Spouse similarity for antisocial behaviour in the general population.

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.

Completed suicides among the Inuit of northern Quebec, 1982-1996: a case-control study.

BACKGROUND: The rate of completed suicide among Inuit in Canada has been alarmingly high in recent years, and the suicide rate among Inuit in northern Quebec has increased since 1982. Our objectives were to describe the characteristics of Inuit people who died by suicide in Nunavik between 1982 and 1996, and to identify the antecedents and correlates of completed suicide. METHODS: We carried out a case-control study of 71 people who died by suicide between 1982 and 1996 and 71 population-based living control subjects matched for sex, community of residence and age within 1 year. Comprehensive medical charts were reviewed for data on sociodemographic characteristics, medical and psychiatric history, childhood separations and family history, and use of health care services. RESULTS: Most of the case subjects were single males aged 15 to 24 years. The two principal means of suicide were hanging (in 39 cases [54.9%]) and gunshot (in 21 cases [29.6%]). About 33% had been in contact with medical personnel in the month before their death. The case subjects were significantly more likely than the control subjects to have received a lifetime psychiatric diagnosis (one or more of depression, personality disorder or conduct disorder) (odds ratio [OR] 4.3 [95% confidence interval (CI) 1.2-15.2]) and to have had a history of psychiatric symptoms, disorder (including solvent sniffing) or treatment (OR 3.5 [95% CI 1.4-8.7]). The case subjects had experienced more severe types of nonpsychiatric illnesses and injuries than the control subjects (p = 0.04). The case subjects had more lifetime contacts with health care services than the control subjects (p = 0.01) and were more likely than the control subjects to have had contact with health care services in the year before death of the case subject (p = 0.03), even when psychiatric diagnoses were controlled for in conditional regression analysis (OR 1.02 [95% CI 1.01-1.04] and 5.0 [95% CI 1.07-23.7] respectively). INTERPRETATION: Since case subjects had frequent contact with health care services, frontline medical personnel may be in a position to identify people at risk for suicide.

Linkage of tuberculosis to chromosome 2q35 loci, including NRAMP1, in a large aboriginal Canadian family.

An epidemic of tuberculosis occurred in a community of Aboriginal Canadians during the period 1987-89. Genetic and epidemiologic data were collected on an extended family from this community, and the evidence for linkage to NRAMP1, a candidate gene for susceptibility to mycobacterial diseases, was assessed. Individuals were grouped into risk (liability) classes based on vaccination, age, previous disease, and tuberculin skin-test results. Under the assumption of a dominant mode of inheritance and a relative risk of 10, which is associated with the high-risk genotypes, a maximum LOD score of 3.81 was observed for linkage between a tuberculosis-susceptibility locus and D2S424, which is located just distal to NRAMP1, in chromosome region 2q35. Significant linkage was also observed between a tuberculosis-susceptibility locus and a haplotype of 10 NRAMP1 intragenic variants. No linkage to the major histocompatibility-complex region on chromosome 6p was observed, despite distortion of transmission from one member of the oldest couple to their affected offspring. The ability to assign individuals to risk classes was crucial to the success of this study.

Treatment seeking for depression: role of depressive symptoms and comorbid psychiatric diagnoses.

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.

Attempted suicide among Inuit youth: psychosocial correlates and implications for prevention.

OBJECTIVE: To identify potential risk and protective factors associated with attempted suicide among Inuit youth, a population known to have a high rate of both attempted and completed suicide in recent years. METHOD: A secondary analysis of data on 203 Inuit youth (aged 15 to 24 years) from a random community survey conducted by Santé Québec in 1992. Factors previously identified in the literature and in clinical consultation and ethnographic research were tested with bivariate statistics and logistic regression models for each gender. RESULTS: At the bivariate level, positive correlates included substance use (solvents, cannabis, cocaine), recent alcohol abuse, evidence of a psychiatric problem, and a greater number of life events in the last year. Regular church attendance was negatively associated with attempted suicide. Multivariate analysis indicated that a psychiatric problem, recent alcohol abuse, and cocaine or crack use were the strongest correlates of attempted suicide for females, while solvent use and number of recent life events were the strongest correlates for males. CONCLUSIONS: Suicide prevention programs can be targeted at youth who are using substances, particularly solvents, cocaine, and alcohol, have psychiatric illness, and have experienced recent negative life events. Involvement in church or other community activities may reduce the risk for suicide. Consideration of gender differences may allow more precise identification of those at risk for attempted suicide.

Spouse similarity for lifetime psychiatric history in the general population.

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.

Teaching on gender-related issues; a survey of psychiatry faculty and residents.

A survey was distributed to 299 members of the McGill Department of Psychiatry regarding the teaching of gender-related issues. The response rate was 62.5%. The majority of respondents indicated that they were moderately or very knowledgeable about, and moderately or very interested in gender issues. Current teaching was rated as less than adequate, while future teaching was rated as very important. Women rated personal interest and importance of future teaching higher than men, but rated adequacy of current teaching lower. Residents rated personal interest higher than certified psychiatrists, but rated self-assessed knowledge lower, and tended to rate adequacy of current teaching lower.

Inuit attitudes toward deviant behavior: a vignette study.

Attitudes toward deviant behavior that might indicate psychiatric disorder were investigated among the Inuit of Northern Québec (Nunavik). In a convenience sample of 137 Inuit adults, respondents were randomly presented with one of six different vignettes that described a man with "strange" behavior who was either threatening or withdrawn and whose problem was labeled either "isumaluttuq" ("burdened or weighed down by thoughts"), "demon possession," or "mental illness." Respondents rated their willingness to live, work, or hunt with this person and allow him into their family on a social distance scale. Significant predictors of greater social distance were female gender, more education, less familiarity with the behavior, and perception of the person as less likely to recover. There were no significant effects of vignette behavior or label on social distance ratings. Rating of likelihood of recovery was influenced by the vignette label, with isumaluttuq associated with less chance of recovery. Ascribing strange behavior to morally wrong action and to spirits or demons were highly inter-correlated and each was associated with perception of greater likelihood of recovery. Results suggest that Inuit attitudes toward deviant behavior are influenced more by perceived familiarity and likelihood of recovery than by labels, causal attributions, or explanations. The indigenous psychological concept of isumaluttuq does not serve to reduce social stigma. Efforts to promote the community integration of psychiatric patients through education should aim to increase familiarity with the problematic behavior and emphasize potential for recovery.

Suicide attempts among Inuit youth: a community survey of prevalence and risk factors.

The prevalence of and risk factors for attempted suicide and suicidal ideation were examined with a survey of 99 Inuit, aged 14-25 years, residing in a community in Northern Québec. A total of 34% of survey respondents reported a previous suicide attempt, and 20% had attempted suicide more than once. A suicide attempt had resulted in injury in about 11% of those surveyed. The prevalence of suicidal ideation was also very high: 43% of subjects reported past thoughts of suicide, and 26% had had suicidal thoughts during the month before the survey. Risk factors for suicide attempts included male gender, having a friend who had attempted or committed suicide, a history of being physically abused, a history of solvent abuse, and having a parent with an alcohol or drug problem. Protective factors included a family history of having received treatment for a psychiatric problem, more frequent church attendance, and a high level of academic achievement. While individuals in the community who are at high risk for suicide can be targeted for preventive measures, the high prevalence and effect of family problems on likelihood of suicide attempts indicate the need for family- and community-based approaches.