S E P Munce

Major depressive episodes and work stress: results from a national population survey.

OBJECTIVESnWe determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes.nnnMETHODSnData were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview.nnnRESULTSnOf the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority.nnnCONCLUSIONSnA significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.

Characteristics of adults with incident traumatic spinal cord injury in Ontario, Canada

Study design:Cohort study.Objectives:To provide recent estimates of the incidence of traumatic spinal cord injury (SCI) in adults living in Ontario.Setting:Ontario, Canada.Methods:The study included all men and women aged 18 years and older living in Ontario. The two primary data sources used for this study were the census data provided by Statistics Canada and the hospital Discharge Abstract Database (DAD) provided by the Canadian Institute for Health Information. Incidence was estimated for the fiscal years 2003/04–2006/07, and examined by age, gender, mechanism and seasonality of injury, the level of injury, the presence of comorbidity and in-hospital mortality.Results:The incident cases had a mean age of 51.3 years (s.d. 20.1). The majority of the cases was male (74.1%) and had a cervical SCI caused by falls (49.5%). The age-adjusted incidence rate was stable over the 4-year study period, from 24.2 per million (95% CI: 21.2–27.6) in 2003 to 23.1 per million (95% CI: 20.2–26.3) in 2006.Conclusion:Despite worldwide trends that have indicated motor vehicle collisions (MVCs) as the leading cause of injury, falls emerged as the leading cause of traumatic SCI in this study. This finding, and the fact that the number of fall-induced injuries increased steadily with age, may indicate that there is growing concern for the consequences of falls in the elderly. Further work is needed to understand this trend in age and gender and the causes of falls to develop effective fall prevention strategies.

Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Study Design:Retrospective cohort design.Objectives:To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation.Setting:Ontario, Canada.Methods:Inpatient stays (2003–2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization.Results:NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P<0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median=24) and 29.7 (median=22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR=1.5; 95% CI=1.2–1.9), urban living (OR=1.59; 95% CI=1.12–2.22) and lowest quartile (18–88) discharge FIM (OR=1.8; 95% CI=1.4–2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3–3.2), urban living (OR=1.92; 95% CI=1.3–2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2–2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1–2.1), low income (OR=1.4; 95% CI=1.1–1.9) and low (18–88) discharge FIM (OR=1.7; 95% CI=1.3–2.2).Conclusion:Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.

Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study.

Study design:This is a cohort study with 1-year follow-up.Objectives:The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization.Methods:All persons who had an acute care hospitalization for traumatic SCI in Ontario between 1 April 2003 and 31 March 2006 were identified according to International Classification of Diseases, Tenth Revision codes and followed for 1 year following acute care discharge through record linkage of administrative databases. Index cases with an SCI admission the year before 2003 as well as persons who died within 1 year after the index hospitalization were excluded from the analysis. Factors associated with 1-year rehospitalization were assessed using multivariate logistic regression analyses and included age, sex, rurality, length of stay, comorbidity, level of injury, discharge disposition, in-hospital complication, physician visits and specialist visits measure and etiology of injury.Results:A total of 559 individuals met the inclusion criteria and 27.5% (n=154) were rehospitalized 1 year after initial acute care discharge. Factors significantly associated with 1-year rehospitalization were length of stay, rural residence, 50+ outpatient physician visits and 50+ specialists visits following the index admission. The main causes of rehospitalization were musculoskeletal, respiratory, gastrointestinal and urological disorders.Conclusion:This study presents recent data on rehospitalization and yet rehospitalization rates continue to remain high. Our findings have significant implications for healthcare policy and planning in Ontario, Canada with respect to the management of SCI to achieve optimal health outcomes, in particular in rural areas.

The role of depression and chronic pain conditions in absenteeism: results from a national epidemiologic survey.

Objective: This study examined whether depression is associated with absenteeism in a sample of individuals with chronic pain. Methods: Data were obtained from the Canadian Community Health Survey Cycle 1.2. Key variables were chronic pain, defined as fibromyalgia, arthritis/rheumatism, back problems, and migraine headaches, absenteeism, and depression. The sample comprised 9,238,154 individuals who reported at least one chronic pain condition and were absent from their job in the previous week because of illness or disability. Results: Nineteen percent of absent individuals met criteria for major depression versus 7.9% of non-absent individuals. The presence of major depression represented a three-fold risk of absenteeism. Other risk factors for absenteeism included younger age, higher income, and more education. Conclusions: Comorbid depression and chronic pain represents a significant source of disability in the workforce.

Psychosocial and clinical correlates of suicidal acts: results from a national population survey

BACKGROUNDnClinical samples have identified a number of psychosocial risk factors for suicidal acts but it is unclear if these findings relate to the general population.nnnAIMSnTo describe the prevalence of and psychosocial risk factors for suicidal acts in a general adult population.nnnMETHODnData were obtained from a Canadian epidemiological survey of 36,984 respondents aged 15 years and older (weighted sample n=23,662,430).nnnRESULTSnOf these respondents, 0.6% (weighted n=130,143) endorsed a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05-4.50), being separated (OR=37.88, 95% CI 33.92-42.31) or divorced (OR=7.79, 95% CI 7.22-8.41), being unemployed (OR=1.70, 95% CI 1.50-1.80), experiencing a chronic physical health condition (OR=1.70, 95% CI 1.67-1.86) and experiencing a major depressive episode in the same 12-month period as the act (OR=9.10, 95% CI 8.65-9.59) were significantly associated with a suicidal act.nnnCONCLUSIONSnThe psychosocial correlates of suicidal acts in this sample are consistent with those previously reported in clinical and general population samples. These findings reinforce the importance of the determination of suicide risk and its prevention not only of psychiatric illness but of physical and psychosocial factors as well.

Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study.

Study design:Retrospective cohort study.Objectives:To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury.Setting:Ontario, Canada.Methods:A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified.Results:The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0–6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0–13.1) and in-hospital complication (OR=2.34, 95% CI=1.3–4.3). Age 70 or less (OR=0.19, 95% CI=0.0–0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED.Conclusions:Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.

Women's mental health: A silent cause of mortality and morbidity

It is estimated that 450 million individuals worldwide are affected by mental, neurological or behavioral problems at any time, and that 873,000 die annually by suicide. Key international authorities and a literature review suggest that women are disproportionately affected by depression, anxiety and eating disorders, which usually go unrecognized and untreated, and that the mental health of women can be understood only if their biological, social, cultural, economic and personal context is considered. International efforts should increase to prevent, recognize and treat mental disorders in girls and women. An International Womens Mental Health Consensus Statement is herein provided, for endorsement by interested organizations wishing to begin this task.

Who is portrayed in psychotropic drug advertisements

The purpose of our study was to determine who is portrayed in psychotropic drug advertisements across time in three national psychiatric journals. All psychotropic drug advertisements portraying people were collected from the American Journal of Psychiatry, the British Journal of Psychiatry, and the Canadian Journal of Psychiatry at three time intervals (1981, 1991, and 2001). The advertisements were classified according to patient demographics, patient portrayal, and product information. Chi-square analysis was used to test for statistically significant associations among the variables. Fifty-seven percent of the psychotropic drug advertisements featured women, and 88% portrayed white patients. Statistically significant associations were detected between gender and the setting in which the patient was portrayed (χ2 = 13.54, df = 3, p < .004), and gender and role (χ2 = 29.41, df = 3, p < .001). Disproportionate gender representation was most notable in the 2001 time interval in the American Journal of Psychiatry. Women and white patients were overrepresented compared with psychiatric epidemiologic data in all three countries. The effect of these advertisements on physician perception, diagnosis, and prescribing is unknown but may be substantial. Future advertisements for psychotropic drugs should seek more balanced representations of gender and race.

Work characteristics and social phobia in a nationally representative employed sample.

Objective: Social phobia is associated with long-term impairment and disability. Environmental and genetic influences may be important in etiology and persistence. This is the first study to examine the association of work characteristics with social phobia in a representative nationally employed population. Method: Self-reported work characteristics were linked to 12-month social phobia diagnosed by the World Mental Health Composite International Diagnostic Interview in 24 324 employed individuals from the Canadian Community Health Survey. Results: High job strain (OR = 1.62, 95%CI, 1.06 to 2.49) and job insecurity (OR = 2.47, 95%CI, 1.73 to 3.51) were associated with an increased risk of 12-month social phobia, adjusting for sociodemographic variables, prevalent depression, and other work characteristics. Conclusions: Work characteristics are associated with social phobia. Characteristics such as job insecurity may be a consequence of illness in employed populations, while high job strain may increase the risk of symptoms. More investigation is needed of the relation between work and social phobia to understand how to reduce occupational disability.