Scott B. Patten

Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8%) of global YLDs and dysthymia for 1.4% (0.9%-2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2%) of global DALYs and dysthymia for 0.5% (0.3%-0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8%) to 3.8% (3.0%-4.7%) of global DALYs.GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden. Please see later in the article for the Editors' Summary.

IMPORTANCECancer is among the leading causes of death worldwide.Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.OBJECTIVE To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. EVIDENCE REVIEWThe general methodology of the Global Burden of Disease (GBD) 2013 study was used.Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios.Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources.The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates.Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.FINDINGS In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs.Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million).Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths.For men, TBL cancer was the leading cause of DALYs (24.9 million).For women, breast cancer was the leading cause of DALYs (13.1 million).Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3).Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. CONCLUSIONS AND RELEVANCECancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990.The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments.The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

<h3>Objective:</h3> To review population-based studies of the prevalence and incidence of epilepsy worldwide and use meta-analytic techniques to explore factors that may explain heterogeneity between estimates. <h3>Methods:</h3> The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed. We searched MEDLINE and EMBASE for articles published on the prevalence or incidence of epilepsy since 1985. Abstract, full-text review, and data abstraction were conducted in duplicate. Meta-analyses and meta-regressions were used to explore the association between prevalence or incidence, age group, sex, country level income, and study quality. <h3>Results:</h3> A total of 222 studies were included (197 on prevalence, 48 on incidence). The point prevalence of active epilepsy was 6.38 per 1,000 persons (95% confidence interval [95% CI] 5.57–7.30), while the lifetime prevalence was 7.60 per 1,000 persons (95% CI 6.17–9.38). The annual cumulative incidence of epilepsy was 67.77 per 100,000 persons (95% CI 56.69–81.03) while the incidence rate was 61.44 per 100,000 person-years (95% CI 50.75–74.38). The prevalence of epilepsy did not differ by age group, sex, or study quality. The active annual period prevalence, lifetime prevalence, and incidence rate of epilepsy were higher in low to middle income countries. Epilepsies of unknown etiology and those with generalized seizures had the highest prevalence. <h3>Conclusions:</h3> This study provides a comprehensive synthesis of the prevalence and incidence of epilepsy from published international studies and offers insight into factors that contribute to heterogeneity between estimates. Significant gaps (e.g., lack of incidence studies, stratification by age groups) were identified. Standardized reporting of future epidemiologic studies of epilepsy is needed.

Background Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study. Method A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis. Results The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4–5.0%). The pooled annual incidence was 3.0% (2.4–3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD. Conclusions Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Knowledge transfer and exchange (KTE) is as an interactive process involving the interchange of knowledge between research users and researcher producers. Despite many strategies for KTE, it is not clear which ones should be used in which contexts. This article is a review and synthesis of the KTE literature on health care policy. The review examined and summarized KTE's current evidence base for KTE. It found that about 20 percent of the studies reported on a real-world application of a KTE strategy, and fewer had been formally evaluated. At this time there is an inadequate evidence base for doing "evidence-based" KTE for health policy decision making. Either KTE must be reconceptualized, or strategies must be evaluated more rigorously to produce a richer evidence base for future activity.

Summary Purpose: The estimated prevalence of mental health disorders in those with epilepsy in the general population varies owing to differences in study methods and heterogeneity of epilepsy syndromes. We assessed the population‐based prevalence of various psychiatric conditions associated with epilepsy using a large Canadian national population health survey. Methods: The Canadian Community Health Survey (CCHS 1.2) was used to explore numerous aspects of mental health in persons with epilepsy in the community compared with those without epilepsy. The CCHS includes administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Age‐specific prevalence of mental health conditions in epilepsy was assessed using logistic regression. Results: The prevalence of epilepsy was 0.6%. Individuals with epilepsy were more likely than individuals without epilepsy to report lifetime anxiety disorders or suicidal thoughts with odds ratio of 2.4 (95% CI = 1.5–3.8) and 2.2 (1.4–3.3), respectively. In the crude analysis, the odds of lifetime major depression or panic disorder/agoraphobia were not greater in those with epilepsy than those without epilepsy, but the association with lifetime major depression became significant after adjustment for covariates. Conclusions: In the community, epilepsy is associated with an increased prevalence of mental health disorders compared with the general population. Epilepsy is also associated with a higher prevalence of suicidal ideation. Understanding the psychiatric correlates of epilepsy is important to adequately manage this patient population.

To determine the prevalence of major depression in multiple sclerosis (MS) in a population-based sample controlling for nonspecific illness effects.This study used data from a large-scale national survey conducted in Canada: the Canadian Community Health Survey (CCHS). The analysis included 115,071 CCHS subjects who were 18 years or older at the time of data collection. The CCHS interview obtained self-reported diagnoses of MS and employed a brief predictive interview for major depression: the Composite International Diagnostic Interview Short Form for Major Depression. The 12-month period prevalence of major depression was estimated in subjects with and without MS and with and without other long-term medical conditions.The prevalence of major depression was elevated in persons with MS relative to those without MS and those reporting other conditions. The association persisted after adjustment for age and sex (adjusted odds ratio = 2.3, 95% CI 1.6 to 3.3). Major depression prevalence in MS for those in the 18- to 45-year age range was high at 25.7% (95% CI 15.6 to 35.7).The prevalence of major depression in the population with MS is elevated. This elevation is not an artifact of selection bias and exceeds that associated with having one or more other long-term conditions.

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.All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling.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.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.

In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008–2009 to reflect advances in the field. The CANMAT guidelines are based on a question–answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included Levels of Evidence and expert clinical support. This section on “Pharmacotherapy” is one of 5 guideline articles. Despite emerging data on efficacy and tolerability differences amongst newer antidepressants, variability in patient response precludes identification of specific first choice medications for all patients. All second-generation antidepressants have Level 1 evidence to support efficacy and tolerability and most are considered first-line treatments for MDD. First-generation tricyclic and monoamine oxidase inhibitor antidepressants are not the focus of these guidelines but generally are considered second- or third-line treatments. For inadequate or incomplete response, there is Level 1 evidence for switching strategies and for add-on strategies including lithium and atypical antipsychotics. Most of the evidence is based on trials for registration and may not reflect real-world effectiveness. Second-generation antidepressants are safe, effective and well tolerated treatments for MDD in adults. Evidence-based switching and add-on strategies can be used to optimize response in MDD that is inadequately responsive to monotherapy.

Many people identified as having common mental disorders in community surveys do not receive treatment. Modelling has suggested that closing this “treatment gap” should reduce the population prevalence of those disorders. To evaluate the effects of reducing the treatment gap in industrialized countries, data from 1990 to 2015 were reviewed from four English‐speaking countries: Australia, Canada, England and the US. These data show that the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants. Several hypotheses for this lack of improvement were considered. There was no support for the hypothesis that reductions in prevalence due to treatment have been masked by increases in risk factors. However, there was little evidence relevant to the hypothesis that improvements have been masked by increased reporting of symptoms because of greater public awareness of common mental disorders or willingness to disclose. A more strongly supported hypothesis for the lack of improvement is that much of the treatment provided does not meet the minimal standards of clinical practice guidelines and is not targeted optimally to those in greatest need. Lack of attention to prevention of common mental disorders may also be a factor. Reducing the prevalence of common mental disorders remains an unsolved challenge for health systems globally, which may require greater attention to the “quality gap” and “prevention gap”. There is also a need for nations to monitor outcomes by using standardized measures of service provision and mental disorders over time.

Depression is common in individuals with mild cognitive impairment (MCI) and may confer a higher likelihood of progression to dementia. Prevalence estimates of depression in those with MCI are required to guide both clinical decisions and public health policy, but published results are variable and lack precision.To provide a precise estimate of the prevalence of depression in individuals with MCI and identify reasons for heterogeneity in the reported results.A search of literature from database inception to March 2016 was performed using Medline, Embase, and PsycINFO. Hand searching of all included articles was performed, including a Google Scholar search of citations of included articles.Articles were included if they (1) were published in English, (2) reported patients with MCI as a primary study group, (3) reported depression or depressive symptoms using a validated instrument, and (4) reported the prevalence of depression in patients with MCI.All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. The overall prevalence of depression in patients with MCI was pooled using a random-effects model. Heterogeneity was explored using stratification and random-effects meta-regression.The prevalence of depression in patients with MCI, reported as a percentage with 95% CIs. Estimates were also stratified by population source (community-based or clinic-based sample), method of depression diagnosis (clinician-administered, informant-based, or self-report), and method of MCI diagnosis (cognitive vs global measure and amnestic vs nonamnestic).Of 5687 unique abstracts, 255 were selected for full-text review, and 57 studies, representing 20 892 patients, met all inclusion criteria. The overall pooled prevalence of depression in patients with MCI was 32% (95% CI, 27-37), with significant heterogeneity between estimates (I2 = 90.7%). When stratified by source, the prevalence of depression in patients with MCI in community-based samples was 25% (95% CI, 19-30) and was 40% (95% CI, 32-48) in clinic-based samples, which was significantly different (P < .001). The method used to diagnose depression did not significantly influence the prevalence estimate, nor did the criteria used for MCI diagnosis or MCI subtype.The prevalence of depression in patients with MCI is high. A contributor to heterogeneity in the reported literature is the source of the sample, with greater depression burden prevalent in clinic-based samples.

Objective: To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions. Methods: The MEDLINE (1948–2012), EMBASE (1980–2012), and PsycINFO (1806–2012) databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided. Results: Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%–28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09–3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1–33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07–4.51) for PWE. Conclusions: Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE. CCHS= : Canadian Community Health Survey; CES-D= : Center for Epidemiologic Studies–Depression Scale; CI= : confidence interval; DSM-IV= : Diagnostic and Statistical Manual of Mental Disorders, 4th edition; HADS= : Hospital Anxiety and Depression Scale; HPA= : hypothalamic-pituitary-adrenal; ICD= : International Classification of Diseases; ICPC= : International Classification of Primary Care; K-6= : Kessler-6; OR= : odds ratio; PWE= : persons with epilepsy; WMH-CIDI= : World Mental Health–Composite Diagnostic Interview

Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes.(1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes.Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization.The prevalence of physician-diagnosed migraine (n=36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone.Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.

Although the detrimental impact of major depressive disorder (MDD) at the individual level has been described, its global epidemiology remains unclear given limitations in the data. Here we present the modelled epidemiological profile of MDD dealing with heterogeneity in the data, enforcing internal consistency between epidemiological parameters and making estimates for world regions with no empirical data. These estimates were used to quantify the burden of MDD for the Global Burden of Disease Study 2010 (GBD 2010).Analyses drew on data from our existing literature review of the epidemiology of MDD. DisMod-MR, the latest version of the generic disease modelling system redesigned as a Bayesian meta-regression tool, derived prevalence by age, year and sex for 21 regions. Prior epidemiological knowledge, study- and country-level covariates adjusted sub-optimal raw data.There were over 298 million cases of MDD globally at any point in time in 2010, with the highest proportion of cases occurring between 25 and 34 years. Global point prevalence was very similar across time (4.4% (95% uncertainty: 4.2-4.7%) in 1990, 4.4% (4.1-4.7%) in 2005 and 2010), but higher in females (5.5% (5.0-6.0%) compared to males (3.2% (3.0-3.6%) in 2010. Regions in conflict had higher prevalence than those with no conflict. The annual incidence of an episode of MDD followed a similar age and regional pattern to prevalence but was about one and a half times higher, consistent with an average duration of 37.7 weeks.We were able to integrate available data, including those from high quality surveys and sub-optimal studies, into a model adjusting for known methodological sources of heterogeneity. We were also able to estimate the epidemiology of MDD in regions with no available data. This informed GBD 2010 and the public health field, with a clearer understanding of the global distribution of MDD.

Background Many studies have used retrospective reports to assess the long-term consequences of early life stress. However, current individual characteristics and experiences may bias the recall of these reports. In particular, depressed mood may increase the likelihood of recall of negative experiences. The aim of the study was to assess whether specific factors are associated with consistency in the reporting of childhood adverse experiences. Method The sample comprised 7466 adults from Canada's National Population Health Survey who had reported on seven childhood adverse experiences in 1994/1995 and 2006/2007. Logistic regression was used to explore differences between those who consistently reported adverse experiences and those whose reports were inconsistent. Results Among those retrospectively reporting on childhood traumatic experiences in 1994/1995 and 2006/2007, 39% were inconsistent in their reports of these experiences. The development of depression, increasing levels of psychological distress, as well as increasing work and chronic stress were associated with an increasing likelihood of reporting a childhood adverse experience in 2006/2007 that had not been previously reported. Increases in mastery were associated with reduced likelihood of new reporting of a childhood adverse experience in 2006/2007. The development of depression and increases in chronic stress and psychological distress were also associated with reduced likelihood of ‘forgetting’ a previously reported event. Conclusions Concurrent mental health factors may influence the reporting of traumatic childhood experiences. Studies that use retrospective reporting to estimate associations between childhood adversity and adult outcomes associated with mental health may be biased.

To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS).We reviewed the literature (1950 to August 2011) and evaluated the available evidence.Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.

Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Administrative data are increasingly used to conduct research on depression and inform health services and health policy. Depression surveillance using administrative data is an alternative to surveys, which can be more resource-intensive. The objectives of this study were to: (1) systematically review the literature on validated case definitions to identify depression using International Classification of Disease and Related Health Problems (ICD) codes in administrative data and (2) identify individuals with and without depression in administrative data and develop an enhanced case definition to identify persons with depression in ICD-coded hospital data.(1) Systematic review: We identified validation studies using ICD codes to indicate depression in administrative data up to January 2013. (2) VALIDATION: All depression case definitions from the literature and an additional three ICD-9-CM and three ICD-10 enhanced definitions were tested in an inpatient database. The diagnostic accuracy of all case definitions was calculated [sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV)].(1) Systematic review: Of 2,014 abstracts identified, 36 underwent full-text review and three met eligibility criteria. These depression studies used ICD-9 and ICD-10 case definitions. (2) VALIDATION: 4,008 randomly selected medical charts were reviewed to assess the performance of new and previously published depression-related ICD case definitions. All newly tested case definitions resulted in Sp >99%, PPV >89% and NPV >91%. Sensitivities were low (28-35%), but higher than for case definitions identified in the literature (1.1-29.6%).Validating ICD-coded data for depression is important due to variation in coding practices across jurisdictions. The most suitable case definitions for detecting depression in administrative data vary depending on the context. For surveillance purposes, the most inclusive ICD-9 & ICD-10 case definitions resulted in PPVs of 89.7% and 89.5%, respectively. In cases where diagnostic certainty is required, the least inclusive ICD-9 and -10 case definitions are recommended, resulting in PPVs of 92.0% and 91.1%. All proposed case definitions resulted in suboptimal levels of sensitivity (ranging from 28.9%-35.6%). The addition of outpatient data (such as pharmacy records) for depression surveillance is recommended and should result in improved measures of validity.

As part of its ongoing effort to combat stigma against mental illness among health care providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes.Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program (n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients.The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs.The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers.

Psychiatric comorbidity in inflammatory bowel disease (IBD) is well known; however, data from a truly representative sample are sparse. We aimed to estimate the incidence and prevalence of psychiatric disorders in an IBD cohort compared with a matched cohort without IBD.Using population-based administrative health data from Manitoba, Canada, we identified all persons with incident IBD from 1989 to 2012 and a general population matched cohort (5:1). We applied validated algorithms for IBD, depression, anxiety disorders, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions post-IBD diagnosis and their lifetime and current prevalence.There were 6119 incident cases of IBD and 30,573 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, and year, there was a higher incidence in the IBD cohort compared with controls for depression (incidence rate ratio [IRR], 1.58; 95% confidence interval [CI], 1.41-1.76), anxiety disorder (IRR, 1.39; 95% CI, 1.26-1.53), bipolar disorder (IRR, 1.82; 95% CI, 1.44-2.30), and schizophrenia (IRR, 1.64; 95% CI, 0.95-2.84). Incidence rate ratios were similar for Crohn's disease and ulcerative colitis between males and females and were stable over time. However, within the IBD cohort, the incidence rates of depression, anxiety, and bipolar disorders were higher among females, those aged 18-24 years vs those older than 44 years, urbanites, and those of lower socioeconomic status. The lifetime and current prevalence rates of psychiatric disorders were also higher in the IBD than the matched cohort.The incidence and prevalence of psychiatric disorders are elevated in the IBD population.

To evaluate the direct and indirect influences of physical comorbidity, symptoms of depression and anxiety, fatigue, and disability on health-related quality of life (HRQoL) in persons with multiple sclerosis (MS).A large (n = 949) sample of adults with MS was recruited from 4 Canadian MS clinics. HRQoL was assessed using the patient-reported Health Utilities Index Mark 3. Expanded Disability Status Scale scores, physical comorbidity, depression, anxiety, and fatigue were evaluated as predictors of HRQoL in a cross-sectional path analysis.All predictors were significantly associated with HRQoL and together accounted for a large proportion of variance (63%). Overall, disability status most strongly affected HRQoL (β = -0.52) but it was closely followed by depressive symptoms (β = -0.50). The direct associations of physical comorbidity and anxiety with HRQoL were small (β = -0.08 and -0.10, respectively), but these associations were stronger when indirect effects through other variables (depression, fatigue) were also considered (physical comorbidity: β = -0.20; anxiety: β = -0.34).Increased disability, depression and anxiety symptoms, fatigue, and physical comorbidity are associated with decreased HRQoL in MS. Disability most strongly diminishes HRQoL and, thus, interventions that reduce disability are expected to yield the most substantial improvement in HRQoL. Yet, interventions targeting other factors amenable to change, particularly depression but also anxiety, fatigue, and physical comorbidities, may all result in meaningful improvements in HRQoL, as well. Our findings point to the importance of further research confirming the efficacy of such interventions.

Depression is associated with IBD, but the effect of antidepressants on IBD has been sparsely studied. We assessed the impact of depression and antidepressant therapies on the development of IBD.The Health Improvement Network (THIN) was used to identify a cohort of patients with new-onset depression from 1986 to 2012. THIN patients who did not meet the defining criteria for depression were part of the referent group. The outcome was incident Crohn's disease (CD) or ulcerative colitis (UC). Cox proportional hazards modelling was performed to evaluate the rate of Crohn's disease or UC development among patients with an exposure of depression after controlling for age, sex, socioeconomic status, comorbid conditions, smoking, anxiety and antidepressant use including atypical antidepressants, mirtazapine, monoamine oxidase inhibitors (MAOI), serotonin norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), serotonin modulators; and tricyclic antidepressants (TCA).We identified 403 665 (7.05%) patients with incident depression. Individuals with depression had a significantly greater risk of developing CD (adjusted HR=2.11, 95% CI 1.65 to 2.70) and UC (adjusted HR=2.23, 95% CI 1.92 to 2.60) after controlling for demographic and clinical covariates. SSRI and TCA were protective against CD, whereas mirtazapine, SNRI, SSRI, serotonin modulators and TCA were protective for UC.Patients with a history of depression were more likely to be diagnosed with IBD. In contrast, antidepressant treatments were selectively protective for Crohn's disease and UC. These results may impact counselling and management of depression and IBD.

The epidemiology of major depressive disorder (MDD) was first described in the Canadian national population in 2002. Updated information is now available from a 2012 survey: the Canadian Community Health Study-Mental Health (CCHS-MH).The CCHS-MH employed an adaptation of the World Health Organization World Mental Health Composite International Diagnostic Interview and had a sample of n=25 113. Demographic variables, treatment, comorbidities, suicidal ideation, and perceived stigma were assessed. The analysis estimated adjusted and unadjusted frequencies and prevalence ratios. All estimates incorporated analysis methods to account for complex survey design effects.The past-year prevalence of MDD was 3.9% (95% CI 3.5% to 4.2%). Prevalence was higher in women and in younger age groups. Among respondents with past-year MDD, 63.1% had sought treatment and 33.1% were taking an antidepressant (AD); 4.8% had past-year alcohol abuse and 4.5% had alcohol dependence. Among respondents with past-year MDD, the prevalence of cannabis abuse was 2.5% and that of dependence was 2.9%. For drugs other than cannabis, the prevalence of abuse was 2.3% and dependence was 2.9%. Generalized anxiety disorder was present in 24.9%. Suicide attempts were reported by 6.6% of respondents with past-year MDD. Among respondents accessing treatment, 37.5% perceived that others held negative opinions about them or treated them unfairly because of their disorder.MDD is a common, burdensome, and stigmatized condition in Canada. Seeking help from professionals was reported at a higher frequency than in prior Canadian studies, but there has been no increase in AD use among Canadians with MDD.

Depressive disorders occur in up to 50% of people living with multiple sclerosis (MS). Prevalence estimates are generally 2-3-times higher than those of the general population. Myriad aetiologic factors may contribute to the aetiology of depression in MS including biological mechanisms (e.g. hippocampal microglial activation, lesion burden, regional atrophy), as well as the stressors, threats, and losses that accompany living with an unpredictable and often disabling disease. Some prominent risk factors for depression such as (younger) age, (female) sex, and family history of depression are less consistently associated with depression in MS than they are in the general population. Management of depression in MS has not been well studied, but available data on detection and treatment align with general principles of depression management. While the validity of standard measurement scales has often been questioned, available evidence suggests that standard scales provide valid ratings. Evidence for the effectiveness of depression treatments in MS is limited, but available evidence supports the effectiveness of standard treatment approaches, including both cognitive behavioural therapies and antidepressant medications.

A growing body of evidence suggests that individuals with eating disorders (EDs) have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. Despite this, no systematic reviews have been conducted examining the COVID-19 and ED peer-reviewed literature. Therefore, this systematic review aimed to synthesize the impact of the COVID-19 pandemic on individuals with EDs.Database searches of the peer-reviewed literature were completed in the subsequent databases: CINAHL, Embase, MEDLINE, and PsycINFO (from November 2019 to October 20, 2021). All research reporting on the relationship between the COVID-19 pandemic on individuals with EDs were included.Fifty-three studies met the inclusion criteria, including 36,485 individuals with EDs. The pooled hospital admissions across the studies demonstrated on average a 48% (pre = 591, post = 876, n = 10 studies) increase in admissions during the pandemic compared to previous pre-pandemic timepoints. In this review, 36% of studies (n = 19) documented increases in eating disorder symptoms during the pandemic, this increase in eating disorder symptoms were documented in AN, BED, BN, and OFSED patients. Studies also demonstrated increases in anxiety (n = 9) and depression (n = 8), however patterns of change appeared to be diagnostic and timing specific (e.g., lockdowns).We found a large increase in the number of hospitalizations and an increase in ED symptoms, anxiety, depression, and changes to BMI in ED patients during the pandemic. However, these changes appeared to be diagnostic and timing specific. Many qualitative studies described deterioration in ED symptomatology due to decreased access to care and treatment, changes to routine and loss of structure, negative influence of the media, and social isolation. Future studies are needed to focus on pediatric populations, new ED diagnoses, and severity of illness at presentation.The scientific literature suggests that individuals with eating disorders have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. This study synthesized 53 articles and explored the impact of the COVID-19 pandemic on patients with eating disorders. We found increases in eating disorder symptoms during the pandemic; this increase in eating disorder symptoms was documented in patients with common eating disorders including anorexia nervosa, binge-eating disorder, bulimia nervosa, and other specified feeding and eating disorders. This review also demonstrated changes in body mass index (an index used to classify underweight, overweight, and obesity in adults) and increases in anxiety and depression during the pandemic compared to previous timepoints; patterns of change appeared to be related to timing of lockdowns. This review provides important information on the impact of COVID-19 on the physical and mental health of individuals with eating disorders.Un creciente conjunto de evidencia sugiere que las personas con trastornos de la conducta alimentaria (TCA) han experimentado síntomas de deterioro, mayor aislamiento y un aumento en los ingresos hospitalarios como resultado de la pandemia de COVID-19. A pesar de esto, no se han realizado revisiones sistemáticas que examinen la literatura revisada por pares de COVID-19 y TCA. Por lo tanto, esta revisión sistemática tuvo como objetivo sintetizar el impacto de la pandemia de COVID-19 en las personas con TCA. MÉTODO: Las búsquedas en las bases de datos de la literatura revisada por pares se completaron en las bases de datos posteriores: CINAHL, Embase, MEDLINE y PsycINFO (de noviembre de 2019 al 20 de octubre de 2021). Se incluyeron todos los informes de investigación sobre la relación entre la pandemia de COVID-19 en individuos con TCA.Cincuenta y tres estudios cumplieron los criterios de inclusión, incluyendo 36,485 individuos con TCA. Los ingresos hospitalarios agrupados en los estudios demostraron en promedio un aumento del 48% (antes = 591, después = 876, n = 10 estudios) en los ingresos durante la pandemia en comparación con los puntos de tiempo previos a la pandemia. En esta revisión, el 36% de los estudios (n = 19) documentaron aumentos en los síntomas del trastorno alimentario durante la pandemia, este aumento en los síntomas del trastorno de la conducta alimentaria se documentó en pacientes con AN, TpA, BN y OSFED. Los estudios también demostraron aumentos en la ansiedad (n = 9) y la depresión (n = 8), sin embargo, los patrones de cambio parecían ser diagnósticos y específicos del momento (por ejemplo, encierros). DISCUSIÓN: Encontramos un gran aumento en el número de hospitalizaciones y un aumento en los síntomas de TCA, ansiedad, depresión y los cambios en el IMC en pacientes con TCA durante la pandemia. Sin embargo, estos cambios parecían ser diagnósticos y específicos del momento. Muchos estudios cualitativos describieron un deterioro en la sintomatología del trastorno de la conducta alimentaria (TCA) debido a la disminución del acceso a la atención y el tratamiento, los cambios en la rutina y la pérdida de estructura, la influencia negativa de los medios de comunicación y el aislamiento social. Se necesitan estudios futuros para centrarse en las poblaciones pediátricas, los nuevos diagnósticos de TCA y la gravedad de la enfermedad al momento de la presentación. PALABRAS CLAVE: trastornos de la conducta alimentaria, pandemia, COVID-19.

A bidirectional relationship exists between epilepsy and depression. However, any putative biological gradient between depression severity and the risk of epilepsy, and the degree to which depression mediates the influence of independent risk factors for epilepsy, has yet to be examined.To determine the effect of depression on the risk of epilepsy and seizure outcomes.An observational study of a population-based primary care cohort (all patients free of prevalent depression and epilepsy at 18-90 years of age who were active after the Acceptable Mortality Reporting date in The Health Improvement Network database) and a prospectively collected tertiary care cohort (all patients whose data were prospectively collected from the Calgary Comprehensive Epilepsy Programme). The analyses were performed on March 16, 2016.The hazard of developing epilepsy after incident depression and vice versa was calculated. In addition, a mediation analysis of the effect of depression on risk factors for epilepsy and the odds of seizure freedom stratified by the presence of depression were performed.We identified 10 595 709 patients in The Health Improvement Network of whom 229 164 (2.2%) developed depression and 97 177 (0.9%) developed epilepsy. The median age was 44 years (interquartile range, 32-58 years) for those with depression and 56 years (interquartile range, 43-71 years) for those with epilepsy. Significantly more patients with depression (144 373 [63%] were women, and 84 791 [37%] were men; P < .001) or epilepsy (54 419 [56%] were women, and 42 758 [44%] were men; P < .001) were female. Incident epilepsy was associated with an increased hazard of developing depression (hazard ratio [HR], 2.04 [95% CI, 1.97-2.09]; P < .001), and incident depression was associated with an increased hazard of developing epilepsy (HR, 2.55 [95% CI, 2.49-2.60]; P < .001) There was an incremental hazard according to depression treatment type with lowest risk for those receiving counselling alone (HR, 1.84 [95% CI, 1.30-2.59]; P < .001), an intermediate risk for those receiving antidepressants alone (HR, 3.43 [95% CI, 3.37-3.47]; P < .001), and the highest risk for those receiving both (HR, 9.85 [95% CI, 5.74-16.90]; P < .001). Furthermore, depression mediated the relationship between sex, social deprivation, and Charlson Comorbidity Index with incident epilepsy, accounting for 4.6%, 7.1%, and 20.6% of the total effects of these explanatory variables, respectively. In the Comprehensive Epilepsy Programme, the odds of failing to achieve 1-year seizure freedom were significantly higher for those with depression or treated depression.Common underlying pathophysiological mechanisms may explain the risk of developing epilepsy following incident depression. Treated depression is associated with worse epilepsy outcomes, suggesting that this may be a surrogate for more severe depression and that severity of depression is associated with severity of epilepsy.

Although psychiatric comorbidity is known to be more prevalent in immune-mediated inflammatory diseases (IMID) than in the general population, the incidence of psychiatric comorbidity in IMID is less understood, yet incidence is more relevant for understanding etiology.Using population-based administrative (health) data, we conducted a retrospective cohort study over the period 1989-2012 in Manitoba, Canada. We identified 19,572 incident cases of IMID including 6119 persons with inflammatory bowel disease (IBD), 3514 persons with multiple sclerosis (MS), 10,206 persons with rheumatoid arthritis (RA), and 97,727 age-, sex- and geographically-matched controls. After applying validated case definitions, we estimated the incidence of depression, anxiety disorder, bipolar disorder and schizophrenia in each of the study cohorts. Using negative binomial regression models, we tested whether the incidence rate of psychiatric comorbidity was elevated in the individual and combined IMID cohorts versus the matched cohorts, adjusting for sex, age, region of residence, socioeconomic status and year.The relative incidence of depression (incidence rate ratio [IRR] 1.71; 95%CI: 1.64-1.79), anxiety (IRR 1.34; 95%CI: 1.29-1.40), bipolar disorder (IRR 1.68; 95%CI: 1.52-1.85) and schizophrenia (IRR 1.32; 95%CI: 1.03-1.69) were elevated in the IMID cohort. Depression and anxiety affected the MS population more often than the IBD and RA populations.Individuals with IMID, including IBD, MS and RA are at increased risk of psychiatric comorbidity. This increased risk appears non-specific as it is seen for all three IMIDs and for all psychiatric disorders studied, implying a common underlying biology for psychiatric comorbidity in those with IMID.

<h3>Objective</h3> Emerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population. <h3>Methods</h3> This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multivariable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores. <h3>Results</h3> A total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (β coefficient = 0.28, <i>p</i> = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (β coefficient = 0.31, <i>p</i> = 0.0004), but not men (β coefficient 0.22, <i>p</i> = 0.17). <h3>Conclusion</h3> Presence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.

The mental health of youth is continually changing and requires reliable monitoring to ensure that adequate social and economic resources are allocated. This study assessed trends in mental health among Canadian youth, 12-24 years old. Specifically, we examined the prevalence of poor/fair perceived mental health, diagnosis of mood and anxiety disorders, suicidality, perceived stress and sleep problems, substance use, and mental health consultations.Data were collected from eight cycles of the annual Canadian Community Health Survey (2011-2018). Prevalence of mental health outcomes was calculated from each survey, and meta-regression was used to assess trends over time. In the absence of a significant trend over time, the eight cycles were pooled together using meta-analysis techniques to gain precision. Trends in prevalence were assessed for the overall sample of youth (12-24 years) and separately for male and female adolescents (12-18 years) and young adults (19-24 years).The prevalence of poor/fair perceived mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased from 2011 to 2018, most strongly among young adult females. Past-year suicidality increased among young adult females but did not change for other age and sex groups. Notably, the prevalence of binge drinking decreased by 2.4% per year for young adult males, 1.0% for young adult females and 0.7% per year for adolescent males, while staying relatively stable for adolescent females. Prevalence of cannabis use declined among adolescents before legalisation (2011-2017); however, this trend did not persist in 2018. Instead, the 2018 prevalence was 5.6% higher than the 2017 prevalence (16.3 v. 10.7%). The combined prevalence of other illicit drug use was stable at 4.6%; however, cocaine use and hallucinogens increased by approximately 0.2% per year.Our findings highlight a growing need for youth mental health services, as indicated by a rise in the prevalence of diagnosed mood and anxiety disorders and past-year mental health consultations. The reason for these observed increases is less apparent - it may represent a true rise in the prevalence of mental illness, or be an artefact of change in diagnostic practices, mental health literacy or diminishing stigma. Nonetheless, the findings indicate a need for the health care system to respond to the rising demand for mental health services among youth.

Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence.Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status.A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%).PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.

The transition to university coincides with a critical developmental period characterised by individuation and separation from family, development of new social connections, and increased autonomy and responsibility. 1 Patton GC Sawyer SM Santelli JS et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016; 387: 2423-2478 Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar At the same time, the brain is undergoing accelerated development and is at heightened sensitivity to risk exposures commonly encountered by university students including psychosocial stressors, recreational drugs, alcohol binging, and sleep disruption. 2 Chung WW Hudziak JJ The transitional age brain: “the best of times and the worst of times”. Child Adolesc Psychiatr Clin N Am. 2017; 26: 157-175 Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar Moreover, most mental disorders emerge by early adulthood and are associated with a substantial delay in treatment. 3 Kessler RC Amminger GP Aguilar-Gaxiola S Alonso J Lee S Ustun TB Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007; 20: 359-364 Crossref PubMed Scopus (1755) Google Scholar Untreated or inadequately treated mental illness is associated with progression to more complex disorders, school dropout, addiction, and self-harm. 4 McGorry PD Purcell R Goldstone S Amminger GP Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Curr Opin Psychiatry. 2011; 24: 301-306 Crossref PubMed Scopus (287) Google Scholar , 5 Hawton K Saunders KE O'Connor RC Self-harm and suicide in adolescents. Lancet. 2012; 379: 2373-2382 Summary Full Text Full Text PDF PubMed Scopus (1155) Google Scholar Taken together, the transition to university coincides with a high-risk period for maladaptive coping, onset of psychopathology, and academic failure; a corollary is that it also represents an important window of opportunity for prevention and timely intervention. Thus, universities need to take a lead role in the development of an integrated system of student mental health care. Mental health initiatives for medical students in BrazilThe comment by Anne Duffy and colleagues1 in The Lancet Psychiatry emphasised that students entering university are dealing with the challenges of family withdrawal, making new friends, and taking on additional responsibilities, while going through a critical period of development. In addition to this, medical students tend to have particular temperament characteristics, including neuroticism, perfectionism, and a strong need for control, and the stressors of facing human suffering and death in a competitive and demanding environment. Full-Text PDF

Background: Cross-sectional studies have reported that certain long-term medical conditions are associated with major depression. Here, these associations are explored using a longitudinal analysis. Methods: Data from the first (1994/95) and second (1996/97) waves of the Canadian National Population Health Survey (NPHS) were utilized. The first wave of the NPHS utilized a probability sample of 17 626 members of the Canadian population. Members of this cohort were recontacted by Statistics Canada 2 years later. The Composite International Diagnostic Interview Short Form for Major Depression was used to identify episodes of major depression in both waves of the survey. Subjects free of major depression in the year preceding the 1994/95 survey were selected for inclusion in this analysis. The incidence of new-onset episodes in subjects with and without reported long-term medical conditions was compared. Results: Individuals suffering from one or more long-term medical conditions were found to be at increased risk of major depression. Migraine headaches, sinusitis and back problems were the conditions most strongly associated with major depression. Having a long-term medical condition approximately doubled the risk of major depression in this analysis. Limitations: The most important limitation of this study was its reliance on self report data about medical conditions. Conclusions: A large proportion of the general population in Canada suffers from long-term medical conditions. These individuals are at increased risk of major depression. This study suggests an important role for long-term medical conditions in the etiology of major depression.

Cross-sectional studies have consistently reported associations between major depression (MD) and chronic medical conditions. Such studies cannot clarify whether medical conditions increase the risk for MD or vice versa. The latter possibility has received relatively little attention in the literature. In this study, we evaluate the incidence of several important chronic medical conditions in people with and without MD. The data source was the Canadian National Population Health Survey (NPHS). The NPHS included the Composite International Diagnostic Interview Short Form to assess past-year major depressive episodes. The NPHS also collected self-report data about professionally diagnosed long-term medical conditions. A longitudinal cohort was interviewed every 2 years between 1994 and 2002. Proportional hazards models were used to compare the incidence of chronic conditions in respondents with and without MD and to produce age-, sex- and covariate-adjusted estimates of the hazard ratios. The adjusted hazard ratios associated with MD at baseline interview were elevated for several long-term medical conditions: heart disease (1.7), arthritis (1.9), asthma (2.1), back pain (1.4), chronic bronchitis or emphysema (2.2), hypertension (1.7) and migraines (1.9). The incidences of cataracts and glaucoma, peptic ulcers and thyroid disease were not higher in respondents with MD. A set of conditions characterized particularly by pain, inflammation and/or autonomic reactivity has a higher incidence in people with MD.

Abstract Background In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008–2009 to reflect advances in the field. There is widespread interest in complementary and alternative medicine (CAM) therapies in the treatment of major depressive disorder (MDD). Methods The CANMAT guidelines are based on a question–answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on Complementary and Alternative Medicine Treatments is one of 5 guideline articles. Results There is Level 1 evidence to support light therapy in seasonal MDD and St. John's wort in mild to moderate MDD. There is also some evidence for the use of exercise, yoga and sleep deprivation, as well as for omega-3 fatty acids and SAM-e . Support for other natural health products and therapies is still limited. Limitations The evidence base remains limited and studies often have methodological problems, including small samples, variability in dose, short duration of treatment, unknown quality of the agent and limited long-term data. Safety data are also sparse with little information about drug interactions. Conclusions Some CAM treatments have evidence of benefit in MDD. However, problems with standardization and safety concerns may limit their applicability in clinical practice.

Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada.A mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta.In total 415 (51 %) residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p < 0.02). Time pressure was reported as the number one factor contributing to stress (44% of males and 57% of females). A considerable proportion of residents would change their specialty program (14%) and even more would not pursue medicine (22%) if given the opportunity to relive their career. Up to 55% of residents reported experiencing intimidation and harassment. Intimidation and harassment was strongly related to gender (12% of males and 38% of females). Many residents (17%) rated their mental health as fair or poor. This was more than double the amount reported in the Canadian Community Health Survey from the province (8%) or the country (7%). Residents highly valued their colleagues (67%), program directors (60%) and external psychiatrist/psychologist (49%) as well-being resources. Over one third of residents wished to have a career counselor (39%) and financial counselor (38%).Many Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

Screening for depression in primary care is an issue that is highly contentious and hotly debated, and recommendations have evolved over time. For example, early policy statements from the 1990s in Canada[1][1] and the United States[2][2] recommended against screening for depression in primary care[

In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. There is renewed interest in refined approaches to brain stimulation, particularly for treatment resistant major depressive disorder (MDD).The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on "Neurostimulation Therapies" is one of 5 guidelines articles.Among the four forms of neurostimulation reviewed in this section, electroconvulsive therapy (ECT) has the most extensive evidence, spanning seven decades. Repetitive transcranial magnetic (rTMS) and vagus nerve stimulation (VNS) have been approved to treat depressed adults in both Canada and the United States with a much smaller evidence base. There is also emerging evidence that deep brain stimulation (DBS) is effective for otherwise treatment resistant depression, but this is an investigational approach in 2009.Compared to other modalities for the treatment of MDD, the data based is limited by the relatively small numbers of randomized controlled trials (RCTs) and small sample sizes.There is most evidence to support ECT as a first-line treatment under specific circumstances and rTMS as a second-line treatment. Evidence to support VNS is less robust and DBS remains an investigational treatment.

The prevalence of major depression (MD) in persons with nonpsychiatric medical conditions is an indicator of clinical need in those groups, an indicator of the feasibility of screening and case-finding efforts, and a source of etiologic hypotheses. This analysis explores the prevalence of MD in the general population in relation to various long-term medical conditions.We used a dataset from a large-scale Canadian national health survey, the Canadian Community Health Survey (CCHS). The sample consisted of 115 071 subjects aged 18 years and over, randomly sampled from the Canadian population. The survey interview recorded self-reported diagnoses of various long-term medical conditions and employed a brief predictive interview for MD, the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression was used to adjust estimates of association for age and sex.The conditions most strongly associated with MD were chronic fatigue syndrome (adjusted odds ratio [AOR] 7.2) and fibromyalgia (AOR 3.4). The conditions least strongly associated were hypertension (AOR 1.2), diabetes, heart disease, and thyroid disease (AOR 1.4 in each case). We found associations with various gastrointestinal, neurologic, and respiratory conditions.A diverse set of long-term medical conditions are associated with MD, although previous studies might have lacked power to detect some of these associations. The strength of association in prevalence data, however, varies across specific conditions.

To evaluate the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) in people with schizophrenia. We conducted a period-prevalence study using a population-based cohort from Alberta administrative databases. Schizophrenia was identified using billing codes; all other individuals served as non-schizophrenic controls. Modifiable CV-RF (hypertension, dyslipidemia, diabetes) and established CV-D (acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), stroke, arrhythmia) were identified using previously validated methods. Analyses were conducted using multivariable logistic regression. From 1995 to 2006, 28,755 people (1.2%) were identified with schizophrenia and compared with 2,281,636 non-schizophrenic controls. Individuals with schizophrenia were older (mean age 47.6 years vs. 45.3) and had lower socioeconomic status (59% received healthcare subsidies vs. 21%; OR: 5.55; 95% CI: 5.42–5.69) than controls. Of the CV-RF, diabetes was more common in those with schizophrenia than controls, particularly in younger males (ages 30–39, 3.8% vs. 1.4%, aOR: 1.57; 95% CI: 1.30–1.91) and females (ages 30–39, 5.8% vs. 2.4%, aOR: 1.72; 95% CI: 1.44–2.04). The prevalence of CV-D was significantly higher in people with schizophrenia than controls (27% vs. 17%, OR: 1.76; 95% CI: 1.72–1.81). On a population-wide basis, people with schizophrenia had a higher prevalence of diabetes and cardiovascular disease than those without schizophrenia, particularly at a younger age. Female sex offered no cardiovascular protection in those with schizophrenia. Our data suggest monitoring for diabetes and other cardiovascular risk factors should begin at the time of diagnosis of schizophrenia, particularly in females with schizophrenia.

Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider.We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties.The initial testing OMS-HC scale showed good internal consistency, Cronbach's alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested.The OMS-HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers.

In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. This article, one of five in the series, reviews new studies of psychotherapy in the acute and maintenance phase of MDD, including computer-based and telephone-delivered psychotherapy.The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. Evidence-based responses are based on updated systematic reviews of the literature and recommendations are graded according to the Level of Evidence, using pre-defined criteria. Lines of Treatment are identified based on criteria that included evidence and expert clinical support.Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) continue to have the most evidence for efficacy, both in acute and maintenance phases of MDD, and have been studied in combination with antidepressants. CBT is well studied in conjunction with computer-delivered methods and bibliotherapy. Behavioural Activation and Cognitive-Behavioural Analysis System of Psychotherapy have significant evidence, but need replication. Newer psychotherapies including Acceptance and Commitment Therapy, Motivational Interviewing, and Mindfulness-Based Cognitive Therapy do not yet have significant evidence as acute treatments; nor does psychodynamic therapy.Although many forms of psychotherapy have been studied, relatively few types have been evaluated for MDD in randomized controlled trials. Evidence about the combination of different types of psychotherapy and antidepressant medication is also limited despite widespread use of these therapies concomitantly.CBT and IPT are the only first-line treatment recommendations for acute MDD and remain highly recommended for maintenance. Both computer-based and telephone-delivered psychotherapy--primarily studied with CBT and IPT--are useful second-line recommendations. Where feasible, combined antidepressant and CBT or IPT are recommended as first-line treatments for acute MDD.

Annals of NeurologyVolume 55, Issue 5 p. 756-756 Letters Minocycline reduces gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis Luanne M. Metz MD, FRCPC, Luanne M. Metz MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorYunyan Zhang MD, Yunyan Zhang MD Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorMichael Yeung MD, FRCPC, Michael Yeung MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorDavid G. Patry MD, FRCPC, David G. Patry MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorRobert B. Bell MD, FRCPC, Robert B. Bell MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorCristina A. Stoian MD, MSc, Cristina A. Stoian MD, MSc Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorV. Wee Yong PhD, V. Wee Yong PhD Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorScott B. Patten MD, PhD, Scott B. Patten MD, PhD Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorPierre Duquette MD, FRCPC, Pierre Duquette MD, FRCPC Department of Neurology, University of Montreal, Montreal, Quebec, CanadaSearch for more papers by this authorJack P. Antel MD, FRCPC, Jack P. Antel MD, FRCPC Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorJ. Ross Mitchell PhD, J. Ross Mitchell PhD Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada Diagnostic Imaging, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this author Luanne M. Metz MD, FRCPC, Luanne M. Metz MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorYunyan Zhang MD, Yunyan Zhang MD Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorMichael Yeung MD, FRCPC, Michael Yeung MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorDavid G. Patry MD, FRCPC, David G. Patry MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorRobert B. Bell MD, FRCPC, Robert B. Bell MD, FRCPC Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorCristina A. Stoian MD, MSc, Cristina A. Stoian MD, MSc Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorV. Wee Yong PhD, V. Wee Yong PhD Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorScott B. Patten MD, PhD, Scott B. Patten MD, PhD Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorPierre Duquette MD, FRCPC, Pierre Duquette MD, FRCPC Department of Neurology, University of Montreal, Montreal, Quebec, CanadaSearch for more papers by this authorJack P. Antel MD, FRCPC, Jack P. Antel MD, FRCPC Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorJ. Ross Mitchell PhD, J. Ross Mitchell PhD Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada Diagnostic Imaging, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this author First published: 26 April 2004 https://doi.org/10.1002/ana.20111Citations: 126Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume55, Issue5May 2004Pages 756-756 RelatedInformation

Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.The prevalence of child hunger was 5.7% (95% CI 5.0-6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4-5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2-4.3).A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health.

Abstract Background The use of complementary and alternative medicine (CAM) is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine. Methods Data from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS) were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use. Results Weighted estimates show that 12.4% (95% Confidence Interval (CI): 12.2-12.5) of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7) and migraine 19.0% (95% CI: 18.4-19.6), and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6) while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2) was not significantly different from the general population. Conclusion A large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care.

A strategy for reducing mental illness-related stigma in health-profession students is to include contact-based sessions in their educational curricula. In such sessions students are able to interact socially with a person that has a mental illness. We sought to evaluate the effectiveness of this strategy in a multi-centre study of pharmacy students. The study was a randomized controlled trial conducted at three sites. Because it was necessary that all students receive the contact-based sessions, the students were randomized either to an early or late intervention, with the late intervention group not having participated in the contact-based education at the time when the primary outcome was assessed. The primary outcome, stigma, was assessed using an attitudes scale called the Opening Minds Survey for Health Care Providers (OMS-HC). We initially confirmed that outcomes were homogeneous across study centres, centre by group interaction, p = 0.76. The results were pooled across the three study centres. A significant reduction in stigma was observed in association with the contact-based sessions (mean change 4.3 versus 1.5, t=2.1, p=0.04). The effect size (Cohen’s d) was 0.45. A similar reduction was seen in the control group when they later received the intervention. Contact-based education is an effective method of reducing stigma during pharmacy education. These results add to a growing literature confirming the effectiveness of contact-based strategies for stigma reduction in health profession trainees.

Major depressive disorder (MDD) is one of the most burdensome illnesses in Canada. The purpose of this introductory section of the 2009 revised CANMAT guidelines is to provide definitions of the depressive disorders (with an emphasis on MDD), summarize Canadian data concerning their epidemiology and describe overarching principles of managing these conditions. This section on “Classification, Burden and Principles of Management” is one of 5 guideline articles in the 2009 CANMAT guidelines. The CANMAT guidelines are based on a question–answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to the Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time in their lives, and approximately 4% during any given year. MDD has a detrimental impact on overall health, role functioning and quality of life. Detection of MDD, accurate diagnosis and provision of evidence-based treatment are challenging tasks for both clinicians and for the health systems in which they work. Epidemiologic and clinical data cannot be seamlessly linked due to heterogeneity of syndromes within the population. In the eight years since the last CANMAT Guidelines for Treatment of Depressive Disorders were published, progress has been made in understanding the epidemiology and treatment of these disorders. Evidence supporting specific therapeutic interventions is summarized and evaluated in subsequent sections.

BackgroundDepression and anxiety are common in persons with multiple sclerosis (MS), and adversely affect fatigue, medication adherence, and quality of life. Though effective treatments for depression and anxiety exist in the general population, their applicability in the MS population has not been definitively established.ObjectiveTo determine the overall effect of psychological and pharmacological treatments for depression or anxiety in persons with MS.MethodsWe searched the Medline, EMBASE, PsycINFO, PsycARTICLES Full Text, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and Scopus databases using systematic review methodology from database inception until March 25, 2015. Two independent reviewers screened abstracts, extracted data, and assessed risk of bias and strength of evidence. We included controlled clinical trials reporting on the effect of pharmacological or psychological interventions for depression or anxiety in a sample of persons with MS. We calculated standardized mean differences (SMD) and pooled using random effects meta-analysis.ResultsOf 1753 abstracts screened, 21 articles reporting on 13 unique clinical trials met the inclusion criteria. Depression severity improved in nine psychological trials of depression treatment (N=307; SMD: −0.45 (95%CI: −0.74, −0.16)). The severity of depression also improved in three pharmacological trials of depression treatment (SMD: −0.63 (N=165; 95%CI: −1.07, −0.20)). For anxiety, only a single trial examined psychological therapy for injection phobia and reported no statistically significant improvement.ConclusionPharmacological and psychological treatments for depression were effective in reducing depressive symptoms in MS. The data are insufficient to determine the effectiveness of treatments for anxiety.

Objective: To determine whether major depression (MD) leads to an increased risk of new-onset high blood pressure diagnoses. Methods: The data source was the Canadian National Population Health Survey (NPHS). The NPHS included a short-form version of the Composite International Diagnostic Interview (CIDI-SF) to assess MD and collected self-report data about professionally diagnosed high blood pressure and the use of antihypertensive medications. The analysis included 12,270 respondents who did not report high blood pressure or the use of antihypertensive medications at a baseline interview conducted in 1994. Proportional hazards models were used to compare the incidence of high blood pressure in respondents with and without MD during 10 years of subsequent follow-up. Results: After adjustment for age, the risk of developing high blood pressure was elevated in those with MD. The hazard ratio was 1.6 (95% Confidence Interval = 1.2–2.1), p = .001, indicating a 60% increase in risk. Adjustment for additional covariates did not alter the association. Conclusions: MD may be a risk factor for new-onset high blood pressure. Epidemiologic data cannot definitely confirm a causal role, and the association may be due to shared etiologic factors. However, the increased risk may warrant closer monitoring of blood pressure in people with depressive disorders. MD = major depression; HR = hazard ratio; CI = Confidence Interval; NPHS = National Population Health Survey; OR = odds ratio; CARDIA Study = Coronary Artery Risk Development in Young Adults; CES-D = Center for Epidemiologic Studies Depression Rating Scale; CIDI-SF = Composite International Diagnostic Interview Short Form.

Diminishing stigmatization for those with mental illnesses by health care providers (HCPs) is becoming a priority for programming and policy, as well as research. In order to be successful, we must accurately measure stigmatizing attitudes and behaviours among HCPs. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was developed to measure stigma in HCP populations. In this study we revisit the factor structure and the responsiveness of the OMS-HC in a larger, more representative sample of HCPs that are more likely to be targets for anti-stigma interventions.Baseline data were collected from HCPs (n = 1,523) during 12 different anti-stigma interventions across Canada. The majority of HCPs were women (77.4%) and were either physicians (MDs) (41.5%), nurses (17.0%), medical students (13.4%), or students in allied health programs (14.0%). Exploratory factor analysis (EFA) was conducted using complete pre-test (n = 1,305) survey data and responsiveness to change analyses was examined with pre and post matched data (n = 803). The internal consistency of the OMS-HC scale and subscales was evaluated using the Cronbach's alpha coefficient. The scale's sensitivity to change was examined using paired t-tests, effect sizes (Cohen's d), and standardized response means (SRM).The EFA favored a 3-factor structure which accounted for 45.3% of the variance using 15 of 20 items. The overall internal consistency for the 15-item scale (α = 0.79) and three subscales (α = 0.67 to 0.68) was acceptable. Subgroup analysis showed the internal consistency was satisfactory across HCP groups including physicians and nurses (α = 0.66 to 0.78). Evidence for the scale's responsiveness to change occurred across multiple samples, including student-targeted interventions and workshops for practicing HCPs. The Social Distance subscale had the weakest level of responsiveness (SRM ≤ 0.50) whereas the more attitudinal-based items comprising the Attitude (SRM ≤ 0.91) and Disclosure and Help-seeking (SRM ≤ 0.68) subscales had stronger responsiveness.The OMS-HC has shown to have acceptable internal consistency and has been successful in detecting positive changes in various anti-stigma interventions. Our results support the use of a 15-item scale, with the calculation of three sub scores for Attitude, Disclosure and Help-seeking, and Social Distance.

While mental comorbidity is considered common in multiple sclerosis (MS), its impact is poorly defined; methods are needed to support studies of mental comorbidity. We validated and applied administrative case definitions for any mental comorbidities in MS.Using administrative health data we identified persons with MS and a matched general population cohort. Administrative case definitions for any mental comorbidity, any mood disorder, depression, anxiety, bipolar disorder and schizophrenia were developed and validated against medical records using a a kappa statistic (k). Using these definitions we estimated the prevalence of these comorbidities in the study populations.Compared to medical records, administrative definitions showed moderate agreement for any mental comorbidity, mood disorders and depression (all k ≥ 0.49), fair agreement for anxiety (k = 0.23) and bipolar disorder (k = 0.30), and near perfect agreement for schizophrenia (k = 1.0). The age-standardized prevalence of all mental comorbidities was higher in the MS than in the general populations: depression (31.7% vs. 20.5%), anxiety (35.6% vs. 29.6%), and bipolar disorder (5.83% vs. 3.45%), except for schizophrenia (0.93% vs. 0.93%).Administrative data are a valid means of surveillance of mental comorbidity in MS. The prevalence of mental comorbidities, except schizophrenia, is increased in MS compared to the general population.

Marital status is important to the epidemiology of psychiatric disorders. In particular, the high prevalence of major depression in individuals with separated, divorced, or widowed status has been well documented. However, the literature is divided as to whether marital disruption results in major depression and/or vise versa. We examined whether major depression influences changes of marital status, and, conversely, whether marital status influences the incidence of this disorder.We employed data from the longitudinal Canadian National Population Health Survey (1994-2004), and proportional hazards models with time-varying covariates.Major depression had no effect on the proportion of individuals who changed from single to common-law, single to married, or common-law to married status. In contrast, exposure to depression doubled the proportion of transitions from common-law or married to separated or divorced status (HR=2.0; 95% CI 1.4-2.9 P<0.001). Conversely an increased proportion of nondepressed individuals with separated or divorced status subsequently experienced major depression (hazard ratio, HR=1.3; 95% CI 1.0-1.5 P=0.04).The high prevalence of major depression in separated or divorced individuals is due to both an increased risk of marital disruption in those with major depression, and also to the higher risk of this disorder in those with divorced or separated marital status. Thus a clinically significant interplay exists between major depression and marital status. Clinicians should be aware of the deleterious impact of major depression on marital relationships. Proactive management of marital problems in clinical settings may help minimize the psycho-social "scar" that is sometimes associated with this disorder.

The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM).A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma.Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p < 0.0001), but were not significantly changed following the one-time contact based educational intervention in the primary analysis. Student confidence in working with people with a mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points.Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student's internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career.

Marital status is associated with major depression prevalence, however, the strength of association may be modified by age and gender.The data sources were a series of cross sectional national health surveys of the Canadian population carried out by Statistics Canada during 1996-2013. These were cross-sectional files from the National Population Health Survey of 1996, together with the Canadian Community Health Surveys from 2000 to 2013; the respondents were 18 years and older. The data was analyzed with meta-analytic techniques and logistic regression.In terms of gender, the odds ratios of depression were smaller for females (vs males) who were single, widowed or separated compared to married people. Regarding age, the odds ratios for depression showed a steady rise with increasing age for those in single and in common-law relationships compared to married people. In contrast the odds ratios for depression declined with age for those widowed, separated and divorced compared to married people. The strength of the interaction terms used to quantify these moderating effects showed no change from 1996 to 2013.Only one member of each household was included, so that relationship issues could not be studied. The generalizability of our findings requires international data. Also the diagnostic interviews used are not as accurate as clinical assessments.Use of large numbers of participants has revealed some robust modifying effects of both gender and age on the depression/marital status relationship. The clinical significance of our findings is that the vulnerability to development of depression is not only related to marital status, but that this relationship is modified by age and gender.

We aimed to evaluate the validity and reliability of multiple screening measures for depression and anxiety for use in the clinical care of people with multiple sclerosis (MS).Participants with MS completed the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Kessler-6 Distress Scale, PROMIS Emotional Distress Depression Short-Form 8a (PROMIS Depression) and Anxiety Short-Form 8a (PROMIS Anxiety), Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Overall Anxiety and Severity Impairment Scale (OASIS). A subgroup repeated the screening measures two weeks later. All participants also completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID). For the screening measures we computed sensitivity, specificity, positive predictive and negative predictive value with SCID diagnoses as the reference standard and conducted receiver operating curve (ROC) analyses; we also assessed internal consistency and test-retest reliability.Of 253 participants, the SCID classified 10.3% with major depression and 14.6% with generalized anxiety disorder. Among the depression measures, the PHQ-9 had the highest sensitivity (84%). Specificity was generally higher than sensitivity, and was highest for the HADS-D with a cut-point of 11 (95%). In ROC analyses the area under the curve (AUC) did not differ between depression measures. Among the anxiety measures, sensitivity was highest for the HADS-A with a cut-point of 8 (82%). Specificity ranged from 83% to 86% for all measures except the HADS-A with a cut-point of 8 (68%). The AUC did not differ between anxiety measures.Overall, performance of the depression and anxiety screening measures was very similar, with reasonable psychometric properties for the MS population, suggesting that other factors such as accessibility and ease of use could guide the choice of measure in clinical practice.

Objective The main objective of this study was to summarize the effects of various individual, caregiver, and system-related factors on the risk of long-term care (LTC) placement for persons with dementia. Methods We searched electronic databases for longitudinal studies reporting on predictors of LTC placement for persons with dementia residing in the community or supportive care settings. We performed meta-analyses with hazard ratios (HRs) of various predictors using random effects models and stratified the HRs with several study variables. Data on predictors not included in the meta-analyses were summarized descriptively. Results Full-text reviews of 360 papers were performed with data from 37 papers used to calculate pooled HRs for LTC placement of select person with dementia (age, sex, race, marital status, type of dementia, living arrangement, and relationship to caregiver) and caregiver (age, sex, and depressive symptoms) characteristics. White race [HR = 1.67, 95% confidence intervals (CI): 1.41–1.99], greater dementia severity (HR = 1.05, 95% CI: 1.03–1.06), and older age (HR = 1.02, 95% CI: 1.01–1.03) increased the risk of LTC placement. Married persons with dementia (HR = 0.38, 95% CI: 0.16–0.86) and living with their caregiver (HR = 0.72, 95% CI: 0.56–0.92) had a lower risk. Behavioral and psychological symptoms of dementia, the degree of functional impairment, and caregiver burden had a consistent effect on the risk of LTC placement in our descriptive review. Conclusion We quantified the predictive effect of several risk factors for LTC placement. These estimates could be used to more precisely categorize the risk of institutionalization and potentially link those at higher risk to appropriate services. Copyright © 2016 John Wiley & Sons, Ltd.

Despite the importance of comorbidity in multiple sclerosis (MS), methods for comorbidity assessment in MS are poorly developed.We validated and applied administrative case definitions for diabetes, hypertension, and hyperlipidemia in MS.Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for diabetes, hypertension, and hyperlipidemia were derived using hospital, physician, and prescription claims, and validated in 430 persons with MS. We examined temporal trends in the age-adjusted prevalence of these conditions from 1984-2006.Agreement between various case definitions and medical records ranged from kappa (κ) =0.51-0.69 for diabetes, κ =0.21-0.71 for hyperlipidemia, and κ =0.52-0.75 for hypertension. The 2005 age-adjusted prevalence of diabetes was similar in the MS (7.62%) and general populations (8.31%; prevalence ratio [PR] 0.91; 0.81-1.03). The age-adjusted prevalence did not differ for hypertension (MS: 20.8% versus general: 22.5% [PR 0.91; 0.78-1.06]), or hyperlipidemia (MS: 13.8% versus general: 15.2% [PR 0.90; 0.67-1.22]). The prevalence of all conditions rose in both populations over the study period.Administrative data are a valid means of tracking diabetes, hypertension, and hyperlipidemia in MS. The prevalence of these comorbidities is similar in the MS and general populations.

We aimed to compare the incidence and prevalence of psychiatric comorbidity in the multiple sclerosis (MS) population and in controls matched for age, sex, and geographic area.Using population-based administrative health data from 4 Canadian provinces, we identified 2 cohorts: 44,452 persons with MS and 220,849 controls matched for age, sex, and geographic area. We applied validated case definitions to estimate the incidence and prevalence of depression, anxiety, bipolar disorder, and schizophrenia from 1995 to 2005. We pooled the results across provinces using meta-analyses.Of the MS cases, 31,757 (71.3%) were women with a mean (SD) age at the index date of 43.8 (13.7) years. In 2005, the annual incidence of depression per 100,000 persons with MS was 979 while the incidence of anxiety was 638, of bipolar disorder was 328, and of schizophrenia was 60. The incidence and prevalence estimates of all conditions were higher in the MS population than in the matched population. Although the incidence of depression was higher among women than men in both populations, the disparity in the incidence rates between the sexes was lower in the MS population (incidence rate ratio 1.26; 95% confidence interval: 1.07-1.49) than in the matched population (incidence rate ratio 1.50; 95% confidence interval: 1.21-1.86). Incidence rates were stable over time while prevalence increased slightly.Psychiatric comorbidity is common in MS, and more frequently affected the MS population than a matched population, although the incidence was stable over time. Men with MS face a disproportionately greater relative burden of depression when they develop MS than women.

Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MEDLINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate‐to‐severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens–Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.

Depression affects approximately 25% of epilepsy patients. However, the optimal tool to screen for depression in epilepsy has not been definitively established. The purpose of this study was to systematically review the literature on the validity of depression-screening tools in epilepsy.MEDLINE, EMBASE, and PsycINFO were searched until April 4, 2016 with no restriction on dates. Abstract, full-text review and data abstraction were conducted in duplicate. We included studies that evaluated the validity of depression-screening tools and reported measures of diagnostic accuracy (e.g., sensitivity, specificity, and negative and positive predictive values) in epilepsy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies Version 2. Medians and ranges for estimates of diagnostic accuracy were calculated when appropriate.A total of 16,070 abstracts were screened, and 38 articles met eligibility criteria. Sixteen screening tools were validated in 13 languages. The most commonly validated screening tool was the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) (n = 26). The Mini International Neuropsychiatric Interview (MINI) (n = 19) was the most common reference standard used. At the most common cutpoint of >15 (n = 12 studies), the NDDI-E had a median sensitivity of 80.5% (range 64.0-100.0) and specificity of 86.2 (range 81.0-95.6). Meta-analyses were not possible due to variability in cutpoints assessed, reference standards used, and lack of confidence intervals reported.A number of studies validated depression screening tools; however, estimates of diagnostic accuracy were inconsistently reported. The validity of scales in practice may have been overestimated, as cutpoints were often selected post hoc based on the study sample. The NDDI-E, which performed well, was the most commonly validated screening tool, is free to the public, and is validated in multiple languages and is easy to administer, although selection of the best tool may vary depending on the setting and available resources.

We estimated the incidence and prevalence of depression, anxiety disorder, bipolar disorder, and schizophrenia in a population-based cohort with rheumatoid arthritis (RA) as compared to an age-, sex-, and geographically matched cohort without RA.Using population-based administrative health data from Manitoba, Canada, we identified persons with incident RA between 1989 and 2012, and a cohort from the general population matched 5:1 on year of birth, sex, and region of residence. We applied validated algorithms for depression, anxiety disorder, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions after the diagnosis of RA, and their lifetime and annual period prevalence. We compared findings between cohorts using negative binomial regression models.We identified 10,206 incident cases of RA and 50,960 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, number of physician visits, and year, the incidence of depression was higher in the RA cohort over the study period (incidence rate ratio [IRR] 1.46 [95% confidence interval (95% CI) 1.35-1.58]), as was the incidence of anxiety disorder (IRR 1.24 [95% CI 1.15-1.34]) and bipolar disorder (IRR 1.21 [95% CI 1.00-1.47]). The incidence of schizophrenia did not differ between groups (IRR 0.96 [95% CI 0.61-1.50]). Incidence rates of psychiatric disorders declined minimally over time. The lifetime and annual period prevalence of depression and anxiety disorder were also higher in the RA than in the matched cohort over the study period.The incidence and prevalence of depression, anxiety disorder, and bipolar disorder are elevated in the RA population as compared to a matched population.

Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year.The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+) participating in the Alberta Continuing Care Epidemiological Studies (ACCES). Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS). The area under the ROC curve (AUC) was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined.Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items) showing no significant association. For death and long-term care placement, the addition of frailty (however derived) or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items) showed significantly better performance over the other measures in predicting long-term care placement.Using different approaches, varying degrees of frailty were detected within the AL population. The various approaches to defining frailty were generally more similar than dissimilar with regard to predictive accuracy with some exceptions. The clinical implications and opportunities of detecting frailty in more vulnerable older adults require further investigation.

To investigate the relation between work environmental factors and the risk of major depressive disorder (MDD) over 1 year, the authors conducted a population-based longitudinal study of randomly selected employees in Alberta, Canada (January 2008 to November 2011). Participants without a current or lifetime diagnosis of MDD at baseline (n = 2,752) were followed for 1 year. MDD was assessed using the World Health Organization's Composite International Diagnostic Interview-Auto 2.1. The overall 1-year incidence of MDD was 3.6% (95% confidence interval: 2.8, 4.6); it was 2.9% (95% confidence interval: 1.9, 4.2) in men and 4.5% (95% confidence interval: 3.3, 6.2) in women. The relations between work environmental factors and MDD differed by sex. In men, high job strain increased the risk of MDD in those who worked 35-40 hours per week; job insecurity and family-to-work conflict were predictive of MDD. Women who worked 35-40 hours per week and reported job insecurity, a high effort-reward imbalance, and work-to-family conflict were at a higher risk of developing MDD. Job strain, effort-reward imbalance, job insecurity, and work-to-family conflicts are important risk factors for the onset of MDD and should be targets of primary prevention. However, these work environmental factors appear to operate differently in men and in women.

After the diagnosis of immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), the incidence of psychiatric comorbidity is increased relative to the general population. We aimed to determine whether the incidence of psychiatric disorders is increased in the 5 years before the diagnosis of IMID as compared with the general population.Using population-based administrative health data from the Canadian province of Manitoba, we identified all persons with incident IBD, MS and RA between 1989 and 2012, and cohorts from the general population matched 5 : 1 on year of birth, sex and region to each disease cohort. We identified members of these groups with at least 5 years of residency before and after the IMID diagnosis date. We applied validated algorithms for depression, anxiety disorders, bipolar disorder, schizophrenia, and any psychiatric disorder to determine the annual incidence of these conditions in the 5-year periods before and after the diagnosis year.We identified 12 141 incident cases of IMID (3766 IBD, 2190 MS, 6350 RA) and 65 424 matched individuals. As early as 5 years before diagnosis, the incidence of depression [incidence rate ratio (IRR) 1.54; 95% CI 1.30-1.84) and anxiety disorders (IRR 1.30; 95% CI 1.12-1.51) were elevated in the IMID cohort as compared with the matched cohort. Similar results were obtained for each of the IBD, MS and RA cohorts. The incidence of bipolar disorder was elevated beginning 3 years before IMID diagnosis (IRR 1.63; 95% CI 1.10-2.40).The incidence of psychiatric comorbidity is elevated in the IMID population as compared with a matched population as early as 5 years before diagnosis. Future studies should elucidate whether this reflects shared risk factors for psychiatric disorders and IMID, a shared final common inflammatory pathway or other aetiology.

To summarize the ongoing activities of the Opening Minds (OM) Anti-Stigma Initiative of the Mental Health Commission of Canada regarding the 4 groups targeted (youth, health care providers, media, and workplaces), highlight some of the key methodological challenges, and review lessons learned.The approach used by OM is rooted in community development philosophy, with clearly defined target groups, contact-based education as the central organizing element across interventions, and a strong evaluative component so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope.Results have been generally positive. Contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across various target groups and sectors. Variations in program outcomes have contributed to our understanding of active ingredients.Contact-based education has become a cornerstone of the OM approach to stigma reduction. A story of hope and recovery told by someone who has experienced a mental illness is powerful and engaging, and a critical ingredient in the fight against stigma. Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming. The next challenge will be to scale these up so that they may have a national impact.

Objective The Mental Health Commission of Canada was formed as a national catalyst for improving the mental health system. One of its initiatives is Opening Minds ( OM ), whose mandate is to reduce mental health‐related stigma. This article reports findings from a qualitative study on antistigma interventions for healthcare providers, which includes a process model articulating key stages and strategies for implementing successful antistigma programmes. Method The study employed a grounded theory methodology. Data collection involved in‐depth interviews with programme stakeholders, direct observation of programmes, a review of programme documents, and qualitative feedback from programme participants. Analysis proceeded via the constant comparison method. A model was generated to visually present key findings. Results Twenty‐three in‐depth interviews were conducted representing 18 different programmes. Eight programmes were observed directly, 48 programme documents were reviewed, and data from 1812 programme participants were reviewed. The analysis led to a four‐stage process model for implementing successful antistigma programmes targeting healthcare providers, informed by the basic social process ‘targeting the roots of healthcare provider stigma’. Conclusion The process model developed through this research may function as a tool to help guide the development and implementation of antistigma programmes in healthcare contexts.

Major depressive disorder (MDD) may be present in 10%-20% of patients in medical settings. Routine depression screening is sometimes recommended to improve depression management. However, studies of the diagnostic accuracy of depression screening tools have typically used data-driven, exploratory methods to select optimal cutoffs. Often, these studies report results from a small range of cutoff points around whatever cutoff score is most accurate in that given study. When published data are combined in meta-analyses, estimates of accuracy for different cutoff points may be based on data from different studies, rather than data from all studies for each possible cutoff point. As a result, traditional meta-analyses may generate exaggerated estimates of accuracy. Individual patient data (IPD) meta-analyses can address this problem by synthesizing data from all studies for each cutoff score to obtain diagnostic accuracy estimates. The nine-item Patient Health Questionnaire-9 (PHQ-9) and the shorter PHQ-2 and PHQ-8 are commonly recommended for depression screening. Thus, the primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2 to detect MDD among adults across all potentially relevant cutoff scores. Secondary analyses involve assessing accuracy accounting for patient factors that may influence accuracy (age, sex, medical comorbidity).Data sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. We will include studies that included a Diagnostic and Statistical Manual or International Classification of Diseases diagnosis of MDD based on a validated structured or semi-structured clinical interview administered within 2 weeks of the administration of the PHQ. Two reviewers will independently screen titles and abstracts, perform full article review, and extract study data. Disagreements will be resolved by consensus. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cutoff values.The proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2.PROSPERO CRD42014010673.

To determine the prevalence of comorbidity in the multiple sclerosis (MS) population at the time of MS diagnosis. We also compared the prevalence of comorbidity in the MS population to that in a matched cohort from the general population.Using population-based administrative health data from 4 Canadian provinces, we identified 23,382 incident MS cases and 116,638 age-, sex-, and geographically matched controls. We estimated the prevalence of hypertension, diabetes, hyperlipidemia, heart disease, chronic lung disease, epilepsy, fibromyalgia, inflammatory bowel disease, depression, anxiety, bipolar disorder, and schizophrenia at MS diagnosis using validated case definitions. We compared the populations using rate ratios.Of the MS cases, 16,803 (71.9%) were female. The most prevalent comorbidity was depression (19.1%). Compared to the matched population, all comorbidities except hyperlipidemia were more common in the MS population. Relative to the matched populations, the prevalence of hypertension was 16% higher for women with MS and 48% higher for men with MS, thus there was a disproportionately higher prevalence of hypertension in men with MS than women. Men with MS also had a disproportionately higher prevalence than women with MS for diabetes, epilepsy, depression, and anxiety.Comorbidity is more common than expected in MS, even around the time of diagnosis. The prevalence of psychiatric comorbidity is particularly high and highlights the need for clinical attention to this issue. The observed sex-specific differences in the burden of comorbidity in MS, which differ from those in the matched population, warrant further investigation.

Idiopathic scoliosis (IS) is a spine deformity that affects approximately 3% of the population. The underlying causes of IS are not well understood, although there is clear evidence that there is a genetic component to the disease. Genetic mapping studies suggest high genetic heterogeneity, but no IS disease-causing gene has yet been identified. Here, genetic linkage analyses combined with exome sequencing identified a rare missense variant (p.A446T) in the centriolar protein gene POC5 that cosegregated with the disease in a large family with multiple members affected with IS. Subsequently, the p.A446T variant was found in an additional set of families with IS and in an additional 3 cases of IS. Moreover, POC5 variant p.A455P was present and linked to IS in one family and another rare POC5 variant (p.A429V) was identified in an additional 5 cases of IS. In a zebrafish model, expression of any of the 3 human IS-associated POC5 variant mRNAs resulted in spine deformity, without affecting other skeletal structures. Together, these findings indicate that mutations in the POC5 gene contribute to the occurrence of IS.

BackgroundWe evaluated the validity and reliability of multiple symptom scales for depression and anxiety for persons with inflammatory bowel disease (IBD).

To evaluate the association between comorbidity and relapse rate in individuals with multiple sclerosis (MS).We recruited individuals with prevalent relapsing-onset MS from 4 Canadian MS Clinics to participate in a 2-year prospective multicenter cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using questionnaires, and relapses were captured from medical records at each visit. The association between comorbidities at baseline and relapse rate over the subsequent 2-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status.Of 885 participants, 678 (76.6%) were women, averaging age 48.2 years at baseline. Anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%), and hyperlipidemia (11.9%) were the most prevalent comorbidities. The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years 1 and 2 post-baseline. After adjustment, participants reporting ≥3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent 2 years (adjusted rate ratio 1.45, 95% confidence interval [CI] 1.00-2.08). Migraine and hyperlipidemia were associated with increased relapse rate (adjusted rate ratio 1.38; 95% CI 1.01-1.89 and 1.67; 95% CI 1.07-2.61, respectively).Individuals with migraine, hyperlipidemia, or a high comorbidity burden (3 or more conditions) had an increased relapse rate over 2 years. These findings have potential implications for understanding the pathophysiology of MS relapses, and suggest that closer monitoring of individuals with specific or multiple comorbidities may be needed. Future research is needed to understand if the presence of comorbidity warrants a tailored approach to MS management.

Because the collection of mental health information through interviews is expensive and time consuming, interest in using population-based administrative health data to conduct research on depression has increased. However, there is concern that misclassification of disease diagnosis in the underlying data might bias the results. Our objective was to determine the validity of International Classification of Disease (ICD)-9 and ICD-10 administrative health data case definitions for depression using review of family physician (FP) charts as the reference standard.Trained chart reviewers reviewed 3362 randomly selected charts from years 2001 and 2004 at 64 FP clinics in Alberta (AB) and British Columbia (BC), Canada. Depression was defined as presence of either: 1) documentation of major depressive episode, or 2) documentation of specific antidepressant medication prescription plus recorded depressed mood. The charts were linked to administrative data (hospital discharge abstracts and physician claims data) using personal health numbers. Validity indices were estimated for six administrative data definitions of depression using three years of administrative data.Depression prevalence by chart review was 15.9-19.2% depending on year, region, and province. An ICD administrative data definition of '2 depression claims with depression ICD codes within a one-year window OR 1 discharge abstract data (DAD) depression diagnosis' had the highest overall validity, with estimates being 61.4% for sensitivity, 94.3% for specificity, 69.7% for positive predictive value, and 92.0% for negative predictive value. Stratification of the validity parameters for this case definition showed that sensitivity was fairly consistent across groups, however the positive predictive value was significantly higher in 2004 data compared to 2001 data (78.8 and 59.6%, respectively), and in AB data compared to BC data (79.8 and 61.7%, respectively).Sensitivity of the case definition is often moderate, and specificity is often high, possibly due to undercoding of depression. Limitations to this study include the use of FP charts data as the reference standard, given the potential for missed or incorrect depression diagnoses. These results suggest that that administrative data can be used as a source of information for both research and surveillance purposes, while remaining aware of these limitations.

Objective To determine if antidepressant drug usage is associated with cognitive impairment or dementia, including Alzheimer disease (AD). Method We conducted a systematic search of Medline, PubMed, PsycINFO, Web of Science, Embase, CINAHL, and the Cochrane Library. An initial screen by abstracts and titles was performed, and relevant full articles were then reviewed and assessed for their methodologic quality. Crude effect estimates were extracted from the included articles and a pooled estimate was obtained using a random effects model. Results Five articles were selected from an initial pool of 4,123 articles. Use of antidepressant drugs was associated with a significant twofold increase in the odds of some form of cognitive impairment or dementia (OR = 2.17). Age was identified as a likely modifier of the association between antidepressant use and some form of cognitive impairment or AD/dementia. Studies that included participants with an average age equal to or greater than 65 years showed an increased odds of some form of cognitive impairment with antidepressant drug usage (OR = 1.65), whereas those with participants less than age 65 revealed an even stronger association (OR = 3.25). Conclusions Antidepressant drug usage is associated with AD/dementia and this is particularly evident if usage begins before age 65. This association may arise due to confounding by depression or depression severity. However, biological mechanisms potentially linking antidepressant exposure to dementia have been described, so an etiological effect of antidepressants is possible. With this confirmation that an association exists, clarification of underlying etiologic pathways requires urgent attention.

Background: There is a role for brief assessment instruments in detection and management of major depression in MS. However, candidate scales have rarely been validated against a validated diagnostic interview. In this study, we evaluated the performance of several candidate scales: Patient Health Questionnaire (PHQ)-9, PHQ-2, Center for Epidemiologic Studies Depression rating scale (CES-D), and Hospital Anxiety and Depression Scale (HADS-D) in relation to the Structured Clinical Interview for DSM-IV (SCID). Methods: The sample was an unselected series of 152 patients attending a multiple sclerosis (MS) clinic. Participants completed the scales during a clinic visit or returned them by mail. The SCID was administered by telephone within two weeks. The diagnosis of major depressive episode, according to the SCID, was used as a reference standard. Receiver-operator curves (ROC) were fitted and indices of measurement accuracy were calculated. Results: All of the scales performed well, each having an area under the ROC &gt; 90%. For example, the PHQ-9 had 95% sensitivity and 88.3% specificity when scored with a cut-point of 11. This cut-point achieved a 56% positive predictive value for major depression. Conclusions: While all of the scales performed well in terms of their sensitivity and specificity, the availability of the PHQ-9 in the public domain and its brevity may enhance the feasibility of its use.

Purpose of review Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression. Recent findings Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with RA and on factors such as medication adherence, both of which lead to poorer disease outcomes. Growing evidence also suggests that inflammation is central both to depression and RA and may account for some of the complex interplay between these conditions. Summary Awareness of a bidirectional relationship between depression and RA through a biopsychosocial framework may assist clinicians in maintaining an appropriate index of suspicion about the co-occurrence of these conditions. This review also suggests an important need for integration of rheumatologic and mental health services and generates hypotheses for future research towards a better understanding of both depression and RA.

It is important to describe the characteristics of well-being in resident physicians to develop resident wellness initiatives in postgraduate medical education.To characterize the predictors of well-being in resident physicians by assessing personal and work-related burnout, work dissatisfaction, nutritional needs while on call, and sleep needs while on call.We set up an online survey in 2012 to collect data from current residents at the University of Calgary in Canada. The WHO-Five Well-Being Index, personal and work-related subscales of the Copenhagen Burnout Inventory, questions on work dissatisfaction, as well as sleep and nutrition management needs while on call, were used in the survey. Descriptive statistics, univariate analysis, and linear regression were applied to the data.The survey response rate was 45% (317 of 706) of eligible residents, with a mean age of 30.9 years (SD = 4.3). Fifty-three percent (168 of 317) of residents had a well-being score of 13 or less, indicating poor mental well-being. There were significant differences between men and women with respect to personal burnout (47.9 versus 54.2, P = .002) and work-related burnout (46.4 versus 50.4, P = .008). The only significant predictors of well-being overall were personal burnout and work dissatisfaction.Survey results suggest that a high proportion of residents at this institution have low well-being. This study did not find work-related burnout to be a significant predictor of well-being, after adjustment for other variables.

Background Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved. Objective The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA. Methods We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators. Results From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, −0.21; 95% confidence interval [CI], −1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, −0.79; 95% CI, −1.34 to −0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, −0.44; 95% CI, −0.96 to 0.08). Seven of the trials had an unclear risk of bias. Conclusions Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.

Inflammatory bowel disease (IBD) is associated with a high prevalence of comorbid depressive and anxiety disorders. A significant proportion of IBD patients with comorbid psychiatric disorders remain undiagnosed and untreated, but factors associated with diagnosis are unknown. We evaluated the prevalence of undiagnosed depression and anxiety in an IBD cohort, along with the associated demographic and clinical characteristics.We obtained data from the enrollment visit of a cohort study of psychiatric comorbidity in immune-mediated diseases including IBD. Each participant underwent a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) to identify participants who met lifetime criteria for a diagnosis of depression or anxiety. Those with a SCID-based diagnosis were classified as diagnosed or undiagnosed based on participant report of a physician diagnosis.Of 242 eligible participants, 97 (40.1%) met SCID criteria for depression, and 74 (30.6%) met criteria for anxiety. One-third of participants with depression and two-thirds with anxiety were undiagnosed. Males were more likely to have an undiagnosed depressive disorder (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.28-8.85). Nonwhite participants were less likely to have an undiagnosed anxiety disorder (OR, 0.17; 95% CI, 0.042-0.72).Our findings highlight the importance of screening for depression and anxiety in patients with IBD, with particular attention to those of male sex and with a lower education level.

<h3>Importance</h3> Levetiracetam is a commonly used antiepileptic drug, yet psychiatric adverse effects are common and may lead to treatment discontinuation. <h3>Objective</h3> To derive prediction models to estimate the risk of psychiatric adverse effects from levetiracetam use. <h3>Design, Setting, and Participants</h3> Retrospective open cohort study. All patients meeting the case definition for epilepsy after the Acceptable Mortality Reporting date in The Health Improvement Network (THIN) database based in the United Kingdom (inclusive January 1, 2000, to May 31, 2012) who received a first-ever prescription for levetiracetam were included. Of 11 194 182 patients registered in THIN, this study identified 7400 presumed incident cases (66.1 cases per 100 000 persons) over a maximum of 12 years’ follow-up. The index date was when patients received their first prescription code for levetiracetam, and follow-up lasted 2 years or until an event, loss to follow-up, or censoring. The analyses were performed on April 22, 2018. <h3>Exposure</h3> A presumed first-ever prescription for levetiracetam. <h3>Main Outcomes and Measures</h3> The outcome of interest was a Read code for any psychiatric sign, symptom, or disorder as reached through consensus by 2 authors. This study used regression techniques to derive 2 prediction models, one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period. <h3>Results</h3> Among 1173 patients with epilepsy receiving levetiracetam, the overall median age was 39 (interquartile range, 25-56) years, and 590 (50.3%) were female. A total of 14.1% (165 of 1173) experienced a psychiatric symptom or disorder within 2 years of index prescription. The odds of reporting a psychiatric symptom were significantly elevated for women (odds ratio [OR], 1.41; 95% CI, 0.99-2.01;<i>P</i>= .05) and those with a preexposure history of higher social deprivation (OR, 1.15; 95% CI, 1.01-1.31;<i>P</i>= .03), depression (OR, 2.20; 95% CI, 1.49-3.24;<i>P</i>&lt; .001), anxiety (OR, 1.74; 95% CI, 1.11-2.72;<i>P</i>= .02), or recreational drug use (OR, 2.02; 95% CI, 1.20-3.37;<i>P</i>= .008). The model performed well after stratified k = 5-fold cross-validation (area under the curve [AUC], 0.68; 95% CI, 0.58-0.79). There was a gradient in risk, with probabilities increasing from 8% for 0 risk factors to 11% to 17% for 1, 17% to 31% for 2, 30% to 42% for 3, and 49% when all risk factors were present. For those free of a preexposure psychiatric code, a second model performed comparably well after k = 5-fold cross-validation (AUC, 0.72; 95% CI, 0.54-0.90). Specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription. <h3>Conclusions and Relevance</h3> This study derived 2 simple models that predict the risk of a psychiatric adverse effect from levetiracetam. These algorithms can be used to guide prescription in clinical practice.

The factors that contribute to the development of psoriatic arthritis (PsA) among patients with psoriasis are not well known; however, systemic inflammation is believed to be important. On the basis of recent laboratory work demonstrating that major depressive disorder (MDD) is associated with increased systemic inflammation, we hypothesized that patients with psoriasis who develop MDD are at increased risk of subsequently developing PsA. We utilized The Health Improvement Network, a primary care medical records database, to identify 73,447 individuals with psoriasis. Patients were followed up to 25 years until the development of the primary outcome of PsA or the censor date. The exposure of interest was the development of MDD. Cox proportional-hazards models showed that patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after accounting for numerous covariates (hazard ratio 1.37, 95% confidence interval 1.05–1.80, P = 0.021). This result was maintained through numerous sensitivity analyses. These data support the hypothesis that MDD increases the risk of developing PsA among patients with psoriasis, suggesting a need for heightened prevention and management of MDD in patients with psoriasis. The factors that contribute to the development of psoriatic arthritis (PsA) among patients with psoriasis are not well known; however, systemic inflammation is believed to be important. On the basis of recent laboratory work demonstrating that major depressive disorder (MDD) is associated with increased systemic inflammation, we hypothesized that patients with psoriasis who develop MDD are at increased risk of subsequently developing PsA. We utilized The Health Improvement Network, a primary care medical records database, to identify 73,447 individuals with psoriasis. Patients were followed up to 25 years until the development of the primary outcome of PsA or the censor date. The exposure of interest was the development of MDD. Cox proportional-hazards models showed that patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after accounting for numerous covariates (hazard ratio 1.37, 95% confidence interval 1.05–1.80, P = 0.021). This result was maintained through numerous sensitivity analyses. These data support the hypothesis that MDD increases the risk of developing PsA among patients with psoriasis, suggesting a need for heightened prevention and management of MDD in patients with psoriasis.

We determined the association between any common mental disorder (CMD: depression, anxiety disorder, bipolar disorder) and mortality and suicide in three immune-mediated inflammatory diseases (IMID), inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), versus age-, sex- and geographically-matched controls.Using administrative data, we identified 28,384 IMID cases (IBD: 8695; MS: 5496; RA: 14,503) and 141,672 matched controls. We determined annual rates of mortality, suicide and suicide attempts. We evaluated the association of any CMD with all-cause mortality and suicide using multivariable Cox regression models.In the IMID cohort, any CMD was associated with increased mortality. We observed a greater than additive interaction between depression and IMID status (attributable proportion 5.2%), but a less than additive interaction with anxiety (attributable proportion -13%). Findings were similar for MS and RA. In IBD, a less than additive interaction existed with depression and anxiety on mortality risk. The IMID cohort with any CMD had an increased suicide risk versus the matched cohort without CMD.CMD are associated with increased mortality and suicide risk in IMID. In MS and RA, the effects of depression on mortality risk are greater than associations of these IMID and depression alone.

Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results.To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10.Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview.Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88).The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

The COVID-19 pandemic has necessitated public health measures that have impacted the provision of care for people living with dementia and their families. Additionally, the isolation that results from social distancing may be harming well-being for families as formal and informal supports become less accessible. For those living with dementia and experiencing agitation, social distancing may be even harder to maintain, or social distancing could potentially aggravate dementia-related neuropsychiatric symptoms. To understand the lived experience of social and physical distancing during the COVID-19 pandemic in Canada, we remotely interviewed 21 participants who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. A reflexive thematic analysis was used to analyze the interview and field note data. The impacts of the public health measures in response to the pandemic emerged through iterative analysis in three main categories of experience: (1) personal, (2) health services, and (3) health status (of both persons living with dementia and care partner). Isolation and mental health needs emerged as important impacts to family experiences. This in-depth understanding of the needs and experiences of the pandemic for people living with dementia suggests that innovative means are urgently needed to facilitate provision of remote medicine and also social interaction and integration.

We aimed to examine associations between elevated symptoms of depression and anxiety and disease activity in inflammatory bowel disease (IBD). Previous findings have been inconsistent and have not accounted for variability in the courses of these conditions over time.We followed 247 participants with IBD (153 Crohn's disease [CD], 94 ulcerative colitis [UC]) for 3 years. Annually, participants underwent an abdominal examination, reported therapies used for IBD, and completed the Hospital Anxiety and Depression Scale (HADS) questionnaire. We evaluated associations of elevated symptoms (scores ≥11) of anxiety (HADS-A) and depression (HADS-D) with the presence of active IBD as measured using the Powell Tuck Index for UC and the Harvey-Bradshaw Disease Activity Index for CD. We employed logistic regression with generalized estimating equations, simultaneously estimating between-person and within-person effects.Of 247 participants, 15 (6.1%) had elevated symptoms of depression (HADS-D ≥11) at enrollment, 41 (16.6%) had elevated symptoms of anxiety (HADS-A ≥11), and 101 (40.9%) had active IBD. On average, individuals with elevated symptoms of depression (odds ratio [OR], 6.27; 95% CI, 1.39-28.2) and anxiety (OR, 2.17; 95% CI, 1.01-4.66) had increased odds of active IBD. Within individuals, elevations in symptoms of depression over time were associated with increased odds of active IBD (OR, 2.70; 95% CI, 1.15-6.34), but elevated symptoms of anxiety were not. After adjustment for covariates (including disease activity), elevated symptoms of depression were also associated with increased odds of biologic therapy use (OR, 2.02; 95% CI, 1.02-4.00).Symptoms of depression and anxiety are associated with disease activity in IBD over time. Reducing these symptoms should be incorporated into the management of IBD.

Objective To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis ( RA ). Methods Participants with RA completed the Patient Health Questionnaire ( PHQ ‐2 or PHQ ‐9), the Patient Reported Outcomes Measurement Information System depression short form 8a and anxiety short form 8a, the Hospital Anxiety and Depression Scale anxiety score ( HADS ‐A) and depression score ( HADS ‐D), the Overall Anxiety Severity and Impairment Scale, the Generalized Anxiety Disorder 2‐ and 7‐item scales, and the Kessler‐6 scale. Clinical depression and anxiety disorders were confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders ( SCID ‐1) research version. We reported sensitivity, specificity, positive predictive value, and negative predictive value using SCID ‐1 diagnoses as the criterion standard. Test–retest reliability was assessed with the intraclass correlation coefficient. Results Of 150 participants, 11.3% had SCID ‐1–diagnosed depression, 7.3% had SCID ‐1–diagnosed generalized anxiety disorder, and 19.3% had any SCID ‐1–diagnosed anxiety disorder. For depression, sensitivity ranged from HADS ‐D (cut point 11; 35%) to PHQ ‐2 (88%) and PHQ ‐9 (87%). Specificity ranged from PHQ ‐9 (77%) and PHQ ‐2 (84%) to HADS ‐D (cut point 11; 94%). Positive predictive value ranged from 30% to 43%. Negative predictive value ranged from 92% to 98%. For generalized anxiety disorder, sensitivity ranged from HADS ‐A (cut point 11; 45%) to HADS ‐A (cut point 8; 91%). Specificity ranged from 81% to 89% for all measures except the HADS ‐A (cut point 8; 63%). Intraclass correlation coefficient estimates ranging from 0.69 to 0.88 confirmed good test–retest reliability. Conclusion Depression screening instruments had good diagnostic performance; anxiety instruments were more variable. Identified depression and anxiety require clinical confirmation.

Abstract Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function ( n = 31, 20%) and mental health outcomes ( n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support ( n = 107, 69%), connection and communication ( n = 107, 69%), and awareness of state of well-being ( n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families ( n = 61, 70%), patients ( n = 51, 59%), and healthcare professionals ( n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration : The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.

Objective To compare the utility of the Mild Behavioral Impairment-Checklist (MBI-C) and Neuropsychiatric Inventory Questionnaire (NPI-Q) to capture NPS in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. Methods In this cross-sectional memory clinic study, linear regression models compared MBI-C (n = 474) and NPI-Q (n = 1040) scores in relation to Montreal Cognitive Assessment (MoCA) score. Results MBI prevalence was 37% in subjective cognitive decline, 54% in mild cognitive impairment, and 62% in dementia. Worse diagnostic status was associated with higher MBI-C and NPI-Q score ( P &lt; .001), lower MoCA ( P &lt; .001), and greater age ( P &lt; .001). Higher MBI-C (β −.09; 95% CI −.13, −.05) and NPI-Q (β −.17; 95% CI −.23, −.10) scores were associated with lower MoCA scores, with psychosis most strongly associated (β −1.11; 95% CI −1.56, −.65 vs β −1.14; 95% CI −1.55, −.73). Conclusions The MBI-C captures global and domain-specific NPS across cognitive stages. Both the MBI-C and NPI-Q have utility in characterizing NPS.

The antidepressant effects of transcranial magnetic stimulation protocols for major depressive disorder (MDD) are thought to depend on synaptic plasticity. The theta-burst stimulation (TBS) protocol synaptic plasticity is known to be N-methyl-D-aspartate (NMDA)-receptor dependent, yet it is unknown whether enhancing NMDA-receptor signaling improves treatment outcomes in MDD.To test whether low doses of the NMDA-receptor partial-agonist, D-cycloserine, would enhance intermittent TBS (iTBS) treatment outcomes in MDD.This was a single-site 4-week, double-blind, placebo-controlled, randomized clinical trial conducted from November 6, 2019, to December 24, 2020, including 50 participants with MDD. Participants were recruited via advertisements and referral. Inclusion criteria were as follows: age 18 to 65 years with a primary diagnosis of MDD, a major depressive episode with score of 18 or more on the 17-item Hamilton Depression Rating Scale, a Young Mania Rating Scale score of 8 or less, and normal blood work (including complete blood cell count, electrolytes, liver function tests, and creatinine level).Participants were randomly assigned 1:1 to either iTBS plus placebo or iTBS plus D-cycloserine (100 mg) for the first 2 weeks followed by iTBS without an adjunct for weeks 3 and 4.The primary outcome was change in depressive symptoms as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) at the conclusion of treatment. Secondary outcomes included clinical response, clinical remission, and Clinical Global Impression (CGI) scores.A total of 50 participants (mean [SD] age, 40.8 [13.4] years; 31 female [62%]) were randomly assigned to treatment groups: iTBS plus placebo (mean [SD] baseline score, 30.3 [4.2]) and iTBS plus D-cycloserine (mean [SD] baseline score, 30.4 [4.5]). The iTBS plus D-cycloserine group had greater improvements in MADRS scores compared with the iTBS plus placebo group (mean difference, -6.15; 95% CI, -2.43 to -9.88; Hedges g = 0.99; 95% CI, 0.34-1.62). Rates of clinical response were higher in the iTBS plus D-cycloserine group than in the iTBS plus placebo group (73.9% vs 29.3%), as were rates of clinical remission (39.1% vs 4.2%). This was reflected in lower CGI-severity ratings and greater CGI-improvement ratings. No serious adverse events occurred.Findings from this clinical trial indicate that adjunctive D-cycloserine may be a promising strategy for enhancing transcranial magnetic stimulation treatment outcomes in MDD using iTBS requiring further investigation.ClinicalTrials.gov Identifier: NCT03937596.

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7-12 (difference range - 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13-15 (all differences - 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10.Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785).

The objective of this paper was to evaluate the lifetime and point prevalence of major depression in a population-based Multiple Sclerosis (MS) clinic sample, and to describe associations between selected biopsychosocial variables and the prevalence of lifetime major depression in this sample. Subjects who had participated in an earlier study were re-contacted for additional data collection. Eighty-three per cent (n=136) of those eligible consented to participate. Each subject completed the Composite International Diagnostic Interview (CIDI) and an interviewer-administered questionnaire evaluating a series of biopsychosocial variables. The lifetime prevalence of major depression in this sample was 22.8%, somewhat lower than previous estimates in MS clinic populations. Women, those under 35, and those with a family history of major depression had a higher prevalence. Also, subjects reporting high levels of stress and heavy ingestion of caffeine (>400 mg) had a higher prevalence of major depression. As this was a cross-sectional analysis, the direction of causal effect for the observed associations could not be determined. By identifying variables that are associated with lifetime major depression, these data generate hypotheses for future prospective studies. Such studies will be needed to further understand the etiology of depressive disorders in MS.

The objectives of this prospective study were to calculate incidence rates for fall-related hospitalization, to compare the effect of risk factors among benzodiazepine (BZD) users and unexposed controls, and to examine variations in risks according to length of time following a BZD prescription. Data were derived from Saskatchewan Health linked data bases, leading to information on 468 hospitalizations for injury due to falls among a study population of 321422. Incidence rates per 10000 within 28 days of the prescription fill date were 26.2, 12.1 and 9.0 for BZD sedative users, BZD tranquillizer users and for unexposed controls, respectively. Incidence rates increased with age, and were higher for women than for men. Results from multivariate logistic regression models also showed a greater risk of falling for BZD users but the odds ratio was higher for men than for women. A history of treatment for alcohol abuse was a very strong risk factor for falls among both men (odds ratio, 10.7) and women (odds ratio, 4.3). The highest risk of serious injury due to falls was within 15 days of filling the prescription, with an odds ratio of 3.6 for BZD sedatives and 2.6 for BZD tranquillizers. Risk decreased with further increase of time after the BZD fill date. For the individual BZD, flurazepam and triazolam showed the highest increase in risk with odds ratios of 3.4 and 2.7, respectively, while oxazepam, lorazepam and diazepam showed odds ratios of 2.2, 2.0 and 1.8 (all odds ratios mentioned are statistically significant at p < 0.05).

To describe the regional distribution of multiple sclerosis (MS) prevalence in Canada, controlling for age and sex.This study used data from the Canadian Community Health Survey, a large general health survey (n = 131,535) conducted in 2000/2001. Subjects aged 18 and over were included in the current analysis (n = 116,109). The presence of MS was determined by self-report. Prevalence was computed in five regions (Atlantic, Quebec, Ontario, Prairies and British Columbia). Logistic regression was used to compare regions and examine for confounding/interaction by age and sex.The overall Canadian MS prevalence was 240 per 100000 (95%CI: 210 280). Prevalence ranged from 180 (95%CI: 90-260) in Quebec to 350 (95%CI: 230-470) in Atlantic Canada. Logistic regression revealed no statistical difference between the odds of MS in Quebec, Ontario and British Columbia adjusted for age and sex. The adjusted odds of MS in the Prairies and Atlantic regions were significantly higher than in the other regions combined, with odds ratios of 1.7 (95%CI: 1.1-2.4, P <0.01) and 1.6 (95%CI: 1.1-2.4, P <0.05) respectively. Sensitivity analysis demonstrated similar prevalence in the nonaboriginal/nonimmigrant group (n = 96219).Results suggest that Canadian MS prevalence differs by region. If validated, these regional differences may facilitate investigation of environmental influences.

Background Depression has been described in people presenting with first-episode schizophrenia, a group at high relative risk of suicide. Method This was a longitudinal cohort study of 113 people during an acute relapse and 13 having a first episode. Follow-up occurred at three months and at one year. This report compares level of depression in the first episode and in the relapsing group. Levels of depression were assessed using the Calgary Depression Scale for Schizophrenia (CDSS). Results The median CDSS score was statistically significantly higher in the first-episode group both during the acute phase and at three month follow-up. At one year the first-episode group continued to have higher levels of depression than the multiple episode group. Conclusions For people with a first episode of schizophrenia, depression is a major problem during the initial acute phase and during the first year of illness. In light of the high risk of suicide in this population, recognition and treatment of depression requires greater attention.

&lt;i&gt;Background:&lt;/i&gt; Certain medications may contribute to the etiology of depressive symptoms and disorders. Research in this area, however, has been hampered by methodological and conceptual problems. This review had two objectives: to identify evidence linking medical drugs to depressive symptoms and disorders, and to summarize this evidence in a clinically meaningful way. &lt;i&gt;Methods:&lt;/i&gt; Electronic literature searches were performed and studies were reviewed with reference to critical methodological features. &lt;i&gt;Results:&lt;/i&gt; No medications causing the typical major depressive syndrome were identified. Evidence was found linking corticosteroids, interferon-α, interleukin-2, gonadotropin-releasing hormone agonists, mefloquine, progestin-releasing implanted contraceptives and propranolol to the etiology of atypical depressive syndromes. &lt;i&gt;Conclusions:&lt;/i&gt; A small number of drugs have been shown capable of inducing depressive symptoms. Drug-induced depression appears to differ symptomatically from classical major depression.