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Biomedical subjects

G C Patton

Publications and source records attributed to G C Patton.

At least 19 recordsLinked to original sources
PubMed2006

Consequences of youth tobacco use: a review of prospective behavioural studies.

BACKGROUND: Cigarette smoking represents a significant health problem and tobacco has been identified as causing more preventable diseases and premature deaths than any other drug. Although health consequences from smoking have been documented, there has been a surprising lack of research into behavioural consequences. AIMS: To review what is known of the long-term relationship between patterns of tobacco use prior to age 18 years and behavioural consequences in adulthood. METHOD: A literature search of electronic abstraction services from 1980 to September 2005 was conducted. To be included in the review, studies had to have large, representative samples, be longitudinal studies with baseline age under 18 years and follow-up age 18 years or older and clarify effects due to attrition, leaving 16 articles that met the inclusion criteria. Two reviewers evaluated each paper. FINDINGS: Adolescent tobacco use predicts a range of early adult social and health problems. Surprisingly few studies met the inclusion criteria. The limited evidence available suggests that adolescent tobacco smoking increases the likelihood of early adult tobacco use and the initiation of alcohol use or the development of alcohol-related problems. The link between adolescent tobacco use and subsequent cannabis use was not resolved convincingly from the studies summarized. The effects of tobacco use on later illicit drug use tended to fall away when adjusting for underlying risk factors. Existing studies of the effects of tobacco use on later mental health have many limitations. Nevertheless, a finding that youth tobacco use may predict subsequent mental health problems deserves further investigation. The possible effects of tobacco use on academic/social problems and sleep problems also warrant further investigation. CONCLUSION: This review highlights links between youth tobacco use and subsequent behavioural and mental health problems. It provides health care professionals with evidence of the possible harmful effects of youth tobacco smoking on later social, emotional, and behavioural well-being.

Adolescent↗
PubMed2006

Dimensional characteristics of DSM-IV personality disorders in a large epidemiological sample.

OBJECTIVE: To assess the five-factor model (FFM) characteristics of young adults with Diagnostic Statistical Manual-IV (DSM-IV) personality disorders in a large community study. METHOD: As part of the eighth wave of a cohort study, 1469 young adults (mean age: 24 years) completed the NEO-five factor inventory, 1145 of whom also had an informant-based personality disorder assessment. RESULTS: The prevalence of personality disorder was 18.6% (95% CI: 16.5-20.7). There were consistent positive associations with neuroticism and negative associations with agreeableness across all three clusters of personality disorder. CONCLUSION: In young adults, high neuroticism and low agreeableness are consistent dimensional characteristics of all personality disorder clusters.

Adult↗
PubMed2005

Youth alcohol and other drug use in the United States and Australia: a cross-national comparison of three state-wide samples.

Although youth drug and alcohol harm minimization policies in Australia are often contrasted with the abstinence and zero tolerance policies adopted in the United States, there has been little research directly comparing youth substance use behaviour in the two countries. Three state representative samples in Victoria, Australia (n = 7898) and in the US states of Oregon (n = 15,224) and Maine (n = 16,245) completed a common cross-sectional student survey. Rates of alcohol use (lifetime alcohol use, recent use in the past 30 days), alcohol use exceeding recommended consumption limits (binge drinking: five or more drinks in a session), other licit drug use (tobacco use), and norm-violating substance use (substance use at school, use in the past 30 days of marijuana or other illicit drug use) were compared for males and females at ages 12-17. Rates were lower (odds ratios 0.5-0.8) for youth in Maine and Oregon compared to Victoria for lifetime and recent alcohol use, binge drinking and daily cigarette smoking. However, rates of recent marijuana use and recent use of other illicit drugs were higher in Maine and Oregon, as were reports of being drunk or high at school. In contradiction of harm minimization objectives, Victoria, relative to the US states of Oregon and Maine, demonstrated higher rates of alcohol use exceeding recommended consumption limits and daily tobacco use. However, findings suggested that aspects of norm-violating substance use (substance use at school, marijuana use and other illicit drug use) were higher in the US states compared to Victoria.

Adolescent↗
PubMed2003

The outcome of adolescent eating disorders: findings from the Victorian Adolescent Health Cohort Study.

The study aimed to ascertain the outcome of adolescent onset eating disorders in a representative cohort of females. The design was a seven wave cohort study conducted over 6 years. 982 female participants from a total sample of 2032 secondary school students initially aged 14-15 years at 44 schools in the state of Victoria Australia. Branched questionnaires (BET) were used for assessing symptoms of eating disorder. A partial syndrome was defined where a subject met two DSM-IV criteria for either anorexia or bulimia nervosa. The revised Clinical Interview Schedule (CIS-R) was used for assessing depression and anxiety, and self-report frequency of use and retrospective diaries for substance use. The mean point prevalence of eating disorders in females between 15-18 years at the partial syndrome level was 2.4 % (1.8-31). At follow-up at the age of 20 years the point prevalence was 3 % (1.9-4.1). In all 8.8 % reported an eating disorder across the six year study period. Eleven percent of those with eating disorder in the teens had persisting disorder at follow-up. In contrast, close to 50 % had high levels of depression and anxiety, a finding that was particularly marked for those with the partial syndrome of bulimia nervosa during the teens. The bulimia group tended to report a higher level of heavy alcohol use at follow-up. Eating disorders at the partial syndrome level are common in young women but most teenage syndromes are brief and self-limiting. The findings are consistent with the partial syndrome of bulimia nervosa being viewed as a variant of affective disorder with different associated behaviours at particular developmental points.

Adolescent↗
PubMed2003

Life events and early onset depression: cause or consequence?

BACKGROUND: Adverse life events prior to episodes of depression are assumed to play a causal role. Earlier studies have, however, not adequately controlled for the potential confounding effects of previous depression. METHOD: A two-phase study was nested within a six-wave population based cohort study of 1947 adolescents. Interviews at two assessment phases with the CIS-R and CIDI were used to generate ICD-10 diagnoses of depressive disorder. Life events with longer-term contextual threat were reported for the 6 months before first diagnosis and categorized on the basis of participant appraisal as negative and neutral/positive in effects. Previous depressive and anxiety symptoms were measured 6 months earlier. RESULTS: Pre-existing depressive and anxiety symptoms predicted later events, increasing three-fold the risks for both neutral/positive and negative events in females and increased seven-fold the risk of negative events in males. Life events in turn predicted the onset of depressive disorder independently of previous symptoms. Single negative events held an over five-fold elevated risk and multiple events an almost eight-fold higher risk. Personal threat and loss were associated with disorder in females but not males. CONCLUSIONS: The findings are consistent with a causal role for life events in early episodes of depression. The association also reflects a reciprocal relationship in which earlier symptoms predict later events, perhaps as a result of an individual's attempts to change unfavourable social circumstances.

Adaptation, Psychological↗
PubMed2001

Parental 'affectionless control' in adolescent depressive disorder.

BACKGROUND: Adults with depressive disorder report high rates of sub-optimal maternal care in childhood. Despite the greater salience of relationships with parents earlier in life, associations with parenting style have not yet been systematically studied in adolescent onset disorder. METHODS: A six-wave, 3-year study of adolescent health in 2032 Australian secondary school students provided an opportunity to undertake a two-phase study of early onset depression. Between waves 2 to 6, a self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used to generate a first phase diagnosis of ICD-10 depressive episode. Each subject with a CIS-R-defined depressive episode was selected for second phase assessment together with two subjects from the CIS-R non-cases in each school. Second phase assessment included a second diagnostic assessment using the depression and hypomania modules of the Composite International Diagnostic Interview (CIDI) and assessment of paternal and maternal style using the Parental Bonding Instrument. RESULTS: A total of 1947 out of 2032 subjects in the sampling frame (95.8%) participated in the cohort study (phase 1) at least once; 406 (94%) of the 435 selected subjects completed second phase assessment. One hundred and nineteen subjects fulfilled criteria for depressive episode on the CIS-R at one or more waves. Over the 30-month study period, 69 subjects (10 male, 59 female) fulfilled both CIS-R and CIDI definitions of depression at the same wave and were classified as 'definite depressive disorder'. Low maternal and paternal care held independent associations with both definitions of depression, with the effects clearest in those in the lowest quartile of reported care. After adjusting for low parental care, the associations between high parental control and depression were small. CONCLUSIONS: Sub-optimal parenting is associated with depressive disorder in adolescents. Low maternal and paternal care are each associated with a two- to three-fold higher rate of depressive disorder. These findings are consistent with an effect of sub-optimal parenting on the onset rather than course of disorder. Whether sub-optimal parenting is associated with a risk for the onset of depression outside the adolescent years has yet to be clarified.

Adolescent↗
PubMed2001

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being.

OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Adolescent↗
PubMed2001

Building capacity for system-level change in schools: lessons from the Gatehouse Project.

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school's social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.

Adolescent↗
PubMed2000

Evaluation of the effectiveness of an educational intervention for general practitioners in adolescent health care: randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of an educational intervention in adolescent health designed for general practitioners in accordance with evidence based practice in continuing medical education. DESIGN: Randomised controlled trial with baseline testing and follow up at seven and 13 months. SETTING: Local communities in metropolitan Melbourne, Australia. PARTICIPANTS: 108 self selected general practitioners. INTERVENTION: A multifaceted educational programme for 2.5 hours a week over six weeks on the principles of adolescent health care followed six weeks later by a two hour session of case discussion and debriefing. OUTCOME MEASURES: Objective ratings of consultations with standardised adolescent patients recorded on videotape. Questionnaires completed by the general practitioners were used to measure their knowledge, skill, and self perceived competency, satisfaction with the programme, and self reported change in practice. RESULTS: 103 of 108 (95%) doctors completed all phases of the intervention and evaluation protocol. The intervention group showed significantly greater improvements in all outcomes than the control group at the seven month follow up except for the rapport and satisfaction rating by the standardised patients. 104 (96%) participants found the programme appropriate and relevant. At the 13 month follow up most improvements were sustained, the confidentiality rating by the standardised patients decreased slightly, and the objective assessment of competence further improved. 106 (98%) participants reported a change in practice attributable to the intervention. CONCLUSIONS: General practitioners were willing to complete continuing medical education in adolescent health care and its evaluation. The design of the intervention using evidence based educational strategies proved an effective and quick way to achieve sustainable and large improvements in knowledge, skill, and self perceived competency.

Adolescent↗
PubMed2000

Initiation and progression of cannabis use in a population-based Australian adolescent longitudinal study.

AIMS: To examine predictors of cannabis use initiation, continuity and progression to daily use in adolescents. DESIGN: Population-based cohort study over 3 years with 6 waves of data collection. PARTICIPANTS: 2032 students, initially aged 14-15 years, from 44 secondary schools in the state of Victoria, Australia. MEASUREMENTS: Self-report cannabis use was categorized on four levels (none, any, weekly, daily) and summarized as mid-school (waves 2/3) and late-school (waves 4/5/6) use. Background, school environment, mid-school peer use and individual characteristics were assessed. FINDINGS: Peer cannabis use, daily smoking, alcohol use, antisocial behaviour and high rates of school-level cannabis use were associated with mid-school cannabis use and independently predicted late-school uptake. Cannabis use persisted into late-school use in 80% of all mid-school users. Persisting cannabis use from mid- to late-school was more likely in regular users (odds ratio (OR) 3.4), cigarette smokers (OR any smoking: 2.0, daily smoking: 3.3) and those reporting peer use (OR 2.1). Mid-school peer use independently predicted incident late-school daily use in males (OR 6.5) while high-dose alcohol use (OR 6.1) and antisocial behaviour (OR 6.6) predicted incident late-school daily use in females. CONCLUSIONS: Most cannabis use remained occasional during adolescence but escalation to potentially harmful daily use in the late-school period occurred in 12% of early users. Transition was more likely in males, for whom availability and peer use were determinants. In contrast, females with multiple extreme behaviours were more likely to become daily users. Cigarette smoking was an important predictor of both initiation and persisting cannabis use.

Adolescent↗
PubMed2000

The Gatehouse Project: a systematic approach to mental health promotion in secondary schools.

OBJECTIVE: The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools. METHOD: The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described. RESULTS: The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out. CONCLUSIONS: Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.

Adolescent↗
PubMed2000

Preventive interventions for youth suicide: a risk factor-based approach.

OBJECTIVE: This review draws on current knowledge of risk for youth suicide to categorize strategies for intervention. Its goal is to identify areas of 'research need' and to provide an evidence base to identify 'best buy' preventive interventions for youth suicide. METHOD: The design, development, implementation and evaluation of prevention strategies ranging from clinical interventions to population-based universal approaches are considered within five risk factor domains: individual, family, community, school and peer. RESULTS: There is a paucity of evidence on the effects of interventions targeting depression and suicidal behaviour. Nevertheless, there are effective indicated, selective and universal interventions for important risk factors for depression and suicidal behaviour. Little evidence has emerged to support the efficacy of some traditional approaches to suicide prevention, such as school based suicide education programs and telephone hotlines. CONCLUSIONS: Youth suicide prevention strategies in Australia have generally employed traditional approaches that focus on clinical interventions for self-harmers, restricting access to lethal means, providing services to high risk groups and enhancing general practitioner responses. Both program development and research evaluation of interventions for many important risk and protective factors for suicide have been neglected.

Adolescent↗
PubMed2000

Adolescent depressive disorder: a population-based study of ICD-10 symptoms.

OBJECTIVE: Earlier studies have suggested that symptoms of depressive disorder in adolescents may differ from those found in adults. Even so, diagnostic criteria developed in adults have come to be widely applied to younger subjects. This study examines the frequency of ICD-10 symptoms in depressive disorder and their association with severity in a large community sample of adolescents aged 15 to 18 years. METHOD: A six-wave prospective study of adolescent health and emotional wellbeing in 2032 Australian secondary school students provided an opportunity to conduct a two-phase study of adolescent onset depression. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used as a first phase diagnostic measure. Second phase assessment using the Composite International Diagnostic Interview (CIDI) allowed the delineation of a group fulfilling criteria on both instruments. The ICD-10 symptoms and severity profiles for depression were generated with standard algorithms. RESULTS: 1947 (95.8%) out of 2032 subjects in the designated sample completed phase 1 assessment at least once. Participation rates at phase 2 interviews were 93%. Over the 30-month study period 69 subjects (10 male, 59 female) fulfilled criteria for ICD-10 depressive episodes on both the CIS-R and CIDI. Thirty-one per cent (n = 21) had experienced a severe episode, 46% (n = 32) moderate and 23% (n = 16) mild episodes. Loss of interest and pleasure, decreased energy and fatigue, sleep disturbance, suicidal ideation and diminished concentration most clearly distinguished adolescents with depressive disorder from controls. Self-reproach and guilt, psychomotor agitation and/or retardation and appetite disturbance with weight change showed the clearest increase in frequency with increasing severity of episode. The somatic syndrome was reported by close to one in three of those with a severe depressive episode, but was uncommon in those with mild and moderate episodes. CONCLUSIONS: The ICD-10 diagnostic criteria are applicable to depressive disorder in older adolescents. With the exception of depressed mood, found in one in five non-cases, all other symptoms were common in cases and uncommon in non-cases. Practitioner awareness of symptoms indicating the presence and severity of disorder should enhance early identification and choice of treatment in adolescent depression.

Adolescent↗
PubMed1999

Analysis of binary outcomes in longitudinal studies using weighted estimating equations and discrete-time survival methods: prevalence and incidence of smoking in an adolescent cohort.

Longitudinal studies are increasingly popular in epidemiology. In this tutorial we provide a detailed review of methods used by us in the analysis of a longitudinal (multiwave or panel) study of adolescent health, focusing on smoking behaviour. This example is explored in detail with the principal aim of providing an introduction to the analysis of longitudinal binary data, at a level suited to statisticians familiar with logistic regression and survival analysis but not necessarily experienced in longitudinal analysis or estimating equation methods. We describe recent advances in statistical methodology that can play a practical role in applications and are available with standard software. Our approach emphasizes the importance of stating clear research questions, and for binary outcomes we suggest these are best organized around the key epidemiological concepts of prevalence and incidence. For prevalence questions, we show how unbiased estimating equations and information-sandwich variance estimates may be used to produce a valid and robust analysis, as long as sample size is reasonably large. We also show how the estimating equation approach readily extends to accommodate adjustments for missing data and complex survey design. A detailed discussion of gender-related differences over time in our smoking outcome is used to emphasize the need for great care in separating longitudinal from cross-sectional information. We show how incidence questions may be addressed using a discrete-time version of the proportional hazards regression model. This approach has the advantages of providing estimates of relative risks, being feasible with standard software, and also allowing robust information-sandwich variance estimates.

Adolescent↗
PubMed1999

Onset of adolescent eating disorders: population based cohort study over 3 years.

OBJECTIVE: To study the predictors of new eating disorders in an adolescent cohort. DESIGN: Cohort study over 3 years with six waves. SUBJECTS: Students, initially aged 14-15 years, from 44 secondary schools in the state of Victoria, Australia. OUTCOME MEASURES: Weight (kg), height (cm), dieting (adolescent dieting scale), psychiatric morbidity (revised clinical interview schedule), and eating disorder (branched eating disorders test). Eating disorder (partial syndrome) was defined when a subject met two criteria for either anorexia nervosa or bulimia nervosa according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). RESULTS: At the start of the study, 3.3% (29/888) of female subjects and 0.3% (2/811) of male subjects had partial syndromes of eating disorders. The rate of development of new eating disorder per 1000 person years of observation was 21.8 in female subjects and 6.0 in male subjects. Female subjects who dieted at a severe level were 18 times more likely to develop an eating disorder than those who did not diet, and female subjects who dieted at a moderate level were five times more likely to develop an eating disorder than those who did not diet. Psychiatric morbidity predicted the onset of eating disorder independently of dieting status so that those subjects in the highest morbidity category had an almost sevenfold increased risk of developing an eating disorder. After adjustment for earlier dieting and psychiatric morbidity, body mass index, extent of exercise, and sex were not predictive of new eating disorders. CONCLUSIONS: Dieting is the most important predictor of new eating disorders. Differences in the incidence of eating disorders between sexes were largely accounted for by the high rates of earlier dieting and psychiatric morbidity in the female subjects. In adolescents, controlling weight by exercise rather than diet restriction seems to carry less risk of development of eating disorders.

Adolescent↗
PubMed1999

A computerised screening instrument for adolescent depression: population-based validation and application to a two-phase case-control study.

Computer-administered questionnaires have been little explored as a potentially effective and inexpensive alternative to pencil and paper screening tests. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was compared with the Composite International Diagnostic Interview (CIDI) in a two-phase study of 2032 Australian high school students (mean age 15.7 years) drawn from a stratified random sample of 44 schools in the state of Victoria, Australia. Prevalence, sensitivity and specificity were estimated using weighting to compensate for the two-phase sampling. Point prevalence estimates of depression using the CIS-R were 1.8% for males and 5.6% for females--an overall prevalence of 3.2%. Prevalence estimates for depression in the past 6 months using the CIDI were 5.2% for males and 16.9% for females--an overall estimate of 12.1%. The CIS-R had a positive predictive value (PPV) of 0.49 and negative predictive value (NPV) of 0.91 for CIDI depression in the past 6 months. Specificity was very high (0.97) but sensitivity low (0.18), indicating that a majority of those with a CIDI-defined depressive episode in the past 6 months were not recognised at a single screening using the CIS-R. Even so, the CIS-R has proved at least as good as any pencil and paper questionnaire in identifying cases for nested case-control studies of adolescent depression. Further exploration of strategies such as serial screening to enhance sensitivity is warranted.

Adolescent↗