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Objective: Child and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P). Methods: This study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (β) estimated in structural equation models. Results: The average differences between the MINI-KID-P and OCHS-EBS-B in κ and β were −0.022 and −0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error. Conclusions: Although falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error. [ABSTRACT FROM AUTHOR]

Background: With the recent legalization of nonmedical cannabis in Canada, it is important to document previous associations between cannabis use and major depressive episode and suicidal ideation, as well as the extent to which these associations have changed over time.Methods: This study uses pooled data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, which are repeated cross-sectional surveys of nationally representative samples of Canadians 15 to 60 years of age (n = 43,466). Binary logistic regression was performed, applying weighting and bootstrapping, to examine the association between at least monthly use of cannabis and past 12-month suicidal ideation and major depressive episode (MDE).Results: At least monthly nonmedical cannabis use was associated with an increased odds of MDE and suicidal ideation, and both associations strengthened in 2012 compared to 2002. Canadians using cannabis at least once a month in 2012 had 1.59 (95% confidence interval [CI], 1.11 to 2.27) times the odds of experiencing suicidal ideation and 1.55 (95% CI, 1.12 to 2.13) times the odds of experiencing MDE compared to those who used cannabis at least once a month in 2002. This temporal change remained after controlling for other substance use.Conclusions: Monthly cannabis use was consistently related to both suicidal ideation and MDE, and these associations were stronger in 2012 compared to 2002. The findings of this study provide a baseline for the association between cannabis use and suicide and depression in the Canadian population that should be reevaluated now that nonmedical cannabis has been legalized. [ABSTRACT FROM AUTHOR]

Objectives: To compare the reliability and convergent validity of parent assessments from the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID-a structured diagnostic interview) and the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) symptom checklist for classifying conduct disorder (CD), conduct disorder or oppositional defiant disorder (CD-ODD), attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and separation anxiety disorder (SAD) based on DSM-5 criteria.Methods: Data came from 283 parent-youth dyads aged 9 to 18 years. Parents and youth completed the assessments separately on 2 different occasions 7 to 14 days apart. After converting the OCHS-EBS scale scores to binary disorder classifications, we compare test-retest reliability estimates and use structural equation modelling (SEM) to compare estimates of convergent validity for the same disorders assessed by each instrument.Results: Average test-retest reliabilities based on κ were 0.71 (MINI-KID) and 0.67 (OCHS-EBS). The average β coefficients for 3 latent measures comprising the following indicators-parent perceptions of youth mental health need and impairment, diagnosis of specific disorders based on health professional communications and youth taking prescribed medication, and youth classifications of disorder based on the MINI-KID-were 0.67 (MINI-KID) and 0.69 (OCHS-EBS).Conclusion: The OCHS-EBS and MINI-KID achieve comparable levels of reliability and convergent validity for classifying child psychiatric disorder. The flexibility, low cost, and minimal respondent burden of checklists for classifying disorder make them well suited for studying disorder in the general population and screening in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: To describe the development and psychometric properties of the 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) for dimensional measurement of 7 disorders based on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).Methods: Scale items were selected by agreement among 19 child psychologists and psychiatrists rating the correspondence between item descriptions and DSM-5 symptoms. Psychometric evaluation of the item properties and parent/caregiver and youth scales came from a general population study of 10,802 children and youth aged 4 to 17 years in 6537 families. Test-retest reliability data were collected from a subsample of 280 children and their caregivers who independently completed the OCHS-EBS checklist on 2 occasions 7 to 14 days apart. Structural equation modelling was used to assess internal and external convergent and discriminant validity-the latter tested against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).Results: Confirmatory factor analyses exhibited adequate item fit to all scales. Except for conduct disorder and youth-assessed separation anxiety disorder, internal (Cronbach's α) and test-retest reliability (Pearson's r) for scale scores were 0.70 or above. Except for youth-assessed conduct disorder, the OCHS-EBS met criteria for internal and convergent and discriminant validity. Compared with the MINI-KID, the OCHS-EBS met criteria for external convergent and discriminant validity.Conclusions: The OCHS-EBS provide reliable and valid dimensional measurement of 7 DSM-5 disorders assessed by caregivers and youth in the general population. Part II describes use of the OCHS-EBS as a categorical (present/absent) measure of disorder. [ABSTRACT FROM AUTHOR]

Background: Depression, anxiety, and substance use disorders are leading causes of morbidity worldwide. The most commonly used illicit substance is cannabis and there is some evidence that the association between cannabis use and poor mental health is more pronounced among females compared with males. This analysis examines sex differences in the association between cannabis use and major depressive episode (MDE), suicidal thoughts and attempts, and psychological distress.Methods: This study uses data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, repeated cross-sectional surveys of nationally representative samples of Canadians 15 years of age and older ( n = 43,466). Linear and binary logistic regressions were performed, applying weighting and bootstrapping.Results: There were significant sex differences in the strength of the association between cannabis use and suicidal thoughts and attempts and psychological distress, but not MDE. Females who reported using cannabis occasionally (defined as 1 to 4 times a month) reported higher levels of psychological distress than their male counterparts. Females who reported using regularly (defined as more than once per week) reported higher levels of psychological distress and were more likely to report suicidal thoughts and attempts.Conclusions: Future research is needed to further our understanding of the nature of these sex differences. Public health messaging should incorporate being female as a potential risk factor for the co-occurrence of cannabis use and emotional problems, particularly at higher frequencies of use. Clinicians should also be aware of this association to better inform integrated mental health and substance use screening, discussions, and care, particularly for female patients. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the prevalence of substance use disorders (SUDs) among emerging adults and quantified the extent to which emerging adults, compared with young adults, have increased odds for SUDs.Methods: Data were from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Respondents were 15 to 39 y of age ( n = 9228) and were categorized as: early emerging adults (15 to 22 y); late emerging adults (23 to 29 y); and, young adults (30 to 39 y). SUDs [alcohol or drug abuse/dependence (AAD or DAD)] were measured using the WHO Composite International Diagnostic Interview 3.0. The prevalence of SUDs was compared across age groups, and odds ratios (OR) and 95% confidence intervals (CI) were computed from logistic regression models adjusting for sociodemographic and health covariates. Analyses were weighted to maintain representativeness to the Canadian population.Results: The prevalence of AAD was 8.0%, 6.6%, and 2.7% for early emerging adults, late emerging adults, and young adults, respectively. For DAD, the prevalence was 6.4%, 3.6%, and 1.3%. After covariate adjustment, early and late emerging adults had greater odds of reporting AAD (OR = 3.2, 95% CI = 2.2 to 4.9 and OR = 2.4, 95% CI = 1.6 to 3.4, respectively) or DAD (OR = 4.2, 95% CI = 2.5 to 7.0 and OR = 2.5, 95% CI = 1.6 to 4.1, respectively) compared with young adults. Differences between early and late emerging adults were not significant.Conclusion: Emerging adults are at increased odds for SUDs. Lack of differences between early and late emerging adults provide evidence of the extension of emerging adulthood into the late 20s. Findings have implications for the provision of screening and treatment of SUDs during this developmental period. [ABSTRACT FROM AUTHOR]

Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS): a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4- to 17-year-olds living in household dwellings.Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children aged 4 to 17 years, who were listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of families.Results: The 2014 OCHS included 6,537 responding households (50.8%) with 10,802 children aged 4 to 17 years. Lower income families living in low-income neighbourhoods were less likely to participate. In addition to measures of childhood mental disorder assessed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and OCHS Emotional Behavioural Scales (OCHS-EBS), the survey contains measures of neighbourhoods, schools, families and children, and includes administrative data held by the Ministries of Education and Health and Long-Term Care.Conclusions: The complex survey design and differential non-response of the 2014 OCHS required the use of sampling weights and adjustment for design effects. The study is available throughout Canada in the Statistics Canada Research Data Centres (RDCs). We urge external investigators to access the study through the RDCs or to contact us directly to collaborate on future secondary analysis studies based on the OCHS. [ABSTRACT FROM AUTHOR]

Objectives: To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems.Methods: Data come from the 2014 Ontario Child Health Study-a provincially representative survey of 6537 families with 10,802 four- to 17-year-olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with children's externalizing and internalizing problems based on parent assessments of children (4- to 17-year-olds) and self-assessments of youth (12- to 17-year-olds).Results: Based on parent assessments, neighbourhood poverty, and antisocial behaviour modified associations between household poverty and children's mental health problems. Among children living in households below the poverty line, levels of mental health problems were 1) lower when living in neighbourhoods with higher concentrations of poverty and 2) higher when living in neighbourhoods with more antisocial behaviour. These associations were stronger for externalizing versus internalizing problems when conditional on antisocial behaviour and generalized only to youth-assessed externalizing problems.Conclusion: The lower levels of externalizing problems reported among children living in poor households in low-income neighbourhoods identify potential challenges with integrating poorer households into more affluent neighbourhoods. More important, children living in poor households located in neighbourhoods exhibiting more antisocial behaviour are at dramatically higher risk for mental health problems. Reducing levels of neighbourhood antisocial behaviour could have large mental health benefits, particularly among poor children. [ABSTRACT FROM AUTHOR]

The authors look at the findings from the 2014 Ontario Child Health Studies to contend that core measures of children's mental health be collected in the general population at regular intervals. Topics discussed include an increase in the proportion of males aged four to 11 years with attention-deficit/hyperactivity disorder, how children with mental health challenges access community-based mental health agencies, and three indicators of the core measures of children's mental health.

Objectives: To present the 12-month prevalence and correlates of suicidal ideation and attempts in a sample of youth in Ontario.Methods: Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 y ( n = 2,396) completed a computer-assisted, self-administered questionnaire in their home to assess the occurrence of suicidal ideation, suicidal attempts, and associated correlates, including non-suicidal self-injury, mental disorders, substance use, peer victimization and exposure to child maltreatment. Socio-demographic information was collected from the parent. Logistic regression models were used to identify correlates that distinguished between youth reporting: 1) no suicidal ideation or attempts, 2) suicidal ideation but no attempts, and 3) suicidal ideation and attempts.Results: The 12-month prevalence of suicidal ideation and attempts was 8.1% and 4.3%, respectively. All clinical and behavioural correlates were significantly higher among youth reporting suicidal ideation or attempts, as compared with non-suicidal youth. In adjusted models, depression and non-suicidal self-injury were each independently associated with elevated odds of suicidal ideation (OR = 4.84 and 4.19, respectively) and suicidal attempt (OR = 7.84 and 22.72, respectively). Among youth who reported suicidal ideation, the only variable that differentiated youth who attempted suicide v. those who did not, in adjusted models, was non-suicidal self-injury (OR = 3.89).Conclusions: Suicidal ideation and attempts are common among youth in Ontario, often co-occurring with mental disorders and high-risk behaviours. These findings underscore the need for effective prevention and intervention strategies, particularly for youth depression and non-suicidal self-injury. [ABSTRACT FROM AUTHOR]

The article summarizes four of the 2014 Ontario Child Health Study (OCHS) findings with particular policy salience. Topics covered include the impact of income disparities and exposure on neighbourhood adversities, the diffusion of responsibility and authority across sectors and groups, and development of central expert leadership mechanisms.

Objectives: To examine: 1) changes in the prevalence of mental disorders and perceived need for professional help among children (ages 4 to 11) and youth (ages 12 to 16) between 1983 and 2014 in Ontario and 2) whether these changes vary by age and sex, urban-rural residency, poverty, lone-parent status, and immigrant background.Methods: The 1983 ( n = 2836) and 2014 ( n = 5785) Ontario Child Health Studies are provincially representative cross-sectional surveys with identical self-report checklist measures of conduct disorder, hyperactivity, and emotional disorder, as well as perceived need for professional help, assessed by integrating parent and teacher responses (ages 4 to 11) and parent and youth responses (ages 12 to 16).Results: The overall prevalence of perceived need for professional help increased from 6.8% to 18.9% among 4- to 16-year-olds. An increase in any disorder among children (15.4% to 19.6%) was attributable to increases in hyperactivity among males (8.9% to 15.7%). Although the prevalence of any disorder did not change among youth, conduct disorder decreased (7.2% to 2.5%) while emotional disorder increased (9.2% to 13.2%). The prevalence of any disorder increased more in rural and small to medium urban areas versus large urban areas. The prevalence of any disorder decreased for children and youth in immigrant but not nonimmigrant families.Conclusions: Although there have been decreases in the prevalence of conduct disorder, increases in other mental disorders and perceived need for professional help underscore the continued need for effective prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Objective: To estimate the alignment between the Ontario Ministry of Children and Youth Services (MCYS) expenditures for children's mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: "assessed need," as the presence of a mental disorder, and "perceived need," as the subjective perception of a mental health problem.Methods: Children's mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data), and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on 1) population size and 2) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived).Results: Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0% to 22.7% of total expenditures, depending on the definition of need.Conclusion: Making needs adjustments to population counts using population estimates of children's mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and children's mental health need. [ABSTRACT FROM AUTHOR]

Objectives: To present the 6-month prevalence and sociodemographic correlates of mental disorders and mental health-related service contacts in a sample of children (4 to 11 years) and youth (12 to 17 years) in Ontario.Methods: The 2014 Ontario Child Health Study is a provincially representative survey of 6537 families with children aged 4 to 17 years in Ontario. DSM-IV-TR mental disorders were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and included mood (major depressive episode), anxiety (generalized anxiety, separation anxiety, social phobia, specific phobia), and behaviour disorders (attention-deficit/hyperactivity disorder, oppositional-defiant disorder, conduct disorder).The MINI-KID was administered independently to the primary caregiver and youth aged 12 to 17 years in the family's home.Results: Past 6-month prevalence of any mental disorder ranged from 18.2% to 21.8% depending on age and informant. Behaviour disorders were the most common among children, and anxiety disorders were the most common among youth. Among children and youth with a parent-identified mental disorder, 25.6% of children and 33.7% of youth had contact with a mental health provider. However, 60% had contact with one or more of the providers or service settings assessed, most often through schools.Conclusions: Between 18% and 22% of children and youth in Ontario met criteria for a mental disorder but less than one-third had contact with a mental health provider. These findings provide support for strengthening prevention and early intervention efforts and enhancing service capacity to meet the mental health needs of children and youth in Ontario. [ABSTRACT FROM AUTHOR]

Objective: We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care.Method: This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated.Results: Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days.Conclusions: The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern. [ABSTRACT FROM AUTHOR]

Objective: To examine sex differences in the association between cyberbullying victimization and mental health (psychological distress and delinquency), substance use-related outcomes (drug and tobacco use, binge drinking), and suicide ideation among adolescents.Method: Data were obtained from the Ontario Student Drug Use and Health Survey (OSDUHS; 2013, N=10,272, grade 7 to 12). The sample for analysis included 4,940 students with a mean age of 15.1 years (43.3% male). A series of multi-level, binary, logistic regression models were conducted separately for female and male adolescents to quantify the strength of associations between cyberbullying victimization and study outcomes, after accounting for traditional forms of bullying and demographic covariates.Results: Female adolescents reported significantly higher prevalence of cyberbullying victimization (once, 9.4%; twice or more, 13.3%) as compared with male adolescents (once, 8.3%, twice or more, 7.8%). Exposure to cyberbullying victimization was associated with an increased odds for psychological distress, suicide ideation, and delinquency among both female and male adolescents (adjusted odds ratios ranged from 1.76 to 4.63); although, the effects were more pronounced in females. Among females, but not males, the odds of reporting psychological distress, suicide ideation, and delinquency increased (in a step-wise fashion) with more frequent exposure to cyberbullying victimization. Cyberbullying victimization was associated with an increased odds of adolescent substance use only among females.Conclusion: Adolescents exposed to cyberbullying victimization demonstrate an increased odds of poorer mental health, substance use outcomes, and suicide ideation. The current study reveals increased risk among female adolescents as compared with male adolescents. These findings lend support for the need to develop and evaluate targeted preventative interventions specifically tailored for female and male adolescents. [ABSTRACT FROM AUTHOR]

Objective: Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population.Method: This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification.Results: Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons.Conclusions: Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine if youth born large for gestational age (LGA; birth weight above the 95th percentile) or small for gestational age (SGA; less than the fifth percentile) are at an increased risk of developing symptoms of externalizing and internalizing problems. Method: Data on members of the Ontario Child Health Study aged 4 to 16 years were used to examine associations between LGA, SGA, and psychopathology. This sample consisted of 2923 youth about whom parent, teacher, and self-reported levels of internalizing and externalizing symptoms were available, and whose caregivers retrospectively reported birth weight and gestational age (GA). Psychopathology was assessed using the Diagnostic and Statistical Manual of Mental Disorders-oriented scales derived from the Child Behavior Checklist. Results: Multilevel linear regression analyses revealed that after adjustment for parental psychopathology, socioeconomic disadvantage, sex, age, maternal age, birth order, and child health and school performance, youth born LGA had higher scores on the self-reported externalizing scale (1.39, 95% Cl 0.01 to 2.78), but not internalizing scale, compared with youth born at an appropriate weight for GA (10th to 90th percentile). Parent and teacher ratings generally supported these findings in direction but did not reach statistical significance. Youth and parents reported increased levels of externalizing and internalizing symptoms in youth born SGA, but these were not statistically significant. Conclusions: Youth born above the 95th percentile for GA manifest increased levels of externalizing symptoms. Given increasing rates of macrosomic births, further study is warranted to replicate and determine the clinical significance of these findings, the contribution of the antecedents of LGA to this risk and the extent to which this association may be causal. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario.Method: This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant.Results: Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype.Conclusions: We identified a seasonal pattern of illness in a proportion of subjects with BD. [ABSTRACT FROM AUTHOR]

Background: This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude.Methods: Random telephone numbers were generated across 8 degrees of latitude (41.5 degrees N to 49.5 degrees N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria.Results: Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude.Conclusions: SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude. [ABSTRACT FROM AUTHOR]

We undertook a systematic review of the literature on the long-term treatment of attention-deficit hyperactivity disorder (ADHD). We used systematic strategies to identify randomized treatment studies in which treatment was administered for 12 weeks or more. We included 14 studies involving 1379 subjects. Because of the limited number of high-quality studies and the heterogeneity of outcome measures, we did not perform meta-analysis. We rated 5 studies as adequate for methodological quality. Five studies followed children for more than 26 weeks. Pharmacologic interventions were studied more frequently than non-pharmacologic ones. Six studies permitted evaluation of the effects of combined drug and behavioural intervention. Twenty-five different outcomes were measured using 26 different tests. Stimulant medication appears to reduce ADHD (7 studies), dysfunctional social behaviour (6 studies), and internalizing symptoms (2 studies). Available studies provide little evidence for improved academic performance with stimulants (3 studies). Medications other than stimulants have not been studied extensively (3 studies). Only 1 study showed that combination therapy adds to the effects of medication. Rigorous treatment research among representative samples of ADHD individuals is needed. [ABSTRACT FROM AUTHOR]

Presents several correspondence related to psychiatry in the September 2001 issue of 'The Canadian Journal of Psychiatry.' Aim of the Alone Mothers Together Program; Analysis of neuroleptic malignant syndrome; Presentation of several lycanthropy cases.

Objective: To examine estimates of lifetime prevalence of seasonal affective disorder (SAD) in Toronto, Ontario.Method: Random telephone numbers were generated for the city of Toronto, and 781 respondents completed a telephone interview. Trained nonphysician interviewers conducted all interviews, which involved structured questions for diagnosing major depression. Patterns of symptom change across seasons were evaluated to establish a diagnosis of SAD according to DSM-III-R criteria.Results: Correcting for sex and age, the prevalence of SAD defined by DSM-III-R criteria was 2.9% (95% CI, 1.7% to 4.0%), and the overall lifetime prevalence of major depression in the sample was 26.4% (95% CI, 23.3% to 29.4%). Some subjects were contacted for a follow-up interview conducted in person; the positive predictive value for the diagnosis of major depression for the telephone interview was 100%, and the negative predictive value was 93%.Conclusions: The seasonal subtype of depression represents 11% of all subjects with major depression, suggesting that SAD is a significant public health concern. The telephone interview demonstrated adequate reliability, indicating that it is appropriate for epidemiological surveys of this nature. [ABSTRACT FROM AUTHOR]

Objective: To review the methodology of the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, and its implications for the design of future child mental health treatment studies.Method: The characteristics of large-scale studies envisioned by trialists engaged in cardiovascular and cancer research provide the framework for reviewing key elements of the MTA study--objectives, research questions, measurement, sampling, and exposure to treatment--and discussing important methodological decisions the MTA investigators had to make.Results: The MTA study is a complex, standardized, carefully implemented, randornized control trial. Review of the MTA study indicated that future studies should be aligned clearly with either effectiveness or efficacy objectives but not both. Questions selected for study should be simple, clear, and important. Measurement, sampling, and data collection must adhere to the principle of simplicity to ensure maximum participation. All methodological decisions should be geared to attaining the research objectives: in effectiveness trials, this means evaluating treatments that have a high potential for dissemination if proven successful and recruiting only new referrals from child mental health settings.Conclusions: The MTA study has raised the standard for technical excellence in child treatment research and will draw attention to some fundamental issues in large-scale child treatment studies, including articulating objectives and questions, setting priorities for measurement and sampling, and identifying treatments for evaluation that have a high probability of dissemination if found effective.(Can J Psychiatry 1999;44:991-998)Key Words: attention-deficit hyperactivity disorder, attention deficit, stimulant medication, behaviour therapy, clinical trials [ABSTRACT FROM AUTHOR]

Context: The Agency for Health Care Policy and Research charged the McMaster Evidence-based Practice Center with conducting a comprehensive systematic review of the literature on the treatment of attention-deficit hyperactivity disorder (ADHD), with input from various groups of stakeholders. One strategy used to avoid duplication of work included a critical appraisal of existing systematic reviews and metaanalyses.Objective: To identify and appraise published metaanalyses and systematic reviews on the treatment of ADHD and to produce an annotated bibliography.Data Sources: Medline, Cumulative Index in Nursing and Allied Health (CINAHL), Healthstar, Psycinfo, and Embase were searched to September 1998; the Cochrane Database (1998 issue 3), selected Internet sites, and the files of investigators were also reviewed.Study Selection: Review articles described as systematic reviews or metaanalyses or including a Methods section were identified independently by 3 reviewers.Data Extraction: Two reviewers extracted, by consensus, relevant information on the name, methodological quality, ADHD-related aspects (comorbid disorders, family characteristics) of those reviews; data on the population, study setting, interventions, and outcomes evaluated by the reviews were also retrieved.Results: Thirteen reviews, published from 1982 to 1998, were included. Eight included metaanalysis and 5 a qualitative review. Nonpharmacological treatments were mentioned in 6 reviews and combination therapies in 3. One review focused on the treatment of adults. Forty-seven drugs and 20 adverse effects were mentioned. Most reviews had major methodological flaws.Conclusions: Most published systematic reviews and metaanalyses on the treatment of ADHD have limited value for guiding clinical, policy, and research decisions. A rigorous, systematic review following established methodological criteria is warranted. [ABSTRACT FROM AUTHOR]

Objective: To compare the identification of psychiatric disorder as informed by parents versus teachers in children aged 6-11 years and parents versus adolescents in youth aged 12-16 years in clinic versus community samples.Method: Study data come from parallel surveys in Hamilton, Ontario, of children aged 6-16 years. The surveys included consecutive referrals (N = 1150) between 1989 and 1991 to the region's 2 agencies providing outpatient child mental health services. Also, a simple random sample (N = 1689) was used, drawn in 1989 from students attending public schools. Conduct disorder, hyperactivity, emotional disorder, and somatization disorder were assessed by informants using the original Ontario Child Health Study scales.Results: The percentage of children identified with a disorder was markedly higher in the clinic sample, irrespective of the type of disorder, the age and sex of the child, and who provided the assessment. Also, there was a statistically significant differential shift between parents and teachers in the percentage of children identified with disorder. The ratio of children aged 6-11 years identified with conduct disorder or hyperactivity by parents versus teachers was higher in the clinic sample than in the community sample. Among youth aged 12-16 years, a similar pattern emerged for parents as informants versus the adolescents themselves, but it was statistically nonsignificant.Conclusions: The data suggest that the relative contribution of informants to the identification of childhood psychiatric disorder varies by sample type: clinic and community. If risk factors for child disorder are influenced by contextually specific factors wedded to informants, then studies conducted in clinic versus community samples may lead to discrepant information about the determinants of psychopathology. The extent of this problem needs to be assessed by comparing the results of parallel studies conducted in clinic versus community samples. [ABSTRACT FROM AUTHOR]