Scott Veldhuizen

Evaluation of 2 Measures of Psychological Distress as Screeners for Depression in the General Population

Objective: Structured diagnostic interviews are very time-consuming and therefore increase both the expense and the respondent burden in epidemiologic surveys. A 2-staged interview that screens potential cases before the full diagnostic instrument is administered has the potential to greatly reduce the average interview length. In this paper, we evaluate 2 measures of psychological distress (the Kessler 6- and 10-Item Psychological Distress Scales [K6 and K10]) as potential screening instruments for depression. Methods: We use data from Cycle 1.2 of the Canadian Community Health Survey and receiver operator characteristic analysis to examine the agreement between the K6 and K10 and the World Mental Health Composite International Diagnostic Interview module for major depression (1-month and 12-month estimates). Results: Of the respondents, 823 were positive for 1-month depression (2.0%; 95% confidence interval [CI], 1.8% to 2.2%), and 1930 were positive for 12-month depression (4.8%; 95%CI, 4.5% to 5.1%). Both the K6 and K10 performed very well as predictors of 1-month depression, with areas under the curve (AUC) of 0.929 (95%CI, 0.908 to 0.949) for the K10 and 0.926 (95%CI, 0.905 to 0.947) for the K6. For 12-month depression, the AUCs remained good at 0.866 (95%CI, 0.848 to 0.883) for the K10 and 0.858 (95%CI, 0.840 to 0.876) for the K6. Conclusions: Both the K6 and the K10 appear to be excellent screening instruments, especially for current depression. Although performance of the 2 instruments is similar, the K6 is more attractive for use as a screening instrument because of the lower response burden.

Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties

Aim  Children with developmental coordination disorder (DCD) are known to participate in active play less than typically developing children. However, it is not known whether the activity deficit between children with and without DCD widens or diminishes over time.

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.

Community Survey of Bipolar Disorder in Canada: Lifetime Prevalence and Illness Characteristics

Objective: This study reports on the lifetime prevalence and illness characteristics of bipolar disorder (BD) in a large, representative sample of Canadians. Method: Data were obtained from the Canadian Community Health Survey: Mental Health and Well-Being. This representative, cross-sectional survey, conducted by Statistics Canada in 2002, examines the mental health of Canadians aged 15 years and over. The national response rate was 77%. We determined the prevalence rate of BD, correlates of a bipolar diagnosis, and illness characteristics. Results: The weighted lifetime prevalence rate of BD was 2.2% (95% confidence interval [CI], 1.94% to 2.37%). Younger age, low income adequacy, lifetime anxiety disorder, and presence of a substance use disorder in the past 12 months were each significantly associated with the presence of a BD diagnosis (P < 0.001 for each). The largest effect found was for the presence of an anxiety disorder (odds ratio 7.94; 95%CI, 6.35 to 9.92). A lifetime history of anxiety disorder was reported by 51.8% (95%CI, 47.1% to 56.5%) of the respondents with BD, with both panic disorder and agoraphobia each being more frequent among women, compared with men (P = 0.01 and P < 0.001, respectively). The mean age at onset of illness was 22.5 years, SD 12.0. Conclusions: According to the estimated lifetime prevalence of BD found in this study, over 500 000 Canadians likely suffer from this condition. Identifying those at highest risk for BD may assist in developing more effective community-based identification and intervention strategies.

Trajectories of relative weight and waist circumference among children with and without developmental coordination disorder

Background: Children with developmental coordination disorder have been found to be less likely to participate in physical activities and therefore may be at increased risk of overweight and obesity. We examined the longitudinal course of relative weight and waist circumference among school-aged children with and without possible developmental coordination disorder. Methods: We received permission from 75 (83%) of 92 schools in southwestern Ontario, Canada, to enrol children in the fourth grade (ages 9 and 10 at baseline). Informed consent from the parents of 2278 (95.8%) of 2378 children in these schools was obtained at baseline. The main outcome measures were body mass index (BMI) and waist circumference. Children were followed up over two years, from the spring of 2005 to the spring of 2007. Results: Over the course of the study, we identified 111 children (46 boys and 65 girls) who had possible developmental coordination disorder. These children had a higher mean BMI and waist circumference at baseline than did those without the disorder; these differences persisted or increased slightly over time. Children with possible developmental coordination disorder were also at persistently greater risk of overweight (odds ratio [OR] 3.44, 95% confidence interval [CI] 2.34–5.07) and obesity (OR 4.00, 95% CI 2.57–6.21) over the course of the study. Interpretation: Our findings showed that children with possible developmental coordination disorder were at greater risk of overweight and obesity than children without the disorder. This risk did not diminish over the study period.

Motor coordination and emotional-behavioral problems in children.

Purpose of review To summarize recent research on developmental coordination disorder (DCD), with particular attention to comorbidity and related questions of etiology. Recent findings Although a general consensus on the disorder definition exists, case identification in research studies remains problematic. Despite this, recent research has reported high levels of attention deficit/hyperactivity disorder and internalizing disorders among children with poor motor coordination. These findings offer some support for the longstanding view that DCD may be one facet of a broader syndrome that includes learning difficulties and deficits in attention. ‘Pure’ cases are common, however, and other work suggests that DCD and attention deficit/hyperactivity disorder have distinct causes. There is also some evidence that internalizing disorder may be a consequence of DCD. Summary Measurement issues in DCD persist, whereas findings on comorbidity have both illuminated the nature of the disorder and heightened debate on its usefulness as a distinct diagnostic entity.

The epidemiology of psychological problems in the elderly.

Objective: To determine the prevalence of mood, anxiety, and other disorders in the population of Canadians aged 55 years and over. Method: We undertook an analysis of the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Results: There was a linear decrease for all disorders after age 55 years. This was true for men and women; for anglophones, francophones, and allophones; and for both people born in Canada and people who immigrated to Canada after age 18 years. Consistent with previous research, the prevalences were higher for women than men. Immigrants reported fewer problems than nonimmigrants, with the differences decreasing with age. Francophones of both sexes reported more mood disorder than anglophones, but francophone men had less anxiety disorder than anglophone men. Conclusions: Unlike other studies that have found an upturn in the prevalence of depression and anxiety in the elderly, our results indicate a steady decrease in these disorders. Our findings are discussed in terms of explanations for age-related differences in psychiatric disorders.

Epidemiology of Social Phobia in Later Life

OBJECTIVE Although anxiety disorders, including social phobia (SP), are common among older adults, very little is known about the epidemiology of SP in later life. METHOD Using data drawn from a large, nationally representative sample of older adults from Canada (N=12,792), the authors estimate lifetime and 12-month prevalence of social phobia and examine demographic predictors and patterns of comorbidity of current SP in this population. RESULTS The results reveal that SP is a prevalent disorder in later life with lifetime and 12-month prevalence estimates of 4.94% and 1.32%, respectively. Current SP (12-month) declines with age and is more common in individuals with other psychiatric disorders. Interestingly, there is no correlation between current SP and gender, marital status, or socioeconomic status. CONCLUSIONS SP remains a highly prevalent disorder even in late life with the pattern of feared/avoided situations being strikingly similar to that of younger populations.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder.

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Trajectories of cardiorespiratory fitness in children with and without developmental coordination disorder: a longitudinal analysis

Objective To compare the longitudinal trajectories of cardiorespiratory fitness (CRF) in children with probable developmental coordination disorder (DCD) with those of typically developing children. Setting School-based study, conducted in a large region of Ontario, Canada. 75 out of a possible 92 schools (83%) consented to participate. Participants A cohort of children, enrolled in grade 4 (mean 9 years 11 months; SD 0.05) at baseline (n=2278) were followed twice-yearly over a 2-year period. Measures The short form of the Bruininks–Oseretsky test of motor proficiency was used to identify children with probable DCD and the Leger shuttle run to measure maximal oxygen uptake (VO2max). Results Mixed-effects modelling was used to estimate the change over time in predicted VO2max for both children with probable DCD and typically developing children. For all children, VO2max declined over time. Children (boys and girls) with probable DCD not only had lower VO2max at baseline compared with typically developing children, VO2max declined among these children at a much steeper rate. Conclusion Although previous research has found children with DCD to have poor CRF compared with typically developing children, most of this work has relied on cross-sectional designs to examine group differences. The results of this study confirm that differences in CRF between children with and without probable DCD persist over time, highlighting the concern that DCD is a risk factor for poor cardiovascular health in children.