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Background. A recent meta-analysis provides evidence that generalized anxiety disorder (GAD) is familial. However, two of the key studies relied on subjects who were self-selected or recruited from the clinic setting, thereby limiting generalizability. Method. We conducted a family study of GAD in which probands and controls came from a community sample originally enrolled in a prevalence study in Edmonton, Canada. One hundred and sixty probands, 764 controls and 2386 first-degree relatives (FDRs) were interviewed using the Diagnostic Interview Schedule (DIS); lifetime diagnoses were made according to DSM-III criteria without exclusions. Logistic regression analysis was performed with GAD (in a proband) as the 'exposure', and GAD in an FDR as the 'outcome'. Several analytic strategies were used to control for potential confounding by major depressive disorder (MDD) and several anxiety disorders (panic disorder, phobic disorders, obsessive-compulsive disorder, and post-traumatic stress disorder). Results. The odds ratios for the association between GAD in a proband and GAD in an FDR were in the range 1.4-1.8 when the entire FDR sample was analysed, and in the range 2.1-2.8 when we restricted to FDRs who were children of probands and controls. Conclusion. In the community setting, GAD exhibits mild to moderate familial aggregation. [ABSTRACT FROM AUTHOR]

Background: Most population studies report higher rates of depression among women than men, and some researchers have observed gender differences in depression symptoms overall, or in sub-groupings (e.g. somatic depression). However, gender symptom differences have been inconsistent, prompting this investigation of gender differences in secondary DSM symptom profiles in the context of bereavement status, age, and depression severity., Methods: Individuals with symptoms of core depression (flat affect or anhedonia) were selected from a large survey of adults in the Alberta, Canada workforce. Analyses involved the comparison of gender profiles across the seven DSM-IV secondary depressive symptoms plus a MANOVA of sex, bereavement, and age, with secondary symptoms comprising the dependent variable., Results: Gender profiles were very similar, irrespective of depression severity or bereavement. Secondary symptoms were marginally more common among women and more frequent among bereaved young adults, but there was no evidence for a gender-related somatic factor., Limitations: First, data were gathered only for persons in the workforce and thus may not be generalizable to, for example, stay-at-home parents or those with employment issues. Second, the focus here is restricted to DSM symptoms, leaving risk factors, social roles, and brain functioning for separate investigation. Third, inferences were drawn from associations between groups of persons, rather than between individuals, requiring caution when speculating about individual attributes., Conclusions: Gender differences in depression represent a difference in amount, not kind, suggesting that the range of depressive experiences is similar for men and women. There was no gender difference ascribable to somatic depression., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to extend an earlier retrospective cohort study of schizophrenia via a prospective study to a follow-up of 34 years, with an emphasis on describing the life-course of the illness., Method: Subjects were 128 first-ever admissions for schizophrenia in 1963 to either of two mental hospital in Alberta, Canada. Follow-up continued until death or 1997. A symptom severity scale, with scores ranging from 0 (no symptoms) to 3 (hospitalized), was used to collect time-series data on each subject and create life-course curves. Indices were constructed to summarize the information in each curve. Information on social functioning was also collected., Results: Results were similar for men and women. The life-course curves showed marked variability of symptom severity across subjects and over time. The average score over the entire period of follow-up for the cohort indicated 'moderate' symptoms, and the change in average score from beginning to end of follow-up demonstrated a slight worsening of symptoms. The measures of social functioning indicated that only about one quarter of the patients had a good to excellent outcome., Conclusions: The long-term course in schizophrenia is one of varying symptom severity, and for many patients, there is a poor overall outcome.

Objective: Life course studies of schizophrenia that have used a 3-phase model (onset, course, and outcome) have had their use restricted owing to differences in definition and methodology. The purpose of this investigation was to describe life course data in mathematical terms and to compare the results with the findings from other life course studies., Method: The study population was comprised of 128 of 137 people who were first admitted for schizophrenia to 1 of the 2 mental hospitals in Alberta in 1963 and followed until 1997 or death. Patient evaluations were based on retrospective and contemporaneous information collected from the patients and hospital files, treatment records, and family members. Mathematically derived ratings were formulated for course, outcome, and onset (pre-admission years). The distribution of the resulting 8 life course types was compared with profiles drawn from other such studies reported in the literature., Results: The use of mathematical descriptions of onset, course, and outcome produced profiles that did not closely match the results of other investigations, largely owing to inconsistency across studies. Further, the present approach to outcome measurement produced results that were less favourable than those found in other studies., Conclusions: Studies on the life course of schizophrenia could be made more comparable by specifying mathematically expressed operational definitions of onset, course, and outcome. Nonetheless, the use of the term outcome can be questioned as it implies an assessment at a specific time rather than providing a summary statement of the quality of a life.

Background: There is a paucity of research on whether minor depression is a familial disorder., Methods: We conducted a population-based family study of minor depression in which subjects were interviewed using the Diagnostic Interview Schedule (DIS). Minor depression only (MDO) was diagnosed if there was a lifetime history of what the DIS refers to as a depressive "spell" and no lifetime history of either Diagnostic and Statistical Manual of Mental Disorders, Third Edition, major depression or dysthymia. There were 71 probands with a lifetime history of MDO; 577 controls with no lifetime history of MDO, major depression, or dysthymia; and 1,539 first-degree relatives (FDRs). Logistic regression was performed with the presence/absence of MDO in a proband/control as the "exposure" and MDO in an FDR as the "outcome"., Results: The odds ratio for the association between MDO in a proband and MDO in an FDR, after adjusting for age and sex of the FDR, was 1.55 (95% confidence interval: 0.93-2.58; P=.093). The study had 80% power to detect an odds ratio as small as 1.97, which is in the range of odds ratios seen for the familial aggregation of major depression., Conclusions: MDO does not appear to be a familial disorder, raising questions about the validity of "minor depression" as a distinct psychiatric syndrome., ((c) 2009 Wiley-Liss, Inc.)

Objective: The objective of the study was to estimate the odds ratio for the association between unemployment and parasuicide, controlling for potential confounding variables., Methods: A case-control study was conducted involving 507 cases of parasuicide and 200 age- and sex-matched controls presenting to emergency departments in Edmonton, Canada. Subjects were interviewed using an extensive questionnaire developed for a World Health Organization study of parasuicide. The data were analyzed using conditional logistic regression., Results: In a crude analysis, the odds ratio for the association between unemployment and parasuicide was 12.0 (95% confidence interval, 6.0-23.9). After controlling for sociodemographic factors, lifetime prevalence of several Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, disorders, previous parasuicide, hopelessness, childhood experiences, and emotional support from family and friends, the odds ratio was 5.2 (95% confidence interval, 2.3-11.4)., Conclusions: Those who are unemployed have an increased risk of parasuicide, and this association persists after accounting for a wide range of potential confounders.

Numerous studies have been conducted in which cases of parasuicide have been followed for repeat parasuicide. By comparison, there have been relatively few studies of other morbidity endpoints. Over a 1-year period, 507 cases of parasuicide and 200 controls were recruited from emergency departments in Edmonton, Canada and interviewed using the Beck Hopelessness Scale, Beck Depression Inventory, State Anger Scale, Trait Anger Scale, Self-Esteem Scale, and Social Adjustment Scale. Over the ensuing 1 to 2 years, 414 cases were reinterviewed using the same questionnaires. Mean symptom scores on all questionnaires improved over the course of follow-up, but did not reach control levels. The pattern of improvement varied according to questionnaire. Only half of cases received treatment for the parasuicide from a psychiatrist, psychologist, or other health care provider during the 3 months following the emergency department visit.

Objective: To identify variables which differentiate future repeaters of parasuicide from non-repeaters in a multivariate analysis., Method: Interviews were conducted with 507 parasuicide cases; data were collected on precipitating factors for the index parasuicide, psychiatric and medical history, stressful life events, prior history of parasuicide, hopelessness, anger, self-esteem and social adjustment. Individuals were followed for 1-2 years to determine if a repeat parasuicide occurred., Results: A logistic regression model identified four significant predictors of repeat parasuicide: prior history of parasuicide, a history of depression, a history of schizophrenia and poor physical health. A risk factor scale constructed from these four variables showed that the risk of repeat parasuicide increases as the number of risk factors increases., Conclusion: This study identifies four key predictors of repeat parasuicide, and provides evidence that the risk of repeat parasuicide increases when multiple risk factors are present.

Previous research has indicated that individuals afflicted with obsessive-compulsive disorder (OCD) have a very low rate of seeking help from mental health professionals. From standardized psychiatric interviews of 7,214 residents of Edmonton, Canada, we identified 172 subjects with a lifetime diagnosis of OCD; 63 (36.6%) had consulted a doctor about their symptoms. Total number of OCD symptoms (odds ratio [OR] = 2.23) and severe obsessions of violence and other unpleasant thoughts (OR = 2.52) were significantly associated with treatment seeking in multivariate analysis. The absence of association between compulsions and treatment seeking was corroborated by a very low prevalence of treatment seeking (17.3%) in individuals suffering from compulsions only. Our findings suggest that there is a need to teach the public about compulsions, and such a strategy may enhance future public health education programs., (Copyright 2003, Elsevier Science (USA). All rights reserved.)

Background: In contrast with the large amount of research on the familial transmission of antisocial behaviour, few studies have investigated similarity between spouses for such behaviour. In addition, none of these studies have examined child conduct disorder (CCD) and adult antisocial behaviour (AAB) separately., Method: We studied 519 pairs of spouses who completed the Diagnostic Interview Schedule. In each pair, one spouse belonged to a random subsample of persons who had participated in a large population survey and was re-interviewed. Association between spouses for lifetime symptoms and DSM-III criteria of CCD, AAB, antisocial personality disorder and co-morbid psychiatric diagnoses was examined with bivariate and multivariate logistic regression analyses., Results: We observed a moderate association between spouses for the presence of CCD (OR = 4.02, 95% CI = 2.03-7.96), and a strong association for the presence of AAB (OR = 20.1, 95 % CI = 5.97-67.5). This similarity for AAB was independent of the similarity for CCD and persisted after adjustment for spousal similarity for disorders co-morbid with AAB. An examination of the relationship between marital status and the presence of CCD and/or AAB in the general population sample (from which originated our sample of couples) suggested that the spousal similarity for AAB was more likely attributable to assortative mating rather than marital contamination., Conclusion: Our finding of a strong similarity between spouses for AAB has significant implications for both clinicians and researchers. It also suggests that adult antisocial behaviour should be considered as a distinct diagnostic entity, an approach which diverges from DSM-IV diagnostic criteria.

Background: A series of surveys were conducted to assess the attitudes of the public, and other groups, toward those with schizophrenia. The aim of these surveys was to aid in the planning and evaluation of the WPA anti-stigma initiative in Alberta, Canada., Method: A questionnaire was devised and administered via telephone to over 1,200 individuals in three Alberta cities, and in paper and pencil format to 40 members of the Schizophrenia Society of Alberta and 67 medical students., Results: In contrast to some earlier findings, "loss of mind" was rated to be more disabling than any other handicapping condition. In general, respondents showed a relatively sophisticated understanding of schizophrenia and a higher level of acceptance than might have been predicted. Nonetheless, this acceptance was not as high for situations where closer personal contact was likely, and fears of dangerousness continue to be associated with schizophrenia. The majority of respondents, however, felt that treatment aided those with schizophrenia, expressed support for progressive programmes for the mentally ill, and stated that they would be willing to pay higher taxes so that programming could be improved., Conclusions: The results do not support the utility of a broad approach for an anti-stigma campaign, but rather suggest a more specific focus, such as perceived dangerousness.

Objective: To examine the Modified Mini-Mental State Examination (3MS) as a screen for dementia., Method: A group of 1092 elderly Edmonton community residents completed the 3MS and the Geriatric Mental State Examination (GMS). 3MS sensitivity and specificity were determined by comparing positive 3MS screens (score < or = 77) with those classified as GMS "organic" (severity level 3, equivalent to a clinical diagnosis). In the Canadian Study of Health and Aging (CSHA), 2914 subjects received the 3MS and a clinical examination. A group described as having "cognitive impairment but no dementia (CIND)" was identified., Results: In Edmonton, the 3MS showed 88% sensitivity, 90% specificity, 29% positive predictive value (PPV), and 99% negative predictive value (NPV). In the CSHA, 30% of subjects receiving both the 3MS and a clinical examination were classified as CIND. One-half of these were classified as having "age associated memory impairment (AAMI)" or as "unspecified.", Conclusions: The 3MS with a cutting score of 77/78 proved a reasonable screening instrument; 1 case in 3 screening "positive" has dementia, but few (0.64%) will be missed by screening "negative." CIND, accounting for 2 out of 3 cases screened positive by the 3MS in the Edmonton study, is a substantial, heterogeneous group that is not necessarily "predementia" but that in many cases merits further investigation.

Background: General population research has indicated that many persons with lifetime major depression report they have never sought medical help for their illness. We examined the role played by both depressive symptoms and comorbid psychiatric diagnoses in treatment seeking., Methods: From standardized psychiatric interviews of 7214 Edmonton residents, we identified 1348 subjects with lifetime depressive illness; 866 subjects (64%) had sought medical treatment., Results: Psychomotor retardation (odds ratio, OR = 1.4), suicidal ideation (OR = 1.4), comorbid mania (OR = 9.5), comorbid panic disorder (OR = 3.0), and comorbid drug abuse/dependence (OR = 0.6) were significantly associated with treatment seeking in multivariate analysis., Conclusion: The finding that only a few depressive symptoms were associated with treatment seeking underlines the importance of public health education to address the undertreatment of depression.

Background: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data., Methods: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand., Results: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married., Conclusions: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Background: Prevalence rates of depression based on the GMS-AGECAT system are markedly higher than rates of major depression diagnosed using DSM-III and DSM-III-R criteria. Interpreting this finding is difficult since AGECAT diagnostic criteria have not been published., Methods: We conducted a survey in Edmonton, Canada, in which 1119 community residents aged 65 years or older were administered the Geriatric Mental State (GMS) questionnaire. Depression was diagnosed using AGECAT and also according to criteria for DSM-IV major depression and minor depression. We identified 57 items in the GMS relating to major and minor depression which were then grouped into dysphoric, somatic and cognitive categories. The relationship of these symptoms to AGECAT depression was investigated by recording symptoms to absent (nullifying) and recalculating the number of AGECAT cases. Data were weighted to reflect the underlying population., Results: There were 143 cases of AGECAT depression (prevalence rate = 11.4%), 14 cases of major depression (prevalence rate = 0.86%) and 44 cases of minor depression (prevalence rate = 3.6%). Of the 154 subjects with either AGECAT or DSM-IV depression, only 47 (31%) were depressed according to both diagnostic systems. Nullifying all dysphoric symptoms reduced the number of AGECAT cases to eight, whereas nullifying somatic and cognitive symptoms reduced the numbers of cases only to 138 and 142, respectively. By themselves, dysphoric symptoms accounted for 77 of the 143 cases of AGECAT depression, while somatic and cognitive symtpoms alone accounted for no cases., Conclusions: AGECAT depression is more inclusive than DSM-IV major or minor depression and AGECAT case status is determined mainly by the proportion of dysphoric symptoms.

Objective: To estimate the current prevalence rate of Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) disorders in the elderly population in Edmonton, Alberta. To compare the prevalence rate of GMS-AGECAT depression with the prevalence rate of Diagnostic Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders (DIS-DSM-III) major depression based on an earlier survey in Edmonton., Method: A sample of 1119 community residents age 65 years and over was selected using the provincial health insurance database. Data on mental disorders were collected using the Geriatric Mental State questionnaire, and diagnoses were made with the Automated Geriatric Examination for Computer Assisted Taxonomy computer program. Prevalence rates, standard errors, and logistic regression coefficients were estimated using software designed to analyze survey data., Results: The prevalence rates of GMS-AGECAT depression and organic disorder were 11.2% and 2.9% respectively. For depression there was a statistically significant difference in the prevalence rates for males (7.3%) and females (14.1%) (P = 0.003), and for organic disorder there was a statistically significant increasing trend across age-groups for females (P < 0.0001). The prevalence rate of GMS-AGECAT depression in Edmonton is comparable to rates reported from several European studies but is much higher than the 6-month prevalence rate of DIS-DSM-III major depression of 1.2% based on an earlier Edmonton survey., Conclusions: GMS-AGECAT depression is a depressive syndrome that has a larger prevalence rate than DIS-DSM-III major depression. Community surveys that measure only the prevalence rate of DSM-III major depression may be missing clinically significant cases of geriatric depression.

Objective: To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system., Methods: Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery., Results: Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly., Conclusions: Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry.

An incidence study was conducted in Edmonton, Alberta, Canada, in which 3956 community residents were interviewed using the Diagnostic Interview Schedule (DIS) and a sample of 1964 subjects were reinterviewed with the DIS an average of 2.8 years later. Incidence rates, estimated for a range of DSM-III disorders, were surprisingly large, raising questions about the reliability of DIS data. We examined major depression in detail to uncover possible sources of unreliability. There were 138 'incident' cases of major depression, giving an annual incidence rate for both sexes of 27.9 (per 1000). However, based on reinterview data, 106 (80%) of the incident cases reported an age of onset prior to the initial interview. These findings appear to be the result of a difference between the DIS definition of age of onset and the one used in our analysis of incidence. A syndrome called depressive spell is defined and used to demonstrate that the large number of incident cases is likely due, at least in part, to incomplete recall of lifetime depressive symptoms. Despite these potential sources of bias, the possibility remains that incidence rates and lifetime risks in Edmonton are larger than has generally been reported in the literature.

Background: Most studies of spouse similarity for psychiatric disorders have focused on clinical samples and are thus limited by selection bias. This study is, to our knowledge, the first comprehensive investigation of spouse similarity for lifetime psychiatric history in a general population sample using standardized diagnostic criteria., Methods: We studied 519 pairs of spouses residing in Edmonton, Canada who completed the Diagnostic Interview Schedule psychiatric interview. In each pair, one spouse belonged to a random subsample of persons who had participated in a large population survey and was re-interviewed. Association between spouses for lifetime DSM-III psychiatric disorders was analysed with bivariate and multivariate logistic regression analyses., Results: We observed significant spousal association for lifetime presence of affective disorders and for the spectrum of antisocial personality and addiction disorders. Antisocial personality in one spouse was also associated with anxiety disorders in the other spouse, namely post-traumatic stress disorder in wives and phobia in husbands; similarly, drug abuse/dependence in wives was associated with generalized anxiety in husbands and male drug abuse/dependence was associated with female post-traumatic stress disorder. Dysthymia in wives was associated with generalized anxiety and post-traumatic stress disorder in husbands., Conclusions: The existence of associations between spouses for the presence of psychiatric disorders, either similar or different, has significant implications for both clinicians and researchers. Future research should aim at exploring the aetiological mechanisms of these associations.

Objective: To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care., Method: A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview., Results: Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, chi 2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care., Conclusion: Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder.

Objective: To examine the relationship between remission of psychiatric disorders and age., Methods: We interviewed 3258 randomly selected adult residents of Edmonton using the Diagnostic Interview Schedule (DIS), which yielded DIS/DSM-III diagnoses. Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview, this being the difference between the lifetime and one-year prevalence. For each age group, the proportion of cases with and without symptoms in the preceding year was calculated. Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size. Only the more common disorders were examined; any comorbidities were ignored., Results: Drug abuse or dependence, antisocial personality disorder (in both sexes), and alcohol abuse or dependence (in men) all showed remission rates that increased with age. Panic disorder and obsessive-compulsive disorder (OCD) showed a decreased likelihood of remission with increasing age. Major depression and phobias showed little tendency to remission with age. Considering all disorders together, the one-year remission rate for all ages combined was only 33.2%, with a tendency for lower remission rates to be found in those aged 55 to 64., Conclusions: As may be expected, antisocial personality, drug abuse or dependence, and alcohol abuse or dependence tend to show increased remission rates with increasing age. In OCD and panic disorder, the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity. For depression, which had an overall remission rate of less than 50%, the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated.

Objective: To review the epidemiology of affective disorders., Methods: This paper reviews recent studies, many of which have used standardized methodology and classification systems, and summarizes their major findings. It also presents trends with particular reference to major depression., Results: There have been major advances in the last 15 years, with many investigators using standard methods in different countries, cultures, and races. Rates of major depression are probably increasing, and both major depression and bipolar disorder are occurring at younger ages., Conclusions: Affective disorders present a major public health problem with poor recognition, diagnosis, and treatment. There is little coordinated action to reduce untreated morbidity despite the availability of reasonably safe, effective, and economical treatments and the established effectiveness of continuing education programs for providers.

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

Background: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures., Method: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries., Results: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries., Conclusions: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Objective: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys., Design and Setting: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand., Participants: Approximately 38000 community subjects., Outcome Measures: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression., Results: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries., Conclusions: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.

We present a preliminary report on cross-national rates, age at onset, comorbidity, suicide attempts and symptom profiles of social phobia. These data are based on epidemiologic community surveys using similar methods from the United States, Canada, Puerto Rico and Korea. The lifetime rate of social phobia (cases per 100 persons) varies by country, from 2.6 in the United States to 0.5 in Korea. Rates are higher in females than in males in all countries. The age of onset for any phobia is mid-teens to early twenties, and social phobia usually has its first onset before other psychiatric disorders. Only a third or fewer cases of social phobia are uncomplicated by another psychiatric disorder. The presence of social phobia increases the risk of suicide attempts in persons with any other psychiatric disorder. Symptom profiles vary by country. Our data indicate consistent patterns but different cultural expressions of social phobia in the countries studied. The early age of onset of social phobia followed subsequently by another psychiatric disorder raises the possibility that early treatment of social phobia could prevent the onset of other psychiatric disorders.

Objective: To abstract and evaluate data on psychiatric illness and health care in Canada from a recent major World Bank/World Health Organization (WHO) publication., Method: A review of the publication and related material provides a picture of the level of disability produced by neuropsychiatric disorders. Changing patterns of life expectancy in developing countries, and some social factors associated with prevention are extracted., Results: Psychiatric disorders account for 15% of disability and premature death in developed countries. A surprisingly small percentage is accounted for by psychoses, and more than expected by post-traumatic stress disorders. Violence against women is highlighted as a risk factor for psychiatric disorders. Objectives for health care systems - improving outcomes, reaching the disadvantaged and containing costs - are detailed., Conclusions: Although little formal attention is given to psychiatric disorders, there is a wealth of information about the extent of disability produced by neuropsychiatric disorders, and future directions of health care systems.

The purpose of this study was to determine the extent of the association between psychiatric disorders and various social problems. The Diagnostic Interview Schedule was administered to a community sample of 3258 individuals and the association between eight "core" psychiatric disorders and eight social problem behaviours was determined. The results confirmed findings from many clinical studies that had previously found a strong relationship between social problem behaviours and mental illness. However, certain disorders tended to be associated with specific problems. In addition, a positive association was found between the number of social problems exhibited and the prevalence of psychiatric disorder. These data suggest the presence of a common underlying factor (or factors) and call into question the common practice of creating separate services for each definable social problem that arises.

The objective of this study was to examine some of the characteristics of parasuicides in Edmonton and to calculate rates of parasuicide. The method involved examining all records of parasuicides attending the University of Alberta Hospitals for a six month period (20% of all parasuicides in Edmonton are treated at the University of Alberta Hospitals). The results indicated that 58% of 275 subjects were single. The most frequent method (88.6%) of parasuicide was overdose. The peak age group was 25 to 29 years of age. The age range was 12 to 80 years (six percent < 15 years), mean age 30.2. The female to male ratio (cases) was 1.6:1; 30.2% were admitted; 46.5% received psychiatric emergency consultation; 41% had made a previous parasuicide. Calculated rates of parasuicide in Edmonton were at 448/100,000/year for those 15 years and older (men 357, women 534). The overall rate is higher than that found in any centre in the WHO/EURO investigation. The conclusion is that parasuicide presents a significant public health problem, and a cost burden on the health care system.

Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.

3258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). One of the diagnostic categories studied was obsessive-compulsive disorder (OCD). The lifetime and six month prevalence rates of OCD were 2.9% and 1.6% respectively. The morbidity risk, was equal in males and females at 5.4%. The peak age of risk of onset for both sexes was from the ages of 10 to 19 and, closely followed by the decade 20-29. Obsessions were found to be more frequently experienced than compulsions. Having a lifetime diagnosis of OCD is associated with an increased likelihood of developing depression, alcohol abuse, drug abuse, phobic disorders, and antisocial personality disorder. The significance of these findings is discussed for clinical practice.

3258 randomly selected household residents of Edmonton, Alberta were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). The lifetime prevalence of mania was 0.6%, for both sexes combined. Lifetime morbidity risk was 1.4% for men and 0.6% for women. The mean age of onset was 20 years of age for both men and women. Ninety-five percent of bipolar individuals had had their first onset by age 26, and less than 5% had their onset before the age of 10. The mean number of manic episodes was 23. Comorbidity with other disorders occurred in 92% of the manic subjects. Depression (62%), alcohol abuse (45%), substance abuse (35%), and phobias (54%) had an increased lifetime prevalence in individuals with a history of a manic episode(s).

3258 randomly selected adult household residents of Edmonton, Canada, were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). 104 subjects fulfilled DSM-III antisocial personality disorder (ASP) criteria. Lifetime prevalence rates were found to be significantly higher in males and in the younger adult age groups. The age of onset (i.e. age at which conduct disorder symptoms first appeared) was found to be under 10 years in the majority of cases, with females lagging just slightly behind males. Symptom patterns and frequencies were examined and the relative risks for these symptoms were calculated. Comorbidity, calculated using full DSM-III severity criteria, but without exclusion criteria, revealed an increased prevalence of nearly every other psychiatric disorder in those with antisocial personality disorder, with 90.4% having at least one other lifetime psychiatric diagnosis.

3258 randomly selected adult household residents of the city of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Using DMS-III criteria, hierarchy-free, the lifetime prevalence for all phobias was 8.9%. Rates for women (11.7%) were almost twice those for men (6.1%). The age at which first phobic symptoms had been reported by 50% of subjects was 12 years for men and 6 years for women. High rates of comorbidity with depression, alcohol abuse/dependence, drug abuse/dependence and obsessive-compulsive disorder were found in all types of phobia, an important point in clinical management.

3258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). The lifetime prevalence of drug abuse/dependence was 6.9%, with a male:female ratio of 3:1. The most commonly used drug was cannabis followed by amphetamines, opiates, barbiturates, hallucinogens and cocaine. 80.3% of those with drug abuse/dependence also had a lifetime diagnosis of another psychiatric disorder. In those with a comorbid diagnosis, the mean age of onset for the other psychiatric disorder was generally found to be younger than for the onset of drug abuse/dependence. Different comorbid disorders were found to significantly affect patterns of drug use.

A community survey was conducted in Edmonton, Alberta, Canada, in which 3,070 respondents completed the Diagnostic Interview Schedule (DIS) and the Life Events Scale (LES) of Paykel. During the year before the interview, there were 222, 234, and 38 cases of major depressive episode (MDE), generalized anxiety disorder (GAD), and panic disorder (PD), respectively, where individuals may have had more than one disorder. It was not possible to time the onset of the disorder relative to the occurrence of life events, and so correlations, no casual relationships, were examined. The LES score showed an increasing trend across disorder categories defined as follows: MDE and GAD both absent; MDE absent and GAD present; MDE present and GAD absent; and MDE and GAD both present. A similar trend was observed for most of the LES subscales studied, but only in the case of events classified as "entrance," "undesirable," and "marital" was there statistical significance. The results suggest that stressful life events are correlated with both MDE and GAD, that individuals with MDE only tend to have a greater burden of stressful events and comorbid disorders than persons with GAD only, and that the presence of both disorders is associated with an even greater level of stress and number of comorbid disorders. The similar patterns across LES subscales suggest that MDE and GAD are not related to specific types of live events, at least not those covered by the LES questionnaire.

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada, were interviewed by trained lay interviewers, using the Diagnostic Interview Schedule (DIS), which generated DSM-III diagnosis data. This paper reports results for major depressive disorder (MDD). MDD was found to affect women more than men by a ratio of nearly 2 to 1. The lifetime prevalence rate for both sexes combined was 8.6%. The period prevalence rates for both sexes combined were 3.2% and 4.6%, for six month and one year, respectively. The presence of a recurrent Major Depressive Disorder was associated with an increased risk of substance abuse, panic disorder and dysthymia, whereas a single major depressive episode was not associated with increased comorbidity.

Population studies have shown that the co-occurrence of psychiatric disorders increases the likelihood of treatment seeking. This leads to a biased estimation of the prevalence of comorbidity in clinical samples, and this overestimation can be attributed to two different sources of selection bias. Using data from a population survey of psychiatric disorders, in which 3258 residents of Edmonton, Alberta, Canada, were interviewed with the Diagnostic Interview Schedule, we assessed the extent of each of these two mechanisms. The first source of selection bias is the mathematical bias known as Berkson's bias and arises from the fact that an individual affected with two psychiatric disorders can seek treatment for either one or the other of these disorders. The second source of selection bias is clinical and results from the changed probability of seeking a treatment for a specific disorder because of the existence of a comorbid disorder.

Thirty lifetime pathological gamblers (DSM-III, no exclusion criteria) were identified when 7,214 randomly selected household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule. The lifelong prevalence of pathological gambling was 0.42% (ratio of males to females 3:1). The peak age of onset was 25 to 29 years. Gamblers had high rates of comorbidity with other psychiatric disorders. They were likely to have made suicide attempts (13.3%), to have been convicted of offences (26.7%), to be spouse and child abusers (23.3% and 16.7% respectively) and to have spent long periods unemployed (40%). In addition, 80% had trouble at home or work because of gambling, and 60% borrowed or stole to gamble.

A cohort study of mortality was conducted in which 4022 patients with affective disorder who were treated during 1976-1985 in a mental institution or community clinic operated by the province of Alberta, Canada, were followed to the end of 1985. Vital status was determined by record linkage to the Statistics Canada Mortality Data Base. There were 326 deaths altogether, 96 from suicide. The standardized mortality ratio (SMR) for all causes of death combined was 2.3, and for suicide the SMR was 26.0. The SMR was also elevated for mental, circulatory and respiratory disorders, but not for neoplasms. The principal objective of the study was to determine whether there was a gradient of increasing mortality risk across the following diagnostic subgroups: manic disorder, bipolar affective disorder and major depressive disorder. A trend was found for suicide but not for all causes of death combined. The pattern of risk persisted after adjustment for the covariates sex, age and marital status in a Cox regression analysis.

A retrospective study of mortality was conducted in which 3,623 patients with schizophrenia receiving treatment in Alberta between 1976 and 1985 were followed to the end of 1985. Vital status was determined by record linkage to the Statistics Canada Mortality Data Base. There were 301 deaths in the cohort, 97 of which were due to suicide. For all causes of death combined, the risk of mortality was approximately double that of the Alberta population; for suicide, risk was increased by a factor of 20. Mortality from circulatory, respiratory, digestive and genitourinary diseases was also greater than expected. It is estimated that those who suffer from schizophrenia have a life expectancy which is approximately 20% shorter than that of the general population. This study confirms earlier research demonstrating an increased risk of mortality associated with schizophrenia and extends those findings to specific causes of death.