[Show abstract][Hide abstract] ABSTRACT: Specialized Early Intervention services (SEI) for first episode psychosis are shown to be effective for the treatment of positive and negative symptoms, medication adherence, rates of relapse, substance abuse disorders, functional outcome and quality of life at two-year treatment follow up. However, it is also reported that these benefits are not maintained when SEI is not sustained. The objective of this trial is to test the efficacy of a 3-year extension of a SEI service (following 2 years of SEI prior to randomization) for the maintenance and consolidation of therapeutic gains as compared to regular care in the community.
Following an initial 2 years of SEI, patients are randomized to receive either 3-years of continued SEI or regular care. SEI provided at three sites within the McGill network of SEI services, using a model of treatment comprised of: modified assertive case management; psycho education for families; multiple family intervention; cognitive behavioural therapy; and substance abuse treatment and monitoring. Blinded research assistants conduct ongoing evaluation of the outcome variables every three months. The primary outcome measure is remission status measured both as the proportion of patients in complete remission and the mean length of remission achieved following randomization during the additional three years of follow up. Based on preliminary data, it is determined that a total of 212 patients are needed to achieve adequate statistical power. Intent to treat with the last observation carried forward will be the primary method of statistical analysis.
The "critical period" hypothesis posits that there is a five year window during which the effects of the nascent psychotic illness can be countered and the impact of the disorder on symptomatic and functional outcomes can be offset through active and sustained treatment. Providing SEI throughout this critical period may solidify the benefits of treatment such that gains may be more sustainable over time as compared to intervention delivered for a shorter period. Findings from this study will have implications for service provision in first episode psychosis.
[Show abstract][Hide abstract] ABSTRACT: Background:
Moderate to severe diabetes distress (DD) is a common comorbidity among adults with type 2 diabetes. Cross-sectional studies find DD is strongly correlated with poor diabetes management, however little is known about the pattern of change of DD symptoms over long periods of time. We sought to identify and describe a set of distinct longitudinal trajectories of DD over 4 years of follow-up time.
We used data derived from the Evaluation of Diabetes Treatment study (2011-2014), a longitudinal community-based survey of Canadian adults (40-75 years) with type 2 diabetes (n=1135). To determine the number and shape of trajectories, we used a latent class growth modeling approach.
Five distinct trajectories of DD were identified. Trajectories 1 and 2 comprised participants with persistently low (61%) or persistently low, but at risk (22%) levels of distress. Trajectory 3 (7.5%) included participants with decreasing moderate levels of distress. Trajectory 4 (6.5%) consisted of participants with increasing moderate levels of distress. Trajectory 5 (2.4%) included participants with persistently severe levels of distress.
Different populations may produce different DD trajectories and thus the generalizability of the strata identified in this report remains to be investigated. Future research is needed to determine the extent to which time-varying covariates might alter the path of DD trajectories.
For most individuals, DD is a fairly stable condition over 4 years of follow-up time. However, for a subset of individuals, DD symptoms worsened over time. Medical health professionals might consider repeated screenings for DD in adults with type 2 diabetes.
[Show abstract][Hide abstract] ABSTRACT: Aim:
To investigate the effect of the neighbourhood built environment on trajectories of depression symptom episodes in adults from the general Canadian population.
Research design and methods:
We used 10 years of data collection (2000/01-2010/11) from the Canadian National Population Health Study (n = 7114). Episodes of depression symptoms were identified using the Composite International Diagnostic Interview Short-Form. We assessed the presence of local parks, healthy food stores, fast food restaurants, health services and cultural services using geospatial data. We used latent class growth modelling to identify different trajectories of depression symptom episodes in the sample and tested for the effect of neighbourhood variables on the trajectories over time.
We uncovered three distinct trajectories of depression symptom episodes: low prevalence (76.2% of the sample), moderate prevalence (19.2%) and high prevalence of depression symptom episodes (2.8%). The presence of any neighbourhood service (healthy food store, fast-food restaurant, health service, except for cultural service) was significantly associated with a lower probability of a depression symptom episode for those following a trajectory of low prevalence of depression symptom episodes. The presence of a local park was also a significant protective factor in trajectory groups with both low and moderate prevalence of depression symptom episodes. Neighbourhood characteristics did not significantly affect the trajectory of high prevalence of depression symptom episodes.
For individuals following a trajectory of low and moderate prevalence of depression symptom episodes, the neighbourhood built environment was associated with a shift in the trajectory of depression symptom episodes. Future intervention studies are recommended to make policy recommendations.
PLoS ONE 07/2015; 10(7):e0133603. DOI:10.1371/journal.pone.0133603 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Individuals with type 2 diabetes are at greater risk of developing a number of mental health conditions, including depression, anxiety, and diabetes-related distress, than individuals without type 2 diabetes. Cross-sectional studies suggest that some coping strategies may increase the risk of mental health conditions in individuals with diabetes, whereas others may be protective. This study extends the cross-sectional evidence base with a prospective study.
Data were collected annually for 2 years from a community sample of 1,742 adults with type 2 diabetes. Coping strategies were measured at baseline and mental health conditions were assessed at each time point with self-report symptom measures. For comparison, cross-sectional and prospective analyses were conducted.
Cross-sectional analyses demonstrated that task-oriented coping was negatively associated with the likelihood of each of the mental health conditions, emotion-oriented coping was positively associated with the likelihood of each condition, and avoidance-oriented coping showed no association. Prospective analyses revealed that among individuals who did not have elevated depressive symptoms at baseline, only emotion-oriented coping predicted the likelihood of developing major depression syndrome during follow-up. Similar patterns of results were observed for elevated anxiety symptoms and diabetes-related distress.
Cross-sectional results differed from prospective results. Only emotion-oriented coping appears to play a role in the development of depressive symptoms, anxiety symptoms, and diabetes-related distress. Results underscore the importance of examining prospective associations and suggest that interventions targeting specific coping strategies might alleviate mental health problems in individuals with type 2 diabetes. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Health Psychology 07/2015; DOI:10.1037/hea0000250 · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care.
In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol.
This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.
[Show abstract][Hide abstract] ABSTRACT: To examine the association between moderate and severe diabetes distress (DD) and lifestyle behaviors (physical activity, smoking, alcohol consumption) in a community sample of adults with type 2 diabetes mellitus.
A total of 1, 971 adults with type 2 diabetes were recruited using mixed methods sampling. Participants were considered eligible if they had a doctor diagnosis of type 2 diabetes (≤10 years), were insulin-naïve, between 40 and 75 years of age and from Quebec, Canada. Participants provided information on DD, lifestyle behaviors, socio-demographic and diabetes related factors. A series of multinomial logistic regressions examined the association between moderate and severe DD and each lifestyle behavior, according to gender. Effect estimates can be interpreted as probability ratios (PR).
The prevalence of moderate to severe DD was 23%. In females, physical inactivity was associated with an increased likelihood of moderate distress (PR: 2.2 (1.49-3.24)) and severe distress (PR: 1.80 (1.00-3.24)). In males, only severe distress was associated with physical inactivity (PR: 1.92 (1.00-3.66)). Current smoking was associated with a greater probability of severe distress in both males and females; however this effect was stronger in male smokers (PR: 3.0 (1.54-5.84) than female smokers (PR: 1.32 (0.67-2.60)). No association was found between alcohol consumption and DD in females, however, in males, frequent alcohol consumption was associated with a reduced probability of moderate (PR: 0.56 (0.34-0.91)) and severe distress (PR: 0.47 (0.21-1.06)).
The findings in this report suggest important gender differences in the association between DD and lifestyle behaviors.
This article is protected by copyright. All rights reserved.
Journal of Diabetes 04/2015; DOI:10.1111/1753-0407.12298 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimDuration of untreated psychosis (DUP) has been associated with negative symptoms in several studies; however, longitudinal findings have been inconsistent. No previous study has accounted for active psychosis after presentation, although this could impact on outcomes in a manner similar to DUP.Methods
We measured Scale for the Assessment of Positive Symptoms at frequent intervals during the 12 months after initial presentation to determine the active psychosis duration for 230 individuals with first-episode psychosis. This duration was added to DUP prior to presentation to create a new variable, duration of active psychosis (DAP). Negative symptoms were divided into expressivity and motivation/pleasure domains as measured by Scale for the Assessment of Negative Symptoms (SANS). The relationship of DUP and DAP with negative symptoms at 24-month follow up was determined and confounders controlled for using regression analysis.ResultsWhen DUP and DAP were compared as binary variables with long and short groups, 25.2% of individuals had differing category membership. DAP had a significant uncorrected association with both expressivity domain and motivation/pleasure domains at 24 months; however, relationship with DUP was not significant. DAP remained a significant predictor of 24-month expressivity domain after controlling for potential confounders.Conclusions
Active psychosis after presentation is substantial, which is a limitation of DUP studies if active psychosis is considered as the key factor within DUP. DAP is a better predictor of negative symptoms than DUP at 2-year follow up, which suggests this concept requires further research.
Early Intervention in Psychiatry 02/2015; DOI:10.1111/eip.12217 · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction Depressive symptoms are associated with increased risk of incident diabetes. Inflammatory mechanisms have been suggested to be involved in depression and diabetes. Specifically, increased levels of C-reactive protein (CRP), a biomarker for inflammation, is associated with depression and have also been linked to risk of developing diabetes.
Objective To assess the association of both CRP and depressive symptomatology with diabetes incidence in a representative sample of English people ≥50 years old.
Methods Participants were 5475 community-dwelling men and women without diabetes at baseline from the English Longitudinal Study of Ageing (ELSA). Wave 2 of ELSA was used as baseline (first assessment of CRP), with assessment of diabetes incidence at waves 3, 4, and 5. Elevated depressive symptoms were based on a score ≥4 using the 8-item Center for Epidemiologic Studies Depression (CES-D) scale, and high CRP level was defined as >3 mg/L. Diabetes incidence was indicated by self-reported doctor diagnosis. Association of diabetes incidence with baseline CRP and depressive symptomatology groups was examined using multivariate logistic regression adjusted for socio-demographic, lifestyle, metabolic, and health variables.
Results In comparison to participants with normal CRP levels and low depressive symptoms, those with both high CRP and elevated depressive symptoms were more likely to develop diabetes over 6 years of follow-up (adjusted OR: 1.90, 95% CI: 1.10–3.30). Individuals with high CRP and low depressive symptoms (adjusted OR: 1.26, 95% CI: 0.89–1.78) and those with normal CRP and elevated depressive symptoms (adjusted OR: 1.55, 95% CI: 0.88–2.73) were not associated with diabetes incidence.
Conclusion People with high CRP and elevated depressive symptoms are more likely to develop diabetes. Further analyses will examine the possible interactions between CRP and depression with diabetes incidence.
Journal of Epidemiology & Community Health 01/2015; 69(1). DOI:10.1136/jech-2014-205217.6 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The neighbourhood environment could play a role in the risk of depression in adults and those with a chronic illness. We investigated the effects of a range of neighbourhood characteristics on the 10-year risk of depression in a representative sample of 9026 Canadian adults and subsamples with a chronic condition. Characteristics of neighbourhoods were not significantly related to the risk of depression in the general sample and subsamples with a chronic condition. However, residing near a park was significantly associated with a lower risk of depression for people living in crowded households, and having a local health service nearby was protective for those living in materially deprived neighbourhoods. Living in a neighbourhood that was both socially advantaged and offered cultural services was also associated with lower risk of depression. Additional research is needed for smaller effect size detection. Future intervention research is warranted for health policy recommendations.
Health & Place 11/2014; 30. DOI:10.1016/j.healthplace.2014.10.009 · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes.Methods
This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008–2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms.ResultsMore physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired.Conclusions
Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.This article is protected by copyright. All rights reserved.
Diabetic Medicine 11/2014; 32(7). DOI:10.1111/dme.12650 · 3.12 Impact Factor