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Objective: Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation.Methods: Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic (n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist-Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation.Results: Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% (n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (β = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (β = 0.043, P = 0.58).Conclusions: Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD. [ABSTRACT FROM AUTHOR]

Objective: To examine baseline mental disorders and other correlates among people who have not previously used drugs as potential risk factors for incident drug use at 3-years' follow-up.Method: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (commonly referred to as the NESARC) Wave 2 (2004 to 2005; n = 34 653), a longitudinal nationally representative survey of mental illness in community-dwelling adults. The study group consisted of people who reported no history of any illicit drug use or prescription drug misuse at Wave 1 (2001 to 2002). Logistic regression analyses were used to compare people with first-episode drug use at Wave 2 (n = 1145) to those who remained abstinent (n = 25 790) across various Wave 1 correlates, including sociodemographic factors, mental disorders (including alcohol use disorders and nicotine dependence), childhood adversity, and family history of substance use disorders.Results: All measures of childhood adversity were associated with an increased risk of incident drug use, as were alcohol or drug problems in first-degree relatives. In models adjusted for childhood adversity and a family history of addiction, a pre-existing mood disorder (AOR 1.31; 95% CI 1.04 to 1.64), personality disorder (AOR 1.82; 95% CI 1.50 to 2.20), previous nicotine dependence (AOR 1.41; 95% CI 1.09 to 1.83), and alcohol abuse or dependence (AOR 1.96; 95% CI 1.48 to 2.60) were independently associated with new-onset drug use at follow-up.Conclusions: Specific mental disorders independently increase the risk of progression to incident drug use among people who were previously abstinent. Early-life adversities and addiction in family members accounts for some, but not all, of this observed relation. [ABSTRACT FROM AUTHOR]

Objective: To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample.Method: Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex.Results: Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals.Conclusion: Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and correlates of chronic depression in comparison with nonchronic depression using a population-representative national database.Methods: Our study used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) to determine the lifetime prevalence and correlates of major depression with chronic symptoms in the population. The CCHS 1.2 is a large, cross-sectional mental health survey conducted by Statistics Canada (n = 36 984, aged 15 years and older).Results: The observed lifetime prevalence of major depression with chronic symptoms was 2.7%, representing 26.8% of all people with major depressive disorder (MDD). In comparison to nonchronic major depression, chronic depression was associated with more frequent psychiatric and medical comorbidity, greater disability, increased health service use, and higher likelihood of suicidal ideation and attempts.Conclusions: Major depression with chronic symptoms is common in the general population, and is associated with more severe health consequences than nonchronic depression. These observations indicate that chronic major depression is a very important subtype of MDD from a public health perspective. [ABSTRACT FROM AUTHOR]

Objective: Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research.Method: Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken.Results: Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide.Conclusions: Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relation between phobic disorders and alcoholism in a Canadian community sample.Method: Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, "hazardous alcohol use." Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses.Results: Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalence of approximately 10%).Conclusions: Given the early onset of most phobic disorders, the findings suggest that these are a risk factor for hazardous patterns of alcohol use. [ABSTRACT FROM AUTHOR]