who snore but are otherwise healthy and who do not have severe OSAS. They further imply that the impact of mild sleep disordered breathing on daytime functioning may be more significant than previously realized with subsequent implications for successful academic and developmental progress.     

四川省6~16岁儿童少年自杀风险及相关因素调查

目的:了解四川省6~16岁儿童少年自杀风险的现况,探索自杀风险的相关危险因素。方法:采用分层整群随机抽样方法,随机选取四川省20所小学、20所中学进行问卷调查,问卷包括自编一般情况问卷、家长用Achenbach儿童行为量表和简明儿童少年国际神经精神访谈父母版。自杀风险的相关因素分析采用多因素Logistic回归模型。结果:1本研究共纳入19 711名儿童少年,其中男生9 938人,女生9 773人;2 6~16岁儿童少年自杀风险为4.7%,6~11岁儿童自杀风险为0.3%,12~16岁少年自杀风险为8.8%;3 6~11岁儿童自杀风险的危险因素是单亲家庭、留守儿童、退缩行为、焦虑抑郁、注意缺陷和攻击行为;12~16岁少年自杀风险的危险因素是女性、单亲家庭、所在地区经济落后、家庭经济差、留守儿童、家长打骂孩子、对孩子不管不问、精神疾病家族史、退缩行为、躯体主诉、焦虑抑郁、社交问题、思维问题、注意缺陷和攻击行为,自杀风险的保护因素是家庭和睦。结论:四川省6~16岁儿童少年自杀风险的现况不容乐观,需引起家庭、学校和社会的高度重视,积极干预儿童少年存在的行为问题及其他危险因素。