Helene Orn

Lifetime prevalence of psychiatric disorders in Edmonton

3,258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Lifetime prevalence for 16 DIS/DSM III diagnoses are given. Overall 33.8% of the population had one or more diagnoses and, excluding substance use disorders, one fifth of the population had a diagnosis. The most common lifetime diagnosis was alcohol abuse/dependence, followed by phobia and major depressive episode. Men were more likely to have had substance use disorders and antisocial personality disorder and women more likely to have had major depressive episode, dysthymia, agoraphobia and simple phobia. Those who were married had generally lower lifetime prevalences. Those over age 65 had the lowest prevalence of any age groups.

Epidemiology of pathological gambling in Edmonton

Thirty lifetime pathological gamblers (DSM-III, no exclusion criteria) were identified when 7,214 randomly selected household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The lifelong prevalence of pathological gambling was 0.42% (ratio of males to females 3:1). The peak age of onset was 25 to 29 years. Gamblers had high rates of comorbidity with other psychiatric disorders. They were likely to have made suicide attempts (13.3%), to have been convicted of offences (26.7%), to be spouse and child abusers (23.3% and 16.7% respectively) and to have spent long periods unemployed (40%). In addition, 80% had trouble at home or work because of gambling, and 60% borrowed or stole to gamble.

Family Violence and Psychiatric Disorder

The relationship between family violence and psychiatric disorders was examined using standardized diagnostic interviews of 1200 randomly selected residents of a large Canadian city. The results showed that higher than expected proportions of those exhibiting violent behavior had a psychiatric diagnosis and the rate of violent behaviors in those with diagnoses (54.4%) significantly (p < .0001) exceeds the rate in the remainder of the sample (15.5%). Particularly high rates of violence are found in those where alcoholism is combined with antisocial personality disorder and/or recurrent depression (80–93%). Also at high risk for violence are those who have made suicide attempts (over 50%) and those who have been arrested for non-traffic offences (two-thirds). These data suggest that psychiatric disorders have a strong relationship to violent behavior, and are not in agreement with the predominantly sociological explanations of family violence.

PREVALENCE OF PSYCHIATRIC DISORDERS IN THE ELDERLY IN EDMONTON

Prevalence rates (six month and lifetime) for a random sample (N=358) of the eldery living at home, are compared to the rates for a sample (N=3,258) of the whole adult popultion of Edmonton and found to be generally lower in the elderly, except for cognitive impairment. These household resident results are similar to those reported from the United States using similar methods. A sample (N = 199) of the elderly living in institutions was found to have a very high overall prevalence of illness, mostly consisting of cognitive impairment (69%). It is estimated that over half of all cases of cognitive impairment live in institutions. This has considerable implications for the programs in institutions for the elderly, and also the need for institutions in the future, unless alternate means of care can be developed.

Help-Seeking for Psychiatric Disorders

Objective: To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care. Method: A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview. Results: Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, χ2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care. Conclusion: Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder.

PERIOD PREVALENCE OF PSYCHIATRIC DISORDERS IN EDMONTON

3,258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Six‐month prevalence figures for DIS/DSM III diagnoses are given, and selected figures for the one‐month and one‐year prevalence, and the one‐year symptom‐free rates. The six‐month prevalence for any diagnosis is 17.1%, comparable to findings from other population studies using DSM III derived diagnoses, but lower than studies using the PSE. The prevalence rates for most disorders tended to be lowest in the elderly, but this was not as marked as the drop in lifetime prevalence. Men had higher prevalence for substance use disorders than women, but women had higher rates for affective disorders and anxiety/somatoform disorders. Prevalences for all disorders were either similar or lower in those who were married or living as though married, than in those who were not cohabiting. One‐year symptom‐free rates were highest for those with substance use disorders and lowest for those with anxiety/somatoform disorders ‐ largely due to the persistence of phobias.

Prevalence of psychiatric disorders and suicide attempts in a prison population.

A survey was conducted in which 180 randomly selected male prisoners ages 18 to 44 were interviewed using the Diagnostic Interview Schedule and other questionnaires. A comparison was made with 1,006 similarly aged male residents of Edmonton who were interviewed using the same instruments. Compared to the general population, prisoners were less likely to be married and were less well educated. There was a higher proportion of Native Indians in the prison sample and lower proportions of Oriental and other racial groups. Prisoners were twice as likely to have a lifetime psychiatric disorder compared with the general population, and all individual disorders investigated were more common in the prison population. Six month prevalence showed even greater rates compared with the general population, indicating recent symptoms. The number of individual disorders per prisoner was also higher than for the general population. Lifetime suicide attempts were seven times more frequent in prisoners than in the general population.

Schizophrenia:.: Lifetime co-morbidity in a community sample

ABSTRACT— Twenty persons with schizophrenia were identified in a community sample of 2144 adult household residents interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The hierarchy‐free lifetime prevalence for a variety of psychiatric disorders is compared in those with and without schizophrenia. Those with schizophrenia were found to have increased chances of having other disorders, all except one having had at least one other disorder. Major depressive episodes, obsessive compulsive disorder, phobia, alcohol abuse/dependence and drug abuse/dependence, each occurred in over half of the schizophrenics, and panic disorder, antisocial personality, and mania were each found in one sixth to one quarter of the schizophrenics.

14-year outcome in early schizophrenia.

Of 45 first admission schizophrenics from 1963, an incidence by first admission group for northern Alberta, 43 were followed‐up 14 years later. Based on these figures the expectancy was found to be 0.49 %. The proportion of patients who were married was less than expected in comparison with the general population, but amongst the married, fertility was probably comparable to the populations. At follow‐up about half the patients were managing well with little or no disability, one quarter had moderate to marked disability and the remainder were socially, psychiatrically and occupationally disabled. From the time of first admission, patients had spent an average of 15 % of their time in hospital and lost 28 % of the total time due to psychiatric disability.

SUICIDE ATTEMPTS AND PSYCHIATRIC DISORDERS IN EDMONTON

The relationship between lifetime histories of attempting suicide, psychiatric disorders and other social problems was assessed by examining data from a random sample of 3,258 household residents of Endmonton who were administered the Diagnostic Interview Schedule (DIS) and the Goldberg General Health Questionnaire (GHQ) by trained lay interviewers. While the overall lifetime rate for suicide attempt was 3.6%, of particular interest was the finding that a lifetime history of a psychiatric disorder was 2.6 times more frequent in those who had made a suicide attempt than in those who had not. Alcoholism, major depressive episode and antisocial personality disorder carried the highest lifetime prevalence rates for male attempters, whereas major depressive episode, alcoholism and phobic diorder were the most common disorders in female attempters. Having thoughts and feelings about wanting to die and committing suicide were strongly associated with having made a sucide attempt in both males and females. GHQ results indicated that in comparison to nonattempters those who attempted suicide were more likely to have high current symptom levels.