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Biomedical subjects

Brian J Cox

Publications and source records attributed to Brian J Cox.

At least 19 recordsLinked to original sources
PubMed2006

Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions.

BACKGROUND: Evidence has been emerging that anxiety disorders are associated with several physical health conditions. We used the first community survey, which assessed physical conditions based on physician assessment and included standardized diagnostic assessment of mental disorders by trained health professionals, to examine the relationship between anxiety disorders and physical conditions. METHODS: The German Health Survey (N = 4181; response rate, 87.6%; ages 18-65 years) used the Composite International Diagnostic Interview to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, substance use, and anxiety disorders (panic disorder, social phobia, specific phobia, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder) and a standardized medical interview supplemented by laboratory data to assess a broad range of physical conditions. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to measure health-related quality of life. Number of days of role impairment was used to measure past 30-day disability. RESULTS: After adjusting for sociodemographic factors and other common mental disorders, the presence of an anxiety disorder was significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions (adjusted odds ratios between 1.39 and 2.12; P<.05). Compared with physical disorders alone, the presence of comorbid anxiety disorder with 1 or more physical disorders was associated with poorer physical component scores on the SF-36 (adjusted mean scores for physical condition alone and physical condition with anxiety disorder, 48.50 and 45.86, respectively; P<.001) and past 30-day disability due to physical problems (adjusted odds ratio, 1.69; 95% confidence interval, 1.20-2.37). CONCLUSION: Anxiety disorders are independently associated with several physical conditions in the community, and this comorbidity is significantly associated with poor quality of life and disability.

Adolescent↗
PubMed2006

Physical punishment, childhood abuse and psychiatric disorders.

OBJECTIVES: Physical punishment, as a means of disciplining children, may be considered a mild form of childhood adversity. Although many outcomes of physical punishment have been investigated, little attention has been given to the impact of physical punishment on later adult psychopathology. Also, it has been stated that physical punishment by a loving parent is not associated with negative outcomes; however, this theory has not been empirically tested with regard to psychiatric disorders. The main objective of the present study was to investigate three categories of increasing severity of childhood adversity (no physical punishment or abuse, physical punishment only, and child abuse) to examine whether the childhood experience of physical punishment alone was associated with adult psychopathology, after adjusting for sociodemographic variables and parental bonding dimensions. METHODS: Data were drawn from the nationally representative National Comorbidity Survey (NCS, n=5,877; age 15-54 years; response rate 82.4%). Binary logistic and multinomial logistic regression models were used to determine the odds of experiencing psychiatric disorders. RESULTS: Physical punishment was associated with increased odds of major depression (AOR=1.22; 95% CI=1.01-1.48), alcohol abuse/dependence (AOR=1.32; 95% CI=1.08-1.61), and externalizing problems (AOR=1.30; 95% CI=1.05-1.60) in adulthood after adjusting for sociodemographic variables and parental bonding dimensions. Individuals experiencing physical punishment only were at increased odds of adult psychopathology compared to those experiencing no physical punishment/abuse and at decreased odds when compared to those who were abused. CONCLUSIONS: Physical punishment is a mild form of childhood adversity that shows an association with adult psychopathology.

Adolescent↗
PubMed2006

Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study.

BACKGROUND: Developmental adversities may be risk factors for adult suicidal behavior, but this relationship has rarely been studied prospectively. The present study examined the association between childhood adversities and new onset suicidal ideation and attempts in an adult population-based sample. METHOD: The study used a large community mental health survey (the Netherlands Mental Health Survey and Incidence Study; n=7076, age range 18-64 years). Logistic regression analyses were used to evaluate the relationship between childhood adversities and new onset of suicidal ideation and attempts over 3 years of longitudinal follow-up. RESULTS: During the study period 85 new cases of suicidal ideation and 39 new onset suicide attempts were observed. The incidence rate for new suicide ideation was 0.67% per year and the incidence rate for new suicide attempts was 0.28% per year. Childhood neglect, psychological abuse and physical abuse were strongly associated with new onset suicidal ideation and suicide attempts. Odds ratios (ORs) ranged from 2.80 to 4.66 for new onset suicidal ideation and from 3.60 to 5.43 for new onset suicide attempts. The total number of adversities reported had a strong graded relationship to new onset suicidal ideation and attempts. These associations remained significant after controlling for the effects of mental disorders. CONCLUSIONS: Childhood abuse and multiple adversities are strongly associated with future suicidal behavior and the mental disorders assessed in the present study do not fully account for this effect. A comprehensive understanding of suicidal behavior must take childhood adversities into account.

Adolescent↗
PubMed2006

Neuroticism and physical disorders among adults in the community: results from the National Comorbidity Survey.

To examine the association between neuroticism and physical disorders among adults in the United States, data were drawn from the National Comorbidity Survey (n = 5,877). Multiple logistic regression analyses were used to examine the relationship between neuroticism and physical disorders among adults in the community, adjusting for differences in demographic characteristics and comorbid mental disorders.Results indicated that neuroticism was associated with significantly elevated rates of a wide range of physical disorders, with the exception of stroke. After adjusting for differences in demographic characteristics and comorbid mental disorders, neuroticism was associated with increased odds of arthritis (OR = 1.5), diabetes (OR = 3.33), kidney/liver disease (OR = 2.56), stomach/gallbladder problems (OR = 2.27), and ulcer (OR = 3.23). Based on those findings, neuroticism appears to be a general predictor of a range of physical health problems among adults in the United States. Much of this association appears to be partially mediated by comorbid mental disorders, yet the association between neuroticism and arthritis, diabetes, kidney/liver disease, stomach problems, and ulcer persist even after adjusting for differences in demographic characteristics and comorbid mental disorders. Future studies that can examine the nature and mechanism of these linkages across the lifespan are needed next.

Adolescent↗
PubMed2006

Personality and seasonal affective disorder: results from the CAN-SAD study.

BACKGROUND: Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. METHODS: Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. RESULTS: SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test-retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. LIMITATIONS: Personality assessment relied on self-report. CONCLUSIONS: The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted.

Adult↗
PubMed2006

Personality correlates of outpatient mental health service utilization: findings from the U.S. national comorbidity survey.

OBJECTIVE: The present paper investigated the relationships between several personality constructs and the use of outpatient mental health services. METHODS: Respondents were from the National Comorbidity Survey (NCS) Part II data set and included those with a past-year mood, anxiety, alcohol/substance use disorder (n=1750). Bivariate logistic regressions were used to examine associations between participants' self-reports of personality traits and outpatient mental health service utilization. Similar multivariate analyses were used to investigate these associations after adjusting for sociodemographic variables and the presence of psychiatric disorders and their comorbidity. RESULTS: The bivariate and multivariate analyses revealed significant positive associations between outpatient mental health service utilization and both Powerful Others Locus of Control and Self-criticism. CONCLUSIONS: These findings suggest that personality traits may play a role in treatment seeking behaviors for mental health problems over and above the presence of psychiatric disorders alone. The assessment of relevant personality constructs has the potential to inform and improve treatment outreach efforts.

Adolescent↗
PubMed2006

Mental health profiles among married, never-married, and separated/divorced mothers in a nationally representative sample.

BACKGROUND: Several studies have found that married mothers compared to single mothers had better mental health (Cairney et al. in Soc Psychiatry Psychiatr Epidemiol 38:442-449, 2003; Cairney et al. in Can J Public Health 90:320-324, 1999; Davies et al. in J Marriage Fam 59:294-308, 1997; Lipman et al. in Am J Psychiatry 158:73-77, 2001; Wang in Soc Psychiatry Psychiatr Epidemiol 39:26-32, 2004). Although a relationship between family structure (single vs married mothers) and psychiatric disorders is well established, several questions remain. The present study addressed the question "Are there differences in the prevalence of psychiatric disorders between married, never-married, and separated/divorced mothers?" METHODS: The present report examined the lifetime prevalence of anxious misery, fear, and externalizing disorders among mothers in relation to family structure (married, never-married, and separated/divorced) in the US National Comorbidity Survey (N=1,534). RESULTS: Results indicated that never-married mothers appeared to be generally similar to married mothers in their mental health profiles. Separated/divorced mothers compared to married mothers had increased odds of having any anxious-misery disorder, depression, dysthymia, generalized anxiety disorder (GAD), posttraumatic stress disorder, any externalizing disorder, and antisocial personality disorder. Differences were found between never-married and separated/divorced mothers, with separated/divorced mothers having increased odds ratios of having any anxious-misery disorder, depression, and GAD. CONCLUSIONS: Results are discussed in light of the unique life contexts of married, never-married, and separated/divorced mothers and as further evidence for the case against combining the separated/divorced and never-married marital status into one "single motherhood" classification in mental health research.

Adolescent↗
PubMed2006

Taxonicity of anxiety sensitivity: a multi-national analysis.

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index--Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.

Adolescent↗
PubMed2006

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

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

Activities of Daily Living↗
PubMed2006

The associations between peer and parental relationships and suicidal behaviours in early adolescents.

OBJECTIVE: To investigate associations between suicidal behaviours, including suicidal ideation and attempts, and poor peer and parental relationships in a nationally representative sample of Canadian adolescents aged 12 to 13 years. METHODS: We used Statistics Canada's National Longitudinal Survey of Children and Youth as the dataset. This cross-sectional sample included 1049 girls and 1041 boys aged 12 to 13 years. We obtained answers to self-report questionnaires that included measures of peer relationships, parental nurturance, and parental rejection, as well as information regarding suicidal ideation and attempts. Unadjusted and adjusted logistic regression models were used for the analysis. We included depression in the multiple logistic regression analysis. Analyses were run separately for boys and girls. RESULTS: The unadjusted logistic regression models found that, among early adolescent boys and girls, depression, poor peer relationships, decreased parental nurturance, and increased parental rejection were all significantly associated with suicidal ideation and attempts. However, after adjusting for all other variables in the multiple logistic regression models, poor peer relationships were no longer significantly associated with suicidal ideation among early adolescent boys and were only weakly associated among early adolescent girls. CONCLUSIONS: Poor parental relationships and depression were more powerfully associated with suicidal ideation and attempts than were peer relationships in a nationally representative sample of boys and girls aged 12 to 13 years, and these factors may be important early intervention targets.

Adolescent↗
PubMed2005

Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults.

CONTEXT: Controversy exists whether anxiety disorders are independently associated (ie, after adjusting for comorbid mental disorders) with suicidal ideation and suicide attempts. OBJECTIVE: To examine whether anxiety disorders are risk factors for suicidal ideation and suicide attempts in a large population-based longitudinal study. METHODS: Data come from the Netherlands Mental Health Survey and Incidence Study, a prospective population-based survey with a baseline and 2 follow-up assessments over a 3-year period. The Composite International Diagnostic Interview was used to assess DSM-III-R mental disorders. Lifetime diagnoses of anxiety disorders (social phobia, simple phobia, generalized anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder) were assessed at baseline. Multiple logistic regression analyses were used to examine whether anxiety disorders were associated with suicidal ideation and attempts at baseline (n = 7076) and whether anxiety disorders were risk factors for subsequent onset of suicidal ideation and attempts (n = 4796). RESULTS: After adjusting for sociodemographic factors and all other mental disorders assessed in the survey, baseline presence of any anxiety disorder was significantly associated with suicidal ideation and suicide attempts in both the cross-sectional analysis (adjusted odds ratio for suicidal ideation, 2.29; 95% confidence interval, 1.85-2.82; adjusted odds ratio for suicidal attempts, 2.48; 95% confidence interval, 1.70-3.62) and longitudinal analysis (adjusted odds ratio for suicidal ideation, 2.32; 95% confidence interval, 1.31-4.11; adjusted odds ratio for suicide attempts, 3.64; 95% confidence interval, 1.70-7.83). Further analyses demonstrated that the presence of any anxiety disorder in combination with a mood disorder was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone. CONCLUSIONS: This is the first study to demonstrate that a preexisting anxiety disorder is an independent risk factor for subsequent onset of suicidal ideation and attempts. Moreover, the data clearly demonstrate that comorbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders. Clinicians and policymakers need to be aware of these findings, and further research is required to delineate whether treatment of anxiety disorders reduces the risk of subsequent suicidal behavior.

Adolescent↗
PubMed2005

The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey.

Although depression has clearly been shown to be associated with physical disorders, few studies have examined whether anxiety disorders are independently associated with medical conditions after adjusting for comorbid mental disorders. We examined the relationship between anxiety disorders and a wide range of physical disorders in a nationally representative sample. Data came from the National Comorbidity Survey (N=5,877, range=age 15-54 years, response rate=82.4%). The Composite International Diagnostic Interview [Kessler et al., 1998] was used to make DSM-III-R [American Psychiatric Association, 1987] mental disorder diagnoses. Physical disorders were assessed based on a list of several conditions shown to respondents. All analyses utilized multiple logistic regression to examine the relationship between past-year anxiety disorder diagnosis and past-year chronic physical disorder. Anxiety disorders were positively associated with physical disorders even after adjusting for mood disorders, substance-use disorders, and sociodemographics. Among respondents with one or more physical disorders, a comorbid anxiety disorder diagnosis was associated with an increased likelihood of disability even after adjusting for severity of pain, comorbid mood, and substance use disorders. Among specific anxiety disorders, posttraumatic stress disorder, panic attacks, and agoraphobia were more likely to be associated with specific physical disorders than generalized anxiety disorder, social phobia, or simple phobia. There is a strong and unique association between anxiety disorders and physical disorders. Clinically, the presence of an anxiety disorder among patients with physical disorders may confer a greater level of disability.

Adolescent↗
PubMed2005

Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample.

The association between posttraumatic stress disorder (PTSD) and positive psychotic symptoms was examined in the National Comorbidity Survey (N = 5,877). The Composite International Diagnostic Interview (CIDI) was used to make DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; American Psychiatric Association, 1987) diagnoses. Posttraumatic stress disorder was found to be associated with an increased likelihood of endorsing one or more psychotic symptoms after adjusting for sociodemographics, psychiatric and medical comorbidity (odds ratios (OR) = 1.83; 95% confidence interval (CI): 1.43-2.45; p < .001). The co-occurrence of PTSD with psychotic symptoms was marked by greater levels of severity (higher total number of PTSD symptoms, greater levels of comorbidity, and high distress) compared with PTSD alone. This is the first population-based study to investigate PTSD in relation to endorsement of positive psychotic symptoms, and a strong association was obtained.

Adolescent↗
PubMed2005

Problem and probable pathological gambling among older adults assessed by the SOGS-R.

This study had three main objectives: to examine the prevalence of gambling and problem gambling among older adults, to examine the socio-demographic and gambling patterns of people with various South Oaks Gambling Screen Revised (SOGS-R) scores, and to examine endorsement of the SOGS-R items. The data were drawn from telephone interviews conducted with a sample of 1000 older adults, 60 years and older, throughout the province of Manitoba. Problem gambling was determined from scores on the SOGS-R (Lesieur, H., & Blume, S. (1987). American Journal of Psychiatry, 144, 1184-1188; Lesieur, H., & Blume, S. (1993). Journal of Gambling Studies, 9, 213-219). The results showed gambling to be a fairly common activity among older adults, with 74.7% of participants having gambled in the year prior to the study. Of the total sample, 1.6% were gambling at problem levels, and a further 1.2% were gambling at probable pathological levels in the past year. Inspection of gambling patterns by SOGS-R score failed to reveal a clear and consistent distinction between problem gambling and probable pathological gambling. Finally, examination of item distribution revealed consistent trends of both over and under endorsement of certain items. These results suggest the need for either refinement of the SOGS-R for use with older adults, or the development of a new measure specific to older adults.

Aged↗
PubMed2005

Symptom structure of posttraumatic stress disorder in a nationally representative sample.

Diagnostic criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) for posttraumatic stress disorder (PTSD) posit three symptom clusters including reexperiencing, avoidance/numbing, and hyperarousal. Factor analytic studies have suggested several alternative models of PTSD symptomatology. It is uncertain whether these new models are widely generalizable as most studies have relied on relatively select treatment seeking samples (e.g., combat veterans). To address this limitation, confirmatory factor analysis was applied to symptom data from National Comorbidity Survey respondents with a lifetime history of PTSD (n = 429). Several models were tested. The model comprised of four intercorrelated factors (reexperiencing, avoidance, numbing, and hyperarousal) received the strongest support, but did not meet all the goodness-of-fit criteria. A follow-up principal-components analysis yielded a four-factor solution, with factors representing dysphoria, cued reexperiencing and avoidance, uncued reexperiencing and hyperarousal, and trauma-related rumination. The theoretical and clinical implications of these findings are discussed.

Adolescent↗
PubMed2005

Childhood adversity and perceived need for mental health care: findings from a Canadian community sample.

Previous community surveys have demonstrated that individuals with self-perceived need for mental health treatment in combination with meeting DSM-III-R criteria display the greatest levels of impairment in the community and have a higher likelihood of reporting parental psychopathology. The current investigation aims to replicate and extend these findings by examining the association between a wide range of childhood adversities with self-perceived need for mental health treatment and DSM-III-R diagnosis in a Canadian community sample (N = 8116). All respondents were questioned about their childhood experiences (physical and sexual abuse, emotional neglect, parental discord/separation, parental death, and parental psychopathology). After controlling for covariates in a multiple logistic regression, we found that emotional neglect (OR = 2.07), physical abuse (OR = 2.16), sexual abuse (OR = 2.39), paternal psychopathology (OR = 2.41), and maternal psychopathology (OR = 2.70) were independently and significantly associated with respondents meeting DSM criteria for a mental disorder and perceiving a need for treatment. These findings underscore the importance of future longitudinal studies considering the influence of a wide range of early childhood adversities on adult psychopathology and perceived need for treatment.

Adolescent↗
PubMed2005

Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey.

This study examined the relationship between anxiety disorders and suicidal ideation or suicide attempts in a nationally representative sample (N = 5877; age, 15-54; response rate, 82.4%). A modified version of the Composite International Diagnostic Interview was used to make DSM-III-R mental disorder diagnoses. Two multivariate logistic regression analyses were performed with suicidal ideation (N = 754) and suicide attempts (N = 259) as dependent variables. In each regression, the independent variables entered were lifetime social phobia, panic disorder, agoraphobia, generalized anxiety disorder, simple phobia, and posttraumatic stress disorder (PTSD). Covariates in the analyses were sociodemographics, lifetime mood disorders, substance use disorders, nonaffective psychosis, antisocial personality disorder, and presence of three or more lifetime DSM-III-R diagnoses. PTSD was significantly associated with suicidal ideation (adjusted odds ratio = 2.79; p < 0.01) and suicide attempts (adjusted odds ratio = 2.67; p < 0.01). None of the other anxiety disorders were significantly associated with suicidal ideation or attempts. The robust association between PTSD and suicide attempts has important implications for psychiatric assessment of suicidal behavior. Future research is required to investigate the mechanisms underlying the relationship between PTSD and suicidal behavior.

Adolescent↗