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Biomedical subjects

Scott B Patten

Publications and source records attributed to Scott B Patten.

At least 19 recordsLinked to original sources
PubMed2006

Affective disorders in motor neuron disease: a population-based study.

Several studies have suggested that there may be an increased prevalence of affective disorders in people with motor neuron disease (MND). However, the literature is inconsistent, possibly because of small sample sizes in the existing studies. The Canadian province of Alberta has a universal health care system in which physician contacts are recorded along with ICD-9-CM diagnostic codes. In this analysis, diagnostic codes indicative of MND and affective disorders were used. Stratified analysis and logistic regression were used in the analysis. There were 336 cases of MND leading to a prevalence of 14.5 per 100,000 in provincial residents > or =20 years old. Affective disorders were identified in 8.6% of the total population during the same year. The crude odds ratio for affective disorders in MND was 2.3 (95% CI = 1.7-3.0). However, the prevalence of affective disorders declined with increasing illness duration.

Adult↗
PubMed2006

Incidence of multiple sclerosis among First Nations people in Alberta, Canada.

Multiple sclerosis (MS) is thought to be rare among North American aboriginals, although few population-based frequency studies have been conducted. Data from government health databases were used to describe the incidence of MS among First Nations aboriginal people in the province of Alberta compared to the general population from 1994 to 2002. The general population rates were consistently higher than First Nations rates, but were essentially stable across this time span for both groups. For First Nations the MS incidence was 7.6 per 100,000 and 20.6 per 100,000 for the general population in 2002. During 2000-2002 for First Nations the incidence was 12.7 for females and 7.6 for males, with a female-to-male ratio of 1.7:1. During the same period the general population incidence was 32.2 for females and 12.7 for males, with a female-to-male ratio of 2.5:1. The peak incidence for both First Nations and the general population of Alberta was in the age group 30-39 years in 2002. The high incidence rates are consistent with high prevalence rates reported for both groups in 2002: 99.9 per 100,000 for First Nations and 335.0 per 100,000 for the general population. While the MS incidence in First Nations people is lower than in the general population of Alberta, it is not rare by worldwide standards.

Adult↗
PubMed2006

Hypnotic use in a population-based sample of over thirty-five thousand interviewed Canadians.

BACKGROUND: As with most medications, benzodiazepine and similar sedative hypnotics (BDZ/SSH) can produce both beneficial and adverse effects. Pharmacoepidemiological studies have been limited in their capacity to evaluate the relationship between these medications and psychiatric diagnoses in non-clinical populations. The objective of this study was to provide a description of the pattern of use of BDZ/SSH medications in relation to both demographic and diagnostic data in a community population. METHODS: The source of data for this study was the Canadian Community Health Survey (CCHS 1.2), also known as the Canadian National Study of Mental Health and Well-being. This study was based on a nationally representative sample that included over 35 thousand subjects with a response rate of 77%. The survey interview included the latest version of the Composite International Diagnostic Interview (CIDI), which was developed for the World Health Organization's WHO Mental Health 2000 project. Current medication use was also recorded. RESULTS: As expected, BDZ/SSH use was more common in women than in men (4.2%, 95% CI 3.9 to 4.6 vs. 2.5%, 95% CI 2.2 to 2.8) and its frequency increased with age, 8.5% (95% CI 7.7 to 9.4) of those over the age of 65 compared to 2.4% (95% CI 2.2 to 2.7) of those aged 18 to 64 years. These medications were more frequently used in subjects with low levels of education (4.8%, 95% CI% 4.3 to 5.2) vs. high levels of education (2.4%, 95% CI 2.1 to 2.6) and low personal incomes (5.7%, 95% CI 5.2 to 6.3) vs. high personal incomes (2.3%, 95% CI 2.0 to 2.6). BDZ/SSH use was strongly associated with the presence of mood or anxiety disorders, but not with substance use disorders. Demographic differences persisted after statistical adjustment for diagnosis. CONCLUSION: The observation that benzodiazepine use is more frequent in women, increases with age and is higher in low income and education groups supports previous findings. These results help to confirm that these differences are not accounted for by psychiatric diagnoses.

Journal Article↗
PubMed2006

A major depression prognosis calculator based on episode duration.

BACKGROUND: Epidemiological data have shown that the probability of recovery from an episode declines with increasing episode duration, such that the duration of an episode may be an important factor in determining whether treatment is required. The objective of this study is to incorporate episode duration data into a calculator predicting the probability of recovery during a specified interval of time. METHODS: Data from two Canadian epidemiological studies were used, both studies were components of a program undertaken by the Canadian national statistical agency. One component was a cross-sectional psychiatric epidemiological survey (n = 36,984) and the other was a longitudinal study (n = 17,262). RESULTS: A Weibull distribution provided a good description of episode durations reported by subjects with major depression in the cross-sectional survey. This distribution was used to develop a discrete event simulation model for episode duration calibrated using the longitudinal data. The resulting estimates were then incorporated into a predictive calculator. During the early weeks of an episode, recovery probabilities are high. The model predicts that approximately 20% will recover in the first week after diagnostic criteria for major depression are met. However, after six months of illness, recovery during a subsequent week is less than 1%. CONCLUSION: The duration of an episode is relevant to the probability of recovery. This epidemiological feature of depressive disorders can inform prognostic judgments. Watchful waiting may be an appropriate strategy for mild episodes of recent onset, but the risks and benefits of this strategy must be assessed in relation to time since onset of the episode.

Journal Article↗
PubMed2006

Mental disorders in a population sample with musculoskeletal disorders.

BACKGROUND: Studies using clinical and volunteer samples have reported an elevated prevalence of mood disorders in association with rheumatoid arthritis and osteoarthritis. Clinical studies using anxiety rating scales have reported inconsistent results, but studies using diagnostic instruments have reported that anxiety disorders may be even more strongly associated with arthritis than is depression. One study reported an association between lifetime substance use disorders and arthritis. METHODS: Data from iteration 1.2 of the Canadian Community Health Survey (CCHS) were used. This was a large-scale national Canadian health survey which administered the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects randomly selected from the national population. In the CCHS 1.2, subjects were asked whether they had been diagnosed by a health professional with arthritis or rheumatism. RESULTS: Subjects reporting arthritis or rheumatism had an elevated prevalence of mood, anxiety and substance use disorders. The strength of association resembled that seen in an omnibus category reporting any chronic condition, but was weaker than that seen with back pain or fibromyalgia. The effect of arthritis or rheumatism interacted with age, such that the odds ratios became smaller with increasing age. Mood and anxiety disorders, along with arthritis or rheumatism made an independent contribution to disability. CONCLUSION: Arthritis is associated with psychiatric morbidity in the general population, and this morbidity is seen across a variety of mental disorders. The strength of association is consistent with that seen in persons with other self-reported medical conditions.

Adolescent↗
PubMed2006

Major depression, fibromyalgia and labour force participation: a population-based cross-sectional study.

BACKGROUND: Previous studies have documented an elevated frequency of depressive symptoms and disorders in fibromyalgia, but have not examined the association between this comorbidity and occupational status. The purpose of this study was to describe these epidemiological associations using a national probability sample. METHODS: Data from iteration 1.1 of the Canadian Community Health Survey (CCHS) were used. The CCHS 1.1 was a large-scale national general health survey. The prevalence of major depression in subjects reporting that they had been diagnosed with fibromyalgia by a health professional was estimated, and then stratified by demographic variables. Logistic regression models predicting labour force participation were also examined. RESULTS: The annual prevalence of major depression was three times higher in subjects with fibromyalgia: 22.2% (95% CI 19.4 - 24.9), than in those without this condition: 7.2% (95% CI 7.0 - 7.4). The association persisted despite stratification for demographic variables. Logistic regression models predicting labour force participation indicated that both conditions had an independent (negative) effect on labour force participation. CONCLUSION: Fibromyalgia and major depression commonly co-occur and may be related to each other at a pathophysiological level. However, each syndrome is independently and negatively associated with labour force participation. A strength of this study is that it was conducted in a large probability sample from the general population. The main limitations are its cross-sectional nature, and its reliance on self-reported diagnoses of fibromyalgia.

Adolescent↗
PubMed2006

Mental health and related disability among workers: a population-based study.

BACKGROUND: In past decades, the nature of work has undergone significant changes including increased psychological demands and job instability. A stressful psychosocial work environment has been shown to have adverse effects on workers' mental and physical health. This goal of this study is to estimate the prevalence of psychiatric syndromes and related disability in a population-based sample of employed adults and investigate associations between psychiatric syndromes and related disability. METHODS: A random-digit dial provincial wide mental health survey was conducted in Alberta, Canada (n = 5,383). The telephone interview included the Mini International Neuropsychiatric Interview (MINI) and the World Health Organization's Disability Assessment Schedule (WHO-DAS-II). In this analysis, participants who were currently employed were included (n = 4,149). RESULTS: In this population, 6.2% had had at least one MINI-defined psychiatric diagnosis with clinically significant interference. Without consideration of the clinical interference criterion, the prevalence of psychiatric syndromes was higher (33.5%). Psychiatric syndromes were strongly associated with disability. A dose-response relationship between the number of diagnoses and disability was found. CONCLUSIONS: Interventional strategies in the workplace should focus on mental disorders at both the clinical and sub-clinical levels.

Adult↗
PubMed2006

Epidemiological associations between gambling behavior, substance use & mood and anxiety disorders.

OBJECTIVE: To compare gambling behaviors in a random sample of community residents with and without mental disorders identified by the Composite International Diagnostic Interview (CIDI). METHOD: A large national community survey conducted by Statistics Canada included questions about problems arising from gambling activities as per the Canadian Problem Gambling Index (CPGI). We compared respondents within three gambling severity categories (non-problem, low severity and moderate/high severity gambling) across three diagnostic groupings (mood/anxiety disorders, substance dependence/harmful alcohol use, no selected psychiatric disorder). RESULTS: Of the 14,934 respondents age 18-64 years who engaged in at least one type of gambling activity in the previous 12 months, 5.8% fell in the low severity gambling category while 2.9% fell in the moderate/high severity category. Females accounted for 51.7% of the sample. The risk of moderate/high severity gambling was 1.7 times higher in persons with mood or anxiety disorder compared to persons with no selected disorder. For persons with substance dependence or harmful alcohol use, the risk of moderate/high severity gambling was 2.9 times higher. Persons with both mood/anxiety and substance/alcohol disorders were five times more likely to be moderate/high severity gamblers. The odds ratio for females was 0.6 and for those with less than post-secondary education it was 1.52. Differences in age and personal income were not significant. CONCLUSIONS: Individuals in the community suffering from mood/anxiety disorders and substance dependence/harmful alcohol, and especially those with both, experience a higher risk for gambling problems. The treatment of these comorbidities should be integrated into any problem gambling treatment program.

Adult↗
PubMed2006

Descriptive epidemiology of major depression in Canada.

OBJECTIVE: The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) is the first national study to use a full version of the Composite International Diagnostic Interview. For this reason, and because of its large sample size, the CCHS 1.2 is capable of providing the best currently available description of major depression epidemiology in Canada. Using the CCHS 1.2 data, our study aimed to describe the epidemiology of major depression in Canada. METHOD: All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling. RESULTS: The lifetime prevalence of major depressive episode was 12.2%. Past-year episodes were reported by 4.8% of the sample; 1.8% reported an episode in the past 30 days. As expected, major depression was more common in women than in men, but the difference became smaller with advancing age. The peak annual prevalence occurred in the group aged 15 to 25 years. The prevalence of major depression was not related to level of education but was related to having a chronic medical condition, to unemployment, and to income. Married people had the lowest prevalence, but the effect of marital status changed with age. Logistic regression analysis suggested that the annual prevalence may increase with age in men who never married. CONCLUSIONS: The prevalence of major depression in the CCHS 1.2 was slightly lower than that reported in the US and comparable to pan-European estimates. The pattern of association with demographic and clinical variables, however, is broadly similar. An increasing prevalence with age in single (never-married) men was an unexpected finding.

Adolescent↗
PubMed2006

Self-reported diagnoses of schizophrenia and psychotic disorders may be valuable for monitoring and surveillance.

OBJECTIVE: To examine whether a plausible estimate of the prevalence of schizophrenia can be obtained with a self-report item in a health survey. METHODS: We estimated a self-reported prevalence of schizophrenia, using a grouped variable for all people who reported schizophrenia or any other psychotic disorder in the Canadian Community Health Survey: Mental Health and Well-Being (n = 36,984). Estimates were stratified according to age, sex, and province of residence. RESULTS: Of survey respondents, 411 (1.1%) reported having schizophrenia or other psychosis, as diagnosed by a health professional; the weighted and adjusted estimate was 0.9% (0.7% to 1.0%). There was no statistical evidence that the prevalence estimates of schizophrenia and other psychosis varied by age, sex, or province of residence. CONCLUSIONS: Additional studies incorporating a gold standard diagnostic interview should be carried out to determine the validity of the approach. However, responses to 2 self-report survey items provide what appears to be a plausible epidemiologic pattern.

Adolescent↗
PubMed2006

Sedative hypnotic use in Alberta.

OBJECTIVE: Benzodiazepines and similar sedative-hypnotics (BDZ-SSHs) are associated with both beneficial and adverse effects. Pharmacoepidemiologic data describing the use of these medications in contemporary Canadian populations has not been readily available. Our objective was to examine the hypothesis that increasing use of antidepressant medications for anxiety and mood disorders during the past decade led to less frequent use of BDZ-SSH medications. METHOD: We used data from an Alberta Mental Health Survey to describe the pattern of BDZ-SSH use and to estimate provincial and health region frequencies of use. We supplemented the data with pharmacy dispensing data from IMS Health. RESULTS: The frequency of use was comparable to that reported in previous studies. Unexpectedly, in the survey data, we observed trends suggesting regional variation both in the frequency and pattern of use. Examination of prescription dispensing data confirmed this pattern. Clinical factors, including the use of other psychotropic medications and psychiatric diagnoses, were strongly associated with BDZ-SSH use. Among the drugs examined, zopiclone had the highest frequency of use. Prescription dispensing data confirmed that the frequency of zopiclone use in Alberta is higher than that in most other provinces. CONCLUSIONS: This descriptive study generates several new research questions and provides benchmarks for future pharmacoepidemiologic monitoring.

Acetamides↗
PubMed2006

Forgetfulness: a role in noncompliance with antidepressant treatment.

OBJECTIVES: To determine the degree of noncompliance with antidepressant treatment in the Alberta population and to investigate the reasons for noncompliance. METHOD: We used data from the Alberta Mental Health Survey, a telephone survey conducted in 2003 (n = 5323 adults), to produce population-based estimates of the frequency of noncompliance and the reported reasons for noncompliance. RESULTS: Reported noncompliance was 41.7% (95% confidence interval [CI], 36.9% to 46.6%) for respondents taking 1, 2, or 3 antidepressants. Noncompliance for those taking 1 antidepressant was 42.0% (95%CI, 36.9% to 47.2%), whereas noncompliance for those taking 2 or 3 antidepressants was 39.4% (95%CI, 26.7% to 53.6%). Among respondents currently taking at least one antidepressant, 64.9% (95%CI, 57.4% to 71.7%) reported that forgetfulness was the most common reason for noncompliance. Of respondents taking 1 medication, 64.1% (95%CI, 56.0% to 71.4%) reported forgetfulness as did 71.3% (95%CI, 48.3% to 86.8%) of those taking 2 or 3 medications. Both the frequency of noncompliance and the reported reasons for noncompliance were independent of sex and age. CONCLUSION: Our study replicates prior reports that indicate that noncompliance is common with antidepressant treatment. Forgetting to take medication is the most important reported reason for this noncompliance.

Adolescent↗
PubMed2006

Medication nonadherence and subsequent risk of hospitalisation and mortality among older adults.

BACKGROUND: Despite a higher risk for medication nonadherence among older adults residing in the community, few prospective studies have investigated the health outcomes associated with nonadherence in this population or the possible variations in risk in urban versus rural residents. OBJECTIVES: The primary objective of this study was to examine, in a prospective manner, the risk for hospitalisation (including an emergency department visit) and/or mortality associated with medication nonadherence in older, at-risk adults residing in the community. A secondary objective was to examine differences in the prevalence, determinants and consequences of medication nonadherence between rural and urban home care clients. METHODS: Data were derived from a 1-year prospective study of home care clients aged > or =65 years (n = 319) randomly selected from urban and rural settings in southern Alberta, Canada. Trained nurses conducted in-home assessments including a comprehensive medication review, self-report measures of adherence and the Minimum Data Set for Home Care (MDS-HC) tool. Hospitalisation and mortality data during 12-month follow-up were obtained via linkages with regional administrative and vital statistics databases. RESULTS: Nonadherent clients showed an increased but nonsignificant risk for an adverse health outcome (hospitalisation, emergency department visit or death) during follow-up (hazard ratio [adjusted for relevant covariates] = 1.24, 95% CI 0.93, 1.65). Subgroup analyses suggested this risk may be higher for unintentional nonadherence (unadjusted hazard ratio = 1.55, 95% CI 0.97, 2.48). The prevalence of nonadherence was similar among rural (38.2%) and urban (38.9%) clients and was associated with the presence of vision problems, a history of smoking, depressive symptoms, a high drug regimen complexity score, residence in a private home (vs assisted-living setting) and absence of assistance with medication administration. In both settings, approximately 20% of clients received one or more inappropriate medications. CONCLUSIONS: Although not associated with rural/urban residence, medication nonadherence was common in our study population, particularly among those with depressive symptoms and complex medication regimens. The absence of a significant association between overall medication nonadherence and health outcomes may reflect study limitations and/or the need to differentiate among types of nonadherent behaviours.

Aged↗
PubMed2005

Describing the longitudinal course of major depression using Markov models: data integration across three national surveys.

BACKGROUND: Most epidemiological studies of major depression report period prevalence estimates. These are of limited utility in characterizing the longitudinal epidemiology of this condition. Markov models provide a methodological framework for increasing the utility of epidemiological data. Markov models relating incidence and recovery to major depression prevalence have been described in a series of prior papers. In this paper, the models are extended to describe the longitudinal course of the disorder. METHODS: Data from three national surveys conducted by the Canadian national statistical agency (Statistics Canada) were used in this analysis. These data were integrated using a Markov model. Incidence, recurrence and recovery were represented as weekly transition probabilities. Model parameters were calibrated to the survey estimates. RESULTS: The population was divided into three categories: low, moderate and high recurrence groups. The size of each category was approximated using lifetime data from a study using the WHO Mental Health Composite International Diagnostic Interview (WMH-CIDI). Consistent with previous work, transition probabilities reflecting recovery were high in the initial weeks of the episodes, and declined by a fixed proportion with each passing week. CONCLUSION: Markov models provide a framework for integrating psychiatric epidemiological data. Previous studies have illustrated the utility of Markov models for decomposing prevalence into its various determinants: incidence, recovery and mortality. This study extends the Markov approach by distinguishing several recurrence categories.

Journal Article↗
PubMed2005

Psychotic disorders in MS: population-based evidence of an association.

Administrative data from a Canadian province were accessed to assess the association of psychotic disorders with multiple sclerosis (MS). Physician-assigned ICD-9-CM codes were used to classify MS and psychotic disorder status. A significant association was observed. Additional research is needed to determine the clinical importance and treatment needs of this population.

Adolescent↗
PubMed2005

Markov models of major depression for linking psychiatric epidemiology to clinical practice.

BACKGROUND: Most epidemiological studies of major depression report estimates of period prevalence. Such estimates are useful for public health applications, but are not very helpful for informing clinical practice. Period prevalence is determined predominantly by incidence and episode duration, but it is difficult to connect these epidemiological concepts to clinical issues such as risk and prognosis. Incidence is important for primary and secondary prevention, and prognostic information is useful for clinical decision-making. The objective of this study was to decompose period prevalence data for major depression into its constituent elements, thereby enhancing the value of these estimates for clinical practice. Data from a series of population-based Canadian studies were used in the analysis. Markov models depicting incidence, prevalence and recovery from major depressive episodes were developed. Monte Carlo simulation was used to constrain model parameters to the epidemiological data. RESULTS: The association of sex with major depression was found to be due to a higher incidence in women. In distinction, the higher prevalence in unmarried subjects was mostly due to a different prognosis. Age-related changes in prevalence were influenced by both factors. Education, which was not found to be associated with major depression in the survey data, had no impact either on risk or prognosis. CONCLUSION: The period prevalence of major depression is influenced both by incidence (risk) and episode duration (prognosis). Mathematical modeling of the underlying epidemiological relationships can make such data more readily interpretable in relation to clinical practice.

Journal Article↗
PubMed2005

The association of depression with disease course in multiple sclerosis.

The relative frequency of depression in people with primary progressive multiple sclerosis (PPMS) (30 patients) compared with those with a history of relapse (106 patients) was determined. Three participants in the progressive group and 28 in the relapsing group had a lifetime history of major depression. The lifetime morbidity ratio for major depression in relapsing patients was 2.64 compared with that of PPMS.

Adult↗