Rural–urban differences in the prevalence of major depression and associated impairment

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.     

Geography of suicide in Japan: spatial patterning and rural–urban differences

Purpose

There are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017.

Methods

Suicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics.

Results

The results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve.

Conclusion

Our results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.

     

Do age differences in odour memory depend on differences in verbal memory?

Studies of human odour memory have in most cases been obscured by the experimental designs utilised, in which verbal memory played a crucial role in the subjects' performance. Previously, attempts have been made to minimise verbal mediation in the assessment of odour memory by the use of incidental or implicit learning, which is how odours are learned in everyday life; it is still under debate whether this form of learning is age-dependent or not. In this experiment we make use of very uncommon odours and show that incidental learning of odours is as good in elderly people as in the young, whereas intentional learning is better in young people.     

Do monthly or seasonal variations exist in suicides in a high-risk setting?

An unequal distribution of suicides over months and seasons has been a consistent finding in epidemiological surveys on suicide. Jails and prisons are a high-risk setting for suicide all over the world. The high prevalence of both outward and self-directed violence in prison populations indicates dysfunctional central serotonin (5-HT) neurotransmission and, therefore, could account for an unequal distribution of suicides over months and seasons due to underlying bioclimatic factors. Within a total survey of suicides in the Austrian penitentiary system, the weekly, monthly and seasonal distribution of custodial suicides between 1947 and 1999 was studied. After an explorative comparison of suicide distribution over weekdays, months and seasons of the year by chi2-tests, a harmonic Poisson regression model was performed to detect seasonality of suicides. No unequal distribution of suicides was evident over the 53-year period. A limitation of this study was its sample size of 412, a low number compared with population-based samples, where a spring suicide peak was consistently found. An explanation for lacking seasonality could be that bioclimatic factors are less relevant in urban, industrialized areas, where jails and prisons usually are located. One of the core characteristics of penal institutions is the limited possibility for communication and social interaction. This social isolation is independent of seasonal changes. If the individual's possibilities for social interactions are limited, the influence of seasonal changes in social activities may be less relevant. This could explain the absence of seasonal changes in custodial suicide incidence.     

Can differences in stress perception and coping explain sex differences in depressive symptoms in adolescents?

A four-year longitudinal study explored the different contribution of low self-esteem, different types of stressors, conflict in close relationships and avoidant coping to the explanation of depressive symptomatology in adolescents. One hundred and ninety adolescents, 101 females and 89 males, participated in four annual assessments using diverse instruments. ANOVAs repeated measurements revealed a higher stress level, more conflicts with mothers and more avoidant coping in females as compared to males at the age of 14 years. Males showed fewer depressive symptoms and higher positive self-esteem at all times. Multiple regression analysis revealed that stress and avoidant coping in early and mid-adolescence explained a significant proportion of depressive symptoms among females in late adolescence. Among males, only the level of conflicts with friends in early adolescence contributed to their level of depressive outcome in late adolescence.     

Are suicides in the psychiatric hospital actually more frequent now?

Annual suicide rates in a North German psychiatric hospital between 1975 and 1997 are reported. There is no overall increase. After a peak in the early eighties there was a moderate but steady decrease of the suicide rate whereas the average of the absolute suicide rate remained stable for almost a quarter of a century.     

Is seasonality of suicides stronger in victims with hospital-treated atopic disorders?

The aim of the present study was to test whether the seasonal distribution of suicides differed between atopic and non-atopic suicide victims. A cross-sectional comparison of the semi-annual and seasonal distribution of suicides was made by using a 13-year database of all suicides (1296 males, 289 females) committed during the years 1988-2000 in the province of Oulu in Northern Finland. During the first half of the year, the proportion of suicides among atopic patients was significantly higher than that linked with non-atopic patients. Of all atopic patients, 72% committed suicide during the first and 28% during the second half of the year. Suicides among victims without any atopic disorders followed a uniform seasonal distribution throughout the year (50 vs. 50%). The exacerbation of an atopic disorder may increase the risk of suicide in spring; something that should be taken note of in clinical work.     

Age–sex differences in medicinal self-poisonings

BACKGROUND: Deliberate self-harm (DSH) is related to suicide and DSH repetition is common. DSH hospital presentations are often self-poisonings with medicinal agents. While older age and male sex are known risk factors for suicide, it is unclear how these factors are related to the nature and severity of medicinal self-poisoning (SP). Such knowledge can guide prevention strategies emphasizing detecting and treating mental illness and controlling access to means. METHODS: Medicinal SP presentations by 18,383 residents of Ontario, Canada, aged 12 years and older, who presented to a hospital emergency department in that province between April 1, 2001-March 31, 2002 were characterized by the agents taken, identification of deliberate intent and medical severity. RESULTS: We found distinct age-sex differences in the nature and severity of medicinal SP. In youths, aged 12-17, about 40% of presentations involved analgesics, typically not prescribed and most often the acetaminophen agent-group. Females aged 12-64 were identified as deliberate more often than their male counterparts and this pattern occurred in most agent-groups, even among those who took antidepressants. The acetaminophen agent-group was most consistently associated with medical severity and this effect was strongest among female youths. Although medicinal SP was less frequent in the elderly, these presentations tended to be more medically serious and less often identified deliberate. CONCLUSIONS: The high proportion of medicinal SP in youths involving agents typically not prescribed and the medical severity of the acetaminophen agent-group underscore how prevention strategies must extend beyond controlling access to antidepressants. Despite a higher risk for suicide, males and the elderly may not have their deliberate intent detected and therefore, may not receive appropriate treatment. The emergency department can serve as important link to mental health care and usage patterns can provide feedback about the need for system-level enhancements and DSH surveillance.     

Gender differences in bipolar–II disorder

Gender differences in bipolar–II disorder (BP–II) are understudied. Study aim was to test if there were gender differences in the clinical and family history features of BP–II. Methods Consecutive 374 BP–II private practice outpatients were interviewed by a senior psychiatrist using the Structured Clinical Interview for DSM–IV, modified to improve the detection of BP–II (by Benazzi and Akiskal 2003, J Affect Disord 73:33–38), the Montgomery Asberg Depression Rating Scale (MADRS), the Hypomania Interview Guide, and the Family History Screen. Logistic regression was used to study associations and control for confounding. Alpha level was set at 0.05; P was two–tailed. Results Females represented 67.3% of the group. The female to male ratio was independent of age. Females were more common in younger onset BP–II. Females, versus males, had significantly lower age at onset, more axis I comorbidity, atypical depressions, intra–depression hypomanic symptoms (i. e., mixed depression), and family history of suicidal behavior. On the MADRS, females had more sadness, loss of energy, loss of interest, and suicidal ideas. The symptom structure of hypomanic episodes was similar between females and males. Limitations Single interviewer, outpatient sample, private practice study setting. Discussion Clinical differences were found between BP–II females and males. Differences were found only on the depressive pole of the disorder.However, the magnitude of the differences had not a strong clinical significance, suggesting that at present, on the basis of the variables and the population studied, there is little ground to support a female BP–II depression.     

Temperaments in completed suicides: Are they different from those in suicide attempters and controls?

BackgroundTemperaments in completed suicides have never been assessed whereas there is substantial research on temperaments in attempted suicides and psychiatric patients.MethodsThe significant others of 18 completed suicides participated in this study in order to provide an assessment of temperaments, hopelessness, depression and the suicide risk of their loved ones. The data were compared with data from 244 psychiatric patients of whom 83 had attempted suicide in the previous month. The following instruments were used: the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A), the Beck Hopelessness Scale (BHS), the Gotland Scale for Male Depression (GSMD), and the Mini International Neuropsychiatric Interview (MINI) module for assessing suicide risk.ResultsIndividuals who died by suicide more frequently had scores of 9 or higher on the BHS and higher MINI suicide risk scores compared with patients with mood disorders who had not attempted suicide in the previous month. Completed suicides also had lower scores on the TEMPS-A Cyclothymia and Anxiety scales and on the MINI suicide risk scale than mood disorder patients with a recent suicide attempt.LimitationsProxy assessment of variables through survivors can result in underestimation of psychiatric morbidity and other parameters investigated, and limits the generalization of our resultsConclusionsOur study adds information about temperamental subtypes and other variables in completed suicides and points to their difference from attempted suicides and non-suicidal psychiatric patients.     

Sex differences in Parkinson’s disease

Sex-related differences in Parkinson’s disease (PD) have been recognised, but remain poorly understood. We aimed to further clarify real-life differences in disease experience according to sex, by evaluating quality of life (QoL), demographic and clinical characteristics of PD patients. A cross-sectional survey was conducted on 210 PD patients (129 men, 81 women) attending specialist neurological clinics across three centres. Outcome measures included the motor examination of the Unified Parkinson’s Disease Rating Scale (UPDRS-III) and QoL as measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39). A male to female ratio of 1.6:1 was observed. Men reported a greater disease burden than women as noted by higher UPDRS-III scores (27 ± 13 versus 23 ± 13, p = 0.032), daily levodopa equivalent doses (898.1 ± 481.3 mg versus 750.7 ± 427.2 mg, p = 0.037) and caregiver reliance (44% versus 29.5%, p = 0.039). The UPDRS-III score was significantly associated with sex after controlling for age and disease duration, with men more severely affected (β = −0.165, r² = 0.101, p = 0.028). The PDQ-39 showed men reported lower QoL in activities of daily living (ADL), cognition and communication sub-scales (p < 0.05). An association was identified in men between PDQ-39 ADL and cognition sub-scales (r = 0.660, p < 0.001). Men with an appointed caregiver had a higher PDQ-39 Summary Index (t = 3.222, degrees of freedom = 122, p = 0.002). PD was found to have greater overall impact on the health and well-being of male patients in sub-specialty clinical practice. Our study further supports the need for increased sex-delineated clinical assessment and consideration of potential differences required in the management of PD.     

Regional differences in expression of β-tubulin isoforms in schizophrenia

A growing body of evidence suggests that abnormal elements of the cytoskeleton may be associated with the pathophysiology of schizophrenia. Isoforms of a major cytoskeleton protein, β-tubulin, were recently demonstrated to have distinct roles in neuronal differentiation and cell viability. For these reasons, we tested the hypothesis that there are differences in the expression of β-tubulin isoforms (βI-βIV) in the brain in schizophrenia, using western blot analysis in an elderly group of subjects with this illness and a control group. We found that βI-tubulin protein expression was decreased in the anterior cingulate cortex and increased in the dorsolateral prefrontal cortex, but not changed in superior temporal gyrus or hippocampus in schizophrenia. Our data supports the growing body of evidence suggesting abnormalities of the cytoskeleton in schizophrenia.     

Association of temporal factors and suicides in the United States, 2000–2004

Objective  

The purpose of the study was to examine the association of temporal factors, in particular days of the week and seasons of the year and death from suicide in the United States.     

Celebrity suicide: Did the death of Kurt cobain influence young suicides in Australia?

Abstract

This study examined the total rate of suicide in Australia for young people (aged 15-19 and 20-24 years) for the 30 day period after the announcement of Kurt Cobain's suicide in 1994, comparing with the identical period for the previous five years and accounting for unequal variability in weekends, Mondays and public holidays. The 1994 rates for male suicides for both age groups were lower than for 1992 and 1993, and were more similar to the 1990 rates. Female rates showed a steady small decline over the five years, sustained in 1994. Rates overall showed a reduction in all of the first five, ten and fifteen day rates, compared with previous years. There was no evidence of any increase in deaths from gunshot, the method used by Cobain. The conclusion appears to be that this celebrity suicide had little impact on suicide in young persons in Australia. Possible reasons for this are discussed.     

Sex differences in α-adrenergic support of blood pressure

We tested whether the inter-individual variability in α-adrenergic support of blood pressure plays a critical role in the sex differences in tonic support of blood pressure by the autonomic nervous system. Blockade of the α-adrenergic receptors was achieved via phentolamine and showed a smaller (P < 0.05) decrease in blood pressure in women compared to men, implying that α-adrenergic support of blood pressure is less in women than in men.     

Are there gender differences in DSM-IV personality disorders?

This study examined gender differences in DSM-IV personality disorders (PD) in outpatients. Structured diagnostic interviews were reliably administered to a consecutive series of 145 outpatients with a primary axis I diagnosis of binge eating disorder (BED). To further reduce variability due to heterogeneity of axis I, a subgroup of 75 patients with co-occurring major depressive disorder (MDD) was retested for gender differences. Overall, the proportion of males (34.4%) and females (27.4%) diagnosed with any PD did not significantly differ. Specific PD diagnoses were not differentially distributed by gender in the overall study group of patients with BED or in the subgroup of patients with BED and MDD, except for antisocial PD in males.     

Is sex important? Gender differences in bipolar disorder

Sex is clearly important in unipolar mood disorder with compelling evidence that depression is approximately twice as common in women than in men. In the case of bipolar disorder, however, it is widely perceived that the reported equal rate of illness in men and women reflects no important gender distinctions. In this paper we review the literature on gender differences in bipolar illness and attempt to summarize what is known and what requires further study. Despite the uncertainties that remain some conclusions can be drawn. Most studies, but not all, report an almost equal gender ratio in the prevalence of bipolar disorder but the majority of studies do report an increased risk in women of bipolar II/hypomania, rapid cycling and mixed episodes. Important gender distinctions are also found in patterns of co-morbidity. No consistent gender differences have been found in a number of variables including rates of depressive episodes, age and polarity of onset, symptoms, severity of the illness, response to treatment and suicidal behaviour. Unsurprisingly, however, perhaps the major distinction between men and women with bipolar disorder is the impact that reproductive life events, particularly childbirth, have on women with this diagnosis.     

Sex differences in psychosis: normal or pathological?

BACKGROUND: Schizophrenia first appears in adolescence, in boys at an earlier age than girls. The interpretation of this key epidemiological finding crucially depends on whether similar age-related sex differences exist in the expression of associated, subclinical psychosis-like experiences. METHODS: Findings are based on a population sample of 2548 adolescents and young adults aged 17-28. Subjects were assessed with the core psychosis sections on delusions and hallucinations of the Munich-Composite International Diagnostic Interview. RESULTS: The risk of subclinical psychotic experiences was significantly higher for males in the younger half of the cohort (17-21 years), but similar in the older half (22-28 years). CONCLUSIONS: These findings suggest that normal maturational changes in adolescence with differential age of onset in boys and girls cause the expression of psychosis, the extreme of which is schizophrenia.     

Risk factors of future suicide in suicide attempters – A comparison between suicides and matched survivors

The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide (“completers”), and 15 suicide attempters who did not (“non-completers”), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery–Åsberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.