Substance use disorders among men in prison: a New Zealand study.

OBJECTIVE: This study set out to determine the extent of alcohol and drug disorder among male prisoners prior to their incarceration in a New Zealand prison. METHOD: Sections of the Diagnostic Interview Schedule that assess alcohol and drug disorders according to DSM-III criteria were administered to 100 sequential new arrivals at a male medium/minimum security prison. RESULTS: Eighty-one percent of the prisoners had a lifetime alcohol disorder, and 39% of them had symptoms in the 6 months prior to incarceration. Half of the prisoners had met criteria for an alcohol-dependence syndrome. Thirty percent had a lifetime drug use disorder with 14% showing symptoms in the last 6 months prior to incarceration. One-quarter had been drug dependent. After adjustment of the lifetime prevalence estimates for the differing age distribution within the prison, alcohol disorder was more than twice as common among prisoners as in the general population, and drug use disorder was eight times as common. CONCLUSIONS: Since high rates of alcohol and drug disorder are found among sentenced prisoners, both in the 6 months prior to incarceration and over their lifetime, resources within the prison may need to be directed towards minimising the harm from substance use disorder and associated risk behaviour.

Family history of depression in clinic and community samples.

Because most published family studies of depression ascertained subjects from treatment settings, the reported familial aggregation of depression could be an artifact if a family history of depression increased the likelihood of seeking treatment. To investigate this possibility, we compared the family history of depression in three groups of probands aged 18-44; 54 women randomly selected from the community with depression in the prior year, 41 women who entered a clinical trial for depression and 37 women randomly selected from the community who had not been depressed in the prior year. The presence of depression in the parents and siblings of the probands was assessed by the family history method and quantified via family history scores which took the age, gender and number of relatives into account. Depressed probands ascertained from clinical sources had markedly higher family history scores of depression than other two groups (P < 0.00005 in each instance). In the absence of direct interviews with relatives, we cannot exclude the impact of differential reporting. A family history of depression might be associated with an increased probability of treatment or the differential reporting of family history. It is thus possible that the familial aggregation of depression observed in probands from treatment settings is an artifact.

Impulsivity in disordered eating, affective disorder and substance use disorder.

BACKGROUND: Failure to control impulsive behaviour has been postulated as an underlying mechanism common to substance use disorder, sociopathy and to a substantial subgroup of women with bulimia nervosa. METHOD: Three hundred and one women recruited to a general population study were selected either at random or because they had lifetime substance use disorder, affective disorder or symptoms of bulimia. A subsequent interview determined the existence of problems with impulsivity. Behaviour that is an integral part of a DSM-III axis 1 disorder was excluded from the impulsivity measure. RESULTS: Similar rates of impulsivity were found in all three of these types of disorder, and this was little different from the rate found in the women selected randomly from the general population. However, among those with comorbid disorder there was more impulsivity, and the more comorbid disorders found, the higher the proportion with problems of impulsivity. CONCLUSIONS: Because those in treatment facilities are more likely to have other comorbid disorders (Berkson's bias), findings derived from observations of women with bulimia who are in treatment may be compromised by selection bias and may have limited applicability to those with the disorder who are not in treatment.

Disruptions in childhood parental care as risk factors for major depression in adult women.

OBJECTIVE: The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined. METHOD: The data were obtained from a community probability sample. Caseness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression. RESULTS: It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had experienced prolonged separation from both parents. Parental loss was significantly associated with lifetime depression, but this effect was no longer significant when adjusted for other factors. However, prolonged separation from both parents was associated with an increased risk of current and lifetime depressive episodes of approximately three to fourfold, even when the risk was adjusted for other factors. CONCLUSIONS: The results of this study suggest that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss. Prolonged separation may be a marker for other risk factors and may not be a risk factor on its own.

Adoption as a risk factor for mental disorders.

Although adoption has been viewed as a risk factor for mental disorders in children and adolescents, few studies have investigated this association in adults. To address this question, we analyzed data from a random community sample of adults where the presence of adoption in the first year of life was systematically noted and where the presence of lifetime mental disorders was determined by structured interview. In comparison to individuals raised by both biological parents, adoption was strongly associated with a history of childhood conduct disorder, antisocial personality and drug abuse or dependence. Adoption may thus be a risk factor for these mental disorders.

Adverse parenting and other childhood experience as risk factors for depression in women aged 18-44 years.

65 women who had experienced a recent major depressive disorder, and 81 women who had never been depressed, were recruited from a community probability sample. The two groups of women were compared with regard to a number of childhood experiences, including parenting style, which was assessed with the Parental Bonding Instrument (PBI). When all the childhood factors were considered simultaneously in a logistic regression analysis, only low maternal care was significantly associated with recent depressive episodes. Low maternal care increased the risk of recent major depression approximately 4-fold and the estimate of the population attributable risk was 35%. These findings give further weight to the contention that adverse parenting in childhood, particularly a maternal parenting style typified by low care, is a significant risk factor for adult depression.

Parental bonding in men with alcohol disorders: a relationship with conduct disorder.

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.

Bulimia comorbidity in the general population and in the clinic.

This study compares rates of comorbidity of lifetime psychiatric disorder in a clinical sample of women with bulimia, with general population base rates, and with rates of comorbidity among bulimic women in the general population. Eighty-four per cent of the clinical sample of bulimic women had a lifetime affective disorder, and 44% a lifetime alcohol or drug disorder. These rates of disorder were significantly higher than the base rates in the general population. Bulimic women in the general population also had more affective and substance-use disorders than the general population base rates, but the rates of these disorders were lower than found in the clinical sample. In the general population, quite similar rates of other disorders including generalized anxiety, panic, phobia and obsessive-compulsive disorder, are found among those with bulimia, substance-use disorder and depression. Furthermore, among those with depression and substance-use disorder in the general population, rates of eating disorder are comparable. Rather than suggesting a specific relationship between bulimia and either depression or substance-use disorder, the data from this study suggest that the presence of any disorder is associated with a non-specific increase in the likelihood of other psychiatric disorder.

Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress.

This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Respondents were asked about mental health care ever received, any failure to seek care when required, and symptoms of 14 psychiatric disorders according to DSM-III. The frequency with which respondents reported not seeking care and the popularity of specific reasons for not seeking care were almost identical in the two sites. A common reason offered for not seeking care was doubt about the need for professional help; this appeared to be particularly common for people with alcohol disorder. Respondents who said that they had failed to seek care when needed gave reasons that were mainly attitudinal, such as believing they should be strong enough to cope without professional help. Structural characteristics of services such as cost, times open, and travel distance were given less often. Sociodemographic factors had small or negligible effect on care seeking.

Long-term effects of intrafamilial sexual abuse in childhood.

This study reports results from follow-up interviews with 301 women aged 18-44 years who were first identified 2 years earlier in a cross-sectional study of 1498 adults in the general population of the city of Christchurch, New Zealand. The prevalence of intrafamilial sexual abuse was 13%. This incestuous sexual abuse in childhood was associated with an increase in many adult mental symptoms, particularly symptoms of depression, bulimia and generalized anxiety. In this community study the consequences associated with sexual abuse within the family appear to be widespread and not very specific, and show as additional comorbidity rather than as increased severity within a disorder. These results do not support the strong direct causal effects postulated in some theories derived from clinical studies.

Preventing alcohol problems: the implications of a case-finding study in Christchurch, New Zealand.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained 1498 interviews using the Diagnostic Interview Schedule. Respondents were from a probability sample of adults aged 18-64 years. This article reports results relevant to preventing alcohol problems. The symptoms most likely ever to be experienced were types of heavy drinking (7-22%) and their consequences such as blackouts (13%). Thirty-two percent of men and 6% of women had met criteria for alcohol disorder prior to interview. The predictors of alcohol disorder were gender, childhood conduct disorder symptoms, early drunkenness, family breakdown and age of leaving school. Cohort effects were clear for onset of drunkenness and alcohol problems. The median duration of alcohol problems was at least 10 years, indicating scope for secondary prevention. General practice and hospitals appeared to be the most suitable places for intervention.

Christchurch psychiatric epidemiology study: use of mental health services.

Use of health and mental health services by the 1498 adults in the Christchurch psychiatric epidemiology study is reported. Fourteen percent of the sample had visited a health service for help with mental health problems over the preceding six months. Of those with identified psychiatric disorder during the last six months, only 29% had over that period visited a health service or professional for a mental health consultation though 75% had sought health care. Mental health consultations were more commonly with general practitioners than with mental health specialists, the latter seeing only one in seven of those with recent disorder. Those who at some point in their lives had not sought help, even though they or others had considered it necessary, reported the reasons to be attitudinal rather than to do with practical concerns such as finance, time or access to care.

Prevalence of three bulimia syndromes in the general population.

Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.

Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand.

In a community sample of 1498 urban adults (18-64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.

Factors affecting the use of mental health services in people with alcohol disorders.

In a preliminary analysis of data from a community survey of psychiatric disorders in urban Christchurch, 157 of the 1018 adults interviewed met diagnostic criteria for alcohol abuse and/or dependence. The subjects who met the criteria for alcohol abuse and/or dependence were more likely to have used mental health services than the population at large, although 39% of those with an alcohol disorder had never used any form of mental health service. We examined the impact of severity of alcohol disorder, duration of disorder and gender on the use of services among those with an alcohol disorder. Duration of disorder was not related to use of mental health services. Women are more likely than men to use these services. However, the most important finding was that those with the most severe disorders were most likely to have used mental health services.

Christchurch Psychiatric Epidemiology Study, Part I: Methodology and lifetime prevalence for specific psychiatric disorders.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.

Christchurch Psychiatric Epidemiology Study, Part II: Six month and other period prevalences of specific psychiatric disorders.

The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.

The epidemiology of panic symptomatology and agoraphobic avoidance.

In a random community survey of 1,498 urban adults age 18 to 64 years who were interviewed using the Diagnostic Interview Schedule (DIS), the lifetime prevalence of panic disorder was 2.2% +/- 0.4%. This was higher in women (3.4% +/- 0.7%) than in men (0.9% +/- 0.6%), and in those under the age of 45 years. Lifetime prevalence for panic attacks was 7.8% +/- 0.7%. Panic attacks and panic disorder had a similar distribution by age and sex, with higher rates in women than men, and also in the under 45 age groups. The panic symptomatology reported by those subjects with panic attacks was similar to that described by subjects meeting full criteria for panic disorder. The lifetime prevalence of phobic disorders was 10.7% +/- 0.9% and was more common in women (14.6% +/- 1.3%) than in men (6.8% +/- 1.3%). The lifetime prevalence of agoraphobia was 3.8% +/- 0.5%. The occurrence of panic attacks and phobic disorders were frequently related, and in agoraphobic subjects those with more severe agoraphobic avoidance reported more panic symptoms. Indeed, among agoraphobic subjects with at least moderate agoraphobic avoidance, nearly all had either panic attacks or major depression. Subjects with panic attacks and moderate agoraphobic avoidance compared with patients with panic attacks alone, especially when panic symptoms appear before the age of 15, are more likely to have grown up in a family where there was parental conflict, are more likely to have left school at a younger age and without school exams, and are likely to have had more symptoms of a childhood conduct disorder.

Abnormal illness behaviour and anxiety in acute non-organic abdominal pain.

Of 105 patients admitted to a surgical ward with acute abdominal pain, 18 were considered to be without evidence of any organic aetiology for this symptom. These 'non-organic' patients were almost all female and differed from the 'organic' patients in state anxiety and in the illness behaviour questionnaire scales of psychological versus somatic perception, denial and affective disturbance. The two groups of patients could be differentiated on the basis of scores derived from the Illness Behaviour Questionnaire, and the State-Trait Anxiety Inventory.