Daniel Rasic

Risk of Mental Illness in Offspring of Parents With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder: A Meta-Analysis of Family High-Risk Studies

OBJECTIVE Offspring of parents with severe mental illness (SMI; schizophrenia, bipolar disorder, major depressive disorder) are at an increased risk of developing mental illness. We aimed to quantify the risk of mental disorders in offspring and determine whether increased risk extends beyond the disorder present in the parent. METHOD Meta-analyses of absolute and relative rates of mental disorders in offspring of parents with schizophrenia, bipolar disorder, or depression in family high-risk studies published by December 2012. RESULTS We included 33 studies with 3863 offspring of parents with SMI and 3158 control offspring. Offspring of parents with SMI had a 32% probability of developing SMI (95% CI: 24%-42%) by adulthood (age >20). This risk was more than twice that of control offspring (risk ratio [RR] 2.52; 95% CI 2.08-3.06, P < .001). High-risk offspring had a significantly increased rate of the disorder present in the parent (RR = 3.59; 95% CI: 2.57-5.02, P < .001) and of other types of SMI (RR = 1.92; 95% CI: 1.48-2.49, P < .001). The risk of mood disorders was significantly increased among offspring of parents with schizophrenia (RR = 1.62; 95% CI: 1.02-2.58; P = .042). The risk of schizophrenia was significantly increased in offspring of parents with bipolar disorder (RR = 6.42; 95% CI: 2.20-18.78, P < .001) but not among offspring of parents with depression (RR = 1.71; 95% CI: 0.19-15.16, P = .631). CONCLUSIONS Offspring of parents with SMI are at increased risk for a range of psychiatric disorders and one third of them may develop a SMI by early adulthood.

Spirituality, religion and suicidal behavior in a nationally representative sample.

BACKGROUND Studies show that religion and spirituality are associated with decreased rates of mental illness. Some studies show decreased rates of suicide in religious populations, but the association between religion, spirituality and suicidal behaviors in people with mental illness are understudied. Few studies have examined the influence of social supports in these relationships. METHODS Data were drawn from the Canadian Community Health Survey 1.2. Logistic regression was used to examine the relationship between spiritual values and religious worship attendance with twelve-month suicidal ideation and attempts. Regressions were adjusted for sociodemographic factors and social supports. Interaction variables were then tested to examine possible effect modification by presence of a mental disorder. RESULTS Identifying oneself as spiritual was associated with decreased odds of suicide attempt (adjusted odds ratio-1 [AOR-1]=0.65, CI: 0.44-0.96) but was not significant after adjusting for social supports. Religious attendance was associated with decreased odds of suicidal ideation (AOR-1=0.64, 95% CI: 0.53-0.77) but not after adjusting for social supports. Religious attendance was associated with decreased odds of suicide attempt and remained significant after adjusting for social supports (AOR-2=0.38, 95% CI: 0.17-0.89). No significant interaction effects were observed between any of the tested mental disorders and religion, spirituality and suicidal behavior. LIMITATIONS This was a cross-sectional survey and causality of relationships cannot be inferred. CONCLUSIONS Results suggest that religious attendance is associated with decreased suicide attempts in the general population and in those with a mental illness independent of the effects of social supports.

Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada

PURPOSE We examined relationships of measures of personal importance of religion and frequency of attendance at religious services with risk of depression and risk behaviours in high school students in Cape Breton, Canada. We examined the impact of confounding and explanatory factors on these relationships. METHODS Data were drawn from self-report surveys of adolescents aged 15-19 (N=1615) at three high schools in May, 2006. We used logistic regression to assess associations of religious importance and religious service attendance with risk of depression, suicidal behaviour, binge drinking and frequent marijuana use, controlling in multivariate models for sociodemographic factors, family structure and social capital. RESULTS Among females, higher personal importance of religion was associated with decreased odds of depression, suicidal ideation, drinking and marijuana use, while more religious attendance was protective for substance use behaviours and suicidal ideation. In males, both measures of religiosity were associated with decreased substance use. In multivariate models, religious importance had weak protective effects for depression and suicidal thinking in females, which were respectively modified by social trust and substance use. Attendance was protective for suicidal thinking in females, and was modified by depression. These associations were not seen in males. Attendance was consistently associated with less substance use in females, while importance was not. Importance was consistently protective for marijuana use and attendance was protective for binge drinking in males. LIMITATIONS This was a cross-sectional self-report survey and causality cannot be inferred. CONCLUSION Protective associations of measures of religiosity are seen in Canadian adolescents, as they are elsewhere.

Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students

OBJECTIVE To examine associations of cannabis and other illicit drug use with depression, suicidal ideation and suicidal attempts over a two year period during adolescence. METHODS Nine hundred and seventy-six school students in four high schools in northern Nova Scotia, Canada, were surveyed in grade 10 and followed up in grade 12. Assessments of past 30 day cannabis and illicit drug use as well as mental health variables (risk of depression, suicidal ideation and suicide attempts) were obtained at baseline (2000 and 2001) and follow-up two years later (2002 and 2003). Generalized estimating equations modelled depression, suicidal ideation and attempts among illicit drug users and non-users. RESULTS Illicit drug use with or without cannabis use was significantly associated with higher odds of depression, suicidal ideation and suicide attempt. Heavy cannabis use alone predicted depression but not suicidal ideation or attempt. CONCLUSIONS Illicit drug use, with and without accompanying cannabis use, among high school students increases the risk of depression, suicidal ideation and suicidal attempts. Heavy cannabis use alone predicts depression but not suicidal ideation or attempts.

Protective Associations of School Connectedness with Risk of Depression in Nova Scotia Adolescents

Objective: To determine whether school connectedness demonstrated an independent protective association with risk of depression in students in grades 10 to 12 attending a high school in a rural community in southwestern Nova Scotia. Methods: Students at a high school in rural Nova Scotia participated in a self-completion survey in May 2009. Students were asked about a wide range of health-related factors to determine their needs for health services and promotion. Examining girls and boys separately, we used logistic regression to examine associations of an established measure of school connectedness with risk of depression as measured by the 12-item Center for Epidemiologic Studies Depression (CES-D) Scale, while including numerous potential confounding variables in our models. Results: The response rate was 95.2% among registered students present in class during the survey. Four hundred eight students (216 girls and 192 boys) completed both the CES-D12 and the School Connectedness Scale. Higher school connectedness was independently protective of risk of depression in girls (OR 0.85; 95% CI 0.78 to 0.93, P < 0.01) and in boys (OR 0.81; 95% CI 0.71 to 0.91, P < 0.01). Conclusions: Among adolescents in rural Nova Scotia, higher school connectedness has protective associations with risk of depression in both girls and boys, independent of a wide range of factors known to be associated with depression in adolescents. School may be a key place for helping adolescents to develop positive mental health.

Suicidal behaviours in adolescents in Nova Scotia, Canada: protective associations with measures of social capital.

PurposeFew studies of adolescent suicidality have examined its associations with social capital. We explored associations of measures of individual level social capital with self-reported suicide ideation and suicide attempt in adolescents in Cape Breton, Nova Scotia, Canada, controlling for other factors known to be associated with adolescent suicidality.MethodsWe surveyed 1,597 grade 10–12 students at three high schools in 2006 using self-completion questionnaires. Both sexes were combined for analysis. Outcome measures were suicidal ideation and attempt in the previous year. Measures of social capital included perceptions of trustworthiness and helpfulness of others at school, frequency of religious attendance and participation in extracurricular activities. Logistic regressions were carried out to determine associations of social capital with suicidality while controlling for other factors.ResultsPerceived trustworthiness and helpfulness were protective for suicidal ideation and suicide attempt in the previous year. In adjusted analyses, there were interactions of gender and social capital—females reporting more social capital were more protected from suicide attempt relative to males with similar levels of social capital.ConclusionsThis study provides initial evidence of protective associations of individual level social capital with adolescent suicidality. Our findings suggest that among adolescents low social capital as measured by perceptions of trust and helpfulness of others at school may be a warning sign for suicidality, particularly for females. It may be helpful to inquire of young people how they perceive the trustworthiness and helpfulness of their school environment as a measure of how supportive that environment might be to them when they are facing challenges to their mental health.

Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service

OBJECTIVE To evaluate whether a mixed population of patients treated with Intensive Short-term Dynamic Psychotherapy (ISTDP) would exhibit reduced healthcare costs in long-term follow-up. METHODS A quasi-experimental design was employed in which data on pre- and post-treatment healthcare cost were compared for all ISTDP cases treated in a tertiary care service over a nine year period. Observed cost changes were compared with those of a control group of patients referred but never treated. Physician and hospital costs were compared to treatment cost estimates and normal population cost figures. RESULTS 1082 patients were included; 890 treated cases for a broad range of somatic and psychiatric disorders and 192 controls. The treatment averaged 7.3 sessions and measures of symptoms and interpersonal problems significantly improved. The average cost reduction per treated case was

Time Trends in Mortality Associated with Depression: Findings from the Stirling County Study

12,628 over 3 follow-up years: this compared favorably with the estimated treatment cost of

Elevated depressive symptoms and adolescent injury: examining associations by injury frequency, injury type, and gender

708 per patient. Significant differences were seen between groups for follow-up hospital costs. CONCLUSIONS ISTDP in this setting appears to facilitate reductions in healthcare costs, supporting the notion that brief dynamic psychotherapy provided in a tertiary setting can be beneficial to health care systems overall. CLINICALTRIALS. GOV IDENTIFIER NUMBER NCT01924715.

Longitudinal associations of importance of religion and frequency of service attendance with depression risk among adolescents in Nova Scotia

Objective: To address the question of whether a mortality risk associated with depression in a 1952 representative sample of Stirling County adults changed in a new sample in 1970, and whether there was a change in associations with cigarette smoking and alcoholism. Method: Sample members were interviewed about depression and cigarette smoking. General physicians were interviewed by psychiatrists regarding alcoholism. Information about death as of December 31, 1992, was provided by Statistics Canada. Proportional hazards models were fitted in the 2 samples to assess the mortality risks associated with depression among men and women during 20 years of follow-up, and additionally among men with heavy smoking and alcoholism. Specific causes of death were investigated. Results: Hazard ratios representing the association between depression and premature death among men were 2.6 (95% CI 1.4 to 4.9) and 2.8 (95% CI 1.5 to 5.1), respectively, in the 1952 and 1970 samples for the first 10 years of follow-up. Hazard ratios for women were 1.4 (95% CI 0.6 to 3.2) and 1.2 (95% CI 0.5 to 2.9). The risk associated with depression among men was independent of alcoholism and heavy smoking. Depression and alcoholism were significantly associated with death by external causes and circulatory disease; heavy smoking was significantly associated with malignant neoplasms. Conclusion: The mortality associated with depression did not change during the period from 1952 to 1970. Depressed men experienced a significant mortality risk that was not matched among depressed women and also was not due to alcoholism and heavy smoking.