Scott B. Patten

Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis

Purpose: The estimated prevalence of mental health disorders in those with epilepsy in the general population varies owing to differences in study methods and heterogeneity of epilepsy syndromes. We assessed the population‐based prevalence of various psychiatric conditions associated with epilepsy using a large Canadian national population health survey.

Major depression in multiple sclerosis: a population-based perspective.

Objective: To determine the prevalence of major depression in multiple sclerosis (MS) in a population-based sample controlling for nonspecific illness effects. Methods: This study used data from a large-scale national survey conducted in Canada: the Canadian Community Health Survey (CCHS). The analysis included 115,071 CCHS subjects who were 18 years or older at the time of data collection. The CCHS interview obtained self-reported diagnoses of MS and employed a brief predictive interview for major depression: the Composite International Diagnostic Interview Short Form for Major Depression. The 12-month period prevalence of major depression was estimated in subjects with and without MS and with and without other long-term medical conditions. Results: The prevalence of major depression was elevated in persons with MS relative to those without MS and those reporting other conditions. The association persisted after adjustment for age and sex (adjusted odds ratio = 2.3, 95% CI 1.6 to 3.3). Major depression prevalence in MS for those in the 18- to 45-year age range was high at 25.7% (95% CI 15.6 to 35.7). Conclusions: The prevalence of major depression in the population with MS is elevated. This elevation is not an artifact of selection bias and exceeds that associated with having one or more other long-term conditions.

Descriptive Epidemiology of Major Depression in Canada

Objective: The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) is the first national study to use a full version of the Composite International Diagnostic Interview. For this reason, and because of its large sample size, the CCHS 1.2 is capable of providing the best currently available description of major depression epidemiology in Canada. Using the CCHS 1.2 data, our study aimed to describe the epidemiology of major depression in Canada. Method: All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling. Results: The lifetime prevalence of major depressive episode was 12.2%. Past-year episodes were reported by 4.8% of the sample; 1.8% reported an episode in the past 30 days. As expected, major depression was more common in women than in men, but the difference became smaller with advancing age. The peak annual prevalence occurred in the group aged 15 to 25 years. The prevalence of major depression was not related to level of education but was related to having a chronic medical condition, to unemployment, and to income. Married people had the lowest prevalence, but the effect of marital status changed with age. Logistic regression analysis suggested that the annual prevalence may increase with age in men who never married. Conclusions: The prevalence of major depression in the CCHS 1.2 was slightly lower than that reported in the US and comparable to pan-European estimates. The pattern of association with demographic and clinical variables, however, is broadly similar. An increasing prevalence with age in single (never-married) men was an unexpected finding.

Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature

BACKGROUND Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study. METHOD A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis. RESULTS The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4-5.0%). The pooled annual incidence was 3.0% (2.4-3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD. CONCLUSIONS Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

Comorbidity of migraine and psychiatric disorders--a national population-based study.

Background.— Migraine is common, with an estimated lifetime prevalence of 7‐17%. Population‐based studies have reported an association between various psychiatric conditions and migraine. This is a population‐based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health‐related outcomes.

Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2

BACKGROUND Cross-sectional studies have reported that certain long-term medical conditions are associated with major depression. Here, these associations are explored using a longitudinal analysis. METHODS Data from the first (1994/95) and second (1996/97) waves of the Canadian National Population Health Survey (NPHS) were utilized. The first wave of the NPHS utilized a probability sample of 17626 members of the Canadian population. Members of this cohort were recontacted by Statistics Canada 2 years later. The Composite International Diagnostic Interview Short Form for Major Depression was used to identify episodes of major depression in both waves of the survey. Subjects free of major depression in the year preceding the 1994/95 survey were selected for inclusion in this analysis. The incidence of new-onset episodes in subjects with and without reported long-term medical conditions was compared. RESULTS Individuals suffering from one or more long-term medical conditions were found to be at increased risk of major depression. Migraine headaches, sinusitis and back problems were the conditions most strongly associated with major depression. Having a long-term medical condition approximately doubled the risk of major depression in this analysis. LIMITATIONS The most important limitation of this study was its reliance on self report data about medical conditions. CONCLUSIONS A large proportion of the general population in Canada suffers from long-term medical conditions. These individuals are at increased risk of major depression. This study suggests an important role for long-term medical conditions in the etiology of major depression.

Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta

BackgroundDespite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada.MethodsA mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta.ResultsIn total 415 (51 %) residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p < 0.02). Time pressure was reported as the number one factor contributing to stress (44% of males and 57% of females). A considerable proportion of residents would change their specialty program (14%) and even more would not pursue medicine (22%) if given the opportunity to relive their career. Up to 55% of residents reported experiencing intimidation and harassment. Intimidation and harassment was strongly related to gender (12% of males and 38% of females). Many residents (17%) rated their mental health as fair or poor. This was more than double the amount reported in the Canadian Community Health Survey from the province (8%) or the country (7%).Residents highly valued their colleagues (67%), program directors (60%) and external psychiatrist/psychologist (49%) as well-being resources. Over one third of residents wished to have a career counselor (39%) and financial counselor (38%).ConclusionMany Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

Minocycline reduces gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis

We report a trial of minocycline in people with relapsingremitting multiple sclerosis (RRMS) that evaluates safety and estimates its effect on magnetic resonance imaging (MRI). Ten subjects with active RRMS received oral minocycline 100mg twice daily for 6 months after a 3-month run-in period. A 30-month treatment extension is ongoing. Clinical and laboratory assessments were completed at enrollment and then at 3-month intervals. MRI was performed at enrolment and then every 4 weeks. Patients without MRI activity during the run-in phase continued in the study, including completion of all MRI scans, to confirm lack of MRI worsening. The primary outcome was change in the mean number of gadolinium-enhancing lesions per scan during the first 6 months of treatment compared with the run-in period (Wilcoxon signed rank test, two-sided alpha of 0.05). Eighty percent of participants were women. Mean age was 42.8 years (SD 4.0). Mean MS duration was 11.8 years (SD 6.3). Median baseline extended disability status score (EDSS) was 2.5 (range 1.5–5.5). Mean relapse number in the two prior years was 2.6 (range 2–4). During the trial, there were no serious adverse events or laboratory abnormalities and no change in EDSS. Three relapses occurred during the run-in phase, five during the first 6-month treatment phase, and none during the following 6 months. On-treatment relapses included one associated with MRI enhancement (during month 1), two without enhancement (one scan was a postrelapse scan, and one scan was missed because the patient was taking steroids), and two mild truncal sensory attacks unassociated with MRI enhancement (both at 5 months). Mean total enhancing lesion number decreased from 1.38 lesions per scan during the run-in phase to 0.22 during the treatment phase (z 2.204, p 0.0276), representing a relative reduction of greater than 84%. During the run-in phase, 47.5% of MRI scans (19/40) were active, whereas 9.3% (5/54) were active during the minocycline phase. There were no active scans after month 2 (Fig) and no new active lesions after month 1. Although five patients accounted for all MRI activity before and after treatment, all patient data were included in all analyses. This study provides preliminary evidence that minocycline may be useful in MS and supports its safety. The MRI results are consistent with the ability of minocycline to inhibit matrix metalloproteinases, thus reducing lymphocyte access to the central nervous system. In addition, minocycline may have other beneficial properties including neuroprotection. Small sample size and short trial duration limit conclusions, but reduced MRI activity is encouraging and calls for definitive studies to establish minocycline efficacy in MS.

Major depression as a risk factor for chronic disease incidence: longitudinal analyses in a general population cohort ☆

OBJECTIVE Cross-sectional studies have consistently reported associations between major depression (MD) and chronic medical conditions. Such studies cannot clarify whether medical conditions increase the risk for MD or vice versa. The latter possibility has received relatively little attention in the literature. In this study, we evaluate the incidence of several important chronic medical conditions in people with and without MD. METHOD The data source was the Canadian National Population Health Survey (NPHS). The NPHS included the Composite International Diagnostic Interview Short Form to assess past-year major depressive episodes. The NPHS also collected self-report data about professionally diagnosed long-term medical conditions. A longitudinal cohort was interviewed every 2 years between 1994 and 2002. Proportional hazards models were used to compare the incidence of chronic conditions in respondents with and without MD and to produce age-, sex- and covariate-adjusted estimates of the hazard ratios. RESULTS The adjusted hazard ratios associated with MD at baseline interview were elevated for several long-term medical conditions: heart disease (1.7), arthritis (1.9), asthma (2.1), back pain (1.4), chronic bronchitis or emphysema (2.2), hypertension (1.7) and migraines (1.9). The incidences of cataracts and glaucoma, peptic ulcers and thyroid disease were not higher in respondents with MD. CONCLUSION A set of conditions characterized particularly by pain, inflammation and/or autonomic reactivity has a higher incidence in people with MD.