Eva Monson

Short sleep duration is associated with poor performance on IQ measures in healthy school-age children

OBJECTIVE To examine the associations between habitual sleep duration and intellectual functioning in healthy, well-rested, school-age children. METHODS The study group consisted of 39 healthy children, aged 7-11 years old. Nightly actigraphic sleep recordings were taken for four consecutive nights to determine habitual week-night sleep duration in the home environment. Objective measures of cognitive functioning and sleepiness were used to measure daytime functioning. RESULTS Longer habitual sleep duration in healthy school-age participants was associated with better performance on measures of perceptual reasoning and overall IQ, as measured by the WISC-IV, and on reported measures of competence and academic performance. No association between sleep duration and the studied behavioral measures was found. CONCLUSIONS These findings support the hypothesis that sleep duration is differentially related to some components of cognitive functioning, even in the absence of evidence for sleep deprivation or attention deficits.

Suicide Risk among Active and Retired Canadian Soldiers: The Role of Posttraumatic Stress Disorder

This In Review features a primer by Dr Jitender Sareen1 on PTSD and some of its most well-established risk and resilience factors. As noted by Dr Sareen, there is increasing evidence that PTSD is associated with suicidal risk. The second paper in this In Review is a systematic review by Dr Nicola T Fear and colleagues (see Hines et al2) on the PTSD rates observed in various armies of the world following deployment to Iraq and Afghanistan. As this issue of The Canadian Journal of Psychiatry is being prepared, the last members of the CAF have recently returned from Afghanistan. Several suicides by returnees from Afghanistan have been made public and reports have been echoed by the media; as a result, suicidality among the CAF’s active and retired members has once again become a source of concern for all Canadians. According to the most recent report from the DFHP, between 1995 and 2012, there were no statistically significant increases in suicide rates [in the Canadian Forces]. The number of Regular Force male suicides was generally lower than that expected based on Canadian male suicide rates. SMRs comparing CF [Canadian Forces] suicide rates by deployment history to Canadian suicide rates demonstrated that the number of Regular Force male suicides was consistently less than that expected based on Canadian male suicide rates. Rate ratios indicated that those with a history of deployment were not at an increased risk of suicide compared to those who have never been deployed.3, p 3 Stating that military deployment, per se, does not increase the risk of suicide appears to contradict recent published evidence from the United States4,5 as well as results from the CCHS 1.2–CFS. The CCHS 1.2–CFS is a unique cross-sectional survey in the field of psychiatric epidemiology in that it is perhaps the first to have been carried out on a representative sample (N = 8841) of active members from a national army.6 One of its goals was to provide accurate rates of mental disorders, notably PTSD and suicidality, found within the ranks of the CAF to be disclosed, not only to the CAF themselves but also to Canadians at large. In this data set, during their lifetime, 15.4% of the CAF members report some suicidal ideations, and 2.3% report having made at least 1 suicide attempt. Although SMRs stemming from these data are perhaps not at odds with comparable civilian data covering a similar period in Canada,7 according to the figures presented in Table 1, suicide ideations and attempts are multiplied by 4.8 and 4.7, respectively, among CAF members who report a diagnosis of PTSD at some point in their lives. The data pertaining to past-year prevalence reveal an even more pronounced pattern: the odds of reporting suicide ideations or attempts in the past year are multiplied by 11.5 and 31.6, respectively, among PTSD casualties. Although most people who report suicidal ideations do not attempt or die by suicide, in a recent study concerning a large military sample, 38.5% of ideators developed a plan and 34% of ideators with a plan made an attempt on their own life within the following year.4 Table 1 Suicidality in the Canadian Armed Forces according to the CCHS 1.2–CFS Survey Note in Table 1, comparing CAF members whose PTSD is deployment-related to the rest of the sample (that is, those who are either PTSD-free or whose PTSD is not deployment-related) yields weaker and (or) inconsistent findings that seem, at first sight, to support, in part, the DFHP assertions that deployment does not increase suicidality. However, these figures cannot be taken at face value. It is not always understood that the CCHS 1.2–CFS sample does not include members who, year after year, leave the CAF (or are being dismissed) precisely because of deployment-related mental health problems. People who develop mental health problems while employed by the CAF are dismissed from the CAF after about 2 years, if they remain unfit to be deployed. This workplace policy creates a rosy picture of the mental health in the CAF. It comes as no surprise that several people who died by suicide were former CAF personnel. This notion is supported by a mortality analysis of 2800 former CAF personnel, which reveals higher likelihoods of death by suicide by more than 2-fold in excess of their general population cohort for most age groups.8 Despite its flaws, what the data from Table 1 demonstrate unequivocally is that PTSD increases suicidality, irrespective of whether the PTSD was developed as part of a military deployment or otherwise. The claim by the DFHP that deployment is not suicidogenic misses the point that military deployment is traumatogenic, and that PTSD is suicidogenic. It is time to call a spade a spade and acknowledge what the real societal cost of military deployment entails in Canada and elsewhere.

Assessing trauma and posttraumatic stress disorder: Single, open-ended question versus list-based inventory.

Trauma exposure is a precursor to a diagnosis of posttraumatic stress disorder (PTSD). A dearth of empirical evidence exists on the impact of different measurement practices on estimates of trauma exposure and PTSD within representative epidemiological samples. In the present study, we examined differences in reported trauma exposure and rates of PTSD using single, open-ended question versus list-based trauma assessments in a general community sample. Using data from the third wave of the Montreal epidemiological catchment area study (N = 1029), participants were interviewed in person by a lay interviewer about lifetime history of trauma exposure and PTSD. Prevalence rates of trauma exposure and PTSD diagnosis using single, open-ended question and list-based assessment were compared using a within-subject design. A single, open-ended question versus list-based trauma assessment yielded trauma-exposure rates of 61%, 95% CI [57.8, 63.8] and 78%, 95% CI [75.2, 80.3], respectively. Conditional rates of lifetime PTSD decreased from 6.7%, 95% CI [5.8, 9.4] to 6%, 95% CI [4.4, 7.7], respectively. Increases in trauma exposure were more pronounced in women (33.7%) than men (21.5%), as well as in the younger stratum of study participants (15-24 years old; 36.1%). Underestimation of PTSD using a single, open-ended question assessment was minimal, although all missing cases were women. Our results lend support to the importance of using comprehensive assessments of exposure to potentially traumatic events when conducting epidemiological research, especially when reporting conditional rates of PTSD. Previous research may have underestimated the prevalence of trauma exposure, particularly among young women. (PsycINFO Database Record

Effects of Enactment of Legislative (Public) Smoking Bans on Voluntary Home Smoking Restrictions: A Review

Introduction: The positive effects of worldwide increases in enactment of legislative bans on smoking in public areas have been well documented. Relatively little is known about the effects of such bans on voluntary home smoking behavior. Meanwhile, private spaces, such as homes, have replaced public spaces as the primary milieu of secondhand smoke exposure. Methods: A systematic search of peer-reviewed articles was conducted using multiple databases including Cochrane Library, Cinahl, Embase, Global Health, Health Star, Joanna Briggs, MEDLINE, PsycINFO, PAIS International, PubMed, and Web of Science. We examined peer-reviewed studies that considered the impact of legislation-based public smoking bans on enactment of private home smoking restrictions. Results: Sixteen articles published between 2002 and 2014 were identified and included. Our results suggest overall positive effects post-legislative ban with the majority of studies demonstrating significant increases in home smoking restrictions. Studies focusing on smoking and nonsmoking samples as well as child populations are discussed in depth. Conclusions: Existing evidence indicates an overall significant positive effect post-legislative ban on voluntary home smoking restrictions. While disentangling these effects over space and time remains a challenge, scientific research has converged in dispelling any notion of significant displacement of smoking into the home. Policy makers, especially those in countries without existing public smoking legislation, can rest assured that these types of bans contribute to the minimization of tobacco-related harm. Implications: Findings converge in dispelling notions of displacement of smoking into the home as a consequence of legislative bans that prohibit smoking in public spaces. Evidence from the studies reviewed suggests that through their influence on social norms, legislative bans on smoking in public places may encourage citizens to establish voluntary home smoking restrictions, thus decreasing harm related to secondhand smoke.

Place and Posttraumatic Stress Disorder

Research on traumatic stress has focused largely on individual risk factors. A more thorough understanding of risk factors may require investigation of the contribution of neighborhood context, such as the associations between perceived neighbourhood disorder and social cohesion with reported trauma exposure (yes/no) and posttraumatic stress disorder (PTSD) diagnostic status (past-year PTSD, remitted). To examine these associations, we used a cross-sectional analysis of an epidemiological catchment area survey (N = 2,433). Visible cues, indicating a lack of order and social control in the community (neighbourhood disorder), were associated with increased trauma exposure (adjusted odds ratio [AOR] = 1.21, 95% confidence interval [CI] [1.12, 1.31]). For trauma-exposed individuals, neighbourhood disorder was associated with greater odds of lifetime PTSD (AOR = 1.38, 95% CI [1.10, 1.75]), and the willingness of residents who realize common values to intervene for the common good (social cohesion), was associated with lower likelihood of past-year PTSD (AOR = 0.64, 95% CI [0.42, 0.97]). For participants with a lifetime diagnosis of PTSD (including past-year), increased social cohesion was associated with higher odds of remission (AOR = 2.59, 95% CI [1.55, 4.30]). Environmental contexts play a role in the development and progression of PTSD. As such, traumatic stress outcomes may be better understood through a perspective that integrates individual and contextual risk factors.

Longitudinal analysis of quality of life across the trauma spectrum.

Objective: Few longitudinal studies have examined the relationship between trauma exposure and posttraumatic stress disorder (PTSD) in relation to quality of life or have been designed to consider the relationships between trauma, PTSD diagnosis, and quality of life in terms of both global scores and specific domains. This article aims to provide an essential longitudinal examination of the effects of trauma and PTSD diagnosis on global as well as specific domains of quality of life in a Canadian sample to better understand the diagnosis and unveil possible routes of research and successful treatment methods for the future. Method: Data were drawn from the initial two waves of the Zone d’étude en épidémiologie sociale et psychiatrique du sud-ouest de Montréal (ZEPSOM), an epidemiological catchment area study based in southwest Montréal (N = 2,433 at Wave 1 and N = 1,823 at Wave 2). PTSD diagnosis and global and subscale scores of quality of life outcomes were established by face-to-face structured interviews using standardized instruments. Outcomes were compared among 3 trauma/PTSD categories and healthy controls. Results: This study extends previous cross-sectional findings within the catchment area by demonstrating that the effects of current PTSD diagnosis on quality of life endure with time. Specifically, the negative impact of current diagnosis of PTSD on Wave 2 quality of life is expressed through its influence on Wave 1 quality of life. Subscale findings are discussed. Conclusion: Research needs to focus on understanding more than just global indices of quality of life when it comes to the trauma spectrum. Additional research remains necessary to fully understand these complex relationships over time.

Gender, gambling settings and gambling behaviours among undergraduate poker players

Abstract A gender divide in gambling is commonly observed among college populations. This study examines whether settings where students gamble on poker mediate the relationship between gender and poker gambling behaviours. Undergraduate poker players, 126 females and 242 males, were randomly sampled from three universities in Montreal, Canada. Three outcomes measuring risky behaviours were considered: severity of gambling problems as measured by the Problem Gambling Severity Index (PGSI), past-year poker spending and past-year poker debt. Multiple mediation analyses were conducted. The effect of gender on outcomes was analysed through three putative mediators: gambling on poker in private residences, in public locations or on the Internet. Male gender positively relates to risky gambling behaviours and occurrence of gambling in various settings. Risky gambling behaviours are positively related to gambling in various settings. Overall, the occurrence of playing poker in public locations and on the Internet emerged as significant mediators in relation to PGSI score, past-year poker spending and past-year poker debt. Given the nature of the processes by which gender is related to risky gambling behaviours among undergraduate students, gambling needs to be understood through a perspective that focuses as much on contexts as it does on individuals.

Trauma Exposure and Posttraumatic Stress Disorder in the Canadian Military

Objective: To estimate the lifetime prevalence of trauma exposure and posttraumatic stress disorder (PTSD) among a representative, active military sample, and to identify demographic and military variables that modulate rates of trauma exposure as well as PTSD rates and duration. Method: A cross-sectional weighted sample of 5155 regular members and 3957 reservists (n = 8441) of the Canadian Armed Forces (CAF) was face-to-face interviewed using a lay-administered structured interview that generates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychiatric diagnoses. Results: Within this sample, 85.6% reported 1 or more trauma exposure, with a median number of 3 or more exposures. Compared with males, females were less likely (P < 0.05) to be exposed to warlike trauma (adjusted odds ratio [AOR] 0.40), disasters (AOR 0.43), assaultive violence (AOR 0.52), and witnessing trauma (AOR 0.75). However, they were more likely to report sexual assault (AOR 7.36). The lifetime prevalence of PTSD was 6.6% and the conditional rate was 7.7%. Both lifetime and conditional PTSD rates were higher among female soldiers, but lower among the reserve forces, both male and female. Finally, the median duration of PTSD was negatively influenced by younger age of onset, but not influenced by whether the event occurred during deployment. Conclusions: Active members of the CAF report a high degree of trauma exposure but a moderate rate of lifetime PTSD.

Where Lies the Harm in Lottery Gambling? A Portrait of Gambling Practices and Associated Problems

Lotteries are one of the most prevalent forms of gambling and generate substantial state revenues. They are also argued to be one of the least harmful forms of gambling. This paper is one of the first to examine exclusive lottery gamblers and compares their gambling patterns and problems as well other associated risky behaviours to those who are not exclusive lottery gamblers. Data were derived from two large surveys conducted with representative adult samples in France (n = 15,635) and Québec (n = 23,896). Participants were separated into two groups: exclusive lottery gamblers (ELGs) and non-exclusive lottery gamblers. Using multivariate analysis, study results reveal that ELGs, who represent two thirds of gamblers, generally exhibit less intensive gambling patterns and are less likely to report other risky behaviours. However, harms associated with moderate risk and problem gambling are found to be concentrated in specific subpopulations for both groups, primarily males, older individuals, and those who report lower income and education level. Given widespread participation in lotteries and concentration of harm within specific subgroups, these findings point to the need for prevention efforts despite the lower levels of harm associated with lottery gambling.

Passion for gambling: a scoping review

ABSTRACT Investigating factors that influence a person’s ability to control gambling behaviour is important. The Dualistic Model of Passion, which includes both harmonious and obsessive passion, has proposed an original framework for studying these factors. However, the concept of passion as it pertains to the gambling experience remains relatively new and uncharted territory. This study entails a scoping review undertaken to determine the current state of knowledge concerning passion for gambling, and to provide recommendations for future research directions. The majority of studies included report a positive association between obsessive passion and gambling problems, whereas results related to harmonious passion were less consistent. Recommendations stemming from this scoping review include refining understanding of the relationship between obsessive passion and gambling problems, and broadening research aims to include more diverse sampling, methods and variables of interest when examining the overall contribution of passion to gamblers’ lived experiences. A final recommendation is to initiate research to test the utility of the Gambling Passion Scale in prevention and intervention programming.