Marienne Hibbert

Depression, anxiety, and smoking initiation: a prospective study over 3 years.

OBJECTIVES This report considers the extent to which depression and anxiety predict smoking onset in adolescence. METHODS A 6-wave cohort design was used to study a sample of 14- and 15-year-old students (n = 2032) drawn from 44 secondary schools in the state of Victoria, Australia. The students were surveyed between 1992 and 1995 with a computerized questionnaire that included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. RESULTS Experimental smokers were 29 times more likely than non-smokers to make a transition into daily use in the subsequent 6 months. Depression and anxiety, along with peer smoking, predicted initiation of experimental smoking. Specifically, depression and anxiety accentuated risks associated with peer smoking and predicted experimentation only in the presence of peer smoking. CONCLUSIONS The finding that experimental smoking is an overwhelmingly strong predictor of later daily smoking focuses attention on smoking initiation. Depressive and anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well-being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use.

Is smoking associated with depression and anxiety in teenagers

OBJECTIVES An association of smoking with depression and anxiety has been documented in adult smokers. This study examines this association in a representative group of teenage smokers. METHODS A two-stage cluster sample of secondary school students in Victoria, Australia, were surveyed by using a computerized questionnaire, which included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. RESULTS Subjects reporting high levels of depression and anxiety were twice as likely to be smokers after the potential confounders of year level, sex, alcohol use, and parental smoking were controlled for. Regular smokers were almost twice as likely as occasional smokers to report high levels of depression and anxiety. In a stratified analysis, an association between regular smoking and psychiatric morbidity was found in girls of all ages but for boys only in the youngest group. CONCLUSIONS The cross-sectional association is consistent with the use of smoking by teenage girls as self-medication for depression and anxiety. Therefore, future health promotional campaigns might consider strategies that attend to perceived psychological benefits of smoking.

Childhood asthma and lung function in mid-adult life

The longitudinal lung function data in 286 subjects from a 28 year follow‐up of childhood asthma is reported. Airway obstruction in mid‐adult life was present mainly in those with moderately severe asthma. Subjects who had been wheeze free for at least 3 years, even if asthma had been persistent in childhood, had normal lung function and no increased bronchial reactivity. Only two subjects, both with persistent asthma from childhood, failed to show an improvement in FEV1 of greater than 10% following inhalation of a beta‐adrenergic agonist. Subjects with relatively mild asthma who had not taken inhaled steroids did not appear to be disadvantaged with respect to lung function. Pediatr Pulmonol. 1997; 23:14–20.

The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey

In most cases of schizophrenia the onset of frank psychosis is preceded by a period of prodromal features. This period has been relatively neglected by researchers and is potentially important in promoting early intervention. The prevalence of DSM‐III‐R schizophrenia prodrome symptoms was assessed as part (n= 657) of a large (n= 2525) questionnaire‐based survey of high school students. Individual symptoms were highly prevalent and the prevalence of DSM‐III‐R prodromes ranged from 10–15% to 50%. Despite methodological weaknesses, the data suggest that DSM‐III‐R prodromal features are extremely prevalent among older adolescents and unlikely to be specific for subsequent schizophrenia. Clinically these features cannot be regarded as sufficient evidence of early schizophrenia and more accurate predictors of incipient schizophrenia need to be defined.

Menarche and the onset of depression and anxiety in Victoria, Australia.

STUDY OBJECTIVE: Psychiatric disorder often begins at adolescence. This study aimed to examine the associations between puberty and social circumstances and the adolescent rise in depression and anxiety. DESIGN: A two stage cluster sampling procedure was used to identify a representative group of Australian secondary school students in years 7 (age 12-13 years), 9 (14-15 years), and 11 (16-17 years) of 45 Victorian schools. The computerised clinical interview schedule (CIS) was used to evaluate psychiatric morbidity. MAIN RESULTS: A total of 2525 subjects completed the survey - an overall participation rate of 83%. Levels of depression and anxiety increased with the secondary school years and girls had significantly higher rates at each school year level. For boys, the clearest independent associations with depression and anxiety were rising school year level and high parental educational achievement. For girls menarchal status emerged as the strongest predictor. Associations with age and school year level, evident on univariate analysis, did not persist when the recency of menarche was taken into account. After addition of measures of perceived social stress to a multivariate model, a significant association between depression/anxiety and parental divorce disappeared but the association with menarche persisted. CONCLUSIONS: Menarche marks a transition in the risk of depression and anxiety in girls. The pattern of findings is consistent with a biological mediation of this association.

Long term pulmonary consequences of oesophageal atresia with tracheo-oesophageal fistula.

ABSTRACT. Lung function was studied in 20 children, aged 8‐17 years, who had successfuly repaired oesophageal atresia with tracheo‐oesophageal fistula. Spirometry and plethysmography showed mild restrictive lung disease. Airways obstruction was assessed using maximal expiratory and inspiratory flow‐volume loops in air and after breathing a helium‐oxygen mixture. Analysis of the flow‐volume data demonstrated significant obstruction at the level of the trachea and little evidence of small airways disease. Bronchial hyperreactivity, as assessed by histamine challenge, was present in 22% of subjects. Respiratory and oesophageal symptoms were common, but decreased in frequency with increasing age. The mechanisms involved in the frequent respiratory symptoms these children suffer are discussed in the light of the physiological findings.

Acne in Victorian adolescents: associations with age, gender, puberty and psychiatric symptoms.

Objectives: This study aimed to examine the associations between the frequency and severity of self‐reported acne and age, gender, puberty and psychiatric symptoms in Victorian adolescents.

The association between secondary amenorrhea and common eating disordered weight control practices in an adolescent population

PURPOSE This study examined the relative importance of low weight, in contrast with other symptoms of eating disorder, as a determinant of amenorrhea. METHODS A cross-sectional survey was conducted of students at Year 10 (mean age 15.0 years) attending 43 schools in the state of Victoria. Amenorrhea and symptoms of eating disorder were assessed using the Branched Eating Disorders Test, administered through the medium of a notebook computer. RESULTS The survey response rate was 84% (n = 886). A total of 23% (n = 205) reported either fasting or purging in the previous month. Secondary amenorrhea of at least 3 months duration was reported by 4.1% (n = 35). No statistically significant association was found between amenorrhea and body mass index. In contrast, 40% of amenorrheic subjects reported fasting or purging (P = .03), an association most evident in the heaviest subjects. CONCLUSION These finding suggests that secondary amenorrhea may develop in normal and above-weight teenagers who engage in eating disordered weight control practices.

Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews

Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web‐based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.

Dose rounding of chemotherapy in colorectal cancer: an analysis of clinician attitudes and the potential impact on treatment costs.

Aim:  The aims of this study were to calculate theoretical cost savings of oxaliplatin dose rounding in colorectal cancer (CRC), and to assess clinician attitudes to chemotherapy dose rounding.