Angus H. Thompson

Attitudes about schizophrenia from the pilot site of the WPA worldwide campaign against the stigma of schizophrenia

Background: A series of surveys were conducted to assess the attitudes of the public, and other groups, toward those with schizophrenia. The aim of these surveys was to aid in the planning and evaluation of the WPA anti-stigma initiative in Alberta, Canada. Method: A questionnaire was devised and administered via telephone to over 1,200 individuals in three Alberta cities, and in paper and pencil format to 40 members of the Schizophrenia Society of Alberta and 67 medical students. Results: In contrast to some earlier findings, “loss of mind” was rated to be more disabling than any other handicapping condition. In general, respondents showed a relatively sophisticated understanding of schizophrenia and a higher level of acceptance than might have been predicted. Nonetheless, this acceptance was not as high for situations where closer personal contact was likely, and fears of dangerousness continue to be associated with schizophrenia. The majority of respondents, however, felt that treatment aided those with schizophrenia, expressed support for progressive programmes for the mentally ill, and stated that they would be willing to pay higher taxes so that programming could be improved. Conclusions The results do not support the utility of a broad approach for an anti-stigma campaign, but rather suggest a more specific focus, such as perceived dangerousness.

Psychiatric Disorders in the Population and in Prisoners

Those who commit the most offensive of crimes are regarded by some as inevitably mentally ill, since their actions defy comprehension by the rest of society. On the other hand, some consider that certain people are just very bad and that only truly bad persons would perform such horrendous crimes. Such criminal activity, however, is rare in comparison with the vast body of people (and their acts) who come into conflict with the law. Of wider interest is the proportion of those in various legal difficulties who have mental disorders. Are those with mental disorders over-represented in this group as compared with the general population? Only in the last 15 to 20 years has it been possible to examine that question in a reasonably scientific manner. The ability to show the proportion of people in the population with a mental disorder depends on agreement on the definitions of disorder (that is, clear diagnostic criteria) and the ability to accurately examine large populations using explicit diagnostic criteria. Thus, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition ([DSM-III-R] American Psychiatric Association, 1987), provided detailed operational criteria for diagnosis, and the subsequent development of structured interview questionnaires such as the Diagnostic Interview Schedule (DIS) (Robins, Helzer, Croughan, Williams, & Spitzer, 1981), suitable for use by trained lay interviewers, allowed examination of large populations. These developments were the basis for Epidemiologic Catchment Area (ECA) investigations in the United States (Eaton & Kessler, 1985; Robins & Regier, 1991) and similar investigations in many

The relative age effect and the development of self-esteem.

A recent paper has demonstrated a relationship between suicide during the teen years and the age, relative to ones classmates, at which these individuals entered school. This represents the latest, and perhaps most important, of a series of studies that have focused on the effects of grouping children by age of entry into particular activities. This phenomenon, known as the relative age effect, is strikingly evident in activities that are competitive and where performance is highly correlated with age and level of maturity. To date, relative age research has reported significant and substantial achievement differences within the confines of athletic and academic pursuits. However, with the advent of the study noted above, it now appears that emotional development is also implicated. Here we demonstrate that a relatively young age of entry into the formal educational system is associated with reduced self-esteem several years later. This suggests that self-esteem (or a related factor, such as self-efficacy) serves as an important factor lying functionally between proximal relative age effects and suicide.

A new factor in youth suicide: the relative age effect.

Objective: To determine whether youth in Alberta who had completed suicide were more likely to be younger than their classmates on entering grade 1 (that is, showed a relative age effect). Method: Records were obtained for all deaths by suicide by individuals under the age of 20 years in Alberta during the years 1979–1992. The relative age of each of these persons was determined by comparing his or her month of birth to the birth months of the appropriate school-grade cohort. Results: A disproportionate number of the subjects were born in the second half of the “school eligibility year,” indicating a higher probability that those who completed suicide were younger than their classmates. Conclusions: Previous research indicates that relative age is strongly related to school performance and success in sports. The present study demonstrates that the relative age effect is also a factor in youth suicide. It is suggested that the higher incidence of youth suicide in the group of relatively younger school children may have resulted from poorer school performance, which in turn led to lowered confidence and self esteem. Past research suggests that these conditions may predispose children to hopelessness and depression, which are often thought to be essential components of suicide. Research aimed at neutralizing the negative effects of relative age should have important personal and social consequences.

Relationship and chronology of depression, agoraphobia, and panic disorder in the general population.

The comorbidity of disorders and chronology of first symptoms of depression, agoraphobia, and panic disorder were investigated. The Diagnostic Interview Schedule was administered to 3258 household residents. Strong associations were shown among all three disorders. However, the comorbidity of agoraphobia and panic disorder seemed to be accounted for by the relationship of both disorders with depression. The mean age at appearance of first symptoms was earlier for agoraphobia (low teens) than for depression or panic disorder (both about age 20). The results do not support the view that panic disorder is an integral component of agoraphobia, but rather that it is more closely associated with depression. The fact that agoraphobia precedes depression casts doubt on the thesis that depression is primary to anxiety disorders. Interpretation should, however, be viewed with caution because of the retrospective nature of the diagnostic instrument.

The Association of Treatment of Depressive Episodes and Work Productivity

Objective: About one-third of the annual

The association between pathological gambling and attempted suicide: findings from a national survey in Canada.

51 billion cost of mental illnesses is related to productivity losses. However, few studies have examined the association of treatment and productivity. The purpose of our research is to examine the association of depression and its treatment and work productivity. Methods: Our analyses used data from 2737 adults aged between 18 and 65 years who participated in a large-scale community survey of employed and recently employed people in Alberta. Using the World Health Organizations Health and Work Performance Questionnaire, a productivity variable was created to capture high productivity (above the 75th percentile). We used regression methods to examine the association of mental disorders and their treatment and productivity, controlling for demographic factors and job characteristics. Results: In the sample, about 8.5% experienced a depressive episode in the past year. The regression results indicated that people who had a severe depressive episode were significantly less likely to be highly productive. Compared with people who had a moderate or severe depressive episode who did not have treatment, those who did have treatment were significantly more likely to be highly productive. However, about one-half of workers with a moderate or severe depressive episode did not receive treatment. Conclusions: Our results corroborate those in the literature that indicate mental disorders are significantly associated with decreased work productivity. In addition, these findings indicate that treatment for these disorders is significantly associated with productivity. Our results also highlight the low proportion of workers with a mental disorder who receive treatment.

Effects of emotional context on impulse control.

Objective: To examine the association between pathological gambling (PG) and attempted suicide in a nationally representative sample of Canadians. Methods: Data came from the Canadian Community Health Survey, Cycle 1.2, conducted in 2002, in which 36 984 subjects, aged 15 years or older, were interviewed. Logistic regression was performed with attempted suicide (in the past year) as the dependent variable. The independent variables were PG, major depression, alcohol dependence, drug dependence, and mental health care (in the past year), as well as a range of sociodemographic variables. Survey weights and bootstrap methods were used to account for the complex survey design. Results: In the final logistic regression model, which included terms for PG, major depression, alcohol dependence, and mental health care, as well as age, sex, education, and income, the odds ratio for PG and attempted suicide was 3.43 (95% confidence interval, 1.37 to 8.60). Conclusions: PG (in the past year) and attempted suicide (in the past year) are associated in a nationally representative sample of Canadians. However, it is not possible to say from these data whether this represents a causal relation.

Social dysfunction and mental illness in a community sample

High risk behaviors such as narcotic use or physical fighting can be caused by impulsive decision making in emotionally-charged situations. Improved neuroscientific understanding of how emotional context interacts with the control of impulsive behaviors may lead to advances in public policy and/or treatment approaches for high risk groups, including some high-risk adolescents or adults with poor impulse control. Inferior frontal gyrus (IFG) is an important contributor to response inhibition (behavioral impulse control). IFG also has a role in processing emotional stimuli and regulating emotional responses. The mechanism(s) whereby response inhibition processes interact with emotion processing in IFG are poorly understood. We used 4.7 T fMRI in 20 healthy young adults performing a rapid event-related emotional Go/NoGo task. This task combined the Go/NoGo task, which is a classic means of recruiting response inhibition processes, with emotionally neutral and aversive distractor images. In IFG, both response inhibition in an emotionally neutral context (neutral NoGo trials) and aversive emotional picture processing (aversive Go trials) evoked activation greater than the simple response baseline (neutral Go trials). These results are consistent with the literature. Activation for response inhibition in aversive contexts (aversive NoGo-neutral Go trials) was approximately the sum of response inhibition activation (neutral NoGo-neutral Go) and aversive emotional distractor activation (aversive Go-neutral Go). We conclude that response inhibition and aversive emotional stimulus processing activities combine additively (linearly) in IFG, rather than interfering with each other (sub-linearly) or mutually-enhancing each other (super-linearly). We also found previously undocumented interaction effects between response inhibition (NoGo vs. Go) and emotional context (aversive vs. neutral distractor pictures) in bilateral posterior middle temporal gyrus and angular gyrus, right frontal eye field, and other brain regions. These results may reflect the interaction of attention processes driven by emotional stimuli with conflict resolution processes related to Go/NoGo performance.

The suicidal process: age of onset and severity of suicidal behaviour

The purpose of this study was to determine the extent of the association between psychiatric disorders and various social problems. The Diagnostic Interview Schedule was administered to a community sample of 3258 individuals and the association between eight “core” psychiatric disorders and eight social problem behaviours was determined. The results confirmed findings from many clinical studies that had previously found a strong relationship between social problem behaviours and mental illness. However, certain disorders tended to be associated with specific problems. In addition, a positive association was found between the number of social problems exhibited and the prevalence of psychiatric disorder. These data suggest the presence of a common underlying factor (or factors) and call into question the common practice of creating separate services for each definable social problem that arises.