Depression and anxiety disorders and the link to physician diagnosed cardiac disease and metabolic risk factors.

OBJECTIVE: There has been increasing interest in the relationship between cardiac and metabolic conditions with mental illness. Many studies have found associations between these conditions and depression but results with anxiety disorders have been mixed. We explore these relationships in a nationally representative survey using physician diagnoses of physical conditions and DSM-IV psychiatric disorders. METHODS: Data came from the nationally representative German Health Survey (N=4181, age 18-65). Physician diagnoses of angina, myocardial infarction, congestive heart, hypertension, dyslipidemia, diabetes, and obesity were examined in relation to depression and anxiety disorders, which were assessed through a modified version of the Composite International Diagnostic Interview. Multiple logistic regression analyses were used to examine the associations between these conditions. RESULTS: After adjusting for sociodemographics, psychiatric comorbidity, and substance use, having an anxiety disorder was associated with increased odds of cardiac conditions and metabolic risk factors with odds ratios ranging from 1.3 to 3.3. Depression was not associated with any of the conditions but was associated with poor medical compliance for health conditions on two outcomes measured. Anxiety was also associated with reduced medical compliance for one health behaviour measured. CONCLUSION: Anxiety disorders, but not depression, were associated with metabolic and cardiac conditions in our sample. Both conditions were related to some aspects of poor self-care for health conditions and therefore may be linked to negative outcomes.

A sex-specific comparison of major depressive disorder symptomatology in the canadian forces and the general population.

OBJECTIVE: To compare major depressive disorder (MDD) symptomatology within men and women in a large, representative sample of Canadian military personnel and civilians. METHOD: We used the Canadian Community Health Survey: Mental Health and Well-Being (Cycle 1.2 and Canadian Forces Supplement) (n = 36 984 and n = 8441, respectively) to compare past-year MDD symptomatology among military and civilian women, and military and civilian men. Logistic regression models were used to determine differences in the types of depressive symptoms endorsed in each group. RESULTS: Men in the military with MDD were at lower odds than men in the general population to endorse numerous symptoms of depression, such as hopelessness (adjusted odds ratio [AOR] 0.44; 99% CI 0.23 to 0.83) and inability to cope (AOR 0.53; 99% CI 0.31 to 0.92). Military women with MDD were at lower odds of thinking about their death (AOR 0.52; 99% CI 0.32 to 0.86), relative to women with MDD in the general population. CONCLUSION: Different MDD symptomatology among males and females in the military, compared with those in the general population, may reflect selection effects (for example, personality characteristics and patterns of comorbidity) or occupational experiences unique to military personnel. Future research examining the mechanisms behind MDD symptomatology in military personnel and civilians is required.

Media use and health outcomes in adolescents: findings from a nationally representative survey.

OBJECTIVE: Examine the association between quantity of media use and health outcomes in adolescents. METHOD: Multiple logistic regression analyses were conducted with the Canadian Community Health Survey 1.1 (youth aged 12-19 (n=9137)) to determine the association between hours of use of television/videos, video games, and computers/Internet, and health outcomes including depression, alcohol dependence, binge drinking, suicidal ideation, help-seeking behaviour, risky sexual activity, and obesity. RESULTS: Obesity was associated with frequent television/video use (Adjusted Odds Ratio (AOR) 1.10). Depression and risky sexual behaviour were less likely in frequent video game users (AOR 0.87 and 0.73). Binge drinking was less likely in frequent users of video games (AOR 0.92) and computers/Internet (AOR 0.90). Alcohol dependence was less likely in frequent computer/Internet users (AOR 0.89). CONCLUSIONS: Most health outcomes, except for obesity, were not associated with using media in youth. Further research into the appropriate role of media will help harness its full potential.

Panic attacks as a risk for later psychopathology: results from a nationally representative survey.

BACKGROUND: There is a growing body of literature suggesting that panic attacks without panic disorder are associated with increases in a wide range of psychopathology and impairment. However, the majority of the literature to date has been cross-sectional. Some longitudinal research supports the view that panic attacks are a nonspecific risk factor for future psychopathology. Using a large nationally representative longitudinal survey of adults, we sought to determine whether panic attacks predict new onset Axis I disorders. METHODS: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version was used to make diagnoses of psychiatric disorders in the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n = 34,653, aged 18 and older, response rate = 70.2%). Incident psychiatric disorders at Wave 2 were compared between people with and without panic attacks at Wave 1. RESULTS: Panic attacks at Wave 1 were significantly associated with increased incidents of generalized anxiety disorder, panic disorder, social phobia, major depression, dysthymia, mania and hypomania, any anxiety disorder, and any mood disorder even after adjusting for sociodemographic variables, Wave 1 Axis I disorders, and Axis II disorders (OR's ranging from 1.62 to 2.77). CONCLUSIONS: The presence of panic attacks may be an important indicator of overall psychological distress and the risk of more severe psychopathology in the future.

Panic attacks and panic disorder in a population-based sample of active Canadian military personnel.

BACKGROUND: The factors contributing to psychiatric problems among military personnel, particularly for panic, are unclear. The objective of this study was to examine the prevalence and correlates of panic disorder and panic attacks in the Canadian military. METHOD: Statistics Canada and the Department of National Defense conducted the Canadian Community Health Survey-Canadian Forces Supplement in 2002 (May to December) with a representative sample of active Canadian military personnel (aged 16-54 years; N = 8,441; response rate, 81.5%). Comparisons were made between respondents with no past-year panic attacks, panic attacks without panic disorder, and panic disorder on measures of DSM-IV mental disorders, as well as validated measures of disability, distress, suicidal ideation, perceived need for mental health treatment, and mental health service use. Lifetime exposure to combat operations, witnessing of atrocities, and deployments were also assessed. RESULTS: Panic disorder and panic attacks were common in the military population, with past-year prevalence estimates of 1.8% and 7.0%, respectively. Both panic disorder and panic attacks were associated with increased odds of all mental disorders assessed, suicidal ideation, 2-week disability, and distress. Perceived need for mental health treatment and service use were common in individuals with panic attacks and panic disorder (perceived need: 46.3% for panic attacks, 89.6% for panic disorder; service use: 32.5% for panic attacks, 74.5% for panic disorder). CONCLUSIONS: Panic attacks and panic disorder in the military are associated with outcomes that could be detrimental to well-being and work performance, and early detection of panic in this population could help reduce these negative outcomes.

The relationship between physical conditions and suicidal behavior among those with mood disorders.

BACKGROUND: There has recently been increased interest in the relationship between physical illness, mental illness, and suicide. The present study utilizes a large community-based sample to investigate the association between certain physical conditions and suicidal behavior, among those with a history of a mood disorder. METHODS: Data came from the nationally representative German Health Survey (N=4181, age 18-65). Physical conditions were assessed by a general practice physician. DSM-IV mental disorders were assessed using a modified version of the Composite International Diagnostic Interview. Among those with a lifetime mood disorders, suicidal ideation, plans, and attempts were assessed by self-report. Multiple logistic regression analyses were used to examine the association between physical conditions and suicidal behavior among those with a history of mood disorder. RESULTS: Anxiety and substance use disorders were significantly positively associated with suicidal behavior [OR 1.61, 95% CI 1.13-2.31 and 2.01, 95% 1.34-3.00, respectively]. After adjusting for anxiety and substance use disorders as well as sociodemographic variables, respiratory illness, hypertension, and number of physical disorders were significantly associated with suicidal behavior [AORs 1.72, 1.68, and 1.16, respectively]. LIMITATIONS: The findings of this study are limited to adults with a history of a mood disorder. Personality disorders were not assessed. CONCLUSION: The present study suggests that among people with mood disorder, respiratory illnesses, hypertension, and number of physical conditions are associated with suicidal behavior independent of the effects of comorbid mental illness. Clinicians should recognize the contributing risk of physical health problems to suicidal behavior.

Panic attacks and their relation to psychological and physical functioning in Canadians: results from a nationally representative sample.

OBJECTIVE: US-based studies have suggested that panic attacks (PA) are common and associated with an increased prevalence of mental disorders and poorer quality of life, and may be a marker of severe psychopathology. Using a population-based survey with a greater sample size than has been previously used, we sought to determine the prevalence rates and correlates of PAs among Canadians aged 15 years and older. METHOD: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition classification was used to determine the past-year prevalence of PAs in the Canadian Community Health Survey: Mental Health and Well-Being (n = 36,984, aged 15 and older, response rate = 77%). Psychological and physical function variables were compared among people with PAs, with panic disorder (PD), and without PAs. RESULTS: The prevalence of past-year PAs was 6.4%. Compared to people without PAs, those with PAs had poorer overall functioning for disability, mental disorders, suicidal ideation, psychological distress, restriction of activity, chronic physical conditions, psychological well-being, and self-rated physical and mental health. PD was associated with poorer overall functioning than PAs for numerous variables; however, there were no significant differences between these 2 panic groups for several other variables. CONCLUSIONS: Though associated with less severe impairment than PD in some domains, PAs are associated with mental health problems and reduced overall psychological and physical functioning and may be an indicator of more severe psychopathology.