Yvonne Racine

Stress, social support and depression in single and married mothers.

Background: This study examined the effect of stress and social support on the relationship between single-parent status and depression. Method: A secondary data analysis of the 1994–95 National Population Health Survey was conducted. Single and married mothers who participated in the survey were derived from the general sample (N = 2,921). Logistic regression techniques were used to assess the mediating and moderating effects of stress and social support on the relationship between family structure and depression. Results: Bivariate analyses showed that, compared to married mothers, single mothers were more likely to have suffered an episode of depression (12-month prevalence), to report higher levels of chronic stress, more recent life events and a greater number of childhood adversities. Single mothers also reported lower levels of perceived social support, social involvement and frequency of contact with friends and family than married mothers. The results of the multivariate analyses showed that, together, stress and social support account for almost 40% of the relationship between single- parent status and depression. We also found a conditional effect of stress on depression by family structure. Life events were more strongly related to depression in married than in single mothers. Conclusions: A substantial part of the association between single-parent status and depression can be accounted for by differences in exposure to stress and social support.Our results suggest that it is important to examine multiple sources of stress, as exposure to both distal and proximal stressors were higher among single mothers. Limitations and directions for future research are discussed.

Integrating Assessment Data from Multiple Informants

OBJECTIVE To examine the consequences for measurement of child psychiatric disorder (conduct and oppositional disorders) of not integrating the data on the same individual from different informants compared with integrating the information from parents and teachers, using three different strategies. METHOD Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,134) selected with known probability from a general population sample and from structured interviews obtained in a stratified random subsample (n = 251). RESULTS As expected, parent-teacher agreement was low. The pattern of associated features of disorder was found to vary markedly in parent-identified compared with teacher-identified disorder. Furthermore, combining informants had the disadvantage of masking the distinctive patterns of associated features noted in informant-specific disorders. Finally, by treating disorder as informant-specific, the internal properties of the measure are not generally inferior to those obtained by combining informants in various ways. CONCLUSION Child psychiatric disorders should be conceptualized as informant-specific phenomena.

One-Year Prevalence of Psychiatric Disorder in Ontarians 15 to 64 Years of Age

Objective: To present the one-year prevalence of 14 psychiatric disorders in a community sample of Ontarians aged 15 to 64 years. Method: Data on psychiatric disorders were collected on 9953 respondents using the University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI). DSM-III-R criteria were used to define the psychiatric disorders. Results: Almost 1 in 5 Ontarians (18.6%) had one or more of the disorders measured in the survey. Among 15- to 24-year-olds, 1 in 4 was affected. The distribution of individual disorders varied by sex and age. Conclusion: Because of the immense burden of suffering associated with psychiatric disorders, clinical and research efforts in this area should receive high priority within the health budget.

Outcome, prognosis, and risk in a longitudinal follow-up study.

This study reports the results of a 4-year follow-up of a community sample of children who were ages 4 to 12 in 1983 at the first wave of data collection. Results on outcomes revealed that conduct disorder showed the greatest stability especially from late childhood to early adolescence. In multivariate analyses, both family dysfunction and problems getting along with others significantly predicted the persistence of one or more psychiatric disorders 4 years later, and low income predicted one or more psychiatric disorders among children free of disorder 4 years earlier. The implications of the results for the child psychiatric field, especially prevention, are discussed.

Ontario Child Health Study: Correlates of Disorder

Data from the Ontario Child Health Study were used to examine the prevalence and selected correlates of conduct disorder, hyperactivity, emotional disorder, and somatization in children 4 to 16 years of age by informant (parent and teacher for children 4 to 11, and parent and youth for children 12 to 16). The results indicate that the prevalence and pattern of correlates of the individual disorders differ in important ways by informant. This suggests that we need to understand the factors that influence assessments provided by informants from different contexts (e.g., parents and teachers) before combining information from them to arrive at singular classifications.

Evaluation of the Diagnostic Interview for Children and Adolescents for Use in General Population Samples

This article presents evaluative data on the use of the Diagnostic Interview for Children and AdolescentsRevised (DICAR) to classify DSM-IIIR disorders in the general population. Data for the analyses came from a probability sample (N=251) of parentchild/adolescent dyads aged 6 to 16 separately administered the DICAR on two occasions, 10 to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence,testretest reliability, parentchild/adolescent agreement, and trained lay interviewerchild psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6 to 11year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parentchild/adolescent dyads was generally low while agreement between trained lay interviewerschild psychiatrists was generally high.

Tri-ministry study: correlates of school-based parenting course utilization.

This study examined factors associated with the utilization of universally available school-based parent training. In a randomly selected, prospectively screened, unreferred community sample of 1,498 5- to 8-year-olds, 28% to 46% of families of children with high parent-reported externalizing problems enrolled. Externalizing problems, first-child status, and a high school education were associated with increased enrollment. Single-parent status, immigrant background, and limited extracurricular child activities were associated with lower enrollment. Economic disadvantage, stress, family dysfunction, and parental depressive symptoms were not associated with participation. Most families attributed nonparticipation to busy personal schedules, inconvenient times, and logistical difficulties.

DSM-IV Internal Construct Validity: When a Taxonomy Meets Data

The use of DSM-IV based questionnaires in child psychopathology is on the increase. The internal construct validity of a DSM-IV based model of ADHD, CD, ODD, Generalised Anxiety, and Depression was investigated in 11 samples by confirmatory factor analysis. The factorial structure of these syndrome dimensions was supported by the data. However, the model did not meet absolute standards of good model fit. Two sources of error are discussed in detail: multidimensionality of syndrome scales, and the presence of many symptoms that are diagnostically ambiguous with regard to the targeted syndrome dimension. It is argued that measurement precision may be increased by more careful operationalisation of the symptoms in the questionnaire. Additional approaches towards improved conceptualisation of DSM-IV are briefly discussed. A sharper DSM-IV model may improve the accuracy of inferences based on scale scores and provide more precise research findings with regard to relations with variables external to the taxonomy.

Community influences on intimate partner violence in India: Women's education, attitudes towards mistreatment and standards of living.

Intimate partner violence (IPV) directed towards women is a serious public health problem. Womens education may offer protection against IPV, but uncertainty exists over how it might reduce risk for IPV at the community and individual levels. The objectives of this study are to: (1) disentangle community from individual-level influences of womens education on risk for IPV; (2) quantify the moderating influence of communities on individual-level associations between womens education and IPV; (3) determine if womens attitudes towards mistreatment and living standards at the community and individual levels account for the protective influence of womens education; and (4) determine if the protective influence of education against IPV is muted among women living in communities exhibiting attitudes more accepting of mistreatment. Study information came from 68,466 married female participants in the National Family Health Survey conducted throughout India in 1998-1999. Multilevel logistic regression was used to address the study objectives. IPV showed substantial clustering at both the state (10.2%) and community levels (11.5%). At the individual level, there was a strong non-linear association between womens education and IPV, partially accounted for by household living standards. The strength of association between womens education and IPV varied from one community to the next with evidence that the acceptance of mistreatment at the community level mutes the protective influence of higher education. Furthermore, womens attitudes towards mistreatment and their standards of living accounted for community-level associations between womens education and IPV. Place of residence accounted for substantial variation in risk of IPV and also modified individual-level associations between IPV and womens education. At the community level, womens education appeared to exert much of its protective influence by altering population attitudes towards the acceptability of mistreatment. However, there was no residual association between womens education and IPV at the community level once living standards are taken into account. While womens education provides strong, independent leverage for reducing the risk of IPV, planners must keep in mind important community factors that modify its protective influence.

Mental Health Supplement to the Ontario Health Survey : Methodology

Objective: To describe the methodology of a province-wide, cross-sectional, epidemiologic study of psychiatric disorder among those aged 15 years and over living in household dwellings in Ontario. Method: Respondents for the survey were drawn from households (N = 13 002) participating in a province-wide health survey. One person per household was selected, and 9953 (76.5%) participated. Results: Participants and nonparticipants were similar to each other. An extensive array of data, including measures of psychiatric disorder classified using a revised version of the Composite International Diagnostic Interview (CIDI), are available for all respondents. Conclusions: The Ontario Health Supplement is contained in a public-use data file at the Ontario Ministry of Health and is available to investigators for study. A strong survey design, careful measurement, and acceptable levels of response provide the rationale for our inviting researchers to access and use the Ontario Health Supplement data base.