Shay-Lee Belik

Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective.

ObjectivesInvestigations of the association between chronic pain conditions and suicidal ideation (SI) and suicide attempts (SA) have rarely taken the effect of mental disorders into account and have been limited by nonrepresentative samples. The present study used a large population-based sample to investigate the association between chronic pain conditions and SI and SA. MethodsData were from the Canadian Community Health Survey Cycle 1.2 public use file conducted by Statistics Canada from 2001 to 2002 (N=36,984; response rate 77%). Respondents were asked if they had been diagnosed with the following painful conditions: migraine, back problems, arthritis, and fibromyalgia. Respondents were assessed for past 12-month SI and SA. The Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders-IV. ResultsAfter adjusting for sociodemographics, Axis I mental disorders and comorbidity (3 or more mental disorders), the presence of 1 or more chronic pain conditions was associated with both SI and SA. Among respondents with a mental disorder, comorbidity with 1 or more chronic pain conditions was also associated with SI and SA. In models adjusting for other painful conditions, migraine had the strongest link with SI and SA. DiscussionThis is the first study to demonstrate the association between several chronic pain conditions and SI and SA while adjusting for mental disorders in a nationally representative sample. Moreover, this study demonstrates that among individuals with a mental disorder, having a chronic pain condition significantly increased the association with SI and SA.

Does co-morbid depressive illness magnify the impact of chronic physical illness? A population-based perspective

OBJECTIVE To examine the relative and combined impact of depressive and chronic physical conditions on functional status and health-care use in the general population. METHOD Canadian, representative, population-based cross-sectional survey (n=130,880). Major depressive disorder (MDD) in the past 12 months was assessed by structured interview, and physical disorders, activity reduction, role impairment and work absence by self-report. The relative impact of MDD and six common chronic physical illnesses (asthma, arthritis, back problems, chronic obstructive pulmonary disease, heart disease and diabetes) was estimated using multivariate regression, adjusting for sociodemographic characteristics and overall chronic physical illness burden. RESULTS After adjusting for sociodemographic characteristics, alcohol dependence and chronic physical illness burden, the presence of co-morbid MDD was associated with significantly greater (approximately double the) likelihood of health-care utilization and increased functional disability and work absence compared to the presence of a chronic physical illness without co-morbid MDD. This impact of MDD was seen across each of the six chronic physical illnesses examined in this study, with the strongest associations seen for work absence. CONCLUSIONS These observations confirm prior findings of a strong association at the population level between major depression and health-care use and role impairment among persons with chronic physical disorders. They also point to the significant impact of co-morbid major depression on health-care seeking, disability and work absence in persons with chronic physical illness, underscoring the need for greater efforts to design and test the impact of detection and treatment programs for such individuals.

The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face‐to‐face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40–2.08). Panic disorder (AOR=1.31, 95% CI: 1.06–1.61) and PTSD (AOR=1.81, 95% CI: 1.45–2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58–7.25) and with PTSD (AOR=6.90, 95% CI: 5.41–8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010.

Spirituality, religion and suicidal behavior in a nationally representative sample.

BACKGROUND Studies show that religion and spirituality are associated with decreased rates of mental illness. Some studies show decreased rates of suicide in religious populations, but the association between religion, spirituality and suicidal behaviors in people with mental illness are understudied. Few studies have examined the influence of social supports in these relationships. METHODS Data were drawn from the Canadian Community Health Survey 1.2. Logistic regression was used to examine the relationship between spiritual values and religious worship attendance with twelve-month suicidal ideation and attempts. Regressions were adjusted for sociodemographic factors and social supports. Interaction variables were then tested to examine possible effect modification by presence of a mental disorder. RESULTS Identifying oneself as spiritual was associated with decreased odds of suicide attempt (adjusted odds ratio-1 [AOR-1]=0.65, CI: 0.44-0.96) but was not significant after adjusting for social supports. Religious attendance was associated with decreased odds of suicidal ideation (AOR-1=0.64, 95% CI: 0.53-0.77) but not after adjusting for social supports. Religious attendance was associated with decreased odds of suicide attempt and remained significant after adjusting for social supports (AOR-2=0.38, 95% CI: 0.17-0.89). No significant interaction effects were observed between any of the tested mental disorders and religion, spirituality and suicidal behavior. LIMITATIONS This was a cross-sectional survey and causality of relationships cannot be inferred. CONCLUSIONS Results suggest that religious attendance is associated with decreased suicide attempts in the general population and in those with a mental illness independent of the effects of social supports.

Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample

BACKGROUND Anxiety disorders and insomnia are each prevalent, impairing, and highly comorbid. However, little is known about whether specific types of sleep complaints are associated with specific anxiety disorders, and whether poor sleep has an additive effect on functional impairment in anxiety disorders. METHOD Data from the German Health Survey (GHS; N = 4181; ages 18-65) were utilized to examine relationships among anxiety disorders, sleep quality (assessed by the Pittsburgh Sleep Quality Inventory; PSQI), and functional impairment (assessed by the Medical Outcomes Scale Short Form; SF-36; and past-month disability days due to physical and emotional problems, respectively). RESULTS Most anxiety disorders were significantly associated with global PSQI scores. Social phobia (AOR 3.95, 95% CI 1.73-9.04) and GAD (AOR 3.94, 95% CI 1.66-9.34) had the strongest relationships with global PSQI scores. Daytime dysfunction was the PSQI subscale most strongly associated with anxiety disorders, particularly GAD. Having a comorbid anxiety disorder and poor sleep was associated with significantly lower Mental Component Scores on the SF-36 than having an anxiety disorder alone (40.87 versus 43.87, p = .011) and with increased odds of one or more disability days due to emotional problems (AOR 2.72, 95% CI 1.35-5.48), even after controlling for sociodemographic factors and past-month mood and substance use disorders. CONCLUSIONS Most anxiety disorders are moderately associated with reduced sleep quality. Individuals with anxiety disorders and poor sleep experience significantly worse mental health-related quality of life and increased disability relative to those with anxiety disorders alone.

Relation between Traumatic Events and Suicide Attempts in Canadian Military Personnel

Objective: To determine whether exposure to particular types of traumatic events was differentially associated with suicide attempts in a representative sample of active military personnel. Method: Data came from the Canadian Community Health Survey: Mental Health and Well-Being Canadian Forces Supplement (CCHS-CFS), a cross-sectional survey that provided a comprehensive examination of mental disorders, health, and the well-being of currently active Canadian military personnel (n = 8441; aged 16 to 54 years; response rate 81.1%). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicide attempts were measured using a question about whether the person ever “attempted suicide or tried to take [his or her] own life.” Results: The prevalence of lifetime suicide attempts for currently active Canadian military men and women was 2.2% and 5.6%, respectively. Sexual and other interpersonal traumas (for example, rape, sexual assault, spousal abuse, child abuse) were significantly associated with suicide attempts in both men (adjusted odds ratios [AORs] ranging from 2.31 to 4.43) and women (AORs ranging from 1.73 to 3.71), even after adjusting for sociodemographics and mental disorders. Additionally, the number of traumatic events experienced was positively associated with increased risk of suicide attempts, indicating a dose–response effect of exposure to trauma. Conclusions: The current study is the first to demonstrate that sexual and other interpersonal traumatic events are associated with suicide attempts in a representative sample of active Canadian military men and women.

Impairment Associated With Sleep Problems in the Community: Relationship to Physical and Mental Health Comorbidity

Objective: To explore the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Sleep problems are being increasingly recognized as a source of morbidity and role impairment. Little is known, however, about the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Methods: We utilized data from the German Health Survey (n = 4181; response rate: 87.6%; ages 18–65 years) to examine the relationships between sleep problems (assessed by the Pittsburgh Sleep Quality Inventory (PSQI)), mental and physical health comorbidity, and disability and health-related quality of life (assessed by the Medical Outcomes Scale Short Form-36 (SF-36)). Results: A total of 1595 (35.2%) respondents reported current sleep problems (PSQI score of >5). After adjusting for sociodemographic factors, we found the presence of sleep problems was associated with having one or more physical health problems (adjusted odds ratio (AOR) = 1.21, 95% Confidence Interval (CI) = 1.01–1.45) and one or more mental disorders (AOR = 3.58, 95% CI = 2.95–4.35). Among persons with one or more physical health problems, the co-occurrence of a sleep problem was associated with poorer physical component scores on the SF-36 (45.7 versus 48.6, p <.001) and increased odds of ≥1 disability days in the past 30 days due to physical problems (AOR = 1.55, 95% CI = 1.20–1.98), even after adjusting for sociodemographic factors and comorbidity with other mental and physical health conditions. Conclusions: More than one third of adults in the community report sleep problems. These often co-occur with other physical and mental health problems, and when they do they are generally associated with an increased burden of role disability and functional impairment. AOR = adjusted odds ratio; CCI = Charlson Comorbidity Index; GHS = German Health Survey; MCS = Mental Component Score; NCS-R = National Comorbidity Survey Replication; OR = odds ratio; PCS = Physical Component Score; PSQI = Pittsburgh Sleep Quality Index; SF-36 = Short Form-36.

Traumatic Events and Suicidal Behavior: Results From a National Mental Health Survey

The current study examined whether exposure to different types of traumatic events was differentially associated with suicidal ideation and attempts after adjusting for sociodemographic factors and presence of mental and physical disorders. Data came from the US National Comorbidity Survey Part II (N = 5877, aged 15–54 years, response rate: 82.4%) public use dataset. Interpersonal traumas and exposure to three or more types of traumatic events were particularly associated with suicidal behaviors. Age of onset analyses revealed that the age of traumatic exposure was earlier than the age at which suicidal behaviors began in the majority of respondents. The results imply that exposure to traumatic events is associated with the incidence of suicidal behaviors above and beyond the effect of sociodemographics, mental disorders, and physical disorders assessed in the survey. Clinicians and researchers need to be aware of these findings to determine early intervention programs.

The relationship between migraine and mental disorders in a population-based sample

OBJECTIVE There is emerging evidence from clinical and community samples to suggest that migraines are associated with mental disorders. The present study utilized a large population-based sample to investigate the association between physician-diagnosed migraine and mental disorders. METHOD Data were from the German Health Survey conducted between 1997 and 1999 (N=4181, response rate 61.4%, age 18-65 years). Lifetime and 12-month history of migraines were assessed by self-report and by a physician. Past 12-month DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS After adjusting for sociodemographic factors, past-year migraine was significantly and positively associated with depression, dysthymia, bipolar disorder, panic attacks, panic disorder, agoraphobia and simple phobia [adjusted odds ratios (AOR) ranging from 1.74 to 3.21]. After additionally adjusting for other mental disorders, any anxiety disorder (AOR=1.82) and any mood disorder (AOR=1.61) remained significantly associated with past-year migraine. CONCLUSION Although causal inferences cannot be made due to the cross-sectional nature of the data, the present study adds to a growing body of literature that suggests a strong association between migraines and mood and anxiety disorders.

Mental disorder and threats made by noninstitutionalized people with weapons in the national comorbidity survey replication.

Controversy exists as to whether mental disorders are associated with a higher risk of violent behavior. Data from the nationally-representative National Comorbidity Survey Replication was examined. Multiple logistic regression was used to determine whether mood, anxiety, impulse control, and substance use disorders were associated with a higher rate of potentially violent behavior as assessed by threatening others with a gun or other weapon. After adjusting for sociodemographic factors, an association was found between mood, anxiety, impulse control, and substance use disorders and the rate of threatening others. A significant association was found between threats made against others with a gun and both substance use disorders (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI] 1.62-3.20) and impulse control disorders (AOR 2.67; 95% CI 1.95–3.66). Threats made against others with any other type of weapon were significantly associated with any anxiety (AOR 1.76; 95% CI 1.34–2.31), substance (AOR 2.63; 95% CI 1.87–3.71), or impulse control disorder (AOR 2.49; 95% CI 1.96–3.18). Of the disorders studied, social phobia, specific phobia, and impulse control disorders seemed to have their onset before the act of threatening others with weapons. This finding was also true for those who had attempted suicide. Further research is needed to determine whether treatment of mental disorders decreases the risk of violence in this population.