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Summer 2010, Vol 13 No 4


Research Update


By Mark de la Hey


Past mental health disability episodes increase likelihood of future episodes

A new study from the Centre for Addiction and Mental Health in Toronto, Ontario, has found that workers who have had disability leave for a mental illness are at high risk for another such episode. These findings are based on data from 10,061 workers employed by a Canadian resource company. Twelve per cent of these employees had a disability episode in 2005: two per cent for a mental health disorder and 10 per cent for a physical disorder. Compared with workers who had disability episodes related to a physical disorder, those with mental health disability episodes were more likely to be women, to have disrupted marriages or to be single. Rates of recidivism were high among those with mental health disability episodes. Workers with previous mental health disability episodes were almost seven times more likely than those without a previous episode to have a subsequent mental health disability episode. In contrast, those with previous disability episodes related to physical disorders were only twice as likely as those without a previous episode to have a subsequent physical disability episode. The fact that workers who were married were less likely to have a mental health disability episode than those with disrupted marriages suggests that ensuring a supportive work environment might help to protect workers against mental health disability.

Journal of Occupational and Environmental Medicine, December 2009, v. 51 (12): 1394–1402. Carolyn S. Dewa et al., Work and Well-being Research and Evaluation Program, Centre for Addiction and Mental Health, Toronto, Ontario.


Early cannabis use may increase risk of psychosis

Cannabis use at an early age significantly increases the risk of psychosis among young adults, according to research from the Park Centre for Mental Health in Wacol, Australia. Researchers studied the relationship between cannabis use and mental health among 3,801 individuals born between 1981 and 1984. Participants were followed for 21 years, at the end of which they were asked about past cannabis use and were assessed for non-affective psychosis, hallucinations and delusions. Sixty-five participants were diagnosed with a non-affective psychosis, such as schizophrenia, persistent delusional disorder or acute and transient psychotic disorders, and 233 endorsed at least one hallucination item on a diagnostic interview. Those who had used cannabis for six or more years were twice as likely as those who had never used cannabis to develop a non-affective psychosis, four times as likely to have high delusion scores, and almost three times as likely to have experienced hallucinations. Within the 228 sibling pairs in the sample, siblings who had been using cannabis for longer periods were more likely to have higher delusion scores. This makes it less likely that the associations found in the study were the result of genetic or environmental influences, since the siblings could be expected to have a common genetic and environmental background.

Archives of General Psychiatry, March 1, 2010, v. 67 (5), doi: 10.1001/archgenpsychiatry.2010.6. John McGrath et al., Queensland Centre for Mental Health Research, Park Centre for Mental Health, Wacol, Australia.


Children of psychiatric clients benefit from nurse attention

Children of parents with mental illness are known to be at increased risk of mental health and behavioural disorders later in life. However, research from the University of Kuopio in Finland indicates that nurses, who have frequent contact with clients and their families, can make a significant contribution to improving outcomes for these children. The study results are based on the questionnaire responses of 222 registered mental health nurses (RNs) and 88 practical mental health nurses (MHNs) working in adult psychiatric units in Finnish university hospitals. While most of the nurses reported that they met with the children of clients a few times a year or not at all, 95 per cent of RNs and 96 per cent of practical MHNs said they regularly collected information about the children. All nurses reported that they sought to guarantee the children’s safety and arrange care for them when necessary. Sixty-eight per cent of RNs and 70 per cent of MHNs took the time to explain the parent’s illness to the children. However, only 46 per cent of nurses talked to the children about their fear of becoming mentally ill themselves. RNs were more likely to discuss the parent’s situation with children if they were parents themselves, or if they were older, had 20 or more years of experience, were divorced or widowed, used family-centred care or had further family education. The authors conclude that family-centred care increases nurses’ interaction with children and increases their ability to “implement preventive child-focused family work into practice.”

Scandinavian Journal of Caring Sciences, March 2010, 24 (1): 65–74. Teija Korhonen et al., Department of Nursing Science, University of Kuopio, Kuopio, Finland.


Youth clinics aid immigrant women concerned about family honour

There has been growing concern in many countries over the number of young women from immigrant backgrounds who have been exposed to murder, violence and other acts by male relatives in the name of family honour. Now, research from Sweden’s Karolinska Institute indicates that youth clinics can play a key role in addressing the problems of women who fear repercussions related to protecting family honour. Seven midwives and five counsellors from four Stockholm youth clinics participated in a series of group interviews as part of the study. The main concern expressed by youth clinic staff in assisting young women with honour-related problems was to avoid making the situation worse. Staff typically engaged in a worry analysis process that involved the creation of a refuge, risk assessment, and worry-reducing measures. The constant fear that the secret of their sexual activity would be discovered, as well as the fear of isolation and violence, was a source of stress for the women that could potentially result in depression. One difficulty they faced was that the simple act of coming to the youth clinic could be seen by their families as meaning that they had had sex, which would be a breach of honour rules. As a result, the women might be reluctant to seek help if the clinic was in a public place. The worry-reducing measures employed by youth clinic staff could include empowerment, keeping the woman’s secret, mediation with the family, or secondary prevention designed to prevent the woman from getting into a worrying situation again. Empowerment generally involved providing the women with information about bodily function, sexual matters, taking sides with them and encouraging them to take control of their own bodies.

Scandinavian Journal of Caring Sciences, March 2010, 24 (1): 32–40. Venus Alizadeh et al., Center for Family and Community Medicine, Karolinska Institute, Huddinge, Sweden.


Hostility may link depressive mood and mortality

Depressive mood is known to be associated with an increased risk of death. Now, new research from the European Georges Pompidou Hospital in Paris indicates that much of that association may be explained by hostility. Researchers followed 14,356 employees of the French national gas and electricity companies over an average of 15 years, beginning in 1989. Employees were asked to fill out questionnaires assessing their mood and personality. By the end of the study, 687 of the participants had died. Mortality was predicted by depressive mood, even after taking into account variables such as age, sex, education level, body mass index, alcohol consumption and smoking. However, adjusting for hostility (hostile thoughts) considerably reduced this association. On the other hand, hostility was the only personality trait that remained significantly associated with mortality after taking into account depressive mood and the full set of variables. Mortality was not predicted by type A personality, challenging previous findings that linked type A personality with ill health and mortality. The authors speculate that hostility may increase mortality by promoting depressive mood, or depressive mood could result in more hostility, which in turn might increase mortality. They recommend further research to determine whether therapeutic interventions that target hostility could improve health outcomes associated with depressive mood in both healthy and ill individuals.

Psychotherapy and Psychosomatics, 2010, v. 79 (3): 164–171. Cédric Lemogne et al., Department of C-L Psychiatry, European Georges Pompidou Hospital, Paris, France.


Discrimination related to sexual orientation increases risk of substance abuse

The experience of discrimination appears to increase the likelihood of substance abuse among lesbian, gay and bisexual adults, according to research from the University of Michigan in Ann Arbor. Researchers used data on more than 34,000 American adults from wave 2 of the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions, 577 of whom identified themselves as lesbian, gay or bisexual (LGB). Overall, substance use disorders were more prevalent among LGB adults (28%) than among heterosexual adults (11%). Approximately two thirds of LGB adults experienced at least one type of discrimination in their lifetimes. In the past year, 38 per cent of LGB adults reported discrimination related to their sexual orientation; 48 per cent reported gender discrimination; 50 per cent reported racial/ethnic discrimination; and 11 per cent reported all three types of discrimination. For LGB adults who reported all three forms of discrimination, the adjusted odds of having a substance use disorder in the past year were almost four times greater than for those who reported no discrimination. Those who reported lifetime racial discrimination only or both sexual discrimination and gender discrimination also had significantly increased odds of substance use disorders compared with those who reported no discrimination. The authors conclude that health care professionals should take into account “the role multiple types of discrimination plays in the development and treatment of substance use disorders among LGB adults.”

American Journal of Public Health, January 14, 2010 online: e1-e7, doi: 10.2015/AJPH.2009.163147. Sean Esteban McCabe et al., Substance Abuse Research Center, University of Michigan, Ann Arbor, Michigan.


Pressure keeps substance-using pregnant women in treatment

External pressure can increase the likelihood that substance-using pregnant women will remain in treatment, according to a study from Wayne State University in Detroit, Michigan. Researchers looked at data on 200 women from a National Institute on Drug Abuse clinical trials study who were receiving community-based substance abuse treatment. The women were asked whether they had been pressured to attend treatment under threat of jail terms, having their children removed from them, or losing their housing. Thirty-six participants reported being pressured to enter treatment, while 164 were not pressured. Of those who reported coercion, 44 per cent faced legal pressure; 17 per cent were pressured regarding their housing; 36 per cent reported pressure from child protection services; and three per cent were pressured by both legal and housing authorities. The researchers found that those in the coerced group attended an average of 71 days of treatment before dropping out, compared with 46 days for the non-coerced group. The coerced group also had fewer drug-positive urine tests at baseline (29% vs. 40%), during treatment (15% vs. 29%) and at three-month follow-up (18% vs. 27%) compared with the non-coerced group. Although the reduction and prevention of drug use during pregnancy is an important goal, the authors caution that “the use of external pressure could lead to avoidance of health care settings or could inhibit disclosure of substance use among those who do seek care.”

Drug and Alcohol Dependence, March 1, 2010, v. 107 (2-3): 149–153. Steven J. Ondersma et al., Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan.