Ronald J. Dyck

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

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.

Effect on retaliation of causal attributions concerning attack.

In two studies, men were defeated on either 17%, 50%, or 83% of reaction time trials, received aversive noise, and could ostensibly retaliate by delivering shock to their partner. The noise level delivered was described in Experiment 1 as typical of most other people (high consensus) or atypical of most other people (low consensus) and in Experiment 2 as from a partner who knew (high foreseeability) or did not know (low foreseeability) the kind and level of stimulation controlled by the switches delivering reinforcement to the recipient. Hypotheses were based on the notion that retaliation increases as more personal causality is attributed to a provoker and that more personal causality is inferred in highly foreseeable--or low consensus--50% defeat conditions. As expected, greater differences in aggression between high and low consensus and between high and low foreseeability were displayed in the 50% defeat condition than in the other defeat conditions. Anticipated differences in inferences were obtained.

A Conceptual Model of Community Capacity Development for Health Promotion in the Alberta Heart Health Project

Purpose. The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project. Method. Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation. Results. Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions. Conclusion. Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.

The epidemiology of parasuicide in Edmonton.

The objective of this study was to examine some of the characteristics of parasiticides in Edmonton and to calculate rates of parasuicide. The method involved examining all records of parasuicides attending the University of Alberta Hospitals for a six month period (20% of all parasuicides in Edmonton are treated at the University of Alberta Hospitals). The results indicated that 58% of 275 subjects were single. The most frequent method (88.6%) of parasuicide was overdose. The peak age group was 25 to 29 years of age. The age range was 12 to 80 years (six percent < 15 years), mean age 30.2. The female to male ratio (cases) was 1.6:1; 30.2% were admitted; 46.5% received psychiatric emergency consultation; 41% had made a previous parasuicide. Calculated rates of parasuicide in Edmonton were at 448/100,000/year for those 15 years and older (men 357, women 534). The overall rate is higher than that found in any centre in the WHO/EURO investigation. The conclusion is that parasuicide presents a significant public health problem, and a cost burden on the health care system.

On the age-period-cohort analysis of suicide rates

Cohort analysis has become a popular method of examining national trends in suicide rates. Most of the studies investigating this phenomenon have reported a cohort effect to be present. Using a graphical approach, this paper places cohort analysis within the broader framework of age-period-cohort analysis. It is shown that published reports may have failed to identify cohort effects due to using only portions of the available data. With a simple mathematical model it is demonstrated that what appears to be a cohort effect may be a period effect, and conversely. It is recommended that suicide rates be examined for both period and cohort effects before conclusions are drawn regarding trends, and that the complete data set be used for this purpose.

Patient satisfaction in a Psychiatric Walk-In Clinic.

The present study examined consumer satisfaction with services provided in a Psychiatric Walk-In Clinic in order to determine not only general levels of satisfaction but also whether or not differences in satisfaction exist between different user groups. Although levels of reported satisfaction were generally high, group psychotherapy patients reported being significantly less satisfied than patients who had been assessed at the clinic or who were in individual psychotherapy. None of the demographic variables including previous psychiatric experience, diagnosis and patient visits were related to satisfaction. These data were discussed in terms of program development.

Treatment noncompliance as a function of therapist attributes and social support.

Premature termination of short-term psychotherapy was examined as a function of therapist and social support variables. Patient perceived therapist competence, knowledge, relaxed manner, understanding of the help wanted, attitude, acceptance, listening ability, and sensitivity differentiated Continuers from Terminators. Although few of the social support variables were related to the mode of treatment termination, Continuers were found to be more likely than Terminators to have discussed attendance at the Clinic with others, especially family members. These findings were discussed in terms of their relevance to treatment of the emotionally ill and to the training of clinicians.

Current utilization of day hospitalization.

The present study examined characteristics of comparable samples of patients admitted to nonaffiliated day and full-time psychiatric hospitals. Moreover, the influence of the day hospital program on symptomatology and social functioning was assessed. In general, the results indicated that day patients were of higher socioeconomic status and had fewer previous hospitalizations in comparison to 24-hour patients. While fewer day patients were diagnosed as psychotic, they did obtain higher scores of social inadequacy, depression and social introversion. Participation in the day hospital program was generally found to be related to decreased psychopathology, increased self-esteem and social role activities, and symptom relief. However, patients suffering from functional psychoses were found to demonstrate improvement below the average of the patient sample. These results were discussed in relation to previous research.

Impact of an outpatient psychiatry rotation on Family Medicine Residents and Interns.

The present study examined the relative impact of a training program for Family Medicine Residents and Rotating Interns located in a Psychiatric Walk-In Clinic. Specifically, it was of interest to assess students’ satisfaction with the orientation to the rotation, the degree of involvement in different activities and the amount of supervision received, as well as the skills acquired during the rotation. In addition to the information collected immediately following the rotation, student perceptions of the relative benefits of the rotation to their medical practice and their general attitude toward mental health facilities were obtained in a follow-up survey. The results indicated that students were generally satisfied with their rotation. In particular, their level of satisfaction was related to the exposure to a wide variety of psychiatric patients, the supervision received, and the fulfillment of their expectations of the rotation. The findings also indicated that the training program did not meet all the needs of the students, particularly in the area of the assessment and treatment of couples and families and the utilization of psychotropic medications.